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Guidance on COVID-19 testing for healthcare workers to ensure the safety of patients and service users.

First published:
17 December 2021
Last updated:

Introduction

This guidance is for health and social care providers and workers to set out the current testing regime for health and social care staff. Informed by public health and clinical advice which takes account the current public health conditions. 

The aim is to ensure, where advised, that people have access to testing to enable symptomatic COVID-19 positive cases to be identified quickly to protect the more vulnerable. We will keep this guidance under review as prevalence changes and as knowledge of current and future COVID-19 variants increases.

Who does this guidance apply to?

This guidance replaces all previous guidance for testing for health and social care workers and applies to staff working in close contact with patients and service users. It also applies to prisons and special schools.

Staff with symptoms of a respiratory tract infection including COVID-19

Any patient/service user facing staff member who has symptoms of a respiratory tract infection including COVID-19 and who has a high temperature is advised to stay at home, notify their employer as soon as possible and take a test as soon as possible. Further advice is provided on the type of test staff should take. 

Free symptomatic lateral flow device (LFD) testing is available through employers for staff working in patient/service user facing roles in the settings and services listed. 

  • health boards and trusts 
  • primary care services
  • care homes 
  • hospices
  • domiciliary care services
  • health and care inspectorates
  • independent health providers treating NHS patients
  • social workers
  • supported living facilities 
  • prisons
  • special schools

A symptomatic individual who tests negative for COVID-19 may have another infectious illness like flu. Staff can return to work if they are no longer symptomatic and they do not have a high temperature.

If the staff member works with patients whose immune system means that they are at higher risk of serious illness despite vaccination (gov.uk) they should discuss this with their line manager who should undertake a risk assessment.

Multiplex PCR tests for COVID-19 and other respiratory viruses

In addition to COVID-19 this winter we also face additional uncertainty in relation to other circulating respiratory viruses, including flu. Multiplex PCR tests diagnose a wider range of respiratory viruses. To protect the more vulnerable this autumn and winter symptomatic staff and services users who work in  closed settings and routinely work with individuals who are at higher risk from respiratory infections should take a multiplex PCR test.

Our current approach to testing in different settings is set out in the table. This is based on the objective of protecting the more vulnerable and reducing the risk of transmission to those who are at highest risk of adverse outcomes and within high risk/ closed settings.

Approach to closed settings
Setting Situation Type of test

NHS Hospitals

Symptomatic patient facing staff working with high-risk groups COVID-19 treatments Multiplex PCR

NHS Hospitals

Symptomatic staff not routinely working with high-risk groups LFD - if negative, then a PCR/Multiplex test is advised
NHS Symptomatic Independent Health Providers treating NHS patients in hospitals LFD - if negative, then a PCR/Multiplex test is advised
Care homes Symptomatic residents - If residents present with an influenza like illness (ILI) three symptomatic residents should be tested in the first instance to understand which respiratory virus is circulating in the care home. Other care home residents who subsequently present with ILI can be assumed to have the circulating respiratory virus.  Further testing should only be undertaken if clinically indicated Multiplex PCR
Care homes Symptomatic staff Multiplex PCR
Hospices Symptomatic staff Multiplex PCR
Social care Symptomatic staff working in supported living facilities LFD - if negative, then a PCR/Multiplex test is advised
Prisoners Symptomatic prisoners - If prisoners in the same block present with ILI three symptomatic residents should be tested in the first instance to understand which respiratory virus is circulating in the prison. Other prisoners in the unit who subsequently present with ILI can be assumed to have the circulating respiratory virus Further testing should only be undertaken if clinically indicated. Multiplex PCR
Special schools (residential) If residents present with ILI three symptomatic residents should be tested in the first instance to understand which respiratory virus is circulating in the school. Further testing should only be undertaken if clinically indicated LFD - if negative, then a PCR/Multiplex test is advised
Approach to testing in other settings
Setting Situation Type of test
NHS Symptomatic Independent Health Providers treating NHS patients in the community LFD
NHS Symptomatic primary care staff  LFD
Social care Symptomatic domiciliary care staff LFD
Social care Symptomatic social care workers LFD
Health and Care Inspectorates Symptomatic staff LFD
Special schools Staff and students in non-residential schools LFD

Staff who have tested positive

Staff who test positive are very likely to have COVID-19 and can pass on the infection so they are advised to:

  • stay at home and avoid contact with other people if they can (if they have taken a test)
  • report their result online (gov.uk) if they have taken an LFD test
  • notify their manager
  • engage with the contact tracing process which, as health and social care professionals, will include potential follow up telephone calls with a contact tracer or completion of an e-form
  • take a lateral flow test on day 5 and 6 after they tested positive and: 
    • when they have two consecutive negative lateral flow tests 24 hours apart they can return to work 
    • If they test positive on either day 5 or 6, they should continue to stay away from work until they have 2 negative tests taken 24 hours apart or up until day 10. They are also strongly advised to stay at home and avoid contact with others whilst they continue to test positive

The likelihood of a positive LFD in the absence of symptoms after 10 days is very low. However, if their LFD result is positive on the 10th day, they should continue to test and only return to work when a single negative LFD is achieved. 

Asymptomatic testing

At this time, staff should no longer conduct regular asymptomatic testing. During an outbreak or a high level of cases within a facility some staff without symptoms may be asked to undertake both LFD and/or PCR testing. 

Staff who are household contacts of someone with COVID-19

People who live in the same household as someone with COVID-19 are at the highest risk of becoming infected because they are most likely to have prolonged close contact. People who stayed overnight in the household of someone with COVID-19 are also at high risk.

If a staff member is a household or overnight contact of someone who has had a positive COVID-19 test result it can take up to 10 days for the infection to develop. It is possible to pass on COVID-19 to others, even if a staff member has no symptoms.

Staff who are identified as a household or overnight contact of someone who has had a positive COVID-19 test result should discuss ways to minimise risk of onwards transmission with their line manager.

This may include considering:

While they are attending work, staff must continue to comply rigorously with all relevant infection control precaution (nhs.uk).

If staff develop any symptoms within the 10 days, they should follow the advice for staff with symptoms of a respiratory infection, including COVID-19.

Infection prevention and control

To support the mitigation of risks, workers must continue to adhere to their employer’s guidance on infection prevention and control measures. This includes social distancing and the use of PPE in line with the current guidance: Infection Prevention and Control Measures for SARS-CoV-2 (COVID-19) in Health and Care Settings (pdf, phw.nhs.wales).

All health and care staff should be familiar with the principles of standard infection control precautions (SICPs) and transmission based precautions (TBPs) for preventing the spread of infection in health and care settings and should implement IPC measures in line with the National Infection Prevention and Control Manual for Wales NIPCM - Public Health Wales (nhs.wales).

Use of facemasks or coverings for all patients and visitors in areas that are dealing with known or suspected cases of SARS-CoV-2 and other respiratory infections should be continued in compliance with IPC guidance. 

It remains the responsibility of the Health Board to ensure that staff and visitors comply with IPC guidance for health and care settings.,- and continue to be advised and supported to use masks/ face coverings.

How to use a lateral flow test

Watch this short training vide (nhs.uk) on how to self-test using a LFD. Once you have seen the training video, you are deemed competent in using a LFD. The manufacturer’s instructions for use are also included in each box of LFDs. They explain how to take the test and how to interpret the results.

Further details and Standard Operating Procedures have also been shared with health and social care employers. They will be distributed locally.

How to report LFD test results

Reporting the result of every LFD test is encouraged, even if it is negative or void. Staff members can register LFD tests individually (nhs.uk).  Where organisations have a UON, staff should report results using that UON.

If the test shows an invalid result, you need to repeat the test with a new test kit.

Report all positive LFDs results to your employer immediately.