COVID-19 - information and guidance for social, community, and residential care settings
- 2.6 Show version history
- 06 March 2023 (Latest release)
- Public Health Scotland, ARHAI Scotland
- Coronavirus (COVID-19)
- Health protection
Purpose and scope
This guidance aims to provide a clear, concise, and accessible overview of the public health measures that should be taken to prevent and manage COVID-19 in the settings described below.
This guidance now also covers prison settings. Appendix 1 and Appendix 2 contain extra information specific to prison settings.
Most of the information in this guidance is relevant for all listed settings. Where no specific setting is noted then the guidance is applicable to all settings. For example, sometimes there is specific information provided for older adult care home and prison settings. This is explicitly listed throughout.
Most settings are considered 'lower risk' as there is relatively lower risk of direct health harm arising from infection. However, some settings may be considered as 'higher risk' due to the vulnerable population or the configuration of the setting itself. Care homes for the elderly, prisons or other closed settings are considered as higher risk settings. The outbreak management section has more information on higher and lower risk settings.
Settings covered by this guidance include:
- situations where care is provided 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 – whether registered as care homes or not
- 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
'Service user' is used throughout this guidance as a generic term to denote a service user, resident, inmate or patient associated with any of the settings covered within this document. Where guidance is specific to either a prison or care home setting, the term 'resident' is used for those living there.
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.
The guidance should be read alongside PHS COVID-19 HPT guidance and Management of Public Health Incidents: Guidance on the roles and responsibilities of NHS led incident management teams.
The guidance should also be read alongside other relevant prison specific policy, guidance and legislation such as:
- The Scottish Prison Service Prison Rules and Directions
- Healthcare Directions
The Scottish Prison Service (SPS) produce guidance and other resources to operationalise public heath guidance. It is important that where the application of SPS guidance differs from national PHS or Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) guidance, reasons for this are documented.
Health protection team contacts
Health Protection Teams in each health board area are the primary team supporting the control of outbreaks in community settings. Local services have access to their local HPT for such operational advice. Public Health Scotland, at national level, does not provide this.
Access up-to-date contact information for local HPTs.
Developing this guidance
This is a Public Health Scotland publication. The guidance has been developed by PHS in collaboration with various stakeholders, including Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland.
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.
SARS-CoV-2 is spread by respiratory particles. This occurs mainly through close contact with infectious individuals.
Transmission risk increases when:
- people are close to each other (usually within 2 metres)
- people are displaying symptoms
- in indoor, poorly ventilated environments that are not regularly cleaned
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.
The amount of virus on surfaces is not always enough to cause infection.
SARS-CoV-2 can be transmitted even if the infected person does not have symptoms. This is called asymptomatic transmission.
Infectious and incubation periods
Studies show that the highest risk of transmission occurs a few days before and within the first 5 days after symptom onset but can be up to 10 days after symptom onset.
The average incubation period is between 3 and 6 days, with a range from 1 to 14 days.
The cardinal symptoms, as outlined by NHS inform, are:
- new, continuous cough
- change in or absence of sense of smell or taste
Symptoms of COVID-19 can vary in severity.
Some people have:
- sore throats
- general weakness
- muscular pain
- acute respiratory distress syndrome and other complications
Mortality is an unfortunate potential outcome in those with severe disease.
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
- shortness of breath
- excessive sleepiness
- difficulty in breathing (this is an important symptom to be aware of in older adults)
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.
General prevention measures
This section outlines a range of measures that are recommended to reduce transmission of SARS-CoV-2.
Each setting is strongly advised to continue to follow and regularly review the implementation of COVID-19 mitigation measures to minimise transmission of SARS-CoV-2 and other infections.
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 which is not specific to COVID-19.
Additional measures may need to be introduced when there are localised clusters or outbreaks. The health protection team (HPT)/Incident Management Team (IMT) will advise in these instances.
Refer to NHS inform for general advice on COVID-19.
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 also plays a role in reducing 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).
COVID-19 vaccinations and boosters offer the best protection against the virus. Where possible, staff and service users should be assessed for vaccine status and offered COVID-19 (and other) vaccinations at the earliest opportunity.
The Joint Committee for Vaccines and Immunisation (JCVI) provides details on the groups that are to be prioritised for vaccination.
Refer to The Green Book, chapter 14a (COVID-19) for the most up to date advice.
Find more information about vaccination boosters on NHS inform.
Services should aim to vaccinate service users before admission to a residential setting, 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 should not delay admission.
Vaccination of staff and service users, particularly in care homes, has altered the COVID-19 mitigation measures, making these less restrictive – for both vaccinated and unvaccinated people. When vaccination uptake rates are not satisfactory, this presents a potential risk to everyone in the setting.
Vaccination is strongly recommended, including of those who are pregnant, breastfeeding or planning a pregnancy, where the safety profile for COVID-19 vaccination remains good.
Additional sources of information for the COVID-19 vaccination are available.
Public Health Scotland
We provide materials to:
- promote the COVID-19 immunisation programme to:
- guidance for care home managers on consent in care homes in Scotland
- guidance for health protection teams
Workforce education materials
Access these on the Turas Learn site.
NHS inform provide information about:
- the vaccine
- invitations and appointments
- after the vaccine
- leaflets and other languages and accessible formats
Advice for contacts
Routine identification of contacts of COVID-19 cases is no longer undertaken.
Those with symptoms or confirmed COVID-19 should tell:
- everyone in their household that they are are symptomatic or have tested 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
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 is no longer required for staff, service users or visitors. Some health and social care 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 in specific circumstances.
Those who are isolating or part of a cohort should keep a 2 metre distance from other service users and staff, where possible.
The HPT or IMT may recommend a temporary reintroduction of physical distancing as a control measure during an outbreak.
Personal protective equipment (PPE) and face coverings
PPE is used to provide the wearer with protection against risks associated with the care tasks they are doing. All staff undertaking a procedure should assess any likely exposure to blood or bodily fluids and ensure PPE that provides adequate protection is worn.
Staff within health and care settings should continue to apply Standard Infection Control Precautions (SICPs) at all times to minimise transmission of infectious organisms.
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.
A poster from the NIPCM describes the safe methods for donning and doffing PPE.
Staff should undergo regular PPE training.
Face masks and face coverings
There is a difference between face masks and face coverings.
- Face mask
The use of the term 'face mask' means surgical or other medical grade masks.
For example, fluid resistant surgical masks (FRSM) used in certain health and social care situations.
