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Introduction

As we move beyond the emergency response to the pandemic, and into autumn and winter 2022 to 2023 we will need to consider the vulnerability of many individuals accessing social care services given the uncertainty of the impact of COVID-19 and other respiratory viruses and the higher risks associated with closed and indoor settings such as care homes. We will build on what we have learned to date following the rollout of a successful vaccination programme with excellent uptake by care home residents and social care staff. Those working in social care continue to work tirelessly to establish improved infection prevention and control practices.

This document is supplementary guidance following the publication of the ‘Public health approach to respiratory viruses including COVID-19 2022 to 2023’.The approach we will continue to adopt is that COVID-19 is not over, and the transition from pandemic to endemic needs to be determined by public health conditions. 

Some safeguards and good practices will continue to be advised moving forward, but we will also encourage care home providers to move confidently towards re-introducing a far greater sense of normality in their care homes and in the day-to-day lives of the people they care for. It is important that we all remember that care homes are a person’s home and not a clinical environment. For this reason there will always be some inherent risk of acquiring infection and while we recognise residents are vulnerable, and we do our best to prevent this risk, any actions taken have to always consider the wider harms that may incur.

People working and living in social care settings and receiving domiciliary support services (DSS) have experienced very significant challenges throughout the pandemic [Footnote 1] and we do not underestimate the impact this has had on people’s mental and physical health and their wellbeing. We will continue to achieve a balance between supporting people’s wellbeing and keeping people safe. 

This document is intended to provide the social care sector with an outline summary of changes to the Test, Trace, Protect (TTP) arrangements and Infection Prevention & Control (IPC) guidance, and incorporates advice on care home visiting. This document signposts to more detailed Welsh Government and PHW guidance. A quick reference guide to the key messages can be found at Annex 1.

Testing and IPC requirements for social care workforce and residents

Welsh Government’s transition plan, Together for a safer future: Wales’ long-term COVID-19 transition from pandemic to endemic, was published in March 2022. It sets out the principles upon which Wales will base its continued response to COVID-19 as we look to the future of living with the virus along with other infectious diseases, and what that will mean for public health services and protections. The situation regarding respiratory viruses for winter 2022 to 2023 is arguably more unclear than previous years, especially as the pattern of seasonal viruses has been significantly disrupted due to the pandemic. These new arrangements move us to an approach targeted at protecting the most vulnerable from COVID-19 and other respiratory viruses.

Further guidance on IPC best practice including standard infection control precautions (SICPS) in the National infection prevention and control manual (NIPCM) is available on the Public Health Wales website.

Measures Guidance
Testing social care staff

Based on the latest available clinical advice about the benefits of asymptomatic testing when the prevalence of coronavirus is lower, from 8 September we will pause regular asymptomatic testing for social care settings, including care homes and hospice services.

It is recommended for this autumn/winter that all symptomatic care home and hospice staff have a multiplex test that will diagnose COVID-19 and other respiratory viruses including influenza and RSV. 

Testing - residents

We will continue to provide symptomatic testing for care home residents and we are providing multiplex tests that detect COVID-19 and other respiratory viruses. This will help to manage outbreaks and inform our ongoing surveillance.

We will continue to provide LFD and PCR testing for those eligible for COVID-19 treatments.

Residents being discharged from hospital to a care home will be offered an LFD test.

Social care staff - positive cases and identified contacts

The legal requirement to self-isolate positive cases and unvaccinated contacts ended on 28 March 2022. The Self-Isolation Support payment scheme ended on 30 June 2022. The COVID-19 statutory sick pay enhancement scheme ended on 31 August 2022. 

Social care 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
  • report their result online (gov.uk) 
  • 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 LFT in the absence of symptoms after 10 days is very low. However, if their LFT result is positive on the 10th day, they should continue to test and only return to work when a single negative LFT is achieved. Full guidance can be found at: COVID-19 testing for health and social care workers 

Social care staff identified as household contacts should follow specific social care guidance here. In brief however: 

  • social care 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 COVID-19 IPC guidance and the National Infection Prevention and Control Manual Wales.

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.

Use of Personal Protective Equipment (PPE)

The current COVID-19 IPC Guidance provides disease specific IPC measures to prevent transmission of SARS-CoV-2 in health and care settings in Wales. This guidance should be read in conjunction with the National Infection Prevention and Control Manual Wales. This describes the application of Standard Infection Prevention and Control Precautions (SICPs) and Transmission Based Precautions (TBPs).

Details on the PPE recommended for providing direct care in COVID-19 confirmed or suspected cases can be found at: Infection Prevention and Control Measures for SARS-CoV-2 (COVID-19) in Health and Care Settings - Wales

In summary, single use gloves, aprons and single use FRSM Type 11R mask and visor or goggles should also be worn when providing direct, personal care to people with suspected or confirmed COVID-19.  

A risk assessment tool to support social care organisations in applying the Hierarchy of Controls (HoC) including PPE is available: Criteria for completing a local risk assessment. It is recommended that assessment using this tool is performed on a regular basis to ensure preparedness.

