Guidance

Managing healthcare staff with symptoms of a respiratory infection or a positive COVID-19 test result

Updated 31 March 2023

What has changed

The likelihood of being admitted to hospital directly due to coronavirus (COVID-19) is greatly reduced in the general population, with testing in healthcare settings mainly targeted at informing clinical care.

The main changes to this guidance are:

• most healthcare staff who have symptoms of a respiratory infection are no longer asked to test for COVID-19
• healthcare staff who test positive for COVID-19 are no longer required to have 2 negative lateral flow device (LFD) tests for COVID-19 before they return to work
• healthcare staff whose job primarily involves providing direct care to inpatients who are severely immunosuppressed, such as those working in inpatient areas for solid organ, stem cell or bone marrow transplant or haemato-oncology patients, should take an LFD test if they develop symptoms of a respiratory infection, in line with locally decided protocols
• healthcare staff whose job primarily involves providing direct care to inpatients who are severely immunosuppressed and who have a positive COVID-19 test should return to work in line with locally decided protocols

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 healthcare staff who have symptoms of a respiratory infection including COVID-19. It also provides advice on the management of healthcare staff with a positive test result for COVID-19, and those who are close contacts of a confirmed case of COVID-19.

In this document, the term ‘severely immunosuppressed patients’ refers to patients who are unlikely to mount an effective vaccine response, such as solid organ, stem cell or bone marrow transplant or haemato-oncology patients.

Routine asymptomatic testing

Routine asymptomatic testing for healthcare staff should only continue where local healthcare organisations have sought appropriate advice to undertake this as part of broader infection prevention and control measures. Examples might include routine testing of staff whose job primarily involves providing direct inpatient care to severely immunosuppressed patients. Appropriate advice should be sought from medical directors, nursing directors or infection prevention and control teams.

Healthcare staff with symptoms of a respiratory infection including COVID-19, or a positive LFD test result

Symptoms of a respiratory infection

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

Healthcare staff who are not providing direct inpatient care to those who are severely immunosuppressed

Healthcare staff whose job does not primarily involve providing direct inpatient care to severely immunosuppressed patients, who have symptoms of a respiratory infection, and who have a high temperature or do not feel well enough to go to work, are advised to stay at home and avoid contact with other people.

They are not required to take a COVID-19 test and should follow the guidance for people with symptoms of a respiratory infection including COVID-19. They should stay at home until they no longer have a high temperature (if they had one) or until they no longer feel unwell.

If these staff members have a positive COVID-19 test result, regardless of whether they have symptoms, they should follow guidance for the general public who have a positive test result.

Line managers should undertake a risk assessment before patient-facing healthcare staff return to work in line with normal return to work processes.

On returning to work, all staff members must continue to comply rigorously with all relevant infection control precautions, including appropriate personal protective equipment (PPE) use.

Local circumstances may lead to a decision to undertake symptomatic staff LFD testing in these settings, following risk assessment and direction from medical directors, nursing directors or infection prevention and control teams. In this situation, staff should follow local policy regarding criteria for returning to work.

Healthcare staff providing direct care to inpatients who are severely immunosuppressed

Healthcare staff whose job primarily involves providing direct inpatient care to severely immunosuppressed patients, who have symptoms of a respiratory infection, and who have a high temperature or do not feel well enough to go to work, should take an LFD test as soon as possible.

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

If the result of this LFD test is positive, they are advised not to attend work for at least 5 days. They should only return if they feel well enough to work, and they do not have a high temperature. If they are still displaying respiratory symptoms when they return to work, they should speak to their line manager who should undertake a risk assessment.

A locally decided protocol, following risk assessment and direction from medical directors, nursing directors or infection prevention and control teams, may be used for staff who are returning to work 5 or more days after a positive test result. This may include:

• redeployment to lower risk areas up to day 10 after symptom onset or the first positive test result
• asking staff to wear a surgical face mask up to day 10 after symptom onset or the first positive test result
• negative results on LFD test prior to returning to work

Healthcare staff must continue to comply rigorously with all relevant infection control precautions, including appropriate PPE use.

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.

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.

While they are attending work, staff who are household or overnight contacts of someone with COVID-19 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.