- Face covering
The use of the term 'face covering' means something that is made from cloth or other textiles that covers the mouth and nose, and through which you can breathe.
For example, a scarf.
Continuous use of face masks in social care settings, including care homes, is no longer required nor advised routinely. This is due to the effective combination of natural and vaccine immunity in protecting populations at this stage of the pandemic and the risks that covering the face can present to social interaction, particularly for vulnerable individuals.
Staff should refer to the NIPCM for face mask requirements when applying SICPs which address general precautions. TBPs are to be used when infections are suspected or confirmed in individuals in the care home.
In care homes and other specific settings, care plans can support the person-centred approach of exceptional use of face masks and coverings for individuals. This occurs be in discussion with the resident, the care home and when indicated with relatives. Similarly, staff use of face masks outwith SICPs and TBPs protocols must be agreed with the line manager. Local HPTs can support complex risk assessment, if needed.
Scottish Government regularly update their guidance on the:
- use of face coverings in social care settings including adult care homes (for social care settings)
- extended use of face masks and coverings in hospitals, primary care and wider community healthcare (for healthcare settings, including prison healthcare settings)
Staff and residents wearing face coverings and face masks in prison settings
Residents are encouraged to wear face coverings when they leave the residential area of their household. This is also advised when mixing with others outside of their household group/cohort. This is especially important in crowded areas.
Wearing face coverings when outdoors is not needed for residents if there is no crowding. If there is an outbreak in the prison, face coverings are advised to be worn outdoors if different household cohorts are present.
This is in line with advice for the general population available in Scottish Government guidance on staying safe and protecting others.
Prison staff working in residential areas of the prison do not need to always wear face masks. However, this is a necessary precaution for those working with symptomatic/COVID-19 confirmed cases.
A resident may need to wear a face mask when working in a situation where PPE is required to be worn or leaving an establishment under escort.
If a staff member or resident cannot tolerate a face covering or a face mask when this is indicated, a local risk assessment must be completed and other mitigations considered, such as change in work role.
Hand, respiratory and environmental hygiene
Follow hand 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.
Good ventilation in indoor spaces can reduce the transmission risk of SARS-CoV-2 and other respiratory infections.
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
The below advice is not directly applicable for prison settings or individuals receiving care in their own home but may be used to inform good practice if fan use is required.
A fan may be used in a service user's own private room if they are feeling too warm after turning off the heating and opening windows.
The fan must be:
- 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.
Use of fans during an outbreak
Fans are permitted in the private room of a service user who is symptomatic or COVID-19 diagnosed, using the above guidance.
The window should remain open when in use.
Fan use is not advised 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 HPT.
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 individuals are at higher risk of severe illness if they are infected with SARS-CoV-2, even when fully vaccinated.
This includes those with a weakened immune system.
View the Scottish Government COVID-19 advice for people who are immunosuppressed.
Scottish Government ended the highest-risk list in Scotland on 31 May 2022.
View further information on COVID-19 and pregnancy on:
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 settings in some parts of this section.
Staff should 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 (or NHS healthcare team in certain settings).
- If they need urgent ambulance or hospital care
Tell the call handler that the unwell person may have COVID-19.
Service users who have had contact with a COVID-19 case
HPTs will not routinely do contact tracing.
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/IMT.
Notify staff if symptoms develop.
Service managers should check there is no one else with symptoms and that all NIPCM community IPC COVID-19 measures are in place.
Where appropriate, management can communicate with service users in residential settings (including prisons) when a new case of COVID-19 has been identified in their area. This is to promote symptom awareness and provide advice for other service users.
Service users who are symptomatic or have a positive COVID-19 test
All symptomatic or COVID-19 diagnosed service users should self-isolate immediately and follow the stay at home advice on NHS inform.
- 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 specific COVID-19 treatments.
Find out more about COVID-19 treatments on NHS inform.
Older adult care home residents who are symptomatic or have a positive COVID-19 test
Residents in older adult care homes should self-isolate immediately for at least five days if they have any of the following:
- cardinal COVID-19 symptoms
- other respiratory symptoms
- confirmed COVID-19
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 of residents without symptoms is no longer advised and can lead to unnecessary restrictions if applied – see testing recommendations for service users.
When a resident is symptomatic and COVID-19 PCR negative
If an older adult care home resident is symptomatic and their COVID-19 PCR is negative, then consideration should be given to:
- testing for different organisms, e.g. flu
- further clinical assessment of the symptoms, if they remain unwell
- repeat testing in case this is a false negative result (for example, the test being taken too early after symptom onset)
Residents 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.
Care at home and supported housing setting service users who are symptomatic or have a positive COVID-19 test
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 feeling unwell
Cough and loss of, or change in, taste and smell may persist for several weeks and is not an indication of ongoing infectiousness when other symptoms have resolved. However, cough and fever can be symptoms of other infectious and non-infectious conditions. These may require GP investigation if they do not improve.
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 amongst service users 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 and household members.
Open windows to increase ventilation and reduce the risk of transmission.
Sometimes it may be inappropriate for household members 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 HPT if needed.
Staff should adhere to:
Prison residents who are symptomatic or have a positive COVID-19 test
Prison residents should self-isolate immediately and continue for at least five days if they are a confirmed COVID-19 case. Day one is the day after symptom onset or the day after a positive test (whichever was earlier). Advice should also be sought from prison healthcare staff, if there is clinical concern.
Residents with symptoms suggesting possible COVID-19 should be placed into isolation separately from their household cohort. Isolation in their own single cell is sufficient.
See managing self-isolation in prison settings for more information.
Table 1 outlines the testing requirements for symptomatic residents in prison.
Symptomatic residents should be tested by PCR.
Symptomatic residents who decline PCR testing are required to isolate for a minimum of 5 days from symptom onset and be re-assessed.
When a prison resident is symptomatic and PCR negative
Isolation can be discontinued if the PCR test result is negative and they:
- are feeling well
- have not had a fever for 48 hours
If fever continues, further clinical assessment is advised and possible further testing, e.g. for flu.
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 should be notified and can discuss further testing with their local laboratory service if needed.
Managing self-isolation in care homes or other residential settings
Service users who are self-isolating are advised 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.
The Scottish Government COVID-19: living with dementia in care homes guidance provides information on supporting people to remain safe especially those who may find self-isolation difficult.
