Guidance

COVID-19 care home testing guidance for regular and outbreak testing of staff and residents

Updated 1 April 2022

This guidance was withdrawn on 4 April 2022

Information on testing for staff and residents in care homes is available at COVID-19 testing in adult social care guidance.

Information for professionals visiting care homes is available at Infection prevention and control in adult social care: COVID-19 supplement.

Applies to England

• Publication for Northern Ireland
• Publication for Scotland
• Publication for Wales

Changes in this publication

Updated to reflect that there is no longer a legal requirement for people with coronavirus (COVID-19) infection to self-isolate, however the public health advice for people with any of the main symptoms of COVID-19 or a positive test result is to stay at home and avoid contact with other people. Due to the higher risk nature of health and social care settings, the advice for staff member working in these settings has not changed.

Introduction

This guidance is for care home managers and providers to set out the current policy for regular asymptomatic and outbreak testing in care homes. Based on the latest clinical advice, the aim of this policy is to enable positive cases to be identified quickly, enabling action to stop the spread. We will keep this guidance under review as the situation changes.

Providing testing within all adult care homes will help you protect your residents and staff and is an important part of the national effort to tackle COVID-19. This testing policy applies to everyone regardless of vaccination status. Thank you for everything you are doing to help the country beat the virus at this hugely challenging time.

Testing guidance for staff and residents

Regular testing for staff

You should test all asymptomatic staff daily using a rapid lateral flow test (LFT) before their shift begins on the days they are working.

Regular testing for residents

You should test all asymptomatic residents monthly using a PCR test kit. Further testing may be required for visits in and out of the care home or if a resident is exposed to COVID-19 or is a new admission.

Regular testing pattern – overview

Asymptomatic regular testing for staff and residents. Staff should test every day that they are working. The below diagram is based on a Monday to Friday working pattern – the exact testing days will vary according to shift patterns.

	Days
	1	2	3	4	5	6	7
Staff	LFT	LFT	LFT	LFT	LFT
Residents	1 x PCR per month

Residents and staff displaying symptoms of COVID-19

If there are 2 or more individuals displaying symptoms, you should contact your local health protection team (HPT).

Residents with symptoms of COVID-19 should be isolated and tested for COVID-19 immediately, with a PCR test. Do not wait until you have received the PCR test results before contacting your HPT. Staff with symptoms of COVID-19 should stay at home and conduct their PCR test in their own home or go to an in-person test site. Following a PCR test, residents can also be tested with an LFT for speed of detection. The LFT can provide an early warning that someone is positive and inform the outbreak management approach, whilst awaiting their PCR result. If either the LFT or PCR is positive, the resident should be treated as having COVID-19.

An individual who tests negative for COVID-19 but continues to have symptoms may have another infectious illness, like flu. You may need to take action to limit transmission, including the use of appropriate PPE when working with residents and ensure those who are unwell avoid contact with others.

Residents with symptoms

Residents who develop symptoms should be isolated immediately and need to conduct a PCR test provided by the setting (and if possible, an LFT). As far as possible, residents should be offered the choice to either self-administer the tests on themselves or to have the tests administered by a suitable member of staff. They should remain in self-isolation until the result of this PCR is communicated. If the PCR result is negative, they can come out of self-isolation.

If residents develop new symptoms, as far as possible, residents should be isolated immediately and tested – contact your local HPT.

For residents in the highest risk group eligible for COVID-19 treatments, see final section of this guidance.

Staff with symptoms

Staff with symptoms should not be tested in the care home.

Staff with symptoms should instead be referred for PCR testing at a regional or local test centre or in their own home and should stay at home.

What to do in case of a positive result

Care homes with one or more positive COVID-19 results should contact their local HPT. Do not delay contacting your HPT, interventions are more effective the earlier they are started.

Staff who test positive for COVID-19 should follow the management of staff and exposed residents guidance.

If a resident tests positive for COVID-19, follow the admissions and care of residents in a care home during COVID-19 guidance.

