COVID-19 - information and guidance for social, community, and residential care settings
Version 2.6

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.

Recovery

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

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

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

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.

Pregnancy

View further information on COVID-19 and pregnancy on:

• NHS inform
• Royal College of Obstetricians and Gynaecologists (RCOG)

COVID-19 vaccines are recommended in pregnancy.

Ending self-isolation

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.

Resilience planning

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.

Agency staff

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.

Prison staff

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.

Risk assessment

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
  and
• do not have a high temperature

Positive LFD test result

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

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

Tests should only be taken by staff that are both:

• symptomatic
  and
• 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.

Visiting professionals

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

Testing

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

Symptom awareness

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.

Vaccination

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. 

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 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.

Lower risk

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.

Higher risk

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

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

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

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

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.

Reporting outbreaks

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

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

Lower-risk settings

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.

Mitigation measures

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

Consider any improvements made to their implementation as a priority.

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

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.

Visiting arrangements

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

Using communal spaces

Sometimes it is possible to manage 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

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

Consider the:

• 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

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. 

General advice

This section covers:

• admissions to settings
• visits away from settings ​

Respiratory screening

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

Risk assessment

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

This will inform the 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:

• symptomatic
• 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.

Testing

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.

Non-COVID-19 admissions

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.

Testing

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.

Testing

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.

Admission testing

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

Risk assessment

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

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

Communication

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

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

Testing

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.

Risk assessment

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

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

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

Testing

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

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

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

Operating the respite service

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

Consider this through a risk assessment for the service.

The risk assessment can include factors such as:

• 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

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.

Prison settings

See Appendix 2 for information on court attendance and home leave.

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.

Prisons should:

• 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

Visitors should:

• 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.

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.

Resident cohorting

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.

Staff cohorting

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. 

Regime groups

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

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.

Court attendance

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

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.

Home leave

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.

Liberations

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.