Staff 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:
- advice in the NIPCM community IPC COVID-19 pandemic appendix
- cleaning arrangements for communal facilities
Symptomatic or confirmed COVID-19 service users should have their own personal toiletries.
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.
For prison settings, refer to managing self-isolation in prison settings.
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:
- safety concerns
Seek advice from the local HPT on the management of individuals with special requirements if needed.
- individuals with:
- mental health conditions
- learning disabilities
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.
Carry out all necessary care within the service user’s room, where possible.
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.
Staff must inform 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.
Managing self-isolation in prison settings
If a resident's PCR test result is positive, self-isolation in their cell should continue for a minimum of 5 days from symptom onset. Positive cases can isolate together as a cohort.
Offer residents entering isolation the option to inform a family member/next of kin.
Further information relating to outbreak management is provided in Appendix 1.
Providing care in prisons
If cells with en-suite facilities are not available for self-isolation, then access to hot water and showers must be ensured for personal hygiene.
Those in isolation must continue to have access to health and care including prescribed medication.
Maintain symptom vigilance during the self-isolation period. This includes for signs of deterioration or mental health problems.
Outdoor exercise in prisons
Access to outdoor exercise should continue during the self-isolation period. This is provided the resident feels well enough.
The frequency and duration of exercise is determined by a local risk assessment that considers:
- staffing levels
- ability to maintain physical distancing
Transferring from prison to hospital during self-isolation
Residents 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.
Escorting staff should wear PPE in line with the Community IPC COVID-19 Pandemic appendix.
Escorting staff must follow hospital IPC procedures. If they are asked to wait in an area away from the prison resident, they should inform their prison Duty Manager. The Duty Manager will risk assess and advise as required. Special IPC precautions will be needed by escort staff in hospital areas of higher risk, such as Intensive Care Units.
Service users 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.
Higher risk settings (including care homes or prisons)
Residents 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
When other symptoms have resolved, a cough or change to taste and smell is not a sign of ongoing COVID-19 infection. Further testing is not usually needed. These symptoms can persist for weeks in people who have had recent COVID-19. However, cough and fever can be symptoms of other infectious and non-infectious conditions and may require GP investigation if they do not improve.
Further testing is not required, if the person is otherwise well.
On some occasions, the HPT may extend self-isolation. See Appendix 1 for further information on self-isolation recommendations in prison settings during outbreaks.
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 HPT.
Measures for staff
To reduce the spread of SARS-CoV-2, staff should follow measures in this guidance.
Plan ahead to prepare for extra demands on staffing needs due to outbreaks or staff absence.
This is known as resilience planning.
It should include:
- encouraging a high uptake rate of COVID-19 vaccine and annual flu vaccine amongst all staff
- help for staff self-isolating when they are symptomatic or 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
- good hand hygiene and cough/respiratory etiquette
- increased cleaning
- staff cohorting
- training updates
- guidance review
Workplaces and their staff should risk assess the infection risk, both within and outwith the workplace.
This is particularly important for small departments where even a few staff absences could have significant impacts on resilience arrangements.
To enable home working, hybrid working and safer office working, follow the Scottish Government advice in COVID-19 safer businesses and workplaces.
Carefully consider using clinical staff from other care homes, residential settings or healthcare services to replace staff during an outbreak.
This is at the discretion of the local HPT managing the outbreak in collaboration with service provider management.
Staff should not work across two facilities if one has an ongoing outbreak.
If staff are required to work in more than one prison, a risk assessment should be documented.
During an outbreak, sharing of staff across prisons should cease and staff should only work in one prison at a time to reduce the risk of transmission.
Staff who have contact with a COVID-19 case
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.
Staff who come into contact with a COVID-19 case are no longer automatically required to self-isolate. However, a risk assessment may need to be conducted.
The service manager should check appropriate infection prevention and control measures are in place, if the contact occurred in the workplace.
Patient-facing health and social care 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.
Staff need to be vigilant to COVID-19 symptoms at all times. This is very important during the incubation period after contact with a COVID-19 case.
If symptoms develop, see the measures for staff who become symptomatic or have positive PCR or LFD test.
The service manager should risk assess the placement of staff who may be contacts of a case if there are any extremely vulnerable individuals in the setting. This includes those who are severely immuno-suppressed. Risk assessment may result in a temporary change to location or tasks of work.
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.
Staff who become symptomatic or have a positive COVID-19 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
See Table 2 for testing eligibility.
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
You can return to work when you feel better and no longer have a high temperature.
Staff with persistent symptoms should be risk assessed by their line manager when returning to work. This would be part of a return to work interview, as per usual processes. Particular consideration should be given to the placement of staff working with individuals at higher risk of serious illness.
Follow all relevant infection control precautions on your return.
Staff eligible for testing
See Table 2 for testing eligibility.
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
- 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 staff that are both:
- eligible for testing
Situations should no longer arise whereby staff return positive results even when they are advised not to test, since asymptomatic testing is no longer indicated except under the conditions outlined in Director's Letter (DL) (2022) 32. See Scottish Government social care and community-based testing guidance for more information on testing eligibility.
Symptomatic LFD test positive staff who are not eligible for testing should avoid contact with other people for a minimum of 5 days after the day they took the test, regardless of the presence of symptoms. Follow the advice on NHS inform.
Household members of the case should follow the advice on NHS inform.
Returning to work
The Director's Letter (DL) (2022) 32 outlines the requirements for returning to work.
Risk assessing return to work
Line managers should risk assess staff with persistent symptoms when returning to work. This is 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, this would be 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 require a risk assessment, HPTs should have oversight of how these decisions are being made.
HPTs do not need to undertake the risk assessments.
Continue to support professional visits. 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 them essential.
New staff or agency staff
Proof of a negative SARS-CoV-2 test result is not needed prior to starting work.
Staff should not start work if they are symptomatic. 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.
Support all staff to become fully vaccinated as soon as possible to protect service users and other staff. Vaccination status should not be a barrier to staff starting work in the setting. It is strongly advised and work placements should be risk assessed.
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, LFD and Point of Care Tests (POCT) is available in our COVID-19 guidance for HPTs.
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.
PCR testing can be used as a diagnostic tool or as part of surveillance.
