Purpose and scope

This guidance is to support those working in social, community and residential care (SCRC) settings and users of their services about COVID-19.

This guidance is now the advised guidance for adult and older adult care homes registered with the Care Inspectorate.

Settings covered

Social, community and residential care settings covered by this guidance includes:

  • providing care to individuals in their own home
  • adult social care building-based day services
  • community-based settings for people:
    • with mental health needs
    • with a learning disability
    • who misuse substances
  • rehabilitation services
  • residential children’s homes – including settings registered as care homes
  • secure accommodation services for children and young people
  • residential settings for adults – including respite services for adults
  • residential respite/short breaks services for children
  • care home services, registered with the care inspectorate – now including older adult care homes
  • services helping those experiencing homelessness
  • sheltered housing
  • supported accommodation settings

Using this guidance

The guidance supports, but does not replace:

  • individual expert clinical judgment
  • local response arrangements

The guidance supports maintenance of agreed health protection principles and national policy in line with the Public Health etc. (Scotland) Act 2008 including:

  • exercising functions to encourage equal opportunities
  • observance of equal opportunities requirements

Employers should consider specific conditions of each place of work and follow the Health and Safety at Work etc. Act 1974 and other appropriate legislation.

Health protection team contacts

Access up-to-date contact information for local HPTs.

Reproducing content

This is a joint publication between Public Health Scotland and Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland, part of NHS National Services Scotland.​ ARHAI content is not made available under terms of the OGL and you should request permission to reproduce content contained in this publication.

Introduction

The disease COVID-19 is caused by severe acute respiratory syndrome coronavirus 2, also known as SARS-CoV-2.

SARS-CoV-2 is a ribonucleic acid (RNA) virus.

The first cases of COVID-19 in the UK were detected on 31 January 2020.

The World Health Organization (WHO) declared COVID-19 as a pandemic on 12 March 2020.

Transmission

SARS-CoV-2 is spread by respiratory particles. It occurs mainly through close contact with infectious individuals.

Transmission risk increases:

  • when people are close to each other (usually within 2 metres)
  • in indoor, poorly ventilated environments that are not regularly cleaned [1]

There is limited evidence of long-range aerosol transmission. Further research is needed to better understand aerosol transmission of SARS-CoV-2 virus.

SARS CoV-2 virus can survive on surfaces from a few hours to days [2].

The amount of virus on surfaces is not always enough to cause infection.

COVID-19 can be transmitted even if the infected person does not have symptoms. This is called asymptomatic transmission [3].

Infectious period

The infectious period begins around 2 days before symptom onset to 10 days after [4].

People are most infectious when they have symptoms, usually in the first 3 days [4].

The average incubation period is between 5 and 6 days, with a range from 1 to 14 days [5].

COVID-19 symptoms

The cardinal symptoms, as outlined by NHS inform, are:

  • new, continuous cough
  • fever
  • change in or absence of sense of smell or taste

Symptoms of COVID-19 can vary in severity [6].

Some people have:

  • headaches
  • sore throats
  • diarrhoea
  • general weakness
  • fatigue
  • muscular pain
  • pneumonia
  • acute respiratory distress syndrome and other complications

Mortality is an unfortunate potential outcome in those with severe disease.

Atypical symptoms

Atypical symptoms of COVID-19 are more likely to present in:

  • older adults
  • very young people
  • people with underlying health conditions
  • immunocompromised individuals

These atypical symptoms can include: 

  • increased confusion
  • reduced appetite
  • vomiting and diarrhoea
  • headache
  • shortness of breath
  • falls
  • dehydration
  • delirium
  • excessive sleepiness
  • difficulty in breathing (this is an important symptom to be aware of in older adults)

Recovery

Most people recover quickly, usually starting to feel better in a few days. Some people take longer and symptoms can affect the whole body.

SIGN has produced a booklet for anyone with ongoing signs and symptoms of COVID-19.

NHS inform provides a variety of useful information on long-term effects.  

Latest data

PHS provides a dashboard with the latest available data including, but not limited to:

  • positive cases reported
  • tests carried out
  • numbers of vaccinations administered
  • percentage of Scotland's population who are vaccinated

General prevention measures

This section outlines a range of measures that are recommended to reduce transmission of COVID-19.

Advice on enhanced COVID-19 infection and prevention control (IPC) measures for health and care settings is available in the NIPCM community IPC COVID-19 pandemic appendix.

Care homes can also seek IPC advice in the Infection Prevention and Control Manual for older people and adult care homes.

The COVID-19 pandemic is ongoing.

Each social, community and residential care (SCRC) setting should regularly review the implementation of COVID-19 mitigation measures.

SCRC settings must continue to follow robust mitigation measures to minimise transmission of COVID-19 and other infections.

The advice included in this section applies to all settings captured in the scope of this guidance unless stated otherwise.

Vaccination

Evidence for vaccination across adult age groups shows protection against:

  • symptomatic disease
  • infection (including in healthcare workers and in care home service users)
  • hospitalisation due to severe illness and mortality

Vaccination may also reduce transmission.

View a summary of the most recent data on real-world effectiveness, schedule and other relevant information in the Green Book, chapter 14a (COVID-19).

Vaccination recommendations

Getting your COVID-19 vaccinations and boosters offers the best protection against the virus for you, your family and those you care for.

The Joint Committee for Vaccines and Immunisation (JCVI) provides details on the groups that are to be prioritised for vaccination.

The JCVI recommends a:

  • booster COVID-19 vaccine for everyone 18 years and above
  • winter booster vaccine for extremely high-risk groups, including residents living in care homes for older adults

Find more information about vaccination boosters on NHS inform.

Care home service users and staff are strongly encouraged to have booster vaccination.

The excellent uptake of vaccination in staff and service users, particularly in care homes, has altered the COVID-19 mitigation measures – for both vaccinated and unvaccinated people – required in such settings.

Pregnancy

Vaccination of all staff is strongly recommended, including those who are pregnant, breastfeeding or planning a pregnancy, where the safety profile for COVID-19 vaccination remains good. 

Vaccination status

Vaccination status, if required in public health decision making, should be defined as:

Fully vaccinated

An adult – 18 years and 4 months or older – who has had three or more doses of Medicines and Healthcare products Regulatory Agency (MHRA) approved vaccines.

This is either through completing one of the following, at least 14 days ago (where day 1 is the day of the most recent vaccination):

  • 2-dose course of approved vaccine and received a booster
  • 3 doses of an approved vaccine – for example, in the case of someone who is immunocompromised 

This includes people vaccinated as part of a formally approved COVID-19 vaccine clinical trial.

Unvaccinated

All other adults, including the partially vaccinated, are considered unvaccinated.

Additional resources

Additional sources of information for the COVID-19 vaccination are available.

Public Health Scotland

We provide materials to:

Workforce education materials

Access these on the Turas Learn site.

Public information

NHS inform provide information about:

  • the vaccine
  • invitations and appointments
  • after the vaccine
  • leaflets and other languages and accessible formats
  • the helpline for the public – 0800 030 8013

View the resources on NHS inform.

Advice for contacts

Routine identification of contacts of COVID-19 cases is no longer undertaken.

Those with confirmed COVID-19 should tell:

  • everyone in their household that they are positive and follow the NHS inform stay-at-home guidance.
  • anyone they have had contact with in the 48 hours before:
    • they became symptomatic
    • the date of their test, if asymptomatic

Individuals with possible COVID-19 should tell people they were in contact with in the 48 hours before they became symptomatic that they are feeling unwell with respiratory symptoms.

This ensures that contacts are vigilant of respiratory symptoms that may develop.

Definition of a contact

There is no formal definition of a contact.

The transmission risk for any respiratory illness, including COVID-19, increases with length of exposure and proximity to the infected individual.

The risk is also greater in indoor, crowded settings as opposed to outdoor activities.

Individuals at the highest risk of infection are those who have spent significant time with a case, such as household members and overnight contacts.

Find out more information about what to do in the event of contact with a COVID-19 case for:

Physical distancing

Physical distancing is no longer required for staff, service users or visitors. Some services may choose to continue with physical distancing measures.

The Scottish Government guidance for safer workplaces and public settings remains available.

Overcrowding in any area of a facility increases the risk of transmission for respiratory viruses. Staff should remain mindful of the volume of people in a space at any one-time. Facilities should take action to prevent a return to any pre-pandemic practices which facilitated overcrowding.

See the NIPCM community IPC COVID-19 pandemic appendix for more information on physical distancing.

The health protection team may recommend a temporary reintroduction of physical distancing during an outbreak.

Face masks and coverings

There is a difference between face masks and face coverings.

Face mask

When we use the term 'face mask' we mean surgical or other medical grade masks.

For example, fluid resistant surgical masks (FRSM) used in certain health and social care situations.