Staff should continue to wear single use gloves and aprons when providing direct, personal/ intimate care where there is anticipated blood/body fluid exposure.

Where there is no COVID-19 outbreak or incident at the care home setting, providers may risk assess the continued use of masks for staff not providing direct, personal care. 

Mask wearing for staff not providing direct, personal care should resume if COVID-19 infection is suspected or confirmed within the setting.

Maintaining social distancing The guidance that social care staff, care home residents and recipients of DSS should maintain social distancing can be relaxed when there is no evidence of COVID-19 circulating in the home. Should an incident or an outbreak occur in a care home, social distancing could be re-introduced as a mitigating measure.

Care homes

People working and living in care homes and their families have experienced particularly significant challenges throughout the pandemic. The anguish caused by restrictions, the loss of loved ones and the separation from family and friends will not be forgotten. Similarly we acknowledge and reflect on the work of care home providers and their staff in caring for people and keeping them safe in very difficult circumstances. We do not underestimate the impact all of this has had on people’s mental and physical health and their well-being.

Life in care homes is still very different to how it was pre-pandemic. We have to build on what we have learnt and what we have achieved over the last two years. We have a successful vaccination programme with excellent uptake by care home residents and the majority of care home staff. If staff vaccination uptake in particular at care homes is identified as being below optimal levels, we will continue to target attention with a view to increasing vaccination levels in order to keep both themselves and those they care for safe.

Care homes have established improved infection prevention and control practices and there needs to be a continued focus to ensure these gains are maintained. Although some safeguards will continue to be advised as we transition beyond alert level zero, we will encourage care home providers to move confidently towards re-introducing a greater sense of normality and homeliness in their care homes and enriching the day-to-day lives and enjoyment of the people they care for. People should be able to relax and spend time together, eat together and participate in communal activities. 

A key aspect of the return to greater normality is ensuring that people are supported in their right to go out and to participate in family and community life and that this right is not restricted or inhibited. 

Likewise, we expect visitors to be welcomed and encouraged in an open and flexible way. Routine indoor visiting should be supported by care home providers without restrictions when there is no outbreak. If appointment systems are considered necessary they should facilitate rather than restrict visiting. We do not expect there to be inappropriate restrictions on visitor numbers or on the length and frequency of visits.

Visiting care homes  

Measures Guidance
Visiting care homes

Visitors should be welcomed, encouraged and enabled when there is no outbreak at the care home. Visiting arrangements should be as open and flexible as possible. With regular asymptomatic testing being paused for social care settings,  visitors will no longer need to undertake LFD testing before visiting a care home.

Anyone with symptoms or who is a close contact of a positive case of COVID-19 in the last 10 days, or has had any other respiratory virus symptoms are asked to not attend the care home during this period of time. 

Care homes should take a risk-based approach to supporting visiting during an outbreak/incident. If a care home is in outbreak/incident status decisions about supporting visitors into the home should be informed by the characteristics of the outbreak and advice from the local health and public protection teams supporting that home. In some circumstances it maybe proportionate to introduce additional control measures to enable routine visiting to continue. An example would be where infection is confined to a defined building or floor of the home or confined to kitchen staff. 

Essential visitors can continue to visit during an outbreak/incident. People may nominate 2 essential visitors in order to give greater flexibility without significantly increasing footfall into the home during an outbreak. They may visit separately or at the same time. 

Face coverings when visiting a care home     The legal requirement for visitors to wear face coverings when in public areas of care homes and when moving through the care home will ended on 30 May 2022. Providers may take a risk assessed approach.
Routine visiting into and out of care homes during an outbreak   Routine visiting into and out of care homes may be supported during some COVID-19 incidents or outbreaks, depending on public health advice for the specific outbreak.

Care home residents

Measures Guidance
Admissions to care homes following hospital discharge

We would encourage health boards to work with care home providers on discharge testing arrangements.

Patients who have tested positive for COVID on or since admission can assume non-infectivity when symptoms have resolved, plus:

  • 20 days have elapsed, or
  • 10 days have elapsed with either a negative LFD or a negative or low positive NAAT

Asymptomatic patients who have not previously tested positive for COVID to be tested with an LFD within 24 hours of planned discharge to a care facility. Care home residents are still recommended to self-isolate following discharge, but may test to release using LFD tests on day 3.

Guidance on testing prior to discharge and subsequent self-isolation arrangements can be found at: COVID-19 Hospital Discharge Service Requirements.

Admission to a care setting from elsewhere

Individuals requiring admission to a care home from their own home, the home of a relative or from another care setting should receive a risk assessment in regard to their infection risk, including for COVID-19 infection.

If an individual has symptoms of COVID-19 or has tested positive, placement or admission could be delayed for 10 days (or 14 days for those who are clinically or extremely clinically vulnerable) or the care home could consider admitting into isolation if they have the facilities to do so.

Care home residents going out     

Providers should support and encourage people living in care homes to exercise their right to go out and to participate in family and community life. This right should not be restricted or inhibited.

With asymptomatic testing being paused from 8 September, LFD testing is not advised when returning from visits out into the community.