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 residents||PCR test||No testing required||No testing required|
|Older adult care home residents - admission from hospital (asymptomatic service users)||Not applicable as this is referring to asymptomatic service users only||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 residents - admission from hospital (COVID-19 recovered)||No testing required if 10-day isolation completed in hospital OR one negative LFD test before discharge (preferably within 48 hours prior to discharge), if 10-day isolation not complete||No testing required if 10-day isolation completed in hospital OR one negative LFD test before discharge (preferably within 48 hours prior to discharge), if 10-day isolation not complete||Not applicable as they are a recovered COVID-19 case.|
|Older adult care home residents - admission from the community (including from other care homes and hospices)||One negative LFD test or PCR if available (taken within 3 days prior to admission date). See 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 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 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 (asymptomatic service users)||Not applicable as this is referring to asymptomatic service users only.||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.|
|Prison residents||PCR test||No testing required.||No testing required.|
|Prison residents - admission from the community or transfer from other setting||PCR test prior to or upon transfer||Admission LFD testing advisable, if feasible (e.g. outbreak or vaccine uptake risk assessment).||Admission LFD testing advisable, if feasible (e.g. outbreak or vaccine uptake risk assessment).|
Find out more information on managing symptomatic or test positive service users.
The respiratory screening questions should be asked to all admissions/transfers. When testing is not possible, the responses to the questions can inform a risk assessment.
Local HPTs can advise in complex situations.
Testing for hospital discharges
See advice in moving between settings section for more details on transferring service users from hospital to the relevant setting.
With no test result
It is possible to discharge a service user without an available test result from hospital to a setting where admission testing is advised - see Table 1. 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 the receiving setting before their 10-day self-isolation period in hospital has ended is possible. This should be risk assessed.
See the testing advice outlined in Table 1 for the receiving service.
The testing advice in Table 1 still applies even if the service user is not required to self-isolate on admission to the setting.
|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 DL (2022) 32)||No testing indicated||No testing indicated|
|Staff included in the social care and community based testing guidance||Take a LFD test immediately (see advice in DL (2022) 32)||No testing indicated||No testing indicated|
|All other staff not included in the social care and community based testing guidance||No testing indicated - follow stay at home guidance on NHS inform for the general population||No testing indicated||No testing indicated|
|NHS Prison healthcare staff||Take a LFD test immediately (see advice in DL (2022) 32)||No testing indicated.||No testing indicated|
|Prison staff||No testing indicated - follow stay at home guidance on NHS inform for the general population.||No testing indicated||No testing indicated.|
Some NHS health workers attend community settings as part of their clinical role. The Scottish Government COVID-19: Staff testing in NHS Scotland guidance has more information.
Further information is available in measures for staff who become symptomatic or have positive PCR or LFD test.
Further information on testing
Symptomatic testing is only retained for eligible groups:
- in table 1 and table 2
- outlined in COVID-19: guidance for HPTs
Testing advice following confirmed COVID-19 infection
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 90 days
Day one is the day after symptom onset or the day after a positive test (whichever was earlier) if asymptomatic or displaying other non-cardinal symptoms.
The advice for symptomatic staff or those that have a positive COVID-19 test or symptomatic service users or those that have positive COVID-19 test should be followed if either
- new symptoms of COVID-19 develop during the time periods defined above
- a positive test is returned after the time periods above
Contact the HPT for advice in complex situations.
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 public health principles and practice.
Find out more information in the management of public health incidents – guidance on the roles and responsibilities of NHS-led incident management teams.
HPTs do not need to identify and manage outbreaks in all settings.
HPTs 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 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.
There are some settings where there is a lower risk of direct health harm arising from COVID-19 than in other settings e.g. settings mainly comprised of younger or working-age populations.
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.
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.
Prisons are also considered as higher-risk settings for outbreak management purposes. This is due to:
- the size of prison estates and their large resident and staff populations
- opportunities for infections to spread quickly throughout the facility due to the communal nature of the setting
- variable levels of vaccination coverage across the prison population
There may also be some 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 can quickly become an issue during an outbreak due to the size and nature of some services.
Management teams 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 to staffing shortages based on a risk assessment approach led by the HPT.
This risk assessment considers the vulnerability to COVID-19 of service users balanced with the risk of suspending important services and the wider harms this could pose.
Some settings may have obligations to report clusters or outbreaks to other agencies, for example:
- Care Inspectorate
- Environmental health departments
- Health and Safety Executive
Reporting to 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 can be contacted for support in complex situations.
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.
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 guidance.
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 higher risk facility, the service provider should:
- alert the local HPT who will carry out a risk assessment and investigate whether an outbreak is occurring – 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 guidance
Where indicated, the HPT can 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.
See Appendix 1 for further prison specific outbreak information.
Identifying linked cases
The assessment of linked service user cases when considering any potential outbreak should include those individuals who are present in the location where a case has been identified. It should also include service users who have either been transferred from the setting to hospital, or elsewhere, or died within the same time period of 14 days.
Further information can be found in providing care for service users who are symptomatic or have confirmed COVID-19 infection.
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 setting and implementing mitigation measures, this should be decoupled from the identification of staff cases if no links are found.
Declaring an outbreak
Declaring an outbreak is the responsibility of the HPT.
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 were in close contact with a case and are well should not be tested. They should be monitored for the development of symptoms. Testing in this circumstance can lead to unnecessary restrictions and is at the discretion of the local HPT.
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. Service users and their families should be advised of the possibility of wider testing if this is needed as part of outbreak investigation.
This can include influenza and other organisms, in line with local diagnostic laboratory protocols.
PCR is the preferred test for symptomatic service users. LFD tests may also be used to support an initial risk assessment under direction of the HPT during suspected outbreaks.
When a cluster of symptomatic cases arises, it is now good 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. See COVID-19: guidance for HPTs for more information.
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 is now unlikely to be justifiable in most circumstances.
Limited testing of a cluster of symptomatic service users is now considered more appropriate.
Any mass testing should be based on a risk assessment by the HPT/IMT. PCR testing is strongly advised, rather than LFD testing, due to increased sensitivity and potential to test for other respiratory viruses. However, when indicated, both may be able to be used effectively in combination, under the direction of the HPT.
Service users who are asymptomatic and well should not be tested, since a positive result will lead to isolation when this may not be needed.
Mass testing can lead to case finding of asymptomatic or mildly symptomatic cases of limited consequence to others.
Testing asymptomatic residents can have unintended consequences such as prolonged periods of self-isolation.
Any cases should be cared for in line with advice provided in providing care for service users who are symptomatic or have a positive COVID-19 test.
If an asymptomatic service user tests negative but then becomes symptomatic, they should self-isolate. If an outbreak has already been declared and the organism identified, no further testing is likely to be needed.
