Coronavirus (COVID-19) infection control for care providers

Updated: 3 February 2022

Managing infection control is essential to prevent the spread of coronavirus (COVID-19) for your setting or service. As care providers, you are likely to be providing essential care and support to people, which will often require close contact. This quick guide sets out best practice for care providers to remain safe and prevent COVID-19 from spreading.

Looking for training for your staff? See our free infection control e-learning.

What is coronavirus (COVID-19)?

COVID-19 is an infectious disease caused by a newly discovered coronavirus first identified in 2019. Whilst most people infected will experience mild to moderate respiratory illness and recover without needing specialist treatment, there are people at higher risk of developing a serious illness. This includes older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer. It also includes pregnant women and those who have not been vaccinated.

Although age and underlying health conditions are the greatest risk factors, the evidence suggests that other groups are also more likely to become seriously ill. This includes men, people from Black, Asian and minority ethnic (BAME) backgrounds, those living in more deprived areas, those born outside the UK or Ireland, and those living in a care home.

In recognition of the increased risk of serious illness for some individuals in the social care workforce, guidance has been issued to support employers to assess and reduce these risks.

The main symptoms are developing a new continuous cough and/or a high fever (above 37.8°C) and/or a loss/change in your normal sense of smell or taste. Other symptoms that may appear are aches, pains, nasal congestion, sore throat or diarrhoea. However, the dominant variants of the virus in circulation currently (known as the Delta and Omicron variants) appear to have a different set of symptoms, with headache, sore throat, runny nose and fever most commonly reported.

How does coronavirus (COVID-19) spread?

As COVID-19 is a new disease, we are still learning about the effects of the virus and how to best prevent its spread, as well as how best to respond as the virus mutates. Some recent mutations appear able to spread more easily and quickly and have been classed as variants of concern (VOCs).

We know that COVID-19 is mainly spread through two methods:

  • respiratory droplets released when someone sneezes, or coughs and sometimes exhales
  • touching surfaces contaminated with respiratory droplets that can then be transferred by touching your eyes, nose or mouth.

The virus has been found in stool samples of people confirmed as suffering from COVID-19. Whilst this is not thought to be the main transmission route, all secretions (excluding sweat) and excretions (such as diarrhoea) from those suffering or suspected to be suffering from COVID-19 should be managed as being possibly infectious.

How to help prevent the spread of coronavirus (COVID-19)

Many adults, including those living and working in care homes, have received both doses of the vaccine and a booster jab. However, as it is still possible to catch and spread COVID-19 even when fully vaccinated, it is recommended that everyone continues to follow the measures outlined in this guide.

General measures

COVID-19 will continue to be part of our lives for the foreseeable future, and it is important to understand where and when the risk of transmission and infection is higher. There are no legal restrictions in place, but everyone is advised to:

  • have the vaccines you are offered
  • let in fresh air when indoors; it is still safer to remain outdoors
  • consider wearing a face covering in public spaces
  • order a PCR test and stay at home if you experience any of the main symptoms of COVID-19
  • stay at home and avoid contact with others if you test positive
  • consider regular testing, even if you have no symptoms
  • try to stay at home if you are feeling unwell
  • wash your hands regularly, and cover coughs and sneezes.

Advice for all

In addition to the specific measures outline above, it continues to be sensible to:

  • always carry tissues and use them to catch a cough or sneeze, then bin the tissue, wash hands, or use a sanitiser gel
  • wash your hands more often than usual, for 20 seconds each time with soap and water or hand sanitiser, especially when you:
    • get home or into work
    • blow your nose, sneeze or cough
    • eat or handle food.
  • avoid touching your eyes, nose and mouth with unwashed hands
  • avoid close contact with people who are unwell.

Test and Trace

As part of the transition to living with COVID-19, routine contact tracing has ended and contacts of those with a positive result are no longer required to isolate or take daily tests. Access to free testing will end for most people on 1st April 2022. The NHS COVID-19 app can still be used by individuals.