Face covering

When we use the term 'face covering' we mean something that are made from cloth or other textiles that cover the mouth and nose, and through which you can breathe.

For example, a scarf.

Face coverings or face masks should be worn in health and social care settings in line with the Scottish Government guidance on the:

These provide guidance for many groups and settings on the use of face masks and face coverings.

All staff within the health and care settings should continue to apply Standard Infection Control Precautions (SICPs) at all times for all supported individuals.

Additionally, transmission-based precautions (TBPs) – in other words, enhanced precautions – should continue to be applied when caring for individuals who have suspected or known infection or colonisation.

The National Infection Prevention and Control Manual (NIPCM) and the Care Home Infection Prevention and Control Manual (CH IPCM) provide more details on TBPs to be applied depending on the route of infection.

Hand, respiratory and environmental hygiene

Follow hand hygiene and respiratory hygiene advice in the National Infection Prevention and Control Manual (NIPCM).

Ensure that workplaces and work areas are cleaned regularly.

Follow the advice on safe management of the care environment in the NIPCM community IPC COVID-19 pandemic appendix.

Further advice is available on NHS inform's COVID-19 general advice pages.

Ventilation

Good ventilation in indoor spaces can reduce the risk of SARS-CoV-2 transmission.[7]

Maximise fresh air entering a room through:

  • natural ventilation – opening windows, vents and doors (excluding fire doors)
  • mechanical ventilation systems – minimising the recirculation of air in rooms and throughout buildings.

Maintain the safety and thermal comfort of service users and service providers by ensuring adequate room temperatures.

Find out practical steps on improving ventilation in the HSE ventilation in the workplace guidance.

The UKHSA COVID-19 ventilation of indoor spaces guidance advises to keep room temperature to at least 18ºC as temperatures below this can affect health.

This is especially applicable to those who:

  • are 65 years or older
  • have a long-term health condition

Using fans in residential care settings and care homes

A fan may be used in a service user's own private room if they are still feeling too warm after turning off the heating and opening windows.

The fan must be:

  • clean
  • directed away from the door
  • well maintained

Fans in communal areas of the residential setting – outside the service user’s private room – should only be used following a risk assessment and during very warm weather.

Staff should turn off the heating and open windows and doors (if possible) to reduce the temperature before using a fan.

Using fans should be an exception and not routine.

This advice does not apply to individuals receiving care in their own homes.

During an outbreak

Private rooms

Fans are permitted in the private room of a service user who is symptomatic or COVID-19 diagnosed.

The window should remain open when in use.

Communal areas

Avoid using fans in communal areas if a setting has:

  • COVID-19 cases
  • an ongoing outbreak of COVID-19 or any other infectious pathogen

If extra temperature control measures are needed, the service manager should complete a risk assessment with support from their local health protection team.

If the risk assessment results in use of fans, it is essential that fans are:

  • cleaned regularly (including the blades)
  • not pointed directly at service users

Advice for people at highest risk

Some groups of people are at higher risk of severe illness if they catch COVID-19, even when fully vaccinated.

This includes those with a weakened immune system.

View the Scottish Government advice for people who are immunosuppressed.

Scottish Government ended the highest-risk list in Scotland on 31 May 2022.

Pregnancy

View further information on COVID-19 and pregnancy on:

Pregnant staff may also seek advice from their line manager or local OH service.

COVID-19 vaccines are recommended in pregnancy.

Providing care for service users

This section covers providing care for service users during the COVID-19 pandemic.

Advice varies between SCRC settings in some parts of this section.

Remain vigilant to service users developing any COVID-19 symptoms.

Older adults may have atypical symptoms.

If a service user is unwell

Seek advice on NHS inform and contact NHS 111 by telephone or online.

Contact the GP for clinical advice.

If they need clinical assessment

Contact the GP.

If they need urgent ambulance or hospital care

Call 999.

Tell the call handler that the unwell person may have COVID-19.

Who have had contact with a COVID-19 case

HPTs will not routinely do contact tracing in SCRC settings.

Find out more in the advice for contacts section.

  • Service users that have been in contact with a COVID-19 case who are asymptomatic do not need to self-isolate or test – exceptionally they may be advised otherwise by the HPT.
  • Notify staff if symptoms develop.

Service managers should check there is no one with symptoms and that all NIPCM community IPC COVID-19 measures are in place.

Who are symptomatic or have confirmed COVID-19 infection

All symptomatic or COVID-19 diagnosed service users should self-isolate immediately and follow the stay at home advice on NHS inform.

It explains:

  • when to stay at home
  • how to reduce risk of onward transmission to other people
  • how to protect people at higher risk of harm from COVID-19 infection.

Some service users may also be eligible for more COVID-19 treatments.

Find out more about COVID-19 treatments on NHS inform.

Older adult care home service users

Service users in older adult care homes should self-isolate immediately for at least five days if they have any of the following:

Day one is the day after symptom onset or the day after a positive test (whichever was earlier). Medical advice should be sought if needed.

Find out more information on managing self-isolation of service users in SCRC settings.

Testing

You should not test asymptomatic service users – see testing recommendations for service users.

Only during exceptional circumstances may the HPT advise testing an asymptomatic service user.

The advice for symptomatic service users applies if they test positive.

They do not need to reset their self-isolation period or be re-tested if they develop symptoms.

Support on risk assessment can be sought about the length of the self-isolation period.

Reduced self-isolation period

The self-isolation period for care home residents has reduced to five days.

This reflects the less severe presentation of COVID-19 in care home residents in recent months.

It also recognises the potential harms associated with prolonged isolation.

When a service user is symptomatic and PCR negative

If an older adult care home resident is symptomatic and their test is PCR negative, then consideration should be given to:

  • further clinical assessment of the symptoms
  • repeat testing in case this is a false negative result
  • the test being taken too early after symptom onset

Service users who are symptomatic can be released before their self-isolation period ends with a negative result if:

  • they are well and have no fever for 48 hours, without using medication (such as paracetamol)
  • the sampler was adequately trained and the sample was not deemed unsatisfactory
  • they are not completing a period of self-isolation following hospital discharge

If respiratory symptoms lead to suspicion of an outbreak and COVID-19 testing is negative, other organisms may need to be considered and tested for.

The local HPT can discuss this with their local laboratory service and provide advice.

Managing self-isolation in care homes or other residential settings

Staff should tell service users who are self-isolating to:

  • remain in their single room with en-suite facilities where possible
  • keep their room door closed
  • avoid using shared spaces within the facility where possible

Staff can support service users with this.

They should assign specific staff to provide care during the service users' self-isolation.

Arrange dedicated toilet facilities or a commode if en-suite accommodation is not available.

Decontaminate these immediately after use by following either:

Symptomatic or confirmed COVID-19 service users should have their own personal toiletries.

These may include:

  • towels
  • toothbrushes
  • razors

Consider a rota for showering and bathing placing the symptomatic service user last.

Find out more information in the NIPCM community IPC COVID-19 pandemic appendix.

Managing self-isolation as households

Some residential care settings are managed as households with varying levels of support.

This includes supported housing services.

If complete self-isolation is unmanageable, advice can be sought from the local HPT.

Placing a service user in an unsupervised or isolated area may not be in their best interests in some circumstances.

This may be due to:

  • distress
  • vulnerability
  • safety concerns

Seek advice from the local health protection team on the management of individuals with special requirements if needed.

For example:

  • children
  • individuals with:
    • mental health conditions
    • dementia
    • learning disabilities

Providing meals

Provide meals for the individual to eat within their room.

Communal spaces can be used if risk assessed to be the most appropriate arrangement, especially in household-type services.

Providing care

Carry out all necessary care within the service user’s room.

Accessing outdoor space during self-isolation

Service users can take daily exercise outdoors during their self-isolation if staff can assist with this.

This needs a local risk assessment by staff to ensure appropriate infection control precautions are in place.

While self-isolating, service users should:

  • not leave the grounds of the setting
  • Minimise contact with other service users and staff as far as possible
  • wear a FRSM during this activity – if service user cannot wear a FRSM, a risk assessment should take this into account

This advice also applies during an outbreak where staffing capacity allows.

Transferring to hospital during self-isolation

Service users may need to go to hospital during their self-isolation period.

Tell the ambulance service and ward staff in advance that the individual has respiratory symptoms or confirmed COVID-19 and of the need for self-isolation on arrival.

Ending self-isolation

Service users in SCRC settings who are symptomatic should follow the stay at home advice on NHS inform.

They should do this until they:

  • are absent from fever without the use of medication such as paracetamol
  • no longer feel unwell

When other symptoms have resolved, a cough or change to taste and smell is not a sign of ongoing infection.

These symptoms can persist for weeks.