Consideration should be given regarding the need to inform local microbiology laboratory services where it is anticipated there will be a large volume of samples received.
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 lead on the management of outbreaks in the community, when indicated, including care homes, prisons and other closed settings, according to their statutory duties under the Public Health Etc. (Scotland) Act 2008.
The local HPT has a duty to support these settings in the management of the outbreak.
They make decisions on outbreak control using a population-based risk assessment approach. This considers the circumstances of the outbreak, the setting itself, and the individuals involved.
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. The Scottish Government COVID-19: living with dementia in care homes guidance has more information.
Non-residential services should consider pausing activity for a few days in discussion with their local HPT.
More information on outbreak management measures in prisons is available in Appendix 1.
Infection prevention and control measures
A number of outbreak management measures are available, as advised by the HPT.
These include, but are not limited to:
- regular monitoring of resident's symptoms
- isolation of cases
- appropriate PPE use
- enhanced cleaning
- changing from routine visiting to named person (and exceptionally, moving to essential 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.
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 selected areas of a residential facility as a separate unit or units, with no shared activities or staff.
Unaffected services can continue with normal arrangements, with 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 who 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.
They should be reopened as soon as practical.
Transfers of service users in and out of the setting during an outbreak must be risk assessed.
- service user's tested or presumed COVID-19 status
- size of the outbreak
- spread within the setting
- units which 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 residential 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.
Appendix 1 contains information on transfers in prisons during outbreaks.
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 member.
The HPT should also consider whether:
- 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 are needed.
Staff working in the service should enable the return to routine visiting once the outbreak has been declared over by the HPT.
Moving between settings
This section covers:
- admissions to settings
- visits away from settings
Prior to admission, respiratory screening questions should always be asked of 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 from the community
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 admission 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 a 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 a positive COVID-19 test if a new admission is either:
- a 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.
See testing recommendations for service users for guidance for admission purposes.
Admissions from hospital
Prison settings should refer to the admissions to prison settings from hospital section for advice.
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 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 been completed.
Service users should do this until they are absent from fever without the use of antipyretics and no longer feel unwell.
No self-isolation or testing is required prior to admission to a 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 setting in communication with the hospital team.
Service managers undertaking such risk assessment should refer to the respiratory screening questions contained within the NIPCM community IPC COVID-19 pandemic appendix.
Older adult care homes: admissions from hospital
COVID-19 recovered admissions to older adult care homes
The self-isolation period in hospital is 10 days.
COVID-19 recovered residents 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 resident 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. It is good practice to involve the family of the resident.
To inform a risk assessment, use:
- responses to the respiratory screening questions in the NIPCM community IPC COVID-19 pandemic appendix
- clinical judgement
Residents 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 residents being discharged from hospital into the care home.
Discharging before completion of the self-isolation period in hospital
If a resident 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.
Residents self-isolating inside the care home require a minimum of 5 days.
Residents 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.
Day 1 of isolation is counted as the day after the date of their positive test/symptom onset.
They do not need to continue with the remaining 10 days of self-isolation as applies to inpatients.
Both inpatients and residents 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.
See testing recommendations for residents for guidance for admission purposes.
Non-COVID-19 admissions to older adult care homes
Residents do not need to self-isolate on admission to the care home if they:
- are not a COVID-19 case
- answered 'no' to the respiratory screening questions in the NIPCM community IPC COVID-19 pandemic appendix before transfer to the care home
Support residents 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.
This should be agreed with the care home. Rarely the risk assessment may determine the resident should self-isolate upon return to the care home – for example, if there are new symptoms.
See testing recommendations for service users for guidance for admission purposes.
Contacts of COVID-19 cases
Residents identified as a contact by the infection prevention and control team (IPCT) during their hospital stay do not need isolation in the care home upon transfer.
Admissions or transfers to prison settings
Prison settings are advised to consider appropriate admission and transfer processes, depending on local arrangements. As a minimum, respiratory screening should be undertaken and acted upon prior to admission/transfer.
If a resident answers 'yes' to any of the respiratory screening questions - see Prison: residents who are symptomatic or have a positive COVID-19 test for information.
Prisons may wish to consider and implement an admission process that cohorts new admissions/transfers (10 days recommended) before they join the general prison population.
Residents can be grouped into a household cohort by day of admission or individual cells, if needed.
Residents are encouraged to wear a face covering and physically distance, if they leave their household cohort.
See Appendix 1 for additional information for prison settings for relating to outbreaks.
COVID-19 vaccination status should also be checked, and vaccinations offered as appropriate.
Table 1 contains testing advice for residents being admitted or transferred to prison settings.
There may be circumstances when a local risk assessment determines that asymptomatic testing should be undertaken for admission or transfer purposes. For example:
- as an outbreak control measure
- when vaccine uptake rates are sub-optimal
- when there are particularly high levels of SARS-CoV-2 circulating in the community
Symptomatic/COVID-19 positive residents
PCR testing is recommended for symptomatic individuals in prison settings. If a newly admitted resident becomes symptomatic or tests positive, self-isolation should commence in their own cell immediately. They should self-isolate for a minimum of 5 days.
Residents can be released from self-isolation if the test is negative, following clinical assessment for possible other infections.
Contact tracing may be considered, even though it is no longer routinely part of the prison management of COVID-19. Any resident who has shared a cell with a case during the symptomatic period from and including the 48 hours prior to onset of symptoms in the case, is advised to be vigilant for symptoms and report these if feeling unwell.
Meals and healthcare interventions including medicine dispensing should be provided for residents within their cell. Only essential staff wearing appropriate PPE should enter cells during this time.
A risk assessment should be conducted when it is deemed that a resident may need to leave their cell, e.g. for the purpose of attending a healthcare appointment.
Where all single cells are occupied and cohorting of residents by 'household' is unavoidable:
- Those with possible COVID-19 should not be placed with confirmed COVID-19 residents.
- Possible cases who are still awaiting test results should not be cohorted together.
- Those with confirmed COVID-19 can share double occupancy cells.
Admissions to prison settings from hospital
Residents who have been admitted to hospital for non-COVID-19 related reasons are not required to be cohorted on return if infection control measures are followed throughout their hospital stay, and:
- they are not a COVID-19 case
- they have answered 'no' to the respiratory screening questions in the NIPCM community IPC COVID-19 pandemic appendix
Confirmed COVID-19 cases who have completed their self-isolation period of 5 days in hospital should be clinically assessed before transfer to the prison.