PCR testing is available for anyone with coronavirus symptoms, and for care home residents. Guidance is available detailing the testing procedure that should be followed for residents and staff. All homecare workers can access lateral flow tests via their employers and should take a test before starting work each day. Personal assistants should also take a lateral flow test before starting work each day and can order tests themselves.

All information on testing relevant to adult social care settings, including a summary, has now been brought together. This includes testing for family and professionals visiting the care home.

What can care homes do to stop the spread of coronavirus (COVID-19)?

Preventing the spread of infection

More videos from HCI

The Government has issued guidance for adult social care, including care homes.

For people living and working in care settings, infections can be serious and, in some cases, life-threatening. They can also make existing medical conditions worse. Regular contact with staff, other residents, family and friends and the shared living space all mean infection can easily be passed around. It is therefore vital to take the steps that can help prevent COVID-19 occurring and spreading. So even though the legal restrictions have now been lifted, PPE and other infection control measures will still be needed in care homes.

Isolation and testing

New residents admitted from the community, or transferring from another care home or interim care facility, do not need to isolate but should take a PCR test no more than 72 hours prior to admission and again on the day of admission. A risk assessment should also be completed, taking into account:

  • whether the person is fully vaccinated, including a booster
  • guidance from the local Director for Public Health about the community transmission of variants of concern
  • their circumstances prior to admission, including whether they have been in contact with someone with symptoms of COVID-19 in the last 10 days
  • levels of transmission within the community and COVID-19 outbreak management from where they are admitted (if transferring from another care setting) are considered.

If the risk assessment indicates the person should isolate, this should be for 10 days.

More detail and specific advice for urgent admissions and those returning to the care home after a hospital stay can be found in the full guidance.

Residents identified as a close contact of someone with COVID-19 should isolate and take daily lateral flow tests. Anyone fully vaccinated can end their isolation if they have negative tests on days 4,5 and 6. Anyone not fully vaccinated can end their isolation if they have negative tests on days 6,7 and 8. If a resident is unable to test, they should isolate for 10 days, whether or not they have been vaccinated.

Regular testing is crucial to keeping residents and staff safe and guidance has been issued explaining the testing needed in a care home, including in an outbreak.

As testing and tracing is crucial to an effective COVID-19 response, care homes should keep a temporary record of current and previous residents, visitors and staff.

Care staff

If any staff member develops symptoms, they should stay at home and take a PCR test. Anyone with a positive PCR or lateral flow test result should not attend work until they have had two consecutive negative lateral flow tests. The first test should be taken no earlier than five days after their symptoms started (or the date of the positive test if they do not have any symptoms).

They may return to work on the day of the second negative test if they:

  • have no symptoms beyond a cough and loss of smell – these may last several weeks
  • have daily negative lateral flow tests for the rest of a 10-day period starting from when they first had symptoms (or tested positive)
  • take all relevant infection control precautions and wear PPE throughout each shift.

The lateral flow tests should be taken before their shift starts and as close as possible to the start time. If the test result on day 10 is positive, daily tests should continue and they should not return to work until the result is negative.

A risk assessment should be undertaken if the member of staff works with residents who are considered especially vulnerable to COVID-19, and redeployment for the remainder of the 10-day period should be considered.

Any member of staff considered to be a close contact of someone who tests positive will be asked to take a PCR test and daily lateral flow tests, and can continue to work as long as the results are negative.

Guidance has been issued to assist managers and staff in determining the right action to take in various circumstances.

Handwashing and hand hygiene

Frequent hand washing and good hand hygiene is an essential method to control infection in your setting. All people and staff should decontaminate their hands with alcohol-based rub when moving in and out of areas where care for suspected and confirmed cases of COVID-19 is being delivered.

Hand hygiene must be performed before every direct contact with a resident, and any contact that could result in your hands being contaminated such as touching care equipment, PPE or waste.

There are three important stages to cover when talking about suitable hand hygiene: when you need to do it, preparing to wash your hands and the best way to wash your hands.

