Table of Contents
Summary
During the coronavirus (COVID-19) pandemic some settings have been more likely to see large outbreaks of COVID-19. These include prisons, homeless hostels and asylum settings.
This is because these settings often have new people regularly moving in, meaning COVID-19 is easy to bring in. They also often share accommodation and facilities, which are often crowded, so if COVID-19 is brought in, it can spread quickly. These settings are also more likely to have people with poor health living in them, and some people with certain medical conditions may get very ill with COVID-19.
Because these settings were more at risk of outbreaks of COVID-19 during the pandemic, they often had extra testing or extra restrictions compared to the general population or other settings, to try and prevent people in the setting from becoming ill.
We are now seeing fewer people becoming very ill or dying from COVID-19 in these settings, thanks to vaccines, better immunity levels and better treatments. This means we can reduce testing and restrictions for these settings.
From April 2023, testing will only be used in these settings for the following reasons:
- to help people access treatment if they need it
- to help local public health teams understand if an outbreak in one of these settings is caused by COVID-19 or by something different
- to help control an outbreak of COVID-19 if local public health teams decide it is necessary
Changes to guidance
The main changes to this guidance are:
- removing symptomatic testing for all residents and service users, except those eligible for COVID-19 treatments, or if short term symptomatic testing is recommended as part of a health protection team (HPT) led outbreak response
- removing symptomatic testing for all staff, unless recommended short term as part of an HPT led outbreak response
- alignment of advice for symptomatic staff and residents with current guidance for the general public who have symptoms of a respiratory infection, including COVID-19
- introducing limited use of lateral flow device (LFD) testing in the first 5 cases in a suspected outbreak of acute respiratory infection (ARI) to identify positive individuals
Who this guidance is for
This guidance is for commissioners, providers and staff in the following settings and services in England:
- adult prisons (both public and privately managed)
- Approved Premises
- immigration removal centres (IRCs)
- asylum settings
- bridging accommodations (for example, initial accommodation centres and contingency hotels)
- homeless accommodation settings (for example, hostels and night shelters)
- domestic abuse refuges
- respite rooms
- Ministry of Defence healthcare settings
- young offender institution (YOI) units for those aged 18 years and over
This guidance does not apply to secure children’s homes (SCHs), secure training centres (STCs) and YOI units for those aged under 18 years. For these settings, UK Health Security Agency (UKHSA) guidance for staff on managing cases of infectious diseases in children and young people settings in England is available.
This guidance replaces previous guidance on:
Background
As a result of high levels of population immunity, the availability of COVID-19 vaccines and treatments, and reduced severity of illness, we are now able to manage COVID-19 like other respiratory infections.
In line with this approach, testing and infection prevention and control (IPC) measures in this guidance are focused on reducing severe outcomes in individuals who are at a higher risk from COVID-19 and who are eligible for treatments.
This guidance describes measures to manage cases and outbreaks of COVID-19 for prisons and places of detention (PPDs), homelessness, domestic abuse refuge, respite room and asylum seeker accommodation settings. These settings will be referred to in this guidance as ‘inclusion health accommodation settings’.
These settings are considered higher risk for transmission of COVID-19 and poor outcomes for the following reasons:
- there is a higher risk of COVID-19 transmission due to crowding, people sharing rooms, shared facilities, staff turnover and less adequate ventilation
- individuals within these settings may be at higher risk of severe illness from COVID-19 due to poorer health and/or lower vaccination coverage
- individuals in these settings may be less able to isolate or take other actions to prevent the spread of COVID-19
As a result, outbreaks in these settings may have a greater impact than in other settings.
Symptoms of respiratory infection, including COVID-19: management of staff and service users
Symptoms of COVID-19, flu and common respiratory infections include:
- continuous cough
- high temperature, fever or chills
- loss of, or change in, your normal sense of taste or smell
- shortness of breath
- unexplained tiredness, lack of energy
- muscle aches or pains that are not due to exercise
- not wanting to eat or not feeling hungry
- headache that is unusual or longer lasting than usual
- sore throat, stuffy or runny nose
- diarrhoea, feeling sick or being sick
Individual testing for COVID-19 in inclusion health accommodation settings is now only offered to people experiencing symptoms of a respiratory infection who are eligible for COVID-19 treatment.
