5.12 - Duration of transmission based precautions for COVID-19

5.12.1 Non COVID-19 discharges from hospital to care homes 

5.12.2 Management of contacts of COVID-19

5.12.3 HCWs isolation and exemption requirements

 

It is important to note that service users with COVID-19 deemed clinically fit for discharge can and should be discharged before resolution of symptoms.

The tables below set out number of isolation days required, the clinical requirements for discontinuing TBPs and any testing required.

Table 5: Duration of precautions for hospital inpatients remaining in hospital and residents in residential care areas

Hospital Inpatients and residents in residential settings

Number of isolation days required

COVID-19 Clinical requirement for stepdown

Testing required for stepdown

General

(including critical care patients)

10 days from symptom onset (or first positive test if symptom onset undetermined).

Ceasing isolation before 10 days is possible pending clinical and testing criteria laid out in ‘testing required for stepdown’ column.

Clinical improvement with at least some respiratory recovery. Absence of fever (>37.8oC) for 48 hours without use of antipyretics.

Not routinely required for inpatients isolating for 10 days. 

Testing may be used to cease TBPs sooner where clinical criteria is met and where 2 negative tests are achieved 24 hours apart. If either tests are positive, isolation must continue to 10 days *1.

Testing is not required beyond 10 days to cease TBPs provided clinical criteria met.

Residents in residential settings

10 days from symptom onset (or first positive test if symptom onset undetermined)

Clinical improvement with at least some respiratory recovery.  Absence of fever (>37.8oC) for 48 hours without use of antipyretics.

Not routinely required

Individuals severely Immunocompromised as determined by Chapter 14a of the Green Book

14 days from symptom onset (or first positive test if symptom onset undetermined)

Clinical improvement with at least some respiratory recovery. Absence of fever (>37.8oC) for 48 hours without use of antipyretics.

Individual risk assessment by clinical teams taking account of symptoms, clinical presentation, intended setting for stepdown.

Local clinical teams may consider testing as part of the stepdown process and where undertaken, 1 negative test would be acceptable for stepdown.

*1 The residual risk of infection after a negative test on day 6 and 7 is similar to stepping down isolation precautions without testing at day 10. Starting testing earlier than day 6 slightly increases this risk, however organisations may wish to balance this risk against other potential harms to patients.

Table 6: Stepdown requirements for inpatients being discharged from hospital

Discharging service users

Number of isolation days required

Does isolation need to be completed in hospital?

COVID-19 Clinical requirement for stepdown

Testing required for stepdown

Patient discharging to a residential setting

10 days from symptom onset (or first positive test if symptom onset undetermined).

If they have completed the 10 day isolation in hospital, no further isolation should be required on return/admission to the care home.

No. If a COVID-19 recovered patient is discharged to a care home before 10 day isolation has ended then 2 negative PCR tests are required before discharge at least 24 hr apart.

If not completed 10 days isolation in hospital, they can do so in care home and do not require to start new isolation period on admission, nor require further testing.

Clinical improvement with at least some respiratory recovery. Absence of fever for 48 hours without use of antipyretics

If a COVID-19 recovered patient discharged to care home before 10 day isolation has ended then 1 negative PCR test is required preferably within 48 hours prior to discharge.

If not completed 10 days isolation in hospital, they can do so in care home and do not require to start new isolation period on admission, nor require further testing.

See PHS COVID-19: information and guidance for care home settings for discharge testing details if the COVID-19 recovered patient has completed their 10 day isolation period in hospital

Patients being discharged to their own home - General

10 days from symptom onset (or first positive test if symptom onset undetermined).

Ceasing isolation before 10 days is possible pending clinical and testing criteria laid out in ‘testing required for stepdown’ column.

May revert to community stay at home guidance once discharged if isolation period has not been completed as an inpatient.

Must be given clear advice for what to do if their symptoms worsen.

Clinical improvement with at least some respiratory recovery. Absence of fever for 48 hours without use of antipyretics.

Not routinely required for inpatients isolating for 10 days.

Testing may be used to cease TBPs sooner where clinical criteria is met and where 2 negative tests are achieved 24 hours apart. *1

If either tests are positive, isolation must continue to 10 days.  Testing is not required beyond 10 days to cease TBPs provided clinical criteria met.

Patients being discharged to their own home – someone in household is severely immunocompromised or at risk of severe illness
Chapter 14a of the Green Book

10 days from symptom onset (or first positive test if symptom onset undetermined)

Wherever possible, patient should be discharged to a different household from anyone immunocompromised or at severe risk of infection. If not possible – see ‘testing required for stepdown’ column.