  • When to wash your hands Open

    There are five important moments when you should clean your hands:

    • just before you provide care to a resident
    • as soon as you have finished providing care to a resident
    • straight after you have been exposed to any body fluids
    • straight after touching the person’s surroundings (e.g. chair, door handle) if this may have contaminated your hands
    • as soon as you take off protective gloves.
  • Preparing to wash your hands Open

    To prepare for hand hygiene, it is recommended that you:

    • expose your forearms so that they are bare from the elbows down
    • remove all hand and wrist jewellery, a single plain metal finger ring is permitted; however, it should be removed or must be moved during hand hygiene
    • ensure finger nails are clean, short and that artificial nails or nail products are not worn
    • cover all cuts or abrasions with a waterproof dressing.
  • Washing your hands Open

    When washing your hands, you should:

    • do so for 20 seconds, or the time it takes to sing ‘Happy Birthday’ twice
    • wet your hands with water and apply enough soap to cover your hands
    • use one hand to rub the back of the other and in between fingers – do the same with the other hand
    • rub hands together and clean between your fingers
    • rub fingers against the back of both your palms
    • rub your thumbs using the other hand – do the same with the other thumb
    • rub the tips of your fingers on the palm of the other hand – do the same with the other hand
    • rinse your hands with water
    • dry your hands with a disposable towel
    • use the disposable towel to turn the tap off.

Where running water and soap are not available, an alcohol-based hand sanitiser should be used instead. Hand sanitiser for staff should be close to where care is provided, or personal dispensers used. Hand sanitiser should be used for 20-30 seconds to decontaminate the hands.

Health and Care Innovations (HCI) have created a helpful video to guide you on this process.

Respiratory and cough hygiene – ‘Catch it, bin it, kill it’

To minimise transmission of COVID-19 through respiratory droplets, tissues and waste bins should be available to everyone. All staff, residents, users and visitors should:

  • use disposable tissues to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose
  • dispose of used tissues immediately in the nearest bin
  • clean hands after coughing, sneezing, using tissues, after any contact with respiratory droplets or objects contaminated with respiratory droplets
  • not touch their eyes, mouth and nose
  • help those people who may need help with containing their respiratory droplets such as the elderly
  • provide those who are immobile with a bag close by for immediate disposal of tissues
  • ensure in common areas, or during transportation, that people with symptoms wear a fluid-resistant surgical face mask to minimise dispersal of their respiratory droplets or contamination of surfaces
  • clean frequently touched surfaces.

Personal protective equipment (PPE) guidelines

The current guidance for care homes can be found at COVID-19: how to work safely in care homes. Guidance has also been issued for domiciliary care at COVID-19: how to work safely in domiciliary care. These pages include videos and diagrams about putting on and taking off PPE. PPE can be ordered via the PPE portal.

PPE is only effective when combined with: hand hygiene (cleaning your hands regularly and appropriately); respiratory hygiene and avoiding touching your face with your hands, and following standard infection prevention and control precautions.

PPE should be:

  • compliant with relevant BS/EN standards
  • located close to where it will be used
  • stored correctly to prevent contamination, and expiry dates adhered to.

When using PPE, you should:

  • ensure you have been trained in the proper use and on donning and doffing PPE – videos are available for aerosol generating procedures (AGPs) and non-AGPs
  • only use each PPE item once
  • change PPE between different care tasks for one person
  • change PPE between care tasks for different people
  • remove PPE immediately and dispose of used items correctly
  • practice hand hygiene and extend to exposed forearms after removing any element of PPE.

Disposable aprons and gloves are single use and must be disposed of when a procedure or task is finished, and after each person. Masks must be changed after providing direct personal care to a person with respiratory symptoms or who has had a positive COVID test in the last 14 days. If care is only provided to people who have tested negative and do not have any respiratory symptoms, masks can be worn for up to four hours as long as they don’t become damp or soiled. The PPE guidance recommends the specific type of mask to be worn in different situations.

Laundry and waste management

Do:

  • Wash items as appropriate in accordance with the manufacturer’s instructions.
  • Dispose of items that are heavily soiled with body fluids, such as vomit or diarrhoea, or items that cannot be washed, with the owner’s consent.
  • Store personal waste (such as used tissues, incontinence pads and other items soiled with bodily fluids) and disposable cleaning cloths securely within disposable rubbish bags. Place these bags into another bag, tying securely and keep separate from other waste within the room. This should be put aside for at least 72 hours before being disposed of as normal.