Care home resident isolation - those who have received a positive test result or identified as a contact  

Guidance for people with symptoms of a respiratory infection, including COVID-19 can be found at: Guidance for people with symptoms of a respiratory infection, including COVID-19

Care home resident social distancing     The guidance that staff and residents maintain social distancing can be relaxed when there is no evidence of COVID-19 circulating in the home. Should an incident or an outbreak occur social distancing could be re-introduced as a mitigating measure.

Declaring an outbreak and outbreak management in care homes

Guidance relating to the management of COVID-19 infections within care homes is provided by Public Health Wales and can be found at: Infection Prevention and Control Measures for SARS-CoV-2 (COVID-19) in Health and Care Settings - Wales

Measures Outbreak management
Declaring an outbreak/incident of COVID infection  

The declaration and management of outbreaks of COVID-19 within care homes has been brought in line with existing respiratory infection guidance so that an incident/outbreak is only declared if two or more patients or staff cases of COVID-19 occur within a specific setting where nosocomial infection and ongoing transmission is suspected.

For an outbreak to be declared over, there should be no new outbreak-associated symptomatic or confirmed COVID-19 cases for a minimum period of at least 14 days. 

Testing for outbreak management

Mobile testing units retained to manage and support outbreaks. 

Contingency LFD capacity to be retained to support local outbreak management and investigating emerging variants. 

Annex 1

Quick reference guide
Measures Guidance
Vaccinations
  • The roll-out of the autumn booster dose programme began at the start of September 2022 to help boost the immunity of those at higher risk from COVID-19, improving their protection against severe illness.
Staff testing
  • It is recommended for this autumn/winter that all symptomatic care home and hospice staff have a multiplex test that will diagnose COVID-19 and other respiratory viruses including influenza and RSV. 
  • Staff will not be required to undertake twice weekly asymptomatic testing at this time.
Resident testing 
  • We will continue to provide multiplex PCR testing for COVID-19 and other respiratory viruses for symptomatic care home residents.
  • We will continue to provide LFD and PCR testing for those eligible for COVID-19 treatments.
  • Residents being discharged from hospital to a care home will be offered an LFD test. 
  • Care home residents are still recommended to self-isolate following discharge, but may test to release using LFD tests on day 3.
Stay at home  

Asymptomatic 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 COVID-19 IPC guidance and the National Infection Prevention and Control Manual Wales.

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.

PPE good practice
  • Single use gloves, aprons and single use FRSM Type 11R mask and visor/goggles should be worn when providing direct, personal care to people with suspected or confirmed COVID-19.  
  • Standard Infection Control Precautions (SICPs) should be used by all staff, in all care settings, at all times for all residents/service users.
  • Staff should continue to wear gloves and aprons when providing direct, personal/ intimate care where there is anticipated blood/body fluid exposure.
  • Where there is no COVID-19 outbreak or incident at the care home setting, providers may risk assess the continued use of masks for staff not providing direct, personal care. 
  • Mask wearing for staff not providing direct, personal care should resume if COVID-19 infection is suspected or confirmed within the setting.
  • The legal requirement for visitors to wear face coverings when in public areas of care homes and when moving through the care home ended on 30 May 2022. Providers may take a risk assessed approach.
Social distancing 
  • Social distancing can be relaxed when there is no evidence of COVID-19 circulating in the setting. 
  • Should an incident or an outbreak occur in a care home, social distancing could be re-introduced as a mitigating measure.
Care home visitors
  • Routine indoor visiting should be enabled and encouraged when there is no outbreak at the care home. Visiting arrangements should be as open and flexible as possible and if appointment systems are used they should facilitate rather than restrict visiting.  
  • There should not be inappropriate restrictions on visitor numbers or on the length and frequency of visits.  
  • People may nominate 2 ‘essential visitors’ to ensure continuity of visits during an outbreak. They may visit separately or at the same time. 
  • With regular asymptomatic testing being paused for social care settings, visitors will no longer need to undertake LFD testing before visiting a care home.
  • Anyone with symptoms of COVID-19 or who is a close contact of a positive case of COVID-19 in the last 10 days, or has had any other respiratory virus symptoms are asked to not attend the care home during this period of time. 
  • Care homes should take a risk-based approach to supporting visiting during an outbreak/incident. Decisions about supporting visitors into the home during an outbreak/incident should be informed by the characteristics of the outbreak and advice from the local health and public protection teams supporting that home.
Residents going out returning from visits within the community 
  • Providers should support and encourage people living in care homes to exercise their right to go out and to participate in family and community life. 
  • With asymptomatic testing being paused from 8 September, LFD testing is not advised when returning from visits out into the community. 

Footnote

1. For example, see: Rapid review on the impact of the COVID-19 pandemic on the mental health of health and social care workers within the UK. Report: RR00002, Wales COVID-19 Evidence Centre, July 2021 and Have infection control and prevention measures resulted in any adverse outcomes for care home and domiciliary care residents and staff? Report: RR00018, Wales COVID-19 Evidence Centre, November 2021.