You should also consider whether individuals may be eligible for COVID-19 treatments including antivirals or monoclonal antibodies (through the PANORAMIC national study or through direct access for those at highest risk of becoming seriously ill from COVID-19). Further information on treatments for COVID-19 is available on the NHS website. Any queries regarding priority treatment tests can be raised via 119.

If there is a delay in the HPT returning your call, continue to follow current guidance to isolate the individual(s) and identify contacts whilst awaiting a response.

Advice on what to do in an outbreak situation can be found below.

Outbreak testing

Definition of a care home outbreak

An outbreak consists of 2, or more, positive (or clinically suspected) cases of COVID-19 during a 14-day period. This applies to both staff and residents and includes PCR and LFT results. If you have one or more positive cases (or multiple symptomatic individuals), contact your HPT for advice. One positive test result may be the first sign of an outbreak, so you should also contact your HPT for advice in this instance.

The testing process is as follows:

1. Book couriers for collecting PCR tests on day 1 and for one collection between days 4 to 7.

2. Conduct PCR tests for all staff and residents, once on day 1 of the outbreak and once between days 4 and 7.

3. When you carry out the outbreak PCR test for residents (day 1 and once again between days 4 to 7), also test the resident with a LFT on the same day. If either test is positive, assume the resident has COVID-19.

4. Test any newly symptomatic residents, with a PCR.

5. Continue to isolate residents and ensure contact tracing has been completed.

6. Your HPT may decide to differ from this process based on their professional judgement, and where possible you should follow their instructions. For example, based on their risk assessment and professional judgement, they may decide that if no further positive cases are found through the PCR outbreak testing that the outbreak restrictions can be lifted.

Outbreak testing schedule

Testing at the start of a new outbreak (week 1)

	Day
	1	2	3	4	5	6	7
Staff	PCR			PCR
	LFT	LFT	LFT	LFT	LFT	LFT	LFT
Resident	PCR			PCR
	LFT			LFT

Note: the second round of outbreak PCR tests can take place on any day between day 4 and 7 - the above example shows these taking place on day 4.

Staff should do daily LFTs on working days only.

Once the care home has completed the first week of outbreak testing as above, continue daily asymptomatic LFTs for staff.

When there have been 14 days with no new positive cases, conduct outbreak recovery testing.

Outbreak recovery testing

You should undertake whole home ‘outbreak recovery testing’ 14 days after the last resident or staff had a positive test result or showed COVID-19 symptoms. For outbreak recovery testing, all staff, and residents (who have not tested positive in the last 90 days) should be tested with a PCR test. The regular resident testing cycle of 28 days can be delayed, to coincide with this ‘outbreak recovery testing’, if the 2 test dates fall within a week of each other.

If there are no positive PCR results from this whole home ‘outbreak recovery testing’, the HPT will declare the outbreak restrictions can be lifted and the normal regular testing pattern should be followed. Any further positive cases after this point should be classed as a new potential outbreak and the care home must contact the HPT.

The local HPT will contact the care home if they have identified a particular Variant of Concern/Variant under Investigation which requires additional actions/restrictions. They will discuss whether additional measures need to be put in place to enable additional protection and how this impacts the testing required. This might include delaying the whole home ‘outbreak recovery testing’ until 28 days from the last positive test.

Testing within 90 days of a positive result

If an individual has tested positive with an LFT or PCR test, the testing they undertake in the following 90 days may be different.

Any member of staff who tests positive for COVID-19 with a PCR or LFT should follow the management of staff and exposed residents guidance.

If a resident tests positive for COVID-19, follow the admissions and care of residents in a care home during COVID-19 guidance.

Testing and vaccinations

Whilst vaccination offers vital protection from severe disease, no vaccine is 100% effective, and does not prevent transmission to others from those who are infected.

To identify positive cases and continue to monitor the effects and transmission of COVID-19, we must continue to operate a comprehensive, adhered to, testing programme, even in settings where vaccines have been administered.

Vaccination is just one tool in our collective response and recovery from the effects of COVID-19, and so testing and other infection control measures including the use of appropriate PPE will continue to be the necessary and proportionate approach to help keep care home residents and staff safe.

