Coronavirus (COVID-19) infection control for care providers

Updated: 21 May 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. 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. Approximately 1 in 3 people have no symptoms so will be unaware they are infectious.

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, it remains vital that everyone continues to follow the measures outlined in this guide and to adhere to the guidance on social distancing and wearing face coverings.

General measures

Although the number of coronavirus cases has fallen to a lower level and restrictions continue to ease, there is ongoing spread of COVID-19 and new Variants of Concern continue to be identified. It remains vital to take the following steps to help contain the spread of the virus:

  • regular hand washing for 20 seconds or more
  • covering your face in enclosed spaces
  • keeping a distance of two metres (or one metre plus other precautions) from people outside your group of up to six (or two households) indoors, or up to 30 outdoors.

If any one person in a household develops symptoms of coronavirus, everyone in that household should self-isolate.

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. 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. 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.

Isolation and testing

Current guidance says that all residents being discharged from hospital or another setting, or admitted from the community, should be isolated in their own room for 14 days. If people are part way through an isolation period when they move, they should remain isolated until the 14-day period is complete.

Any resident admitted to hospital 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.

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.

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.

Masks can be worn for up to four hours as long as care is only provided to people who have tested negative for COVID-19 and do not have any respiratory symptoms (for example coughing or sneezing). It should also be changed if it becomes damp or soiled.

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, including social distancing measures.

    Revised guidance has been issued to help protect people considered to be clinically extremely vulnerable. The advice to shield has ended, but people are still advised to maintain distancing, work from home, and keep their number of contacts down.

    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 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.

    Anyone discharged from hospital or from another care setting, and all new residents should be isolated for 14 days in their own room. Anyone who is discharged from hospital whilst still infectious should complete their period of isolation in a designated setting before returning to the care home.

    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. If any staff member develops symptoms, they should isolate for 10 days and be tested. Any member of staff with a symptomatic member of their household should isolate for 10 days. Staff must also not work if they are told to isolate by NHS Test and Trace.

    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. The advice to shield has ended, but people are still advised to maintain distancing, work from home, and keep the number of contacts down.

    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 14 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 14 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

From 17 May, care home residents can receive indoor visits from up to five named visitors (two at any one time/on any one day). The visitors will need to have a negative rapid lateral flow 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 there should not be close physical contact such as hugging. The visitors must observe social distancing from other residents, visitors and staff.

Someone under the age of 18 can be one of the named visitors. Children visiting will need to follow social distancing measures, use PPE (where appropriate) and minimise physical contact. They will count towards the maximum number allowed for the visit, unless they are under the age of 2.

If a greater degree of personal care or support from a loved one is considered critical to the person’s health and wellbeing, an essential care giver can be supported to provide that care. Essential care givers are included in the total of five named visitors, but are exempt from the two at any one time/on any one day limit.

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 care givers. 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.

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.

Detailed guidance for care homes 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, as long as:

  • The visits are entirely outdoors, except for using the toilet
  • Residents are accompanied by care home staff, one or both of their nominated visitors, or their essential care provider
  • The visits do not include the use of public transport
  • Arrangements are discussed in advance

People can also now attend medical appointments, visit day centres, attend educational settings and go to work without needing to isolate on their return.

For any visits out of the care home not meeting these criteria, the resident will need to isolate for 14 days on their return.

In addition, for all visits out of the care home:

  • Follow the national guidance on the number of people who can gather together and where
  • Everyone who is part of the visit should have a negative COVID test and be free from COVID symptoms
  • Everyone involved should maintain distancing, wash their hands regularly, ensure there is plenty of fresh air, and consider wearing a face covering
  • Risks should be minimised ahead of the visit, including agreeing a plan covering the arrangements and how risks identified will be mitigated

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 in the care home, all outward visiting must stop.

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.