Do not:

  • Place dirty laundry on the floor or other surfaces to prevent contamination.
  • Shake dirty laundry before washing to minimise the possibility of dispersing virus through the air.

Note: According to Government guidance, you don't need to separate dirty laundry that has been in contact with an ill person from other people’s items.

Staff uniforms and clothing should be protected from contamination by PPE. For staff taking uniform home for laundering, use a plastic bag.

Ventilation

Natural ventilation can be an effective environmental measure to reduce the risk of spread of infections. Therefore, where safe and appropriate, the opening of windows and doors should be considered.

More information can be found on the World Health Organization (WHO) website and in the guidance issued by the government.

Best practice management of people at high risk or with symptoms of COVID-19

Use the drop-downs below for specific advice.

  • People living in care homes Open

    Some people living in care homes may be at risk of serious illness should they catch coronavirus. It is vital that both care staff and residents continue to follow the main advice from the Government outlined at the start of this quick guide.

    Revised guidancehas been issued to help protect people whose immune system means they are at higher risk of becoming seriously ill.

    Care home residents may not present with the typical (cough/fever) symptoms of this virus and may not be able to report a loss of taste or smell. They should therefore be assessed twice daily for:

    • onset of high temperature (37.8 degrees or above)
    • new persistent cough.

    Softer signs of ill-health should also be assessed, including:

    • shortness of breath
    • less alert
    • new onset of confusion
    • being off food and/or reduced fluid intake
    • diarrhoea or vomiting.

    Anyone who develops symptoms should be isolated in a single room, using a separate bathroom if possible. A test should be arranged, and full infection-control measures put in place. If this is a new outbreak and/or it has been 28 days since the last case of coronavirus, the local Health Protection Team should be informed.

    Any resident who tests positive for COVID-19 should isolate for up to 10 days. Their period of isolation can end earlier if they:

    • Receive two consecutive negative lateral flow tests, with the first test taken no earlier than day 5
    • Have clinically improved, with some respiratory recovery
    • Have no fever for 48 hours without the use of medication
    • Have no underlying severe immunosuppression

    Managers can use the care home portal to arrange tests for staff and residents.

    Movement of staff within the care home should be restricted as far as possible. Guidance also recommends avoiding movement between care settings except where it is necessary to meet needs and maintain safety.

    Managers should encourage and support staff and residents to receive a flu vaccination and make sure residents are up to date with their pneumococcal and shingles vaccines.

  • People supported by home care services, including those living in extra care housing Open

    Many people receiving care and support from home care services will be at risk of serious illness should they catch coronavirus. It is vital that both care staff and people using the service continue to follow the main advice from the Government outlined at the start of this quick guide, as well as the guidance specifically for home care services. Guidance has also been issued for supported living providers. Providers should also reduce contact between members of staff where possible, and minimise the number of different people going into the homes of those considered at higher risk.

    Although all legal restrictions have ended, people may still feel very anxious about the risks they face and need support to continue to keep themselves as safe as possible.

    Care workers should follow the guidance on use of PPE, including how to safely put it on and take it off. If a care worker develops symptoms of COVID-19, they should stay at home and take a test. Asymptomatic COVID-19 testing is available to all homecare workers in England via their employers.

    If a person develops symptoms, they should be supported to contact NHS 111 by telephone or online. Care workers should also inform their manager.

    Managers should strongly encourage staff to take up the booster vaccine.

  • People who receive direct payments Open

    Guidance has been issued for people receiving direct payments and personal assistants.

    Direct payments should continue as before, and local authorities and CCGs should provide support to ensure people stay safe.

    Everyone with symptoms, including personal assistants (PAs), is eligible for testing. Tests can be delivered to the person’s own home. Specific guidance has been issued that invites PAs to register for coronavirus testing where they are self-isolating due to experiencing coronavirus-like symptoms or because a member of their household has symptoms. Twice weekly COVID-19 testing is also now available to all personal assistants via NHS Test and Trace.

