[Withdrawn] Preventing and controlling outbreaks of COVID-19 in prisons and places of detention

Question 1

1. What has changed

Accepted Answer

This guidance has been updated in line with the government announcement to pause routine asymptomatic testing in high-risk settings, for both staff and prisoners or detainees.

Question 2

2. Who this guidance is for

Accepted Answer

This guidance will assist custodial, detention and healthcare staff in addressing COVID-19 in a prison or prescribed place of detention (PPD). It provides operational recommendations to assist staff, local UK Health Security Agency (UKHSA) health protection teams (HPTs) and other stakeholders if an incident or outbreak of COVID-19 is reported in a PPD. Operational practices may vary due to setting specific considerations.

The following establishments in England are included within the definition of PPDs used in this guidance:

prisons (both public and privately managed)
immigration removal centres (IRC)
YOI units for those aged 18 years and over

Recommendations are also relevant to prison escort and custodial services (PECS) staff and approved premises, particularly the sections on environmental cleaning and advice to staff. Controlling the spread of infection and managing outbreaks in PPDs will rely on coordinating healthcare and custodial staff working with UKHSA HPTs, national and regional Health and Justice teams and other stakeholders at both the local and national level. Other key stakeholders include:

NHS England and Improvement Health and Justice Commissioners
Home Office
PPD establishment managers and their teams
His Majesty’s Prison and Probation Service (HMPPS) headquarters functions
Directors of Public Health in local authorities

Further information on specific actions required to identify and manage an incident or outbreak, as well as descriptions of the roles and responsibilities of partner organisations involved, is provided in the multi-agency contingency plan for the management of outbreaks of communicable diseases or other health protection incidents in prisons and other places of detention in England.

Question 3

3. Children and young people

Accepted Answer

Given that children and young people under 18 years are very low risk from clinical harm from COVID-19, this guidance does not apply to secure children’s homes (SCHs), secure training centres (STCs) and YOI units for those under 18 years. Guidance on the management of children and young people with symptoms of a respiratory infection, including COVID-19 is available.

General information on IPC in settings for children and young people can be found in Health Protection in Education and Childcare settings Chapter 2: infection prevention and control.

Question 4

4. Symptoms

Accepted Answer

Symptoms of COVID-19, flu and other respiratory infections in adults 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

The symptoms of COVID-19 and other respiratory infections are very similar. It is not possible to distinguish between COVID-19, flu or another respiratory infection based on symptoms alone. Further guidance on management of acute respiratory illness in prisons and places of detention is available online.

Most people with COVID-19 and other respiratory infections will have a relatively mild illness, especially if they have been vaccinated.

If staff or visitors have symptoms of a respiratory infection, such as COVID-19, and a high temperature or do not feel well enough to go to work or carry out normal activities, they should try to stay at home and avoid contact with other people. Staff or visitors should follow the guidance for People with symptoms of a respiratory infection including COVID-19.

Question 5

5. What to do if a prisoner or detainee has symptoms of COVID-19 or has a positive COVID-19 test result in a PPD

Accepted Answer

In PPD settings, possible cases of COVID-19 are likely to be identified by:

custodial and detention staff
healthcare staff
other prisoners or detained individuals
self-referral (prisoner or detainee reports their symptoms to staff) at or near the point of reception
outbreak testing or through other means

All staff should be alert to prisoners, colleagues, visitors or detained individuals who have symptoms of COVID-19, and follow the steps outlined elsewhere in this guidance.

All PPDs should have a plan in place that identifies appropriate facilities where prisoners or detained individuals with suspected or confirmed COVID-19 infection can self-isolate and avoid contact with other people.

If necessary, access to a language-line, or similar translation service, must be provided as soon as a person with possible or confirmed COVID-19 infection enters the establishment. This will ensure an accurate medical history can be taken and prisoners or detained individuals located appropriately.

People who are self-isolating should have regular opportunities to discuss their wellbeing and any anxieties with a member of staff.

5.1 Prisoners or detained individuals with symptoms of respiratory infections including COVID-19

Due to the high-risk nature of the residential settings of prisons and places of detention, there should be a low threshold for testing of people who present with symptoms of respiratory infection, such as COVID-19.

Prisoners or detained individuals who have symptoms of a respiratory infection and have a high temperature, or prisoners or detainees who have symptoms of a respiratory infection and are too unwell to carry out their usual activities should take a lateral flow device (LFD) test as soon as they feel unwell (day 0). If this first test is negative, they should take another LFD test 24 hours after the first test.

If the second test taken at 24 hours is also negative they can return to their usual activities if well enough to do so.