Prepare your care home for testing

To prepare your care home make sure you:

• familiarise yourself with the testing guidance and the different types of testing
• all staff should have completed the NHS Test and Trace online training if using tests that come in boxes of 25s
• use the token ‘3wkcVi4UTX’ to register for an account – ensure that you have enough trained staff available to process the number of LFTs being conducted
• discuss the testing approach with your residents and staff – spend time preparing residents and explaining the procedure to them
• obtain and record consent
• review your personal protective equipment (PPE) supply and ensure you have the correct PPE to carry out testing
• ensure a proper workstation is available for preparing and packing the tests
• look out for the delivery confirmation email letting you know when tests will be delivered have a workflow to allow tests to be easily registered, conducted, and reported as swiftly as possible – it is recommended to have 2 staff members; one to conduct the test and the other to complete registration
• (if you have received a handheld scanner for easier registration) make sure you have set it up and familiarised your staff with how to use it
• (if using a courier to return your PCR test kits to the lab) have booked a courier collection for PCR tests by 7pm the day before you start testing, using the online courier booking portal

Testing process overview

1. Request tests and place an order

Place an order of COVID-19 tests or return boxes. You will receive an email confirming your successful order of tests.

2. Delivery confirmation

You will receive an email confirming the test kits are scheduled for delivery.

3. Receive test kits

You will receive your delivery of test kits via courier after 10am. Ensure that all kits are stored safely at ambient temperature. Do not refrigerate or leave in direct sunlight.

4. Testing days

Staff should conduct LFTs every day they are working, before starting their shift. Monthly resident PCR testing can be conducted on days of your choice.

5. Report LFT results

You must report the result of every LFT result, even if it is negative or void. You can register LFTs individually, or register them using the multiple upload spreadsheet.

Providers do not need to retain records of proof of registrations.

6. Register PCR tests (resident and outbreak testing)

You must register every COVID-19 test. Note the barcode number and time of each PCR test against the name of the person tested. Register the completed test online as close as possible to the time of the swab. You can register PCR tests individually, or register them using the multiple upload spreadsheet.

More information on how to register tests online can be found below.

7. Return PCR test kits (courier – 9 or more tests)

Use a courier to return 9 or more tests to the lab. You should book a courier collection for PCR tests at least a day before testing (no later than 7pm). Place completed tests in an outer return box and register the box barcode when you register each test. This links your tests to a box and helps us find your tests if they go missing.

8. Return PCR test kits (by post – 8 or fewer tests)

If you have conducted 8 or fewer tests, you should use PCR test kits for return by priority post box. These should be placed into a Royal Mail priority post-box on the same day the test was conducted.

9. The testing process is complete

The regular testing process is now complete. The testing process is outlined in more detail below.

10. Results

Full information about what to do if you receive a positive PCR or LFT result can be found in the management of staff and exposed patients guidance. This also covers how to manage staff and residents who are a contact of someone who has tested positive.

11. Priority treatment tests

Priority treatment tests are being sent directly to individuals who are in the highest risk group from COVID-19, to enable faster treatment of COVID-19 should they become symptomatic. More information on priority treatment tests for residents in the highest risk group is in the final section of this guidance.

Step-by-step guide

To make sure that tests are carried out safely, you must ensure that suitably competent staff conduct the tests. Please ensure every person in the home reads the detailed instructions provided.

It is recommended that residents who would prefer to self-administer the test on themselves should watch this self-swabbing instruction video, as should staff. Staff are expected to self-swab.

If testing a resident, take a moment to reassure them to help them feel more comfortable while you perform the test. Check nasal passages for any recent nasal surgery or abnormalities, cuts or injuries that would make swabbing difficult. Have the resident gently blow their nose and cough into a tissue to dispose of any excess mucus and dispose of the tissue immediately in a bin.

Obtaining consent

Consent for residents

To conduct a test on a resident you should obtain consent from them. If necessary, you should consult with family members and their GP as appropriate and in line with your usual policies and procedures.

Some residents, for example some people with dementia, learning disabilities or mental health conditions, may lack the relevant mental capacity to decide about their own testing.