They should be:
- showing signs of clinical improvement
- fever free for 48 hours without using medication such as paracetamol
Residents can return to the prison if they have not completed their self-isolation period in hospital if they are considered fit for discharge. This is subject to a risk assessment with the support of the HPT. This should consider if there is single cell accommodation available to complete their self-isolation period on return to prison.
Self-isolation is not required on re-admission to the prison if at least 5 days of self-isolation has been completed in hospital. This is providing the additional criteria for ending self-isolation in prison settings has been met.
Children being moved between or to new care facilities
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 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.
There is no need to test children prior to their admission.
If the setting has clinically vulnerable children or if there are complex circumstances identified, then advice on testing can be sought from the local HPT.
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.
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 a positive COVID-19 test.
If they answer 'no' to all the questions, self-isolation is not required.
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:
- outbreak status of the premises
- implementation of staff training and IPC measures
- 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 carers. This will need regular review and should 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 is not needed if the service user remains asymptomatic.
Day visits away from all care homes and other residential settings
Care homes and other residential settings 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 new respiratory symptoms should not participate in an outing.
Visitors are also reminded to follow the advice on NHS inform.
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 advice on NHS inform 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 and acted upon 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, providing the residential facility can accommodate this 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.
See Appendix 2 for information on court attendance and home leave.
Visiting arrangements in residential settings
This advice does not apply to people receiving care in their own home.
Supporting people in residential settings to remain connected with their loved ones is important for their general health and wellbeing. View the staying connected section for advice on different ways to visit.
Residents will have different needs or preferences for visiting.
These should be supported wherever possible to help residents maintain their health and wellbeing.
Each resident should have visiting needs and preferences included in their individualised care plan, balanced against the needs of everyone in the care home.
Visitors should not visit any care home or residential setting if they:
- are a COVID-19 case
- have any COVID-19 symptoms or if they have any other symptoms of illness, e.g.
- sickness or diarrhoea
- respiratory symptoms
Visitors with symptoms of COVID-19 or have tested positive for COVID-19 should follow the NHS inform stay at home guidance.
Visitors who have recently been in contact with a COVID-19 case should be extra vigilant to the development of symptoms and should consider delaying their visit to any communal residential setting.
Infection prevention and control
Visitors should be informed of, and adhere to, IPC measures that are in place.
Length of visit
There are no public health limits on length of visit or how often service users can receive visitors in the care home settings during routine visiting.
Size of group
There are no restrictions on group sizes, but crowding should always be avoided. An assessment should consider the built environment of the care home or residential setting, including factors such as ventilation.
Vaccination of visitors
Vaccination is strongly encouraged for all visitors but is not obligatory for visits.
Scottish Government guidance
The Scottish Government have published Open with Care: supporting meaningful contact in adult care homes – principles.
Further information for visitors is available in our sections on:
Community group visits
Community group visits are now permitted into the residential setting or care home to engage with service users and enhance wellbeing. These are part of routine visiting arrangements. They should be planned and risk assessed ahead of time.
Individuals in community groups should not attend if any of the criteria in the symptom awareness section applies to them.
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
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 (or other infection risks). You can offer them a face mask and their own dedicated space. Others may choose not to participate, and this should be respected.
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 minimum of 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 (excluding prisons).
The local HPT can support a risk assessment for this, if needed.
Service users can receive one visitor per day, the named person, in their private room during the self-isolation period.
The named person 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 who has been diagnosed with COVID-19 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 person 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.
Visiting during an outbreak (named person initiative)
Named person initiative
During a COVID-19 outbreak, when routine visiting is temporarily suspended, the named person initiative is to be used for visiting. This person centred approach can also be considered for visiting arrangements during outbreaks of any organism to support the health and wellbeing of residents as much as possible as long as this does not interfere with effective outbreak management.
The named person initiative does not apply to prisons.
Staff can support service users to choose 'named persons' who may visit them during a COVID-19 outbreak, when this initiative is in place.
Staff will advise on whether the visit can take place in communal areas, or if it must be in the resident’s own room.
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 users have different needs or preferences for visiting. Some service users may wish to not receive any visitors during an outbreak, and this should be respected. The resident's needs and preferences for visiting should be included in their care plans from the outset of admission to the care home.
Having named persons during an outbreak in the care home or residential setting carries a degree of risk for the visitor as well as the resident, as they may themselves be vulnerable to infection or not vaccinated.
Named persons need to use PPE when visiting during an outbreak – see NIPCM for further information on PPE for visitors. They should also follow all other IPC measures in place.
Older adult care homes still remain vulnerable settings due to their closed nature, communal living and the susceptibility of the service user population to infectious disease.
Choosing named persons for outbreak visiting
Care homes and residential settings should:
- support service users to nominate up to three named persons
- keep an updated record of each service user's named persons
- involve family members, friends and advocates in this task, as appropriate
Service users can have up to three named persons but only one named person should visit each day.
Exceptionally, two named persons 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.
Visiting can take place in the service user's private room. Sometimes it is possible to use communal spaces. Staff will advise. Staff can discuss with the local HPT.
Named person eligibility
The named person should not attend if they meet any of the criteria outlined in the symptom awareness section.
The named person is strongly encouraged to be fully vaccinated, though it is not obligatory.
Named persons should be made aware and understand the exposure risks to themselves when visiting during an outbreak.
The named person must be able to follow the advised infection prevention control procedures on the day, as advised by staff.
If your named person is unavailable
If none of the named persons 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 person.
Frequent changes in named person are not practical for this initiative and should be avoided.
Helping with care
Care staff have a duty of care to the people they care for and this needs to consider the resident's wishes.
Named persons 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 persons on factors such as the time and length of visits.
Visiting someone with COVID-19
Named persons can visit a COVID-19-positive service user who may require some comfort in what can be a stressful time.
The local HPT's can support risk assessing whether 'named person' visits to someone with COVID-19 can continue, considering the:
- service users' needs
- nature of the outbreak at that time
- health status/clinical vulnerability of the visitor
The named person 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.
Service users who are neither symptomatic or confirmed COVID-19 cases and their named person may continue to use communal areas if the whole 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 risk assessment
The outbreak management process is overseen by 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 can be via the incident management team IMT or directly by the HPT.
The situation is continuously assessed and the control measures are reviewed by the HPT or IMT, if informed.
Use of essential visiting
The named person initiative is the default visiting process during care home outbreaks.
