g logo nhs blue

Overview

This guidance provides advice on the management of staff and patients or residents in health and social care settings according to exposures, symptoms and test results. There may be further information specific to each country in the UK, as this guidance was written by Public Health England primarily for an English health professional audience, and contact tracing arrangements are variable across the four nations of the UK.

To see if country specific information is available, please refer to Health Protection Scotland, Public Health Wales, or Public Health Agency in Northern Ireland.

This guidance should be considered alongside local risk assessment and local polices— these are guiding principles and there may need to be an individual risk assessment based on staff circumstances, for example for those working with individuals who are immunocompromised.

This guidance should be followed regardless of the results of any SARS-CoV-2 antibody testing. A positive antibody result signifies previous exposure, but it is currently unknown whether this correlates with immunity, including protection against future infections.

This sumary has been abridged for print. View the full summary at guidelines.co.uk/455474.article

Staff with symptoms of COVID-19

If a health or social care worker develops symptoms of COVID-19:

  • they should follow the stay at home guidance
  • while at home (off-duty), they should not attend work and notify their line manager immediately
  • while at work, they should put on a surgical face mask immediately, inform their line manager and return home
  • comply with all requests for testing.

If a member of staff develops symptoms, they should be tested for SARS-CoV-2. Testing is most sensitive within three days of symptoms developing. Guidelines on who can get tested and how to arrange for a test can be found in the COVID-19: getting tested guidance.

If their symptoms do not get better after 10 days, or their condition gets worse, they should speak to their occupational health department if they have one or use the NHS 111 online coronavirus service. If they do not have internet access, they should call NHS 111.

Staff who have previously tested positive for SARS-CoV-2 by PCR should be exempt from re-testing within a period of six weeks from their initial illness onset, unless they develop new symptoms, in which case they will need retesting.

If staff are tested by PCR after six weeks from their initial illness onset and are still found to be positive for SARS-CoV-2, this could be due to a persistently positive test associated with the original infection, rather than a new infection as fragments of inactive virus can remain for some time following infection. 

If they have developed new possible COVID-19 symptoms after six weeks, they would need to self isolate again. If, however, they are asymptomatic, further management should be discussed with an infection specialist (for example a specialist in microbiology, virology or infectious diseases) before a decision is made regarding another self-isolation period.

Test and trace

The NHS test and trace service has been established to minimise community transmission of COVID-19. It is designed to:

  • ensure that anyone who develops symptoms of COVID-19 can quickly be tested to find out if they have the virus
  • help trace close recent contacts of anyone who tests positive for COVID-19 and, if necessary, notify them that they should self-isolate at home to help stop the spread of the virus.

If health and social care staff are providing direct care to a patient or a resident with COVID-19 and are wearing the correct PPE in accordance with the current IPC guidance, they will not be considered as a contact for the purposes of contact tracing and isolation, and will not be required to self-isolate for 14 days.

It is important to note that the effectiveness of the use of face masks, face coverings, or other PPE for prevention of transmission or acquisition of coronavirus infection cannot be guaranteed in settings other than the provision of direct care with patients or residents. Therefore, the use of PPE in other settings (such as a staff room or canteen) will not exclude an individual from being considered a close contact. 

In addition, if health and social care staff have been in contact with a COVID-19 case and are not following appropriate IPC, including wearing correct PPE, they will be considered as a contact for the purposes of contact tracing and isolation.

If a health or social care worker is considered to be a contact, and the recommendation for them to self-isolate would have implications for the provision of the service, their employer will need to escalate this for a risk- assessment to a Tier 1 contact tracer at the local Health Protection Team (HPT). Advice about whether a risk-assessment is needed may also be sought from the HPT. 

All staff who come into contact with COVID-19 cases, whether or not they are protected by the use of PPE or by other factors, should remain vigilant to the possibility of contracting infection and should self-isolate immediately if they develop relevant symptoms.

Staff return to work criteria

If staff are symptomatic when tested

Algorithm 1: Symptomatic worker—flowchart describing return to work following a SARS-CoV-2 test

 

Algorithm 1 Symptomatic worker- flowchart describing return to work following a SARS-CoV-2 test v2

 

Staff who test negative for SARS-CoV-2 can return to work (see Algorithm 1) when they are medically fit to do so, following discussion with their line manager and appropriate local risk assessment. Interpret negative results with caution together with clinical assessment.