Read more about managing self-isolation in care homes or other residential settings.

Older adult care homes

Service users can end self-isolation if they meet all of the following criteria:

  • five full days of isolation completed
  • have been without fever for 48 hrs without use of medication (such as paracetamol)
  • no longer feel unwell

Further testing is not required.

On some occasions, the health protection team may extend self-isolation.

Guidance on discontinuing IPC precautions in community health and care settings for COVID-19-positive service users can be found in the NIPCM community IPC COVID-19 pandemic appendix and from the local health protection team.

Care at home and supported housing settings

All symptomatic or COVID-19 diagnosed service users should follow the NHS inform stay-at-home guidance.

They should self-isolate immediately until they are:

  • absent from fever, without the use of medication (such as paracetamol)
  • no longer feel unwell

Cough and loss of, or change in, taste and smell may persist for several weeks and is not an indication of ongoing infection when other symptoms have resolved.

Service users living in shared housing should follow NHS inform stay-at-home guidance.

Care at home and supported housing workers should report possible or confirmed cases of any respiratory illness to their managers.

Providers should work with community partners and the person receiving care to review and assess the impact on their care needs.

Care should not be discontinued if a service user has tested positive for COVID-19. For information on PPE use and additional IPC measures - see the NIPCM community IPC COVID-19 pandemic appendix.

Symptomatic or COVID-19 diagnosed household members

Symptomatic or COVID-19-diagnosed household members of a service user should be encouraged to remain in a separate area of the service user's home throughout the period of care-giving.

This is to reduce the risk of transmission to staff.

Open windows to increase ventilation and reduce the risk of transmission.

Sometimes it may be inappropriate for them to leave the service user.

For example, due to:

  • distress of the service-user
  • issues of personal safety

A risk assessment to minimise the risk of onward transmission should be carried out by the service manager.

Contact the health protection team if needed.

Further resources

Staff should adhere to:

Measures for staff

Resilience planning

To reduce the spread of COVID-19, enable staff to follow measures in this guidance.

Plan ahead to prepare for extra demands on staffing needs due to outbreaks or staff absence from respiratory viruses.

This is known as resilience planning.

It should include:

  • staff self-isolating as a case – the Scottish Government COVID-19 social care staff support fund guidance aims to ensure social care workers do not experience financial hardship if they are ill or self-isolating due to COVID-19
  • resource needed to support service users when they are unwell or in self-isolation
  • resource to support named visiting during outbreaks
  • time and resource required to follow NIPCM community IPC COVID-19 pandemic measures – this includes:
    • PPE use
    • increased cleaning
    • Staff cohorting
    • training updates
    • guidance review

Workplaces and their staff should risk assess the infection risk, both within and outwith the workplace.

Services should check that enough resilience is available and planned.

This is important for small departments where resilience arrangements may be at moderate to high risk.

To enable home working, hybrid working and safer office working follow the Scottish Government advice in COVID-19 safer businesses and workplaces.

Who have contact with a COVID-19 case at work

It is not routine for the HPT to contact trace care home and other SCRC staff.

Staff who come into contact with a COVID-19 positive service user, another staff member or any individual with COVID-19 whilst at work are no longer automatically required to self-isolate.

However, a risk assessment should be conducted.

The service manager should check appropriate infection prevention and control measures are in place.

Staff need to be vigilant to COVID-19 symptoms at all times. This is very important during the incubation period – up to 14 days after exposure to someone infectious.

If symptoms develop, see the measures for staff who become symptomatic or have positive PCR or LFD test.

Who are a contact of a COVID-19 case

Care home and other SCRC staff will not be routinely contact traced by the local HPT.

Staff should inform their manager if they are aware of being in contact with a COVID-19 case.

This might include contact in their household or an overnight stay.

Symptom vigilance is important.

Staff and their line manager should discuss ways to minimise the risk of onward transmission. 

See Director's Letter (DL) (2022) 32 for further information.

Risk assessment

The service manager should risk assess the placement of staff if there are any extremely vulnerable individuals in the setting. This includes those who are severely immuno-suppressed.

This applies regardless of where contact with a COVID-19 case occurred.

Staff should also continue to be vigilant to the development of any symptoms and adhere to the IPC advice in the NIPCM community IPC COVID-19 pandemic appendix.

Who become symptomatic or have positive test

Staff who are symptomatic should not attend work.

If symptoms develop at work, they should put on a FRSM and return home immediately.

Staff not eligible for testing

Stay at home if you:

  • have symptoms of a respiratory infection
  • have a high temperature
  • do not feel well enough to go to work

Alert your line manager and avoid contact with other people.

See the stay at home guidance on NHS inform for more information. It also provides advice on other actions to take outside of the work environment.

Return to work

Speak with your manager on return to work and they will undertake a risk assessment. Continue to follow all relevant infection control precautions.

Staff eligible for testing

Follow the testing advice in Table 2. Staff should report the test result to their line manager.

If the test result is negative, they can attend work if they:

  • are well enough to do so
    and
  • do not have a high temperature
Positive LFD test result

If the LFD result is positive, the staff member should:

  • stay at home
  • not attend work
  • avoid contact with other people for a minimum of 5 days after the day they took the test

Tests should only be taken by symptomatic staff.

If a positive test result is returned for an asymptomatic staff member then they should also follow this advice.

See Director's Letter (DL) (2022) 32 for further information.

Staff that are asymptomatic LFD test positive may become symptomatic during their isolation period.

They must remain isolated but do not need to reset their self-isolation period or be re-tested.

Household members of the case should follow the advice on NHS inform.

Returning to work

Staff working with patients and service users in face-to-face settings can return to work when they have two consecutive negative LFD test results. Staff should take the tests at least 24 hours apart.

The Director's Letter (DL) (2022) 32 outlines the requirements for returning to work. 

  • Symptomatic staff should take the first LFD test from 5 days after the day their symptoms started.
  • Asymptomatic staff should take the first LFD test 5 days after the day of their first positive test.
Risk assessing return to work

Line managers should risk assess staff with persistent symptoms when returning to work. This outlined in Director's Letter (DL) (2022) 32.

Line managers should risk assess return to work and consider redeploying some staff members until 10 days after their symptoms started. If staff did not have symptoms, 10 days after the day of their first positive test.

This may apply to staff who work with individuals at higher risk of serious illness despite vaccination.

Where HSCWs returning to work requires a risk assessment, HPTs should have oversight of how these decisions are being made.

HPTs do not need to undertake all risk assessments.

Visiting professionals and agency staff

Continue to support professional visits to care homes and other residential settings. These can be essential to wellbeing.

Ensure a renewed focus on anticipatory, preventative and rehabilitative care for all service users.

Plan professional visits in advance to manage footfall – this minimises the risk to the service user population and the burden on staff.

Support visiting clinical staff to attend in person for essential clinical assessments and treatment of service users.

Methods such as telephone and telemedicine remain useful.

All visiting staff should follow the COVID-19 guidance and all control measures implemented in the facility. This includes the IPC advice in the NIPCM community IPC COVID-19 pandemic appendix.

Visits from non-clinical services may pause during an outbreak unless the local HPT deems it essential.

Agency staff

Carefully consider using clinical staff from other care homes, residential settings or healthcare services to replace staff during an outbreak.

It is at the discretion of the local HPT managing the outbreak in collaboration with service provider management.

Testing recommendations

This section focusses on the eligibility for COVID-19 testing.

Vaccination status does not change the relevance of testing. 

There are various tests available to detect SARS-CoV-2 (the virus that causes COVID-19 disease).

More information on PCR test, LFD tests and POCT is available in our COVID-19 guidance for HPTs.

Consent

Testing is not mandatory for individuals or staff.

It needs consent or provision made otherwise, for those without capacity.

See Adults with Incapacity (Scotland) Act 2000 principles for more information.

Purpose of testing

The main purpose of COVID-19 testing has changed from population-wide testing to reduce transmission to targeted testing to support clinical care.

Routine asymptomatic testing is only recommended for specific groups and purposes.

This is line with the Scottish Government's Test and Protect transition plan.

Ordering tests

The COVID-19 page on NHS inform provides information on accessing COVID-19 tests for those who are eligible.

