Updated COVID-19 Guidance from Cromwell Medical

Managing healthcare staff with symptoms of a respiratory infection or a positive COVID-19 test result (Published 1 April 2022)

The Govt has provided an update which all clinical staff placed in health care settings working in England need to be aware of. This affects the staff working for Cromwell Medical only.

What has changed

This new guidance applies to patient-facing healthcare staff in the NHS and NHS commissioned services who have symptoms of a respiratory infection including coronavirus (COVID-19), or a positive test result for COVID-19.

Patient-facing healthcare staff who have symptoms of a respiratory infection, and who have a high temperature or do not feel well enough to attend work, are required to take a lateral flow device (LFD) test as soon as they feel unwell. They are no longer required to take a PCR test.

Staff who are close contacts of a case of COVID-19 are also no longer required to take a PCR test.

Who this guidance is for

This guidance is for staff and managers in the NHS and NHS commissioned services.

It provides advice on the management of patient-facing healthcare staff who have symptoms of a respiratory infection including COVID-19, or a positive test result for COVID-19.

It also includes advice on staff who are close contacts of a confirmed case of COVID-19.

Routine asymptomatic testing

Patient-facing healthcare staff should continue to test twice a week for COVID-19 using LFD tests. Test results should be reported on the GOV.UK portal.

If they receive a positive LFD test result, they should follow the advice in the section for staff members who receive a positive LFD test result for COVID-19.

Staff members with symptoms of a respiratory infection including COVID-19

Anyone who has symptoms of a respiratory infection and has a high temperature or does not feel well enough to go to work, is advised to stay at home and avoid contact with other people.

They should follow the guidance for people with symptoms of a respiratory infection including COVID-19.

Patient-facing healthcare staff who have symptoms of a respiratory infection, and who have a high temperature or do not feel well enough to attend work, should take an LFD test as soon as they feel unwell.

If the result of this LFD test is positive, staff should follow the advice in the section for staff members who receive a positive LFD test result for COVID-19.

If the LFD test result is negative, they can attend work if they are clinically well enough to do so and they do not have a high temperature.

If the staff member works with patients whose immune system means that they are at higher risk of serious illness despite vaccination, they should discuss this with their line manager who should undertake a risk assessment.

If they are still displaying respiratory symptoms when they return to work, they should also speak to their line manager who should undertake a risk assessment – For nurses, midwives or HCAs for Cromwell Medical this should be with Miriam Palk Head of Nursing.

All patient-facing healthcare staff should resume routine asymptomatic LFD testing when they return to work, taking the first of these tests 48 hours after the LFD test that was taken when they developed symptoms.

On returning to work, the staff member must continue to comply rigorously with all relevant infection control precautions and personal protective equipment (PPE) must be worn properly throughout the day.

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

Staff members who receive a positive LFD test result for COVID-19

All healthcare staff who have received a positive COVID-19 test result, regardless of whether they have symptoms, are advised not to attend work for 5 days. They should follow guidance for people with a positive COVID-19 test result.

Patient-facing healthcare staff can return to work when they have had 2 consecutive negative LFD test results (taken at least 24 hours apart).

The first LFD test should only be taken 5 days after the day their symptoms started (or the day their first positive test was taken if they did not have symptoms); this is described as day 0.

If both LFD tests results are negative, they may return to work immediately after the second negative LFD test result, provided they meet the criteria below:

the staff member feels well enough to work, and they do not have a high temperature.
if the staff member works with patients whose immune system means that they are at higher risk of serious illness despite vaccination, a risk assessment should be undertaken, and consideration should be given to redeployment until 10 days after their symptoms started (or the day their first positive test was taken if they did not have symptoms)
the staff member must continue to comply rigorously with all relevant infection control precautions and personal protective equipment (PPE) must be worn properly throughout the day
The staff member should resume twice-weekly asymptomatic LFD testing when returning to work.
If the day 5 LFD test is positive, they should continue to test daily until they have received two negative LFD test results, taken 24 hrs apart. If the staff member’s LFD test result is positive on the 10th day, they should discuss this with their line manager who may undertake a risk assessment.
If a staff member is tested with an LFD test within 90 days of a prior positive COVID-19 test and the result is positive, they should follow the advice for staff members who have received a positive test result for COVID-19 again, unless a clinical or risk assessment suggests that a re-infection is unlikely.

Guidance on reinfection and performing clinical risk assessment is detailed in the Investigation and management of suspected SARS-CoV-2 reinfections: a guide for clinicians and infection specialists.

Staff members who are contacts of a confirmed case of COVID-19.

People who live in the same household as someone with COVID-19 are at the highest risk of becoming infected because they are most likely to have prolonged close contact. People who stayed overnight in the household of someone with COVID-19 are also at high risk.

Patient-facing healthcare staff who are identified as a close contact should continue with twice-weekly asymptomatic LFD testing.

If you are a household or overnight contact of someone who has had a positive COVID-19 test result it can take up to 10 days for your infection to develop. It is possible to pass on COVID-19 to others, even if you have no symptoms.

Staff who are identified as a household or overnight contact of someone who has had a positive COVID-19 test result should discuss ways to minimise risk of onwards transmission with their line manager.

This may include considering:

redeployment to lower risk areas for patient-facing healthcare staff, especially if the member of staff works with patients whose immune system means that they are at higher risk of serious illness despite vaccination
working from home for non patient-facing healthcare staff
limiting close contact with other people especially in crowded, enclosed or poorly ventilated spaces
Whilst they are attending work, staff must continue to comply rigorously with all relevant infection control precautions.

If staff develop any symptoms during these 10 days, they should follow the advice for staff with symptoms of a respiratory infection, including COVID-19.

Ms Miriam Palk (NMC - 83H1895E)

Head of Nursing ICG Medical Ltd

04.04.2022