Clinical improvement with at least some respiratory recovery. Absence of fever for 48 hours without use of antipyretics.

Testing for clearance is encouraged

*1 The residual risk of infection after a negative test on day 6 and 7 is similar to stepping down isolation precautions without testing at day 10. Starting testing earlier than day 6 slightly increases this risk, however organisations may wish to balance this risk against other potential harms to patients.

5.12.1 Non COVID-19 discharges from hospital to care homes 

All non-COVID-19 residents being discharged from hospital who are on the non-respiratory pathway at point of discharge do not require to complete a period of self isolation on return to the care home provided:

A single negative result should be available preferably within 48 hours prior to discharge from hospital. The exception is where a resident is considered to suffer detrimental clinical consequence or distress if they were not able to be discharged to a care home. In these cases, the resident may be discharged to the care home prior to the test result being available and transmission based precautions applied on return to the care home until a negative test result is achieved.

If a resident is admitted to hospital for a single overnight inpatient stay, they do not require to complete a period of self isolation on return to the care home provided they answer no to all of the respiratory screening questions prior to transfer.

For further guidance on admission of COVID-19 recovered and non-COVID-19 residents from hospital or from community to a care home please refer to PHS COVID-19: Information and Guidance for Care Home Settings (for older adults)

5.12.2  Management of contacts of COVID-19

The Test and Protect contact tracing programme in the community has now ceased and there is no requirement to undertake contact tracing in health and care settings with the exception of acute inpatient settings where contact tracing should continue. An individual who has had exposure to a case of COVID-19 may go on to develop COVID-19 with or without symptoms and this presents a risk of transmission to other users of health and care facilities.  Measures should be taken in secondary care settings as described below to reduce transmission risk associated with COVID-19 contacts.

 

Secondary care settings

Contact tracing should be performed for patients identified as COVID-19 on the non-respiratory pathway.  Inpatients who have been identified as a contact of a confirmed case of COVID-19 during their hospital inpatient stay must be isolated or cohorted for 10 days from the date of exposure.

Replacing Transmission based precautions with daily testingWhere these are available, Laboratory PCR or optionally rapid diagnostic tests (including POCT) or LFD can be used to prevent the need to apply transmission based precautions for contacts.For adult contacts who are asymptomatic of respiratory viral symptoms, and for all asymptomatic children and young persons aged 0 to 18 years and 4 months, a daily Laboratory based PCR or optionally Rapid Diagnostic Test (including POCT) or LFD test should be performed for 10 days following the date of exposure.  Application of transmission based precautions (TBPs) are only required should COVID-19 tests be positive at any point and a follow up COVID-19 laboratory based PCR undertaken. Whilst COVID-19 tests remain negative, application of SICPs is sufficient and there is no need to isolate the contact.Any patient who has been COVID-19 positive (confirmed by laboratory based PCR or Rapid Diagnostic Testing (including POCT) or LFD test) in the last 28 days does not need to be considered a contact should there be a subsequent exposure during that 28 period. Daily testing of these patients is therefore not required during this time period.

 

Primary Care and Community Health and Social Care settings

Management of contacts of COVID-19

Contact tracing in the community has now ceased and therefore patients are less likely to know when they have been a contact of a case of COVID-19. Primary care services need only undertake respiratory screening questions detailed in section 5.7 and base Infection Prevention and Control Precautions on the presence or absence of respiratory symptoms and any notification of the patient having confirmed COVID-19.  

 

Care home settings

Contact tracing will not be routinely undertaken in care homes. Asymptomatic residents who are known to have been in contact with a COVID-19 case do not require to self-isolate or be tested. All residents in a care home with a case should be carefully monitored for any symptoms of COVID-19.  See PHS information and guidance for care homes for further information.

 

5.12.3 HCWs isolation and exemption requirements

HCWs who have symptoms of a respiratory infection, a high temperature or do not feel well enough to attend work, are advised to take an LFD test, as soon as they feel unwell and report the results to their line manager.

HCWs who test positive for COVID-19 must not report to work and must follow advice in line with ‘Managing Health and Social care Staff with Symptoms of a respiratory infection, or a positive COVID-19 test, as part of the test and protect transition plan’ DL (2022) 12.

If an LFD was undertaken whilst in the workplace and returns a positive test, the HCW must don a Type IIR FRSM (unless exempt), inform their line manager and go home immediately.

Health and care staff who have been exposed to a case of COVID-19 in their household should follow advice laid out in the ‘Managing Health and Social care Staff with Symptoms of a respiratory infection, or a positive COVID-19 test, as part of the test and protect transition plan’ DL (2022) 12.