Staff and service users with symptoms of respiratory infection should be supported to follow guidance for people with symptoms of a respiratory infection, including COVID-19.
If staff or service users have symptoms of a respiratory infection, such as COVID-19, and have a high temperature or do not feel well enough to go to work or carry out normal activities, they should try to stay at home or in their room and avoid contact with other people. They can return to work or usual activities when they no longer have a high temperature (if they had one) or until they no longer feel unwell.
It is particularly important they try to avoid close contact with anyone known to be at higher risk of becoming seriously unwell if they are infected with COVID-19 and other respiratory infections, especially those whose immune system means that they are at higher risk of serious illness, despite vaccination.
If staff or service users are unable to avoid contact with other people while they have symptoms of a respiratory infection, there are actions that will reduce the chance of passing on the infection to others. These include:
- wearing a well-fitting face covering made with multiple layers or a surgical face mask
- avoiding crowded places such as public transport, large social gatherings, or communal places, or anywhere that is enclosed or poorly ventilated
- taking any exercise outdoors in places where you will not have close contact with other people
- covering your mouth and nose when you cough or sneeze; wash your hands frequently with soap and water for 20 seconds or use hand sanitiser after coughing, sneezing and blowing your nose and before you eat or handle food; avoid touching your face
More information on how to limit the spread of COVID-19 in these settings is available.
Healthcare staff employed by the NHS or other healthcare providers should follow guidance on managing healthcare staff with symptoms of a respiratory infection, including COVID-19.
Service users eligible for COVID-19 treatments
Staff in the respective settings should identify service users who are eligible for COVID-19 treatments and ensure they can access COVID-19 testing if required. COVID-19 and other acute respiratory infections (ARIs) have similar symptoms.
If a resident or service user is experiencing COVID-19 symptoms (even if they are mild) and is eligible for COVID-19 treatments, they should take an LFD test immediately, report the result and follow the guidance for people who are eligible for COVID-19 treatments.
If the test result is positive, they should also follow the guidance on if a person tests positive for COVID-19, found below. The test result should be reported via GOV.UK or by dialling 119 in order to generate a referral to a COVID-19 Medicines Delivery Unit (CMDU) clinician.
If the individual’s LFD test results are all negative, they can return to their usual activities once they are well enough to do so, and they do not have a high temperature.
For prisons and immigration detention centres, there are established pathways to access treatments via healthcare teams in these settings.
Staff in other high-risk inclusion health residential settings should:
- make sure those who are eligible for treatment are registered with a GP
- confirm that the contact details for those eligible are up to date, and they or a representative are contactable
Staff eligible for COVID-19 treatments
If a staff member is experiencing COVID-19 symptoms and is eligible for COVID-19 treatments they should follow NHS guidance on treatment for COVID-19.
Positive COVID-19 test result: managing staff and service users
No routine COVID-19 testing is required for symptomatic staff or service users who are not eligible for treatments.
Staff and service users with a positive COVID-19 test result should be supported to follow guidance for people with symptoms of a respiratory infection, including COVID-19. Most people with COVID-19 will no longer be infectious to others after 5 days.
Staff and service users with a positive COVID-19 test result should be supported to stay away from other people for 5 days after the day the test was taken. They can return to normal activities after 5 days if they feel well enough and no longer have a high temperature.
Where possible, service users with a positive COVID-19 test should be supported to isolate in single occupancy accommodation.
If a person who has tested positive for COVID-19 remains unwell after 10 days or longer, they should seek medical advice.
Service users who are isolating away from others should have regular opportunities to discuss their wellbeing and any anxieties with a member of staff or key workers.
More information on how to limit the spread of COVID-19 in these settings is available.
Healthcare staff employed by the NHS or other healthcare providers should follow guidance on managing healthcare staff with symptoms of a respiratory infection, including COVID-19.
Isolation
All high-risk inclusion health residential settings should have a plan in place to identify appropriate facilities where service users who have been confirmed as positive for COVID-19 or other respiratory infection can be supported to self-isolate appropriately.
