Coronavirus (COVID-19) infection control for care providers

Updated: 06 September 2021

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.

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 most common 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 variant of the virus in circulation currently (known as the Delta variant) appears 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)

The vaccination programme is progressing well. Many people living and working in care homes, as well as adults in the priority groups, have now received both their vaccines. However, as the vaccine is not 100 per cent effective and it isn’t yet known how much it stops COVID-19 from spreading nor how long it will protect people for, it remains vital that everyone continues to follow the measures outlined in this guide.

As a result of progress with the vaccines, from 16 August people who have received both their vaccines at least two weeks ago and those aged under 18 years and six months are no longer required to self-isolate if they are a close contact of someone who tests positive. They will instead be given advice on testing and guidance on preventing spread of COVID-19.

General measures

England moved to step 4 of the roadmap on 19 July 2021 and most legal restrictions were lifted. However, as COVID cases are at a high level and will rise further, everyone should be careful and cautious, and are advised to:

  • continue to wear a face covering in crowded places, including on public transport
  • stay outside where possible, and let fresh air in when indoors
  • continue to minimise the number of people you have close contact with
  • continue to wash your hands or use hand sanitiser regularly
  • consider continuing to work from home.

Advice for all

Public Health England (PHE) has advised the public 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

The NHS Test and Trace service aims to provide access to quick testing and to trace contacts of those with a positive result to let them know that they must self-isolate or to advise on testing and minimising spread of the virus for those no longer required to isolate. The NHS COVID-19 app can help with contact tracing.

PCR testing is available for anyone with coronavirus symptoms, and for asymptomatic health and care staff, and care home residents. It is also available for those who are considered a close contact of someone who has tested positive but who are no longer required to self-isolate. Guidance is available detailing the testing procedure that should be followed for residents, staff and professionals visiting care homes. All homecare workers can also access weekly PCR testing via their employers. Twice-weekly lateral-flow testing is available for personal assistants.

Many local testing sites are now offering asymptomatic testing for all members of the public, and the option of twice-weekly lateral flow testing at home is available for everyone.

All information on testing relevant to adult social care settings, including a summary, has now been brought together.

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 most 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 no longer need to isolate as long as:

  • they have been fully vaccinated for at least two weeks, wherever possible
  • guidance from the local Director for Public Health about the community transmission of variants of concern is followed
  • they have had no known contact with anyone who currently has COVID-19
  • the care home has considered the circumstances in the person’s home prior to admission
  • The person follows an enhanced testing regime:
    • PCR test less than 72 hours before admission
    • PCR test on the day of admission (day 0)
    • PCR test on day seven following admission
    • Daily rapid lateral flow testing is also recommended until the day 7 PCR result is known

Any resident being discharged from hospital following an overnight stay for planned surgery also no longer needs to isolate as long as:

  • they are fully vaccinated, wherever possible
  • guidance from the local Director for Public Health about community transmission of variants of concern is followed
  • they have had no known contact with anyone who currently has COVID-19
  • they receive a negative PCR test once back at the care home.

Any resident admitted to hospital for emergency care should be tested for COVID-19 prior to discharge. They should isolate for a period of 14 days even if the result is negative. Anyone who is still infectious with COVID-19 should be discharged to a designated setting to complete their isolation period prior to returning to the care home.

Fully vaccinated residents no longer need to isolate if they have been in contact with someone who has tested positive as long as:

  • they receive a negative PCR test
  • they take a daily lateral flow test for up to 10 days
  • they avoid contact with highly vulnerable residents
  • all outbreak measures are followed.

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.

Isolation for care staff

If any staff member develops symptoms, they should isolate and take a PCR test. If the result is positive they must isolate for 10 days from the first day of symptoms.

From 16 August, any member of staff considered to be a close contact of someone who tests positive is no longer required to self-isolate as long as they have been fully vaccinated. They will instead be asked to take a PCR test and daily lateral flow tests and can continue to work as long as the results are negative.