For service users

Status Symptomatic Asymptomatic Asymptomatic but known contact with a COVID-19 case
Older adult care home service users PCR test No testing required No testing required
Older adult care home service users - admission from hospital (non-respiratory pathway) Not applicable as only asymptomatic service users are on the non-respiratory pathway One negative LFD result should be available preferably within 48 hours prior to discharge from hospital One negative LFD result should be available preferably within 48 hours prior to discharge from hospital
Older adult care home service users - admission from hospital (COVID-19 recovered) One negative LFD test before discharge (preferably within 48 hours prior to discharge) OR no testing required if 10-day isolation completed in hospital. One negative LFD test before discharge (preferably within 48 hours prior to discharge) OR no testing required if 10 day isolation completed in hospital. Not applicable as the service user is a recovered COVID-19 case.
Older adult care home service users - admission from the community (including from other care homes and hospices) One negative LFD test (taken within 3 days prior to admission date). See admissions to older adult care homes from hospital and new admissions from the community. One negative LFD test, taken within 3 days prior to their admission date (where testing is not possible before, testing on admission to the care home is acceptable). See admissions to older adult care homes from hospital and new admissions from the community. One negative LFD test, taken within 3 days prior to their admission date (where testing is not possible before, testing on admission to the care home is acceptable). See admissions to older adult care homes from hospital and new admissions from the community.
Service users in community and residential settings No testing indicated - follow stay at home advice for the general population. Unless advised otherwise by HPT or clinician. No testing required. Unless risk assessment by HPT or clinician advises otherwise. No testing required. Unless risk assessment by HPT or clinician advises otherwise.
Service users in residential settings - admission from hospital (COVID-19 recovered) No testing required. Unless risk assessment by HPT or clinician advises otherwise. No testing required. Unless risk assessment by HPT or clinician advises otherwise. Not applicable as the service user is a recovered COVID-19 case.
Service users in residential settings - admission from hospital (non-respiratory pathway) Not applicable as only asymptomatic service users are on the non-respiratory pathway. No testing required. Unless risk assessment by HPT or clinician advises otherwise. No testing required. Unless risk assessment by HPT or clinician advises otherwise.
Service users in residential settings - admission from the community No testing indicated - follow stay at home advice for the general population. Unless advised otherwise by HPT or clinician. No testing required. Unless risk assessment by HPT or clinician advises otherwise. No testing required. Unless risk assessment by HPT or clinician advises otherwise.

Find out more information on managing symptomatic or test positive service users.

Admission testing for care homes or residential settings needs consent.

It should not be taken forward if the service user declines or is in distress.

Risk assess transfers using the respiratory screening questions when testing is not possible.

Local HPTs can advise in complex situations.

Discharging from hospital to care homes

See admissions to older adult care homes from hospital for more details on transferring service users from hospital to older adult care homes.

With no test result

It is possible to discharge a service user from hospital to the care home without an available test result. A risk assessment may show self-isolation is not needed.

Find out more information in the ARHAI Scotland respiratory screening assessment.

Recovered service user

Discharging a COVID-19 recovered service user to an older adult care home before their 10-day self-isolation period in hospital has ended is possible.

  • One negative LFD test is advised.
  • This applies even if the service user is not required to self-isolate on admission to the care home.

For staff

Status Symptomatic Asymptomatic Asymptomatic but known contact with a COVID-19 case
Staff working in care homes for older adults Take a LFD test immediately (see advice in Director's Letter (DL) (2022) 32) No testing indicated No testing indicated
SCRC staff included in the Scottish Government social care and community based testing guidance Take a LFD test immediately (see advice in Director's Letter (DL) (2022) 32) No testing indicated No testing indicated
All other SCRC staff not included in the Scottish Government social care and community based testing guidance No testing indicated – follow NHS inform stay at home guidance for the general population No testing indicated No testing indicated

NHS health workers may attend SCRC settings as part of their role. The Scottish Government COVID-19: Staff testing in NHS Scotland guidance has more information.  

Information is available in measures for staff who become symptomatic or have positive PCR or LFD test.

New staff or agency staff working in SCRC settings (including care homes)

Testing

Proof of a negative SARS-CoV-2 test result is not needed prior to starting work in the SCRC setting.

Symptom awareness

Screen any new or agency staff for COVID-19 symptoms before starting work in a SCRC setting using the NIPCM respiratory screening assessment.

Staff should not start work if they are symptomatic during pre-work screening. They should follow the measures for staff who become symptomatic or have positive LFD test.

Infection Prevention and Control

Agency staff should follow the same NIPCM community IPC COVID-19 guidance as permanent staff.

Vaccination

Service managers should check the vaccination status of new or agency staff before they start work. Vaccination status should not be a barrier to staff starting work in the setting.

Support all staff to become fully vaccinated as soon as possible to protect service users.

For visitors to the setting

Friends and family visitors to care homes or residential settings

No testing advised.

Asymptomatic testing of family and friends visiting care homes or other SCRC settings is paused.

More advice for visitors is available in visiting arrangements in residential settings.

Professional visitors to care homes or residential settings

No testing advised.

Asymptomatic testing of professional visitors to care homes or other SCRC settings is paused.

Maintain symptom awareness and continue to follow NIPCM community IPC COVID-19 measures (including on PPE).

Further information on testing

Symptomatic testing is only retained for:

  • eligible groups in table 1 and table 2
  • symptomatic individuals eligible for new COVID-19 antivirals, monoclonal anti-body therapies and other treatments – find out more from NHS inform COVID-19 treatments
  • people with respiratory symptoms who intend to apply for a self-isolation support grant
  • people participating in COVID-19 surveillance programmes

It also includes people advised to test:

  • by a health professional
  • as part of an outbreak investigation
  • in relation to investigation of a COVID-19 variant and mutation (VAM)

Testing advice following confirmed COVID-19 infection in the past 90 days

If staff or service users have had a diagnosis of COVID-19 either via positive LFD test or positive PCR test – they should not:

  • use LFD tests for 28 days
  • use PCR tests for a period of 90 days – this is to avoid individuals being identified as new cases due to remnant RNA material producing a positive test result (false positive)

Day 1 is the date of cardinal symptom onset or date of positive test if asymptomatic or displaying other non-cardinal symptoms.

If new symptoms of COVID-19 develop in staff or service users during this 90-day period, the advice for symptomatic individuals should be followed.

Some groups may be eligible for testing.

After the 90-day period

Repeat PCR positive tests after 90 days should result in the usual public health action.

Any queries should take a risk assessment approach.

Contact the HPT for advice in complex situations.

Outbreak management

Definition of an outbreak

COVID-19 outbreak

Two linked cases of the disease over a 14-day period within a defined setting

COVID-19 outbreak management should follow existing, well-established principles and practice of outbreak management.

Find out more information in the management of public health incidents – guidance on the roles and responsibilities of NHS-led incident management teams.

Health protection teams (HPTs) are not recommended to identify and manage outbreaks in all settings.

They should use a risk-based approach to focus their limited resources on the highest priority settings.

Identifying higher and lower-risk settings

There may be outbreaks that do not fall into either a higher or lower risk setting categories.

The HPT may choose to take a closer management approach if there is potential for severe disruption to health services or critical infrastructure.

Lower risk

There are some SCRC settings where there is a lower risk of direct health harm arising from COVID-19.

For example, settings mainly comprised of younger or working-age population.

These are considered as lower-risk settings.

There may be some individuals with higher vulnerability in lower-risk settings. These individuals should follow the advice provided by their clinician during an outbreak.

Higher risk

Care homes for older adults are considered higher-risk settings.

This is because the population is older and tend to have more underlying health conditions.

This puts them at greater risk of more severe illness in comparison to most younger people.

There may be some SCRC settings that have older or clinically vulnerable people. These may also be considered a higher risk setting for outbreak management.

Service providers can contact the local HPT if they need further advice.

Staff shortages

Staff shortages can quickly become an issue during an outbreak due to the size and nature of some SCRC services.

Staff should complete their resilience planning in advance for this eventuality.

Local authority and Care Inspectorate input during an outbreak may be useful in finding solutions based on a risk assessment approach led by the HPT.

This risk assessment considers the relatively lower vulnerability to COVID-19 of service users in many SCRC settings balanced with the risk of suspending these important services and the wider harms this could pose.

Reporting outbreaks

Some settings may have obligations to report clusters or outbreaks to other agencies, for example:

  • Care Inspectorate
  • environmental health departments
  • Health and Safety Executive

This does not mean HPT notification is always needed or recommended.

Lower-risk settings

Reporting to health protection teams (HPTs)

There is no obligation for lower-risk settings to report clusters of confirmed COVID-19 cases or unusually high levels of absence thought to be associated with COVID-19 – in other words, possible cases – to HPTs.

It is expected that most of these situations will be managed via standard working practices in place in each setting for sickness and absence at work.

HPTs should engage and support setting to manage the outbreak proportionate to their assessment of the risk to public health if approached for advice.

HPTs may make the decision to engage in the handling of any individual cases, clusters or outbreaks at their discretion.

Mitigation measures

Service providers should undertake a rapid internal review of the setting's risk assessment and mitigation measures in response to an outbreak.

Consider any improvements made to their implementation as a priority.

See the NIPCM community IPC COVID-19 pandemic appendix for IPC advice.