Symptomatic staff who test positive for SARS-CoV-2 or who have an inconclusive test result, and symptomatic staff who have not had a test, can return to work:

  • no earlier than 10 days from symptom onset, provided clinical improvement has occurred and they have been afebrile (not feverish) without medication for 48 hours and they are medically fit to return
  • if a cough or a loss of or a change in normal sense of smell (anosmia) or taste is the only persistent symptom after 10 days (and they have been afebrile for 48 hours without medication), and if they are medically fit to return (these symptoms are known to persist for several weeks in some cases).

All members of a household shared with the individual should self-isolate for 14 days from the day the individual’s symptoms started. However, if any household member develops symptoms of COVID-19, they should isolate for at least 10 days from the onset of their symptoms, in line with the stay at home guidance.

If staff are asymptomatic when tested

Algorithm 2: Asymptomatic worker—flowchart describing return to work following a SARS-CoV-2 test

 

Algorithm 2 Asymptomatic worker- flowchart describing return to work following a SARS-CoV-2 test v2

 

Staff without symptoms may also be tested where there is a clinical need to do so, in line with NHS England, PHE, Department of Health and Social Care or Devolved Administration guidance.

Staff who test negative for SARS-CoV-2 and who were asymptomatic at the time of the test can remain at work or return to work immediately as long as they remain asymptomatic if they were tested as part of routine testing. If they were tested as part of contact tracing investigation then they should follow instructions from the local Health Protection Team.

Staff who test positive for SARS-CoV-2 and who were asymptomatic at the time of the test must self-isolate for 10 days from the date of the test. If they remain well, they can return to work on day 11 (see Algorithm 2).

If, during the 10 days’ isolation, they develop symptoms, they must self-isolate for 10 days from the day of symptom onset. They can return to work as per the guidance for symptomatic staff who test positive for SARS-CoV-2.

All members of a household shared with the individual should self-isolate for 14 days from the day the individual’s test was taken. However, if any household member develops symptoms of COVID-19, they should isolate for at least 10 days from the onset of their symptoms, in line with the stay at home guidance.

If staff have been notified that they are a contact of a confirmed case in the community

Staff who have been notified through the NHS test and trace or other national (Northern Ireland, Scotland or Wales) contact tracing service that they are a contact of a confirmed case of COVID-19 in the community (outside the health or social care setting or their place of work) they should inform their line manager and self-isolate for 14 days, in line with the NHS test and trace guidance.

This advice should be followed regardless of the results of any SARS-CoV-2 antibody testing. A positive antibody result signifies previous exposure, but it is currently unknown whether this correlates with immunity, including protection against future infections.

If staff have been notified that they are a contact of a co-worker who is a confirmed case

If a staff member has been notified that they are a contact of a co-worker who has been confirmed as a COVID-19 case, and contact with this person occurred while not wearing PPE, the 14-day isolation period also applies.

Risk assessment for staff exposures in the workplace

If a health or social care worker has come into close contact with a confirmed COVID-19 patient, resident or service-user or a symptomatic patient, resident or service-user suspected of having COVID-19 while not wearing PPE, or had a breach in their PPE while providing personal care to a patient, resident or service-user with confirmed or suspected COVID-19, then the staff member should inform their line manager.

See government’s Infection prevention and control guidance for healthcare workers.

In assessing whether a health or social care worker has had a breach of PPE, a risk assessment should be undertaken in conjunction with local infection prevention and control (IPC) policy. Take into consideration:

  • the severity of symptoms the patient/resident has
  • the length of exposure
  • the proximity to the patient/resident
  • the activities that took place when the worker was in proximity (such as aerosol-generating procedures, monitoring, personal care)
  • whether the health or social care worker had their eyes, nose or mouth exposed.

If the risk assessment concludes there has been a significant breach or close contact without PPE, the worker should remain off work for 14 days.

Additional considerations

Currently it is not known how long immunity to COVID-19 may last. This is being reviewed as evidence emerges. In the current state of knowledge, should staff develop new COVID-19 symptoms, they should self-isolate, even if they have already had a positive SARS-CoV-2 antibody test, for example as a research study participant.

For more information on interpreting test results and the actions required for both symptomatic and asymptomatic individuals, see the flowcharts illustrating the return to work process.

Full guideline:

Public Health England. COVID-19: management of staff and exposed patients or residents in health and social care settings. April 2020. Available at: gov.uk/government/publications/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings

Contains public sector information licensed under the Open Government Licence v3.0.

Published date: 04 April 2020.

Last updated: 18 August 2020.