If the person lacks the relevant mental capacity to consent to the test, and they are aged 16 or over, you should consider if the principles of the Mental Capacity Act 2005 allow you to make a ‘best interests decision’ to swab and receive results, on their behalf.

As far as possible, residents should be offered the choice to either self-administer the test on themselves or to have the test administered by a suitable member of staff. Likewise, the resident should be offered the choice to receive the results directly (rather than via the registered manager on their behalf), in which case you should follow the same process set out in this guidance but using the resident’s contact details to register the test online.

Consent for staff members

Staff members can register both LFTs and PCR tests themselves to receive the test results directly.

Care home managers or providers may also seek consent to register and receive test results on behalf of staff members. This consent should be given in writing. As test results are personal information no staff member should be compelled to provide consent.

Placing your order

Place an order of COVID-19 tests or outer return boxes using the online order portal.

You will need:

1. Your Unique Organisation Number (UON) – this is the unique 8-digit number for your care home or setting and is the gateway to access all COVID-19 services. You can use the online look-up tool to find your UON.
2. The number of staff and essential care givers in your care home.
3. The number of residents (non-staff) that are in your care home.

You can order COVID-19 tests on the online portal every 10 days. We will calculate how many tests you need based on the staff and non-staff figures you provide. This is inclusive of a buffer provided for outbreak testing.

You will be given the option to place an order for the following:

1. LFTs for staff – if these are Innova branded and come in green boxes of 25, they can only be used for self-testing by trained staff or on visitors and residents when supervised by a member of staff. If you receive other self-test kits, they can be used for anyone.
2. LFTs for non-staff – these can be used by visitors and residents to self-test. You can download an overview of the different types of non-staff LFTs you may receive here.
3. Standard swab tests – these are PCR tests to be returned by courier for when you are testing 9 people or more. Alongside your order of standard swab tests, you will be sent larger outer return boxes. You can package up to 50 PCR test kits into these boxes when returning test kits to the lab by courier.
4. Outer return boxes – these are additional return boxes to return by courier if needed.
5. Swab tests to be returned by priority post box – these are PCR tests that can be put into a priority post box and are recommended for if you’re testing 8 people or fewer.

Where to go for help with orders

If you have any questions about your order, please call 119. If you are close to running out of stock and require an urgent and emergency delivery, you should also call 119.

Arranging your test kit courier collection

If you have planned to conduct more than 8 COVID-19 PCR tests in a day you should book a courier collection. You can book a courier collection using the online courier booking portal. You will need your UON and the postcode of the care home or setting.

You must book for next day collections before 7pm. You can book a courier up to 6 days in advance. Once you have confirmed your courier collection, you will receive your courier collection confirmation by email.

There is a 48-hour window to get a swab sample to the laboratory for processing. It is important that the courier collects your tests as close as possible to when the swabs were conducted. As far as possible, tests should be picked up by the courier on the same day that swabs are conducted.

Where to go for help with couriers

If you have any questions about your order, please call 119. There may be a small number of circumstances where you need to conduct many tests urgently and have not booked a courier. This might be because you have entered an outbreak. To arrange an emergency courier booking you should call 119. If you are conducting 8 or fewer tests in a day, you should use the PCR tests for return by post, and return them to the lab by posting them in your closest Royal Mail priority post box.

Registering PCRs and LFTs

Conducting a test

Always read the instructions of each test as they may be different.

For tests that require a nose and throat swab, a combined nose and throat swab should be taken where possible. However, a person-centred approach should be used to assess which sample to take from each resident.

Where a combined nose and throat swab is not possible, a nose swab from both nostrils should be taken.

Registering your test(s)

Every test taken must be registered. This records the barcode of each sample against the name and details of the individual who has been tested. You will not receive a PCR test result if you do not register for the test.

There are 2 ways to register COVID-19 tests, single registration, and multiple registration (using the multiple registration spreadsheet).

Single registration

You can register both PCR and LFTs using the organisation testing registration portal.

Alternatively, you can report LFT results using the report result service. This service allows you to create an NHS account to register tests quicker next time.

