Guidance on additional targeted Covid-19 testing to keep care homes safe this winter

27th October 2022

By Stockport Council Public Health Team, Greater Manchester (GM) IPC Care Homes cell, GM Health Protection Confederation and public health and infection prevention control teams in the ten areas.

Discussions have been ongoing in respect of the escalating number of care home outbreaks as we head into winter, potential emergence of variants, other viruses including flu and gastrointestinal outbreaks, resulting in concerns over pressure on the GM health and care system. This has coincided with the removal of routine asymptomatic testing in care homes and adult social care settings.

Local public health teams have been considering additional testing measures that can supplement the national guidance. This has to be balanced against the availability of reserve stock built up during the pandemic, noting that some areas have low stock in reserve, and we also have responsibility to protect other vulnerable settings beyond social care. In this context, we are proposing targeted asymptomatic testing as below.

The recommendations are intended to protect care homes even further by ensuring people who are more likely to bring in COVID-19 (household contacts) and/or flu and gastrointestinal viruses are screened out before they enter the care home. This will reduce transmission of viruses in the care home and will protect other staff from picking up infections in the workplace. In this way, care homes are kept open with fewer staff going off sick and reduced risk of outbreaks.

Care home managers hold the risk assessment for their setting, staff and residents; and they will be making their decisions on this basis. Additional support from public health and adult social care teams is provided locally to advise on these risk assessments.

All the measures outlined below are consistent with standard infection control advice. These recommendations are for further consideration at GM level to incorporate into locality arrangements in order to promote consistency across the GM health and care system. Should national guidance change to increase testing in care homes and adult social care settings, then care homes will be able to adopt the national guidance backed by the assurance of sufficient national testing supplies.

Local public health teams will continue to support care homes, adult social care settings and other vulnerable settings and can advise regarding risk assessments, infection control, testing, vaccination, and the prevention and management of outbreaks. A stocktake is underway across GM for testing kit held in reserve and expiry dates to ensure all local areas have access to testing as needed. Initial responses are reassuring regarding ability to undertake the targeted testing described below as local areas are happy to share out the testing reserve stock fairly across GM as needed.

Infection control measures outlined in national guidance

In order to use the full suite of infection control protections that we have available to us at this time in the national guidance, we will need to reiterate the following:

1. Ensure all symptomatic staff (with any symptoms) report to the care home manager for a risk assessment.

2. Visitors should not enter the care home if they are feeling unwell, even if they have tested negative for COVID-19, are fully vaccinated and have received their booster.

3. Ensure all visitors are asked about symptoms before they access the care home and should be reminded to let the care home know if they develop symptoms in the 48hrs after their visit.

4. Ensure staff or visitors who tested positive for COVID-19 do not access the care home for 5 days after the positive test or until the cessation of all symptoms and evidence of a negative LFD test. Staff will need to show evidence of 2 consecutive negative lateral flow test results (taken at least 24 hours apart).

5. Any non-resident individual who develops symptoms should leave the care home as soon as possible.

6. Residents with symptoms that may be COVID-19 should be promptly isolated to protect other vulnerable residents. They should immediately take a lateral flow test as soon as they develop symptoms and if this first test is negative, they should take another lateral flow test 48 hours after the first test. In addition, flu and other viruses will need to be considered.

7. Universal masking for staff and visitors continues in adult social care settings and correct use of PPE.

8. Maximise uptake of COVID-19 and flu vaccines by staff and residents in care homes as quickly as possible so as not to lose time and to protect as long as possible this winter.

9. Maximise uptake of the children’s flu vaccination to protect staff working in vulnerable settings, as visitors to care homes, and to protect themselves and older people in the community

The above principles comply with the care home COVID-19 supplement last updated on Tuesday 11 October. COVID-19 supplement to the infection prevention and control resource for adult social care – GOV.UK (www.gov.uk)

Targeted Testing for Greater Manchester to supplement the national guidance:

1. National guidance states that: “Staff with respiratory symptoms who feel well enough to work and do not have a temperature, do not need to take a symptomatic test and can continue working”.

We are recommending that any staff member with symptoms that could be COVID-19 should take an LFD test. They can book a free NHS test as they work in adult social care; or the care home may be able to supply this.

Symptoms of COVID-19, flu and common respiratory infections include:

• continuous cough
• high temperature, fever or chills
• loss of, or change in, your normal sense of taste or smell
• shortness of breath
• unexplained tiredness, lack of energy
• muscle aches or pains that are not due to exercise
• not wanting to eat or not feeling hungry
• headache that is unusual or longer lasting than usual
• sore throat, stuffy or runny nose
• diarrhoea, feeling sick or being sick

2. National guidance states that “If the lateral flow test result is negative, they should take another lateral flow test 48 hours later, staying away from work during this time.”

We are recommending that any staff member with respiratory or gastrointestinal symptoms should stay at home even if their LFD test is negative until they are 48hrs clear from D&V and flu has been excluded.

The local public health team will be able to arrange flu testing alongside COVID-19 testing where there are residents with unresolving influenza like illness symptoms and / or staff members with respiratory symptoms; and this will improve the ability to prevent flu outbreaks.

In all cases, the care home manager should undertake a risk assessment before allowing symptomatic staff (or previously symptomatic staff) into the workplace. Based on their risk assessment, the care home manager will agree with staff their date of return to work.

3. We are recommending that any staff or visitor who is a household contact of a confirmed case of COVID-19 should take an LFD test before they come to work or enter the care home during the ten days after first household contact.

This is to take account of the incubation period before symptoms appear.

Household contacts are more likely to get infected due to the prolonged contact and environmental contamination at home. Care homes can use their LFD testing stock for staff with household contacts to test before they enter the care home each day, or they can contact their local PH team to supply stock from their reserve.

4. Care home managers and staff should be checking visitors are symptom-free and checking that they are not a household contact of a confirmed case of COVID-19 before they enter the care home.

Care homes have always had these risk assessments and they should continue to use them. Some care homes have continued to request testing of visitors. This is an individual care home manager’s discretion as part of their risk assessments for the care home, residents, staff and visitors.

5. The above recommendations can apply to all vulnerable care settings not just care homes and adult social care settings.

As some vulnerable settings do not have access to free testing, we recommend that local teams can use their reserve stock for such vulnerable settings like independent mental hospitals, homeless hostels and learning disability special schools.

Local public health teams will continue to support care homes, adult social care settings and other vulnerable settings and can advise regarding risk assessments, infection control, testing, vaccination, prevention and management of outbreaks.

Contact:

For more information please contact:

Sarah Turner, Health Protection Lead Nurse, sarah.l.turner@stockport.gov.uk, 0161 474 2441