Exceptionally, the HPT may risk assess that it is necessary to move from named person to essential visiting for a few days. This could happen if there is uncertainty in the effectiveness of outbreak management or serious concerns are identified and effective outbreak management is at risk. Examples of factors to consider include:
- PPE shortages
- concerns with staffing levels
- low visitor compliance with IPC advice
- higher levels of severe illness and poor outcomes than would be expected
- concerns reported by the Care Inspectorate
Moving to essential visiting is most likely to arise at the start of an outbreak, albeit rarely and short-lasting.
See advice in the supporting essential visiting section.
The HPT reviews (at least twice weekly) any move to essential visiting in their regular dialogue with care homes with an outbreak. Essential visiting will be in place for the shortest possible period.
It is the responsibility of Care Home staff to communicate any short-term changes to visiting to service users and their families, including if essential visiting is in place for a few days.
Essential visiting should be supported regardless of outbreak status.
Supporting the named person 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 person initiative.
Supporting essential visiting (outbreak)
Essential visiting for service users should be supported regardless of outbreak status.
Essential visits for service users receiving end-of-life care, should be facilitated regardless of outbreak status. Visitor numbers for these visits are generally not limited.
Where a service user would experience distress as a result of visiting being restricted for a short period, service providers should support essential visiting. For example, this would 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 can be included in essential visitor arrangements.
Essential visits should be agreed between the visitor and service manager. The service manager can contact the local HPT for advice in complex situations.
If it is anticipated that even a few days without visiting would have a significant negative impact the service user's physical, emotional, or psychological wellbeing causing distress, this can be recorded in their care plan as a likely reason for essential visiting. At the time of an outbreak, further person-centred assessment of those service users who may require essential visitors may be needed.
Staff are encouraged to ensure care plans are current and reflect the preferences and needs of service users.
Essential visits are not typically restricted in frequency and duration but by their nature need to be agreed with service managers.
Staff should assist service users to stay connected with their loved ones. This can be particularly important during an outbreak, especially when visiting arrangements change.
In addition to visiting, digital methods of communication can be explored. For example, using technology to make video-calls, phone calls and send messages.
Window visits can also be supported wherever possible.
Outings from 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. Arrangements need to be discussed and agreed in advance with staff.
This applies to older adult care home residents also.
Outings should be in line with both the service users' care plans 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.
Visiting in prisons
The following measures are good public health practice to minimise COVID-19 risk to the prison population.
Advice for prisons
Implementation of the below measures need to be balanced with the wellbeing of individual residents. SPS should aim to operationalise these measures according to risk assessment.
- ensure that all visitors are informed on arrival of IPC measures to be followed
- ask visitors to consider before their arrival if they have any symptoms of COVID-19 and decline the visit if they do - see triage questions for a suggested approach, which should be asked upon arrival
- ensure that visiting areas are well ventilated where possible
- ensure that visiting areas are cleaned regularly
- provide alternative measures of communication including telephone or video call where visiting is not possible
When there is a COVID-19 case or an outbreak has been declared
Local visiting arrangements should be reviewed if a case or cases arose.
During an outbreak at the prison, pausing visiting may need to be considered.
Advice for visitors
- not visit if they have been identified as a COVID-19 case or aware they have been in contact with a confirmed COVID-19 case or if they have symptoms of an infectious disease
- be strongly encouraged to complete a course of COVID-19 vaccination if eligible - though this is not obligatory for visiting
- perform hand hygiene on entry to the facility and again on leaving the facility
- not touch their face or face covering once in place, wherever possible. (Individuals may choose to wear face coverings)
- observe physical distancing where possible to other residents and staff
- remain in areas demarcated for visiting.
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.
Alcohol based hand rub
Aerosol generating procedure
Antimicrobial Resistance and Healthcare Associated Infection
Chief Medical Officer
Chief Nursing Officer
Coronavirus disease 19
European Centre for Disease Control
Fluid resistant surgical mask
Health protection team
Health and social care worker
Health and Safety Executive
Incident management team
Infection prevention and control
Infection prevention and control team
Joint Committee for Vaccines and Immunisation
Lateral flow device - refers to test
Medicines and Healthcare Products Regulatory Agency
National Health Service
National infection prevention and control manual
Polymerase chain reaction - refers to test
Public Health Scotland (new organisation formed in 2020, encompassing former Health Protection Scotland)
Point of care test
Personal protective equipment
Severe acute respiratory syndrome coronavirus 2
Standard infection control precautions
Scottish Prison Service
Transmission based precautions
UK Health Security Agency (formerly Public Health England)
Appendix 1: Prison outbreak management
Admissions or transfers
If COVID-19 cases start to appear in a wing, prisons may decide to operate household cohorts (see resident cohorting advice below) after the admission phase.
If one member of a household cohort becomes symptomatic and is isolated pending PCR test result, increased symptom vigilance is recommended for all members of the household.
During an outbreak, the admission/transfer of residents within or out with the facility should be avoided where possible. A risk assessment should be undertaken to ensure all required IPC measures are in place.
Transfers to and from the prison may be reduced or paused during outbreaks. This is on the advice of the IMT and in agreement with the prison Governor.
Individual risk assessments for transfers during an outbreak should be undertaken and should involve LFD testing (or PCR if the resident is symptomatic).
Any resident who is a possible or confirmed COVID-19 case should not be transferred. There are exceptions to this if transferring for medical care or during an operational emergency. Appropriate mitigations should be in place. See managing self-isolation in prison settings for more information on transfers to hospital during self-isolation.
Cohorting may be considered where there is insufficient accommodation to allow cases to isolate in single cells.
Principles for cohorting include:
- cohorting confirmed cases together is possible
- contacts can be cohorted together if indicated by the HPT
- contacts should not be cohorted with cases
- cohorts should be as small as is operationally possible
- those at highest risk from COVID-19 should not be cohorted with others
The IMT may advise for the prison to be temporarily closed to admissions and transfers if there are not enough cell numbers to support cohorting during an outbreak.
Wherever possible, teams of staff should be assigned to care for residents in different cohorts. Movement of staff between cohorts should be avoided.
Exceptionally, staff may need to work between residents with COVID-19 and residents who do not have COVID-19. Efforts should be made to see the residents who do not have COVID-19 first.
Residents can be assigned to a regime group. These are made up of different households. They take exercise and domestic periods together. The operation of regime groups may be constrained in an outbreak.
All regime groups are advised to maintain physical distancing and wear face coverings during an outbreak.