Multiple registration

Only use the multiple upload spreadsheet provided by NHS Test and Trace. You can register both PCR and LFTs using the multiple upload spreadsheet.

1. You will need to use separate record keeping spreadsheets for staff and residents.

2. You must use the latest version of the spreadsheet to register tests using the multiple upload process. Please do not send any personal information along with the completed tests to the lab. This will be reported as a clinical incident and could delay getting your results back.

3. You can register up to 100 tests at a time.

4. Once you have successfully registered each PCR and LFT you will receive a confirmation email or text message. You will receive the test results for PCR by email or text within 72 hours of the PCR test arriving at the laboratory. You should monitor your email account carefully. Registered managers should not use a personal email or phone number to receive test results for any residents or staff.

5. When you receive the test result email, this may not include the name of the resident or staff member. You should therefore retain a careful record of each test barcode and the name of the resident or staff member. Staff members should also retain a record of their own test barcode.

Setting up a handheld scanner

NHS Test and Trace can provide you with a handheld scanner to speed up the test registration process. To apply for a scanner, please call 119. When setting up your scanner you should:

1. Turn off your computer’s power before connecting the scanner.
2. Plug the cable into the bottom of the scanner and plug the other end into a computer.
3. Turn on the computer once the scanner is fully connected.
4. The computer should recognise the scanner automatically as a USB keyboard device.

To register a COVID-19 test using a handheld scanner follow the normal registration process steps until:

• when prompted to ‘Enter the unique test kit barcode’ click the test kit barcode reference box
• once the cursor is live, for a PCR test scan the test kit barcode provided on the spare sticker, plastic tube, or bag
• for rapid LFTs, scan the QR stamp printed directly on to the top of each individual LFT device

Securely package and return PCR tests to the lab

Returning tests by courier

When conducting more than 8 tests in a day, use the standard PCR swab tests for return by courier. Use one of the empty larger outer return boxes you will have received with your test kit delivery and ensure you have registered the box online along with the tests inside. Make certain you have:

1. Arranged a courier collection before you have started testing.
2. Registered the barcode that’s on the blue label on the large outer return box. NHS Test and Trace can track each test sample through the entire end-to-end testing process.
3. Registered every test to an outer return box.
4. Packaged no more than 50 tests inside one box.
5. Packaged no fewer than 9 inside one box.

Returning tests by post

When conducting 8 or fewer tests in a day, use the PCR swab tests for postal return. You can return these to the lab using your closest Royal Mail priority post box and should be packaged in the individual boxes provided with each test kit.

You can find your closest priority post box using the Royal Mail website.

Priority treatment tests for residents in the highest risk group

Residents of care homes who are in the highest risk group from COVID-19 can access new COVID-19 treatments directly.

Priority treatment PCR tests are being sent directly to these individuals to enable faster treatment of COVID-19 should they become symptomatic.

These tests will be addressed to the individual and sent in a purple postal bag.

Residents will receive a ‘pre-notification’ letter or email (to the contact details specified in their GP record) to alert them that they have a condition that may make them eligible should they test positive for COVID-19.

Service and care managers are requested to support residents with where to store these priority tests so that they are available when needed. Each priority treatment test kit will have an information leaflet enclosed which details how these kits should be stored and provide full testing instructions.

What to do if a resident in the highest risk group becomes symptomatic

1. If the resident becomes symptomatic, the priority treatment test should be used.

2. Follow the registration instructions in the test kit and use the individual’s NHS number if available (to help trigger the treatment process).

3. Send the test kit via a Royal Mail priority post box (using a courier will get a slower result given the way the priority red boxes are processed).

4. If positive for COVID-19, the resident will be contacted by a COVID-19 medicines delivery unit clinician who will assess the resident’s eligibility and decide on the appropriate treatment.

5. In most cases the treatment prescribed will be monoclonal antibodies, which are given intravenously, however, if monoclonal antibodies are unsuitable for the individual, they will be given oral antivirals.

If the resident is not contacted within 24 hours of receiving the positive result, contact their GP or call 111.

Further information on treatments for COVID-19 is available on the NHS website. Any queries regarding priority treatment tests can be raised via 119.