Issues may arise in services when implementing mitigations is challenging.

For example, isolation of young children or those with learning disabilities – especially if they create distress for the individual.

Contact the local HPT in situations where applying the guidance is difficult.

Higher-risk settings: initial assessment

If one confirmed service user case arises or two or more linked individuals develop symptoms of COVID-19 within 14 days in a facility, the service provider should:

  • alert the local HPT who will carry out a risk assessment and investigate whether an outbreak has occurred – the level of response to an outbreak from the HPT will be based on the HPT’s risk assessment
  • undertake a rapid internal review of the setting's risk assessment and mitigation measures. Consider any improvements to their implementation as a priority – see the NIPCM community IPC COVID-19 pandemic appendix for IPC advice

Where available, the HPT should review the services’ COVID-19 workplace risk assessment or other outbreak management plan.

These steps should be undertaken collaboratively with the setting and be used to develop an individualised action plan for outbreak management.

Identifying linked cases

Assessment of service user cases when considering any potential outbreak should also include service users who have either been transferred from the care home / residential setting to hospital or died within the same time period of 14 days.

Symptomatic service users should be cared for in self-isolation in line with advice provided in section 4.2.

Continue with symptom vigilance in staff and service users and robust application of IPC measures.

Service providers do not require to contact the HPT following a single confirmed staff case if there are no further staff or service users that are symptomatic or confirmed cases. Local policies can be implemented for notifying a single staff case.

When investigating COVID-19 transmission in a care home / residential setting and implementing mitigation measures, this should be decoupled from the identification of staff cases if no links are found.

Any care home / residential setting that has employed staff, including agency staff, linked with another facility where an outbreak has been declared, must also be risk assessed as part of the heath protection response.

Declaring an outbreak

It is the role of the HPT to declare an outbreak when two linked cases are identified, at least one of which has been confirmed through testing.

An Incident Management Team (IMT) may be convened and led by the HPT.

If not, support will be provided directly by the HPT.

Higher-risk settings: testing

Asymptomatic service users who are well should not be tested.

A service user with fever and/or new respiratory symptoms should have a PCR sample submitted for SARS-CoV-2 and if indicated, a wider respiratory panel of tests.

This includes influenza, in line with local diagnostic laboratory protocols.

PCR testing can be used as a diagnostic tool or as part of surveillance.

LFD tests can also be used to support an initial risk assessment when a COVID-19 case arises in a care home.

When a cluster of symptomatic cases arises, it is now acceptable practice to submit samples for up to five symptomatic service users to confirm the pathogen.

Additional cases matching the outbreak case definition do not all need to be tested once the pathogen is identified.

There can still be a clinical need to test further cases – for example, to confirm the diagnosis in individuals with other respiratory illnesses or to determine eligibility for some treatments.

Testing arrangements during an outbreak is at the discretion of the local HPT.

The HPT has autonomy to deviate from the guidance according to local circumstances and risk assessment.

Mass testing

Mass testing is now unlikely to be justifiable in most circumstances.

Limited testing of a cluster of symptomatic service users is now considered more appropriate.

When COVID-19 was an infection that led to significant morbidity and death in frail elderly populations, it was important to case find and isolate all cases.

Service users and staff are now much better protected through vaccination and robust infection control.

Mass testing can lead to case finding of asymptomatic or mildly symptomatic cases of limited consequence to others.

Service users who are asymptomatic and well should not be tested.

Testing asymptomatic residents can have unintended consequences such as prolonged periods of self-isolation.

Organising mass testing by exception

If whole home testing is used, the local HPT determines whether to limit this to a section of the care home or residential setting.

Test symptomatic service users using PCR tests for diagnostic purposes.

LFD tests can be used in addition to PCR tests to provide a quicker result.

If testing an asymptomatic service user is justifiable by the HPT (expected to occur only exceptionally), and they return a positive LFD result, no confirmatory PCR is required.

They should be cared for in line with advice provided in providing care for service users who are symptomatic or have confirmed COVID-19 infection .

If an asymptomatic service user returns a negative LFD test but then becomes symptomatic, they should self-isolate and have a PCR test.

More information on testing those with recent COVID-19 infection can be found in further information on testing.

Higher-risk settings: outbreak management measures

Local HPTs continue to lead on the management of outbreaks in care homes, according to their statutory duties under the Public Health Etc. (Scotland) Act 2008.  

The local HPT has a duty to support the care home in the management of the outbreak.

They make decisions on outbreak control using a risk assessment approach. This considers the circumstances of the outbreak and the care home itself.

Monitor movements of service users within the facility.

Self-isolation will be in place for service users who are symptomatic or confirmed COVID-19 cases.

Some service users may find restrictions on their movements difficult to follow during an outbreak. For example, service users who walk with purpose. They often need increased support during an outbreak.

Non-residential services should consider pausing activity for a few days in discussion with their local HPT.

Infection prevention and control measures

A number of outbreak management measures are available, as advised by the HPT.  

These include:

  • isolation of cases
  • appropriate PPE use
  • enhanced cleaning
  • pausing routine visiting
  • cohorting of service users and staff
  • a temporary reintroduction of physical distancing

See the NIPCM community IPC COVID-19 pandemic appendix for advice on these measures.

Visiting arrangements

See visiting arrangements in residential settings when a service user is symptomatic or COVID-19 diagnosed.

Using communal spaces

Sometimes it is possible to manage areas of a residential facility as separate unit or units, with no shared activities or staff.

Unaffected services can continue with normal arrangements.

Have an increased vigilance for any contact links or symptoms in their service users or staff.

Communal areas may need to be more closely supervised to ensure service users who are symptomatic or confirmed cases do not mix with others.

Keep communal areas open for use by service users that are not identified as cases or symptomatic of COVID-19 – this is the default position during an outbreak if it can be arranged by staff.

If outbreak measures prove particularly challenging to implement or staffing capacity is low, communal areas may not be able to be used temporarily by service users who are not self-isolating.

They should be reopened as soon as practical.

Transfers

Transfers of service users in and out of the setting during an outbreak must be risk assessed.

Consider the:

  • service user's COVID-19 status
  • size of the outbreak
  • spread within the setting
  • units are affected
  • physical layout of the building
  • vaccination status of the individual and coverage at the setting

Seek support from the local HPT managing the outbreak.

Advise any receiving service, for example a hospital ward or ambulance or back to the facility, of the IPC measures needed for each service user they support.

Service user transfer across services may benefit from a multi-agency approach for challenging service user movements.

This could involve having a conversation between key services when needed.

Declaring an outbreak over

For HPT to declare an outbreak over

There should be no new linked symptomatic or confirmed COVID-19 cases for a minimum period of at least 14 days from last possible exposure to a case, whether in a service user or staff.

The HPT must also be satisfied that:

  • existing cases have been isolated or cohorted effectively
  • guidance on IPC and other interventions is being applied appropriately

Sufficient staff to enable the setting to operate safely using PPE appropriately is needed.

Moving between settings

General advice

This section covers:

  • admissions to SCRC settings
  • visits away from SCRC settings ​

Respiratory screening

Prior to admission to the care home or residential setting, respiratory screening questions should always be undertaken with either the service user or their carer. 

These are outlined in the NIPCM community IPC COVID-19 pandemic appendix.

This also provides further information on individual placement and assessment of infection risk.

Protecting those at highest risk

Residential facilities should also conduct a risk assessment for their facility to determine if there are service users who are at highest risk of severe illness.

Consider whether additional measures are needed to protect these individuals if COVID-19 cases arise in the setting.

Admissions to SCRC settings from hospital

COVID-19 recovered admissions

If self-isolation has been completed in hospital then no further self-isolation or testing is needed for service users being admitted to a SCRC setting.

COVID-19 recovered service users should follow the advice in providing care for service users – managing self-isolation in care homes or other residential settings if discharged before their self-isolation period in hospital has completed.

Service users should do this until they are absent from fever without the use of antipyretics and no longer feel unwell.

Non-COVID-19 admissions

No self-isolation or testing is required prior to admission to an SCRC setting for service users that are asymptomatic and have not tested positive for COVID-19.

The HPT may advise testing prior to admission if the setting provides care to clinically vulnerable individuals.

A local risk assessment should be undertaken by management of the SCRC setting in communication with the hospital team.

Service managers undertaking such risk assessment may wish to refer to the respiratory screening questions for SCRC settings contained within the NIPCM community IPC COVID-19 pandemic appendix.

Admissions to older adult care homes from hospital

COVID-19 recovered admissions to older adult care homes

The self-isolation period in hospital is 10 days.

COVID-19 recovered service users who have completed 10 days of isolation in hospital can be discharged to the care home (10 days after symptom onset or first positive test, if asymptomatic) without further testing or isolation.