Anyone who has not had both vaccines and who has either a symptomatic member of their household or is contacted by NHS Test and Trace should still isolate for 10 days and be tested if they develop symptoms.

Guidance (see section 7.2) has been issued to assist managers and staff determine 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 guidance has been issued to help protect people considered to be clinically extremely vulnerable.

    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 is not fully vaccinated who is exposed to a person with possible or confirmed COVID-19 should be isolated (or grouped with others in the same position if isolation is not possible) until 14 days after their last exposure. If they develop symptoms, they should be tested.

    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.

    Managers should encourage and support staff and residents to receive a flu vaccination.

  • 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.

    Revised guidance has been issued to help protect people considered to be clinically extremely vulnerable. Although most 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 must 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 must self-isolate and take a test. Weekly COVID-19 testing is also now available to all homecare workers in England via their employers.

    Providers should assume that anyone newly receiving support from their service may have COVID-19 for the first 10 days and care workers should use PPE as advised for caring for someone with the virus. If a person being supported by the service is discharged from hospital and the result of their COVID-19 test is not known, assume that the test may be positive for 10 days (or until the result is received) and use PPE as advised.

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

  • 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 as long as it is safe to do so.

Care home providers should have a visiting policy in place, informed by a dynamic risk assessment that considers how visits can best be safely managed and delivered. Advice and support to enable visits to happen safely, taking into account local infection rates and the context for individual care homes, should be provided by the local Director for Public Health and Director of Adult Social Services. Individual risk assessments should also be completed, to assess the rights, needs and vulnerabilities of individual residents.

Care home residents can receive indoor visits from named visitors, taking into account the visiting arrangements for that care home and any guidance from the local Director of Public Health. The visitors will need to show proof of a negative COVID-19 test before every visit and will need to wear appropriate PPE and follow all other infection control measures as advised by the care home. Visitors and residents may wish to hold hands, but it is advisable to keep all physical contact to a minimum. The visitors should minimise any contact with staff and other residents, and keep as much distance as possible.

Someone under the age of 18 can be a named visitor. Children visiting will need to use PPE (where appropriate) and minimise physical contact, as well as keeping their distance from staff and other residents.

All residents can nominate an essential caregiver, who can visit more frequently to provide a higher level of personal care or support. Essential care givers should follow the same testing, PPE and infection control measures as care home staff.

Visits from other friends and family members can continue using the following arrangements:

  • Outdoor visits
  • Substantial screens
  • Visiting pods
  • Behind windows

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

In the event of an outbreak, all visits must stop, except in exceptional circumstances such as of end of life and for essential caregivers, who can continue to visit unless they or the resident test positive. Window and pod visits do not necessarily need to stop. Once the outbreak is over, visits can restart 14 days after the last positive case, assuming everyone in the care home tests negative and no variants of concern are identified.

Although fully vaccinated people are no longer required to isolate if they have been in close contact with someone who has tested positive for COVID-19, the vulnerability of care home residents means that:

  • Anyone identified as a close contact should avoid visiting care homes. If a visit is necessary, the person should have a negative PCR test and a negative lateral flow test from the day of the visit. This includes essential caregivers.
  • Residents considered to be a close contact should avoid receiving visits from anyone who is clinically extremely vulnerable.

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 can now make visits out of the care home without needing to isolate on their return, except for:

  • unplanned overnight stays in hospital
  • visits assessed to be high risk.

In these circumstances, residents should isolate for 14 days on their return to the care home. Residents who have a planned hospital stay do not need to isolate when they return as long as they:

  • are fully vaccinated
  • isolate until a negative PCR test is received
  • complete daily lateral flow tests for 10 days
  • avoid contact with other very vulnerable residents.

The advice is also to maintain social distance, avoid crowded places and avoid using public transport where possible. Those involved in the visit should have a negative test, and follow infection control measures including limiting close contact, following good hand hygiene and wearing face coverings.

If there are high/rapidly rising levels of infection locally, or variants considered to be of concern, care home managers should seek advice from the Director of Public Health. If there is an outbreak, all movement out of the care home should be minimised as far as possible.

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.