If single occupancy accommodation is not available, confirmed cases may be cohorted (grouped and isolated) together.
Testing to end isolation is no longer required for confirmed COVID-19 cases.
Seeking further clinical input
If the health condition of a service users is worsening, settings are advised to seek clinical advice.
If service users are deteriorating despite a negative COVID-19 test, other causes should be considered, including testing for ARIs. Guidance on managing acute respiratory illness in prisons and other prescribed places of detention is available on GOV.UK.
Management of contacts of confirmed COVID-19 cases
There is no need for contacts of a confirmed COVID-19 case to undertake testing. This applies to staff and service users.
Contacts should be supported to:
Routine contact tracing is not currently being undertaken in inclusion health accommodation settings.
COVID-19 outbreak management
An outbreak is defined as 2 or more linked cases of COVID-19 within 14 days.
As most symptomatic COVID-19 testing has been removed, an outbreak may be suspected when there is an increase in the number of staff and/or service users displaying symptoms of COVID-19 at the same time who are linked by personal contact.
Contacting the local HPT
If an outbreak is suspected, staff should undertake a risk assessment as soon as possible to determine whether the local HPT should be contacted.
The setting provider should contact the HPT if there are specific issues of concern. For example, if:
- there are a high number of hospitalisations or unexpected deaths among service users
- there is a rapid increase in the number of service users with symptoms of COVID-19 or other respiratory infections
- there is a suspected outbreak of another infection in addition to COVID-19
Testing during an outbreak
It is important to identify the infection at an early stage of an outbreak to aid public health management, for example, to distinguish between COVID-19 and other ARIs such as flu. This will also ensure access to appropriate clinical care for those who need it.
If an outbreak is suspected, the first 5 linked service users with symptoms should take an LFD test at the earliest opportunity to establish whether the outbreak is being caused by COVID-19.
Staff should continue to test any symptomatic individuals eligible for COVID-19 treatments.
Further testing of symptomatic service users is not required unless testing is instructed by the local HPT.
Outbreak measures
Following initial risk assessment by the HPT with the setting, HPTs may convene an outbreak control team (OCT) to support management and help coordinate the outbreak response.
OCTs may recommend the short-term use of wider testing for staff, service users or those without symptoms based on their local risk assessment. Examples could include:
- temporarily re-introducing staff asymptomatic testing for those working with individuals whose immune system means they are at higher risk of serious illness
- conducting one round of outbreak mass testing at day 5 after the last suspected or confirmed case
After a risk assessment, and subject to discussion with the service managers, further temporary outbreak control measures that may be considered by OCTs include:
- reinstating contact tracing
- proportionate reduction in communal activities
- cohorting of service users suspected or confirmed to have COVID-19 into similar groups to help manage risk
- reintroduction of social distancing
- introduction of enhanced IPC and personal protective equipment (PPE) measures being used in the setting, including the use of face coverings
For PPD-specific settings, other interventions may include:
- organising social and professional visits by wings or buildings, to prevent transmission across areas
- making visitors aware of existing outbreaks prior to attending, so they are fully informed and can manage their own risk
Lifting outbreak measures
Outbreak measures can be lifted 5 days after the last suspected or confirmed case.
Staff are recommended to remain alert for possible new cases between 6 to 10 days after the last suspected case.
As a precaution, infection control measures like hand washing, wearing PPE and social distancing can be maintained for longer than 10 days if required.
Further information
The different roles and responsibilities for stakeholders in PPD settings can be found in the multi-agency contingency plan for the management of outbreaks of communicable diseases, or other health protection incidents, in prisons and other places of detention in England.
An overview of outbreak management in short term asylum seeker accommodation settings is available to provide practical support on managing cases or outbreaks of infectious disease in asylum accommodation settings.
Limiting the spread of acute respiratory infection, including COVID-19
There are actions settings can take to limit the spread of respiratory infections, including COVID-19. Operational practices may vary due to setting-specific considerations.
Vaccination
All eligible service users and staff are strongly encouraged to be vaccinated to protect themselves and others from COVID-19. This is especially important given the vulnerabilities of people in high-risk inclusion health settings. Booster vaccinations are strongly recommended for individuals if they are eligible.