This is providing the service user is both:

  • clinically stable
  • fever free for 48 hours without using medication such as paracetamol

Any decision to discharge should be made in collaboration between the healthcare setting and the receiving care home manager.

To inform a risk assessment, use:

Service users returning to their homely environment, rather than remaining in a clinical setting, is encouraged for their recovery and general wellbeing.

This process for COVID-19 recovered patients who have completed 10 days of isolation in hospital applies to both returning and new service users being discharged from hospital into the care home.

Discharging before completion of the self-isolation period in hospital

If a service user has not completed their self-isolation period in hospital, then they can do so in the care home.

  • They do not need to start a new period of isolation.
  • No further testing is needed once this isolation period is completed.

The self-isolation period for hospital inpatients and care home service users differs.

  • Inpatients require a minimum of 10 days.
  • Service users self-isolating inside the care home require a minimum of 5 days.
  • Both inpatients and service users should also be fever free for 48 hours without the use of medication before self-isolation can end – this is in addition to completing the minimum self-isolation period.

Service users do not need to continue with self-isolation on admission to the care home if they have completed a minimum of 5 days self-isolation whilst in hospital.

Testing

See testing recommendations for service users for guidance for admission purposes.

Non-COVID-19 admissions to older adult care homes

Service users do not need to self-isolate on admission to the care home if they:

Support service users that are fit for discharge from hospital to the care home to return home.

Returning to their homely environment is important for recovery and general wellbeing.

A risk assessment using the respiratory screening questions in the NIPCM community IPC COVID-19 pandemic appendix should be undertaken in the healthcare setting before hospital discharge.

This should be agreed with the care home. Rarely the risk assessment may determine the service user should self-isolate upon return to the care home – for example, if there are new symptoms.

Testing

See testing recommendations for service users for guidance for admission purposes.

Contacts of COVID-19 cases

Service users identified as a contact by the infection prevention and control team (IPCT) during their hospital stay do not need further isolation in the care home upon transfer.

New admissions from the community

Risk assessment

Service users admitted from the community (including from other residential settings) should complete the respiratory screening questions in the NIPCM community IPC COVID-19 pandemic appendix.

This will inform the risk assessment.

No self-isolation is required on admission where there is not an increased risk of infection identified through completion of the respiratory screening questions.

For older adult care homes, a decision on admission and any self-isolation requirements must involve the care home manager.

It may be subject to local processes as guided by the local Partnership oversight group. A clinical or health protection view may also support this.

If the service user is known to have recently been in contact with a COVID-19 case - see our advice for providing care for service users who have had contact with a COVID-19 case

Symptomatic or COVID-19 cases

Follow our guidance for providing care for service users who are symptomatic or have confirmed COVID-19 infection if a new admission is either:

  • symptomatic
  • confirmed COVID-19 case
  • answers 'yes' to any of the respiratory screening questions

Consider whether delaying the admission is appropriate.

If admission to the care home or residential setting is in the best interests of the service user's health and wellbeing then this should be supported.

This is provided the care home or residential setting can isolate and care for the service user appropriately.

Vaccination

Being fully vaccinated before admission (currently 3 doses) is advisable.

This is to minimise the risk of transmission for themselves, staff and any vulnerable service users.

Aim to vaccinate service users before admission, especially if the admission is planned in advance.

Sometimes vaccination may not be possible if there is a sudden need for admission or due to medical exemption.

Vaccination is not needed for admission and should not delay admission.

Testing

See testing recommendations for service users for guidance for admission purposes.

Children being moved between or to new care facilities

Risk assessment

Children admitted from the community (including from other residential settings) should complete respiratory screening questions as advised in the NIPCM community IPC COVID-19 pandemic appendix.

If the child has symptoms of COVID-19 or another respiratory infection their placement should take account of the health protection and IPC requirements of others in that setting.

Communication

Communication is key between service providers and the child or their guardian or carer.

Effective communication and explaining why decisions are being made and what to expect is important to promote wellbeing and reduce distress.

Testing

A decision on whether it is appropriate for a child in this situation to be tested should be made locally based on the answers to the respiratory screening questions.

Discuss with the local HPT if needed.

The decision to test and the results must not impact on the urgency of responding to the needs of the child and ensuring their safety and wellbeing.

Residential respite or short breaks services

Scope of respite guidance

The respite advice included in this guidance applies to:

  • residential respite facilities for children (including those registered as care homes)
  • stand-alone residential respite facilities for adults and older people (settings registered as care homes)
  • respite-providing care homes for older people that are not considered stand-alone facilities

Facilities that are unsure about which guidance applies can contact the Health and Social Care Partnership Oversight Group or local HPT.

They will advise based on the characteristics of the setting.

Risk assessment

Complete the respiratory screening questions in the NIPCM community IPC COVID-19 pandemic appendix for service users admitted from the community for respite or for a short break.

If the individual answers 'yes' to any of the screening questions they should follow the advice in providing care for service users who are symptomatic or have confirmed COVID-19 infection

If they answer 'no' to all the questions, self-isolation is not required.

Testing

Individuals being admitted for respite or short break in care homes for older adults or services with older or clinically vulnerable individuals are recommended to have one negative LFD test within twenty-four hours before arrival or on arrival.

No testing is recommended in settings mainly comprised of younger or working-age population.

Service providers can contact the local HPT if they need further advice.

Operating the respite service

Individual services must identify and set out the capacity for their setting.

Consider this through a risk assessment for the service.

The risk assessment can include factors such as:

  • size and layout of the setting
  • clinical vulnerability of those attending the setting
  • vaccination uptake in staff and service users
  • staffing levels
  • arrangements for hand hygiene facilities and environmental cleaning
  • the ability to maintain physical distancing if implemented by the service
  • the respite area is part of, or separate from, a care home which may or may not provide care to clinically vulnerable individuals

Further information relating to IPC and communal areas can be found in the NIPCM community IPC COVID-19 pandemic appendix.

The measures taken will need to be tailored to the specific residential/short break service and to the individual needs and considerations of those who use the service and of their careers. This will need regular review over the course of the pandemic. This assessment must be documented by the service.

Residential/short break services can use some of the contents of this guidance alongside their local protocols and arrangements. Other useful information can be found in PHS COVID-19: information and guidance for workplace and community settings.

Service users who temporarily leave the residential setting or care home

To attend hospital appointments

Service users attending hospital appointments do not require the same measures as a new service user admission on return to the setting.

Service users who have stayed overnight in hospital do not require the same measures upon return as a new service user admission.

This is provided the service user answers 'no' to the respiratory screening questions in the NIPCM community IPC COVID-19 pandemic appendix immediately prior to hospital discharge.

Testing

Testing is not needed if the service user remains asymptomatic.

At least 24 to 48 hours are needed for a result and the virus will not have had the time to establish itself if infection has occurred.

Day visits away from all care homes and other residential settings

Care homes are encouraged to enable personal and social outings, and routine visiting when there is no outbreak.

Information on the Scottish Government visiting policy is available in Open with Care: supporting meaningful contact in adult care homes-principles.

Follow the Scottish Government guidance on staying safe and protecting others

A brief risk assessment can assist in preparing for community visits.

It can determine whether additional measures should be considered upon return – for example, if symptomatic while away from the setting.

Visitors planning outings

Symptom vigilance amongst service users and their friends and family when planning outings away from the care home or residential setting is an important measure.

Anyone with respiratory symptoms should not participate in an outing.

Visitors are also reminded to follow the Scottish Government guidance on staying safe and protecting others.

Service users and their visitors should be made aware of this risk during the planning of outings – particularly when the course of vaccination has not yet been completed.

Outings arranged by staff

Staff may also take service users on visits away from the care home or residential setting.

It is good infection control practice to increase ventilation by opening windows during shared vehicle journeys.

Face coverings are recommended to be worn in line with the advice for the general public if tolerated.

See Scottish Government advice on staying safe and protecting others for more information.

Service users or staff do not need to change their clothes when they return. 

Overnight stays away from all care homes and other residential settings

Service users can visit family or friends overnight.

It is recommended the Scottish Government advice on staying safe and protecting others is followed.

Symptom vigilance among service users and their family and friends is important.

Service users or their carers or relatives have a duty to report to staff:

  • any symptoms that developed during the visit away
  • potential exposures to COVID-19 cases that have occurred

Respiratory screening questions in the NIPCM community IPC COVID-19 pandemic appendix should be asked on the service users’ return.

Give extra attention to the development of symptoms following service users’ return to the setting.

During an outbreak

When a cluster or outbreak of cases arises within a residential service, visits for essential healthcare reasons – for example, hospital attendance – can be arranged

Service users not identified as cases can also be supported using a risk assessment approach to go on an outing with their relatives.

This is providing the residential facility can accommodate preparation for the outing without adversely impacting the management of the outbreak itself.