If one member of a regime group becomes symptomatic, members of their immediate household cohort or regime group may require isolation and testing. This will be risk assessed by the HPT.
Control measures should be reviewed by the IMT. This may include a visit to the prison setting by:
- the local Health Board HPT
- IPC team
- Local Authority Environmental Health professionals
- other relevant partners
If not already in place, the IMT may consider measures to minimise viral transmission in the prison.
This could include:
- household cohorting
- reinstating of admission testing or where this already exists, its reinforcement
- a temporary closure to new admissions
- pausing of visiting
- pausing of normal daily activities or services (e.g. education, hairdressing etc.)
Staff and residents should remain vigilant for development of respiratory or other COVID-19 symptoms and be encouraged to report these immediately. This enables isolation and PCR testing for residents to be initiated as early as possible - minimising prolonged transmissions and restrictions.
Barriers to reporting symptoms may exist, such as a desire to avoid isolation or testing.
Residents with COVID-19 symptoms require isolation for a minimum of 5 days from symptom onset, whether they have agreed to PCR testing or not. Careful consideration may be needed to extend this further in an outbreak, taking the incubation period into account. Extension of isolation periods must be balanced against the risks that this can cause, e.g. loneliness, psychological distress and resident unrest.
In exceptional circumstances, the HPT/IMT leading the outbreak response may advise that contact tracing of staff or residents is undertaken. SPS may be asked to support this.
Table 3a and 3b contains additional considerations for case and contact management during an outbreak. The HPT/IMT will advise on appropriate measures and may deviate from those outlined in Table 3a and 3b, due to their risk assessment.
|Group||Self-isolation period (days)||Management|
|Residents in prison||5 (default)||Minimum of 5 days self-isolation required. Can end after this period if apyrexial for 48 hours without paracetamol or other anti-pyrexials.|
|Residents in prison||10 (outbreak)||Self-isolation of 10 days may be recommended on HPT/IMT advice. This can be shortened with 2 consecutive negative LFDs at least 24 hours apart, starting no earlier than the fifth day after onset of symptoms (or date of test if asymptomatic) - day 0 is the date of onset (or test).|
|Prison staff||Based on symptoms||Not required, as per the general population, follow stay at home guidance, as outlined on NHS inform.|
|Prison healthcare staff||5 (default)
|Self-isolation of 10 days may be recommended on HPT/IMT advice. This can be shortened with 2 consecutive negative LFDs at least 24 hours apart, starting no earlier than the fifth day after onset of symptoms (or date of test if asymptomatic) - day 0 is the date of onset (or test). See DL (2022) 32.|
|Person and Place||Self-isolation period (days)||Management|
|Residents in prison||N/A||By default, no longer required|
|Residents in prison||10 (outbreak)||Self-isolation of 10 days may be recommended on HPT/IMT advice. This can be shortened with 2 consecutive negative LFDs at least 24 hours apart, starting no earlier than the fifth day after onset of symptoms (or date of test if asymptomatic) - day 0 is the date of onset (or test).|
|Prison staff||N/A||Not required as per the general population.|
|Prison healthcare staff||N/A||Not required, as per the general population. In an outbreak, twice weekly LFD testing can be considered, if advised by the HPT/IMT DL (2022) 32.|
Appendix 2: Leaving the prison temporarily and liberations
Those who have confirmed or possible COVID-19 should not attend court. The court should be informed as soon as possible in these circumstances.
It is the responsibility of the prison establishment to inform any impacted court(s) of a COVID-19 outbreak in their prison.
Any court transfer must follow safe escort and transfer protocols ensuring that IPC measures are fully adhered to as specified in the Community IPC COVID-19 Pandemic appendix.
Virtual court attendance is advised whenever possible for residents who are symptomatic or COVID-19 cases. HPTs can support prison healthcare staff in facilitating this and ensuring IPC measures are maintained adequately. IPC should not be a barrier to the use of virtual courts.
A risk assessment may be necessary for any court attendance where a breach in the above measures has occurred, whether to an outside court or a virtual one, to determine whether resident isolation or testing may be required.
Escorting of residents to courts, other prisons, and hospital is routinely carried out by an escort contractor who will follow their own COVID-19 guidance, which is expected to be aligned with this guidance. In some instances, such as a medical emergency, prison staff may escort a resident to hospital from prison, rather than the escort contractor.
All escorting staff should follow general measures such as physical distancing where possible and hand hygiene. Where staff are required to share transport, FRSMs should be worn. Escorting staff should follow PPE guidance the Community IPC COVID-19 Pandemic appendix and adhere to SPS operational policy.
Any vehicle used to transport a possible or confirmed case will need to be cleaned and disinfected using methods outlined for environmental cleaning before and after use.
Escorting services often operate a 'hub' for COVID-19 issues. GeoAmey can be contacted via their Operation Control Centre: 01698 451738. The SPS Escort Monitor Team (SPSEscortMonitorTeam@prisons.gov.scot) should be informed of any issues.
Escorting staff should wear PPE in line with the Community IPC COVID-19 Pandemic appendix. In addition, hospital staff may advise on further PPE required, which may be ward specific. Escorting staff would be expected to comply with such requests.
The local prison and HPT, with support from SPS when needed, will liaise and develop suitable processes for home leave to be put in place during outbreaks. The guidance on Staying Safe and Protecting others from Scottish Government should be followed during home leave as for the general public.
Residents should inform the prison prior to their return or on return to the prison if they become aware that they:
- have been in contact with a confirmed COVID-19 case whilst on leave
- are symptomatic
- are COVID-19 positive
SPS will arrange transport for this process and organise any self-isolation and testing requirements if required.
The SPS has no legal authority to hold an individual past their liberation date. Prepare for release in advance and work with key partners to organise this.
Standard pre-release planning should be followed for residents who are not COVID-19 cases. This includes during an outbreak.
For those who are a COVID-19 case and still in isolation, or where there is an outbreak, liaison with key partners and any household setting to which the resident is being released, is essential. Consent of the resident to disclose their COVID-19 status should be sought before disclosure to others. If consent is withheld, other arrangements may have to be made until the period of infectiousness is complete. The local HPT can support this process.
Completion of vaccination course should be offered prior to liberation.
If support with transport or housing is needed, SPS and Local Authority respectively, have roles in supporting arrangements, particularly for individuals who may still be within their infectious period. A case conference before release involving SPS, the HPT and the local authority should be considered for complex cases.