Information on the living with COVID-19 vaccination programme is available in the Green Book, chapter 14a (page 29 onwards), with further resources on the COVID-19 vaccination programme also available.
Ventilation
Bringing in fresh air to occupied spaces can help to reduce the concentration of respiratory particles, lowering the risk of airborne transmission of respiratory viruses.
Other mitigation measures should be determined by risk assessment and implemented appropriately.
Infection prevention and control
Hand and respiratory hygiene are important components of IPC measures and essential to reduce cross-contamination and infection.
Staff use of fluid resistant surgical masks (Type IIR) should be considered to reduce transmission of COVID-19, particularly in poorly ventilated or crowded areas. This is known as source control and prevents spread from the wearer to others. This should also be considered when caring for a person who is at higher risk of becoming severely unwell if they are infected with COVID-19.
For more information about PPE use within PPDs, see .
Principles of cleaning
Regular cleaning can help reduce the risk of spreading infection.
Standard cleaning products such as detergents are adequate to clean routinely.
Respiratory infections such as flu and COVID-19 can be spread from person to person through small droplets, aerosols and through direct contact. Surfaces and belongings can also be contaminated when people with infections cough or sneeze or touch them.
When a person is known or suspected to have an infection, chlorine-based products should be used to disinfect the environment. Products that contain both detergent and chlorine may be used to give a measured dose of chlorine in solution for a one-stage clean and disinfection.
Cleaning and disinfection of frequently touched surfaces is particularly important in bathrooms and communal kitchens.
As a minimum, frequently touched surfaces such as door handles, light switches, work surfaces, remote controls and electronic devices should be cleaned daily. Cleaning should be more frequent depending on the number of people using the space, whether they are entering and exiting the setting and access to handwashing and hand-sanitising facilities.
Suitable hand washing facilities should be available including running water, liquid soap and paper towels or hand driers. Hands should be cleaned after removing PPE or handling contaminated surfaces or laundry.
Waste
Waste visibly contaminated with respiratory secretions from a person with suspected or confirmed infection should be sealed in a waste bag before removal from the accommodation and placed into a waste bin as soon as possible. There is no need to store waste for a time before collection. Dispose of routine waste as normal.
Waste produced by healthcare should follow appropriate guidance in the National Infection Prevention and Control Manual from NHS England.
Laundry
Wash items in accordance with the manufacturer’s instructions. Use the warmest water setting and dry items completely. If water-soluble (alginate) bags are available, use this to transport laundry from the individual’s accommodation to the washing machine.
Used laundry that has been in contact with an unwell person can be washed with other people’s items. To minimise the possibility of dispersing virus through the air, do not shake used laundry prior to washing.
Visitors
Visitors should follow the guidance for people with symptoms of a respiratory infection including COVID-19 if they experience symptoms.
Individuals who are isolating because they have symptoms of a respiratory infection, or because they are a confirmed case of COVID-19 should not participate in visits. They can participate in visits again once their symptoms have resolved, and they have satisfied the criteria for starting to participate in normal activities, either for people with symptoms or people with a positive test result.
Immigration removal centres (IRCs)
Asymptomatic testing of new receptions to IRCs is not currently recommended.
No routine service user testing is required, but testing may be required for pre-departure testing for deportation according to the testing requirements of the receiving country and any other considerations regarding advice from travellers domestically.
How to access COVID-19 test kits
Service providers should always have test kits available on site and use these in the first instance. Eligible settings will need to register on the self-referral portal. They will then receive a unique organisational number (UON), which can be used to order test kits once it is verified. If you are unable to find your UON, please contact 119 who will be able to assist.
Only use tests from GOV.UK. Do not use a test bought elsewhere, such as a test from a supermarket or pharmacy, as their results cannot be registered with the GOV.UK website.
Further details of how to undertake testing in these settings can be found in the Standard Operating Procedure, which will be made available during the registration process.
Reporting test results
Where appropriate, staff in the settings should encourage staff and service users to report any COVID-19 test results and use the digital reader option where possible. If settings are advised to do additional testing in response to an outbreak, they will be expected to record the results and provide a summary to the HPT.