    View/download: COVID-19 testing for personal assistants flyer (NHS Test and Trace, 2021).

    It is essential that the correct PPE is used by PAs. Local authorities and CCGs will help source PPE if it proves difficult to get hold of.

Visitors

All care homes should enable and support visiting within the context of robust infection prevention and control measures.

Care home providers should have a visiting policy in place, informed by a dynamic risk assessment that considers:

  • the needs of residents and visitors
  • the right to receive visits and the impact on wellbeing
  • how mixing can be minimised, including on arrival/departure
  • infection prevention precautions during visits
  • legal duties relevant to visits.

End of life visits should always be supported.

Essential care givers should follow the same testing, PPE and infection control measures as care home staff.

Visitors who have been identified as a close contact of someone with COVID-19 are advised not to visit the care home for 10 days. If a visit is necessary, the visitor should have received a negative lateral flow test on the day of the visit. Visitors should also stay away from the care home if they are feeling unwell, even if they have tested negative for COVID-19.

Any professional visiting the care home is required to show a negative PCR test within 72 hours of their visit or a negative lateral flow test from the day of the visit.

All residents can choose an essential caregiver, to provide companionship and additional care and support. Essential care givers can continue to visit during an outbreak and periods of isolation. Essential care givers should follow the same PPE and infection control measures as care home staff.

Everyone should arrange their visit in advance to enable safe visiting practices to be maintained. Visitors should be supported to ensure appropriate PPE is worn, good hand hygiene followed, and a face mask worn within the care home. A negative lateral flow test from that day is required for each visit.

It is strongly recommended that all visitors and residents take the opportunity to be vaccinated.

In the event of an outbreak, visits can continue as usual for essential caregivers and in exceptional circumstances such as end of life. Indoor visiting in all other circumstances should stop but visits in well-ventilated spaces with substantial screens, visiting pods or from behind windows can continue. The local health protection team will inform the care home how long these restrictions need to remain in place.

Visitors who have been identified as a close contact of someone with COVID-19 are advised not to visit the care home for 10 days. If a visit is necessary, the visitor should have received a negative lateral flow test on the day of the visit. Visitors should also stay away from the care home if they are feeling unwell, even if they have tested negative for COVID-19.

Any professional visiting the care home is required to show a negative PCR test within 72 hours of their visit or a negative lateral flow test from the day of the visit.

Detailed guidance, including guidance on rapid lateral flow testing in adult care settings is available, as well as a summary of the guidance for visitors and a one-page overview of visiting arrangements. A video is also available for anyone preparing to visit a care home.

Visits out of care homes

People living in care homes should normally be able to make visits out of the care home without needing to isolate on their return. A risk assessment should be completed ahead of the visit and take into account:

  • the number of people involved and whether they are ‘usual contacts’
  • whether their vaccination status is known
  • whether they have had a recent negative lateral flow test
  • the type of setting (e.g. indoors or in the open air)

A risk assessment should also be carried out for any member of staff accompanying the resident.

Those involved in the visit should have a negative test, and follow infection control measures including ventilation, limiting close contact, following good hand hygiene and wearing face coverings. Transport arrangements should be carefully considered.

All residents should isolate for 10 days following:

  • an emergency stay in hospital
  • a visit assessed to be high risk

Visits out of the care home can still be undertaken during this period of isolation if:

  • a risk assessment shows they can avoid all other residents
  • the visit us not to a social care setting
  • consideration is given to whether anyone involved in the visit is vulnerable

This period of isolation may be able to end early if:

  • residents who are vaccinated have a negative lateral flow test on days 4,5 and 6 following their return to the care home (day 0)
  • residents who are unvaccinated have a negative lateral flow test on days 6,7 and 8

Guidance providing more detail has been issued.

Read more about infection control and COVID-19

Support from SCIE

SCIE's COVID-19 hub contains more relevant information including safeguarding, Mental Capacity Act and infection control. It can be used when working and supporting people who are isolated or vulnerable through COVID-19, and can also be shared with community groups.