Find out more information for visiting during an outbreak (named visitor initiative).

If an outbreak develops in the residential facility whilst the service user is away, the service user can choose to remain away or return to the facility.

This recognises the setting is their place of residence and home.

The local HPT can advise on decisions which need to be discussed and agreed between the service manager and the service user, and their family.

This should consider the restrictive conditions in the setting for outbreak management purposes upon their return.

Visiting arrangements in residential settings

This advice does not apply to people receiving care in their own home.

Routine visiting

Visitors should not visit any care home or residential setting if they have:

  • symptoms of COVID-19, flu or other respiratory infection
  • tested positive for COVID-19

They should follow the NHS inform stay at home guidance.

Infection prevention and control

Visitors should be informed of, and adhere to, IPC measures that are in place.

Length of visit

There are no limits on length of visit or how often service users can receive visitors in the care home settings.

Size of group

There are no restrictions on group sizes, but avoid overcrowding.

The service provider should consider the number of people that can use an area that allows individuals to have their own space.

The assessment should consider the built environment of the care home or residential setting, including factors such as ventilation.

Vaccination of visitors

Vaccination is encouraged for all visitors but is not obligatory.

Scottish Government guidance

The Scottish Government have published Open with Care: supporting meaningful contact in adult care homes – principles.

It is an update of the original Open with Care guidance published in February 2021.

It details the expectation and principles for visiting in adult care homes (including older adult care homes­). It also provides an overview of the current guidance.

Further information for visitors is available in our sections on:

Community groups visiting residential settings

Community group visits to residential settings or care homes can begin to be re-introduced.

Service providers may wish to invite community groups (including groups of children) into the residential setting or care home to engage with service users and enhance wellbeing.

If a setting is organising a visit by a community group, use the principles in this guidance to reduce the risks to the service users.

Individuals in community groups should not attend if they:

  • are a COVID-19 case or a known contact of a case
  • have any COVID-19 symptoms or if they have any other symptoms of illness, for example sickness or diarrhoea, respiratory symptoms, colds or rashes

Use the respiratory screening questions in the NIPCM community IPC COVID-19 pandemic appendix to check for wider symptoms before any interaction with service users.

Size of group

Avoid overcrowding.

Consider the number of people that can use an area so that it allows individuals to have their own space.

Some service users may want to take part but feel anxious about COVID-19 risks. You can offer them a face mask and their own dedicated space.

Outside visits

Where weather permits, visits should take place outdoors.

If this is not possible, visits can occur inside the facility if overcrowding is avoided.

Maximise ventilation in the setting during indoor visits.

Frequency of visits

The frequency of community group visits should be manageable for service providers.

Choirs and singing groups

If a choir or singing group is performing, a 2-metre distance is advised between the choir and the service users while performing.

If there is an outbreak

Postpone visits from community groups if there is an outbreak in the setting.

Visits when a service user is symptomatic or COVID-19 diagnosed

If there is no outbreak and a service user has tested positive for COVID-19 or has symptoms consistent with COVID-19 infection, visiting can be supported.

This needs a risk assessment involving the local HPT.

Service users can receive one visitor per day in their private room during the stay-at-home period.

The visitor should not be symptomatic of COVID-19, or a confirmed case themselves when they are visiting.

They should avoid visiting the setting if they live with someone following the stay at home guidance for people with respiratory symptoms.

If an outbreak has been declared by the local HPT, use the guidance on visiting during an outbreak (named visitor initiative).

Infection prevention and control

The visitor must adhere to IPC measures and only enter the service user's private room.

Avoid other areas of the setting and minimise time spent passing through corridors as much as possible.

See the NIPCM for further information on PPE for visitors.

Visiting during an outbreak (named visitor initiative)

Named visitor initiative

Settings can support service users to choose 'named visitors' who may visit them during a COVID-19 outbreak.

Care home staff will advise on whether the visit can take place in communal areas, or if it must be in the resident’s own room.

Named visitor is the default for visiting arrangements in SCRC settings during outbreaks.

Having a named person to visit during a COVID-19 outbreak can avoid service users experiencing prolonged periods of isolation from their loved ones.

It recognises the benefits to service users' health and wellbeing that visiting brings.

Service managers and HPTs must support and encourage this initiative for service users' general well-being.

Having named visitors during an outbreak in the care home or residential setting carries a degree of risk – especially if the service user is found subsequently to be a COVID-19 case.

Named visitors should use PPE when visiting during an outbreak – see NIPCM for further information on PPE for visitors

Older adult care homes still remain vulnerable settings due to the nature of communal living and the susceptibility of the service user population to infectious disease.

Choosing named visitors

Care homes or residential settings should:

  • support service users to nominate up to three named visitors
  • keep an updated record of each service users named visitors
  • involve family members, friends and advocates in this task, as appropriate

Service users can have up to three named visitors but only one named visitor should visit each day.

Visiting is restricted to the service user in their own room.

Exceptionally, two named visitors can visit at one time if support is needed by one of them, for example, an elderly spouse.

Exceptions remain at the discretion of the care home or residential setting and/or the HPT. 

Named visitor eligibility

The named visitor is:

  • asymptomatic and feels well
  • not a COVID-19 case or has been in contact with a COVID-19 case in the previous 14 days
  • strongly encouraged to be fully vaccinated
    • this is defined as having received the full primary course and booster of an MHRA approved vaccination, with at least 14 days having elapsed since the final dose
    • this is not a requirement for visitors
  • made aware and understands the risks to themselves visiting during an outbreak

If your named visitors are unavailable

If none of the named visitors can visit – for example, if they are self-isolating, on holiday, ill – the care home or residential setting should facilitate an alternative individual that can act as the named visitor.

Frequent changes in named visitor are not practical for this initiative.

Helping with care

Named visitors may, with agreement of the service user (or representative) and the care home or residential setting staff, provide day-to-day basic care to support service users’ health and wellbeing.

This is complementary to the care from staff.

It could include encouragement to eat and drink.

Length of visit

Care homes or residential settings have a range of extra caring tasks during outbreaks.

Relatives and care home or residential setting staff should work together to support named visitors on factors such as the time and length of visits.

Visiting someone with COVID-19

Named visitors can visit a COVID-19-positive service user who may require some comfort in what can be a stressful time.

This would require the local HPT's involvement in risk assessing whether 'named person' visits to a positive case can continue, considering the:

  • service users' needs
  • nature of the outbreak at that time

If the service user they are visiting is diagnosed as a COVID-19 case,  the named visitor must wear appropriate PPE – see NIPCM for further information on PPE for visitors.

Care home or residential setting staff can support and supervise the donning and doffing of the PPE.

Communal areas

Service users who are not symptomatic or confirmed COVID-19 cases and their visitors may continue to use communal areas if the setting is not being managed as a household.

Possible or confirmed COVID-19 cases should not use communal areas.

This is to ensure that those individuals identified as, or working with, COVID-19 cases do not mix with individuals who are not cases of COVID-19.

Outbreak management and visiting

The outbreak management process is at the discretion of the local HPT, led by an appointed competent person under the Public Health Etc. (Scotland) Act 2008.

The HPT lead outbreak management in care homes or residential settings using a dynamic risk assessment approach.

This is often via the incident management team (IMT).

The situation is continuously assessed and the control measures are reviewed by the IMT.

Pausing the named visitor initiative

Sometimes the HPT may risk assess that it is necessary to pause this initiative during an outbreak. This could happen if concerns are identified and effective outbreak management is at risk.

Any restrictions to the named visitor initiative should be in place for the shortest possible period and re-start as soon as possible.

Support essential visiting regardless of outbreak status.

Supporting the named visitor initiative

The local Health and Social Partnership Oversight Team working alongside the local HPT have a role in supporting care homes or residential settings to implement the named visitor initiative. 

They should also monitor the implementation of this initiative.

Outings from SCRC residential settings and care homes during an outbreak

Service users who are not identified as possible or confirmed cases of COVID-19 may leave the setting to go on outings.

This applies to older adult care homes also.

Discuss and arrange outings with staff.

Outings should be in line with the service users care plan and the management of the outbreak.

Staff resource will be prioritised on managing the outbreak and providing safe care.

Service users and their friends and family should be made aware of this.

This means care staff sometimes cannot accommodate outings for a temporary period of time.

Essential visiting

Support visiting for service users’ receiving end-of-life care regardless of outbreak status.

Other reasons for essential visits can include providing support to someone with a mental health issue, a learning disability or autism where not being present causes distress for the service user.

Essential visits are generally not limited to one visitor.

They are not typically restricted in frequency and duration.

Death Certification during COVID-19 pandemic

Details on death certification during the COVID-19 pandemic were outlined in the Chief Medical Officer (CMO) letter dated 20 May 2020.

This was updated in April 2022.

Abbreviations

ABHR

Alcohol based hand rub

AGP

Aerosol generating procedure

ARHAI

Antimicrobial Resistance and Healthcare Associated Infection

BiPaP

Bi-level positive airway pressure

CMO

Chief Medical Officer

CNO

Chief Nursing Officer

CPAP

Continuous positive airway pressure

COVID-19

Coronavirus disease 19

ECDC

European Centre for Disease Control

FRSM

Fluid-resistant surgical mask

HPT

Health protection team

HSCW

Health and social care worker

HSE

Health and Safety Executive

IMT

Incident management team

IPC

Infection prevention and control

IPCT

Infection prevention and control team

JCVI

Joint Committee for Vaccines and Immunisation

LFD

Lateral flow device - refers to test

MHRA

Medicines and Healthcare Products Regulatory Agency

NIPCM

National infection prevention and control manual

PCR

Polymerase chain reaction

PHS

Public Health Scotland

PPE

Personal protective equipment

RNA

Ribonucleic acid

SARS-CoV-2

Severe acute respiratory syndrome coronavirus 2

SCRC

Social, community and residential care

SG

Scottish Government

SICP

Standard infection control precautions

TaP

Test and Protect

TBP

Transmission based precautions

UKHSA

UK Health Security Agency (formerly Public Health England)

References

  1. Rapid Review of the literature: Assessing the infection prevention and control measures for the prevention and management of COVID-19 in healthcare settings - Public Health Scotland [Internet]. [cited 2022 Jan 31].

  2. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Science Brief: SARS-CoV-2 and Surface (Fomite) Transmission for Indoor Community Environments. CDC COVID-19 Science Briefs. Atlanta (GA): Centers for Disease Control and Prevention (US); 2020.

  3. Buitrago-Garcia D, Egli-Gany D, Counotte MJ, Hossmann S, Imeri H, Ipekci AM, et al. Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: A living systematic review and meta-analysis. PLoS Med. 2020 Sep 22;17(9):e1003346.

  4. Questions and answers on COVID-19: Basic facts [Internet]. [cited 2021 Nov 17]. 

  5. Coronavirus disease (COVID-19) [Internet]. [cited 2021 Nov 17]. 

  6. Questions and answers on COVID-19: Medical information [Internet]. [cited 2022 September 27].

  7. Heating, ventilation and air-conditioning systems in the context of COVID-19: first update [Internet]. [cited 2021 Jul 21]. 

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Last updated: 07 October 2022
29 September 2022 - Version 2.4

Face masks and face coverings section updated advising the use of FRSMs as part of SICPs and TBPs in line with ARHAI Scotland guidance.

Hyperlink updated in the ordering tests advice.

Testing advice in residential respite or short breaks services updated.

Hyperlink to the care home COVID-19 outbreak checklist removed.

15 September 2022 - Version 2.3
  • The guidance has been updated throughout to reflect the pausing of asymptomatic testing, as outlined in DL (2022) 32.
  • The guidance has been revised throughout to reflect the updated Scottish Government guidance on COVID-19: use of face coverings in social care settings including adult care homes.
  • Updated to reflect the removal of asymptomatic care home staff weekly PCR testing, as outlined in DL (2022) 29.
  • Reference to winter booster included.
  • Appendix 2 removed.
06 July 2022 - Version 2.2

Key updates that are included throughout the guidance:

  • This guidance has been merged with the COVID-19: guidance for care home settings (for older adults). This means that all care homes (registered with the care inspectorate) are now included in the scope of this guidance and the standalone COVID-19: guidance for care homes (older adults) has been archived. New sections have been added to this guidance where specific advice is only applicable to older adult care homes.
  • Scope of the guidance expanded to included services who provide support to those experiencing homelessness.
  • References to the ARHAI Scotland Winter (21/22), Respiratory Infections in Health and Care Settings Infection Prevention and Control (IPC) Addendum have been removed as the addendum will be withdrawn on 11 July 2022.
  • References to the new ARHAI Scotland Community IPC COVID-19 Pandemic appendix have been added throughout this guidance for IPC advice.

Key updates that are section specific:

  • Physical distancing: advice updated to align with the ARHAI Scotland Community IPC COVID-19 Pandemic appendix.
  • Advice for people at highest risk: section updated to reflect the end of the highest risk list on 31 May 2022.
  • Testing for COVID-19 infection: addition of three testing tables that contain testing advice for each of the following three groups: service users, staff and visitors. Where service user testing for admission purposes remains, LFD testing now indicated (previously PCR or LFD advised).
  • Outbreak management in higher risk settings: advice separated in to three sub-sections that cover the initial assessment, testing during an outbreak, and outbreak management measures.
  • Service users who temporarily leave the residential setting: new sub-section added that contains admission advice for service users who attend a hospital appointment or have an overnight stay in hospital.
  • Community groups visiting residential settings: new sub-section added outlining the health protection principles for services who wish to reintroduce community groups into residential settings (including care homes).
16 May 2022 - Version 2.1
  • Routine asymptomatic testing recommendation no longer covers general population, only HSCW working in specific settings should undertake routine asymptomatic testing.
  • Asymptomatic LFD testing for some HSCWs reverted to twice weekly.
  • Update to LFD kit access advice
  • Asymptomatic LFD testing only advised before attendance at specific health and social care settings for general population (visitors).
  • Updates to hyperlinks to other PHS guidance documents
  • Removal of contact tracing information in line with Scottish Government provision
  • Removal of asymptomatic testing for the general population (and service users)
  • Addition of appendix 2- checklist for COVID-19 outbreaks
31 March 2022 - Version 2.0
  • Scope of guidance updated to include adult care homes registered with the Care Inspectorate.
  • General updates to reflect change in LFD indications (before visiting crowded places and vulnerable individuals).
  • Change in LFD testing frequency and self-isolation requirements as a contact following recent COVID-19 infection for the general public and service users.
  • Change from 1 to 3 possible named visitors.
  • 28-day pause in testing and contact isolation for care home residents.
31 March 2022 - Version 2.0a
  • Scope of guidance updated to include adult care homes registered with the Care Inspectorate
  • General updates to reflect change in LFD indications (before visiting crowded places and vulnerable individuals).
  • Change in LFD testing frequency and self-isolation requirements as a contact following recent COVID-19 infection for the general public and service users.
  • Change from 1 to 3 possible named visitors.
  • 28-day pause in testing and contact isolation for care home residents.
25 February 2022 - Version 1.9

Prison settings and hospice settings removed from this guidance as new separate guidance published for prison settings and hospice advice now included in healthcare settings guidance.

There are general updates to text throughout the document to reflect current situation/policy decisions.

The document has also been restructured to improve readability

  • Section 2. Introduction: Background, spread of COVID-19 and symptom list updated to reflect current evidence
  • Section 3. General measures: all sections updated and addition of ventilation section
  • Section 4. Measures for staff: added information on exemption from self-isolation of close contact HSCWs and general advice updated
  • Section 6.1 Admissions: close contact information added
  • Section 6.2 Providing care during COVID-19: information on exemption from self-isolation of close contacts added
  • Section 6.3 Outbreak management: advice updated
  • Section 6.4 Visiting arrangements: advice updated
  • Appendix 2: tables updated with latest information
16 April 2021 - Version 1.8
  • Relevant links to the Scottish COVID-19 Community Health and Care Settings IPC addendum have been added throughout the guidance. IPC advice has been removed from this guidance where necessary following the publication of the Scottish COVID-19 Community Health and Care Settings IPC addendum.
  • Section 2.4. Shielding and protecting people at extremely high risk: shielding text updated.
  • Section 2.7. Immunisation Programme: updated text on vaccination added.
  • Section 3. Preventing spread of infection in Social, Community & Residential Care Settings: updated to contain information and links to new IPC addendum.
  • Section 4: New wording on 90-day testing exemption added.
  • Section 9: Staff who have contact with a case at work: information on 'testing of close contacts' added.
  • Section 9: Staff testing: information on returning travel added.
  • Section 9: Staff who have recovered from COVID-19: text on 90-day testing exemption updated.
  • Section 9: Staff who have been identified as a close contact: information on 'testing of close contacts' added.
  • Section 9: Staff who have been identified as a 'close contact' added, Lateral flow testing added.
  • Section 12: Additional information for specific settings: information added on providing care to individuals in their own home. Further information on residential respite/short break services added.
  • Appendices: removal of Best Practice How To Hand Wash, Putting on and Removing PPE and PPE tables, Decontamination and cleaning processes for facilities with possible or confirmed cases of COVID-19 and Routine decontamination of reusable non-invasive patient care equipment.
  • Appendix 2: Self-isolation table for cases and contacts updated.