Atypical symptoms, such as delirium and reduced mobility, often in the absence of a fever, can present in:

people who have dementia, autism or learning difficulties
people who are older-aged and frailer
people whose immune system means that they are at higher risk of severe illness from COVID-19

Changes in wellbeing, behaviour and clinical signs including a high temperature should all be considered when undertaking an assessment about testing and clinical advice sought if necessary, for example from the GP if the person is unwell.

Prisoners or detained individuals who have symptoms of COVID-19, should remain (in accordance with relevant powers) in single occupancy accommodation (self-isolate in their cell or room) and be tested for COVID-19. They should stay in their accommodation and avoid contact with other people while awaiting the results of the test.

If single occupancy accommodation is not available, possible cases should self-isolate in higher occupancy accommodation, or where demand exceeds capacity, cases may be cohorted together. The prisoner or detained individual is advised to wear a surgical face mask (Type II or IIR) while being transferred to protective isolation. Appropriate measures should also be in place for COVID-19-positive residents when leaving their accommodation for essential regime and wellbeing activities, such as use of a surgical face mask (Type II or IIR).

Escorting staff should follow the guidance on personal protective equipment (PPE), handwashing instructions and limit close contact wherever possible.

5.2 Prisoners or detained individuals who test positive for COVID-19

Prisoners or detained individuals who test positive for COVID-19 should self-isolate and avoid contact with others. The isolation period includes the day their symptoms started (or the day their test was taken if they do not have symptoms) and the next 10 full days.

Prisoners or detained individuals may be able to end the isolation period before the end of 10 full days. They can take an LFD test from 5 days after the day their symptoms started (or the day their test was taken if they did not have symptoms), and another LFD test on the following day. The second LFD test should be taken at least 24 hours later. If both these test results are negative, and they do not have a high temperature, they may end self-isolation after the second negative test result. They should not take an LFD test before the fifth day of their isolation period, and they should only end self-isolation following 2 consecutive negative LFD tests which should be taken at least 24 hours apart, or after the full 10 days has ended. If they take an LFD test from the fifth day of their isolation period, and the test result is positive, they should wait 24 hours before they take the next test.

If both LFD test results are negative, it is likely that the individual was not infectious at the time the tests were taken.

To further reduce the chance of passing COVID-19 on to others, if prisoners or detained individuals end their self-isolation period before 10 full days they are strongly advised to:

limit close contact with other people outside of their bubble and with those in the wider population, especially in areas which are poorly ventilated
not attend work where possible
wear a face covering when outside of their cell or room
limit contact with anyone who is at higher risk of becoming severely unwell if they are infected with COVID-19, including visitors
follow guidance for People with symptoms of a respiratory infection including COVID-19

5.2.1 Ending protective isolation

PPDs are high-risk settings for COVID-19. Given the high-risk setting, it is important to interpret negative results in symptomatic prisoners or detained individuals with caution and a clinical assessment should be undertaken before they are released from isolation.

If a prisoner or detained individual is clinically unwell after 10 days or longer, they should be advised to continue to self-isolate until they have had a clinical assessment.

Question 6

6. Prisoners or detained individuals who are identified as contacts of a case of COVID-19

Accepted Answer

Prisoners or detained individuals who are contacts of a COVID-19 case do not need to isolate or undertake additional testing. Instead, they should:

minimise contact with the person who has COVID-19
avoid contact with anyone who is at higher risk of becoming severely unwell if they are infected with COVID-19, especially those with a severely weakened immune system
follow the advice regarding testing and isolation if they develop symptoms of COVID-19

If the prisoner or detained individual develops symptoms of COVID-19 during this period, they should follow the guidance for prisoners or detained individuals with symptoms of respiratory infections, including COVID-19.

Routine contact tracing is not currently being undertaken in PPD settings. However, if an outbreak control team (OCT) advises that contact tracing should be re-instated during an outbreak, this can be undertaken by local leads for the prison or PPD.

Prisoners and detained individuals are strongly encouraged to be vaccinated to protect themselves and others from infection. Booster vaccinations are strongly recommended if eligible.

Question 7

7. Clinical assessment and healthcare

Accepted Answer

Where possible, any assessments should be done without entering the cell or room. Detailed guidance for prison healthcare on the management of COVID-19 in secure environments is available from the Royal College of General Practitioners (see ‘Secure environments’ tab and select ‘COVID-19 Guidance for healthcare in secure environments’). It is important to be aware of people whose immune system means they are at higher risk of serious illness if they become infected with COVID-19, needing monitoring or referral for treatment or hospital admission.

Prisoners or detained individuals who have symptoms of COVID-19, but who are clinically well enough to remain in the PPD, do not need to be transferred to hospital. Those who are clinically unwell and require hospitalisation should be transferred to appropriate healthcare facilities following safe escort and transfer protocols for the establishment. Staff should