Guidance on COVID-19 testing for healthcare workers to ensure the safety of patients and service users.
Contents
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/or 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 below if the staff member should take an LFD or multiplex PCR test.
A symptomatic individual who tests negative for COVID-19 may have another infectious illness like flu. Staff can return to work if they are clinically well enough to do so and 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.
Testing approach
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.
Our current approach to symptomatic testing in different settings is set out in the table below. 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. Free LFD tests are available for staff, through their employers, for the situations listed below.
| 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 |
| 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 for COVID-19
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.
Staff who are household contacts of someone with symptoms of COVID-19 or other respiratory virus
People who live in the same household as someone with symptoms of COVID-19 or other respiratory virus are at the highest risk of becoming infected because they are most likely to have prolonged close contact. For COVID-19 it can take up to 10 days for an infection to develop and it is possible to pass on COVID-19 to others even if you are asymptomatic.
People who stayed overnight in the household of someone with symptoms of COVID-19 or other respiratory viruses are also at high risk.
Staff who are identified as a household or overnight contact of someone who has had a positive COVID-19 test result or has symptoms for COVID-19 or other respiratory viruses should discuss ways to minimise risk of onwards transmission with their line manager.
This may include considering:
- redeployment to lower risk areas for patient-facing healthcare staff, especially if the member of staff works with vulnerable patients including those who are immunosuppressed meaning that they are at higher risk of serious illness despite vaccination (gov.uk)
- working from home for non patient-facing healthcare staff
- limiting close contact with other people especially in crowded, enclosed or poorly ventilated spaces
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 acute respiratory infections (ARI) including COVID-19 for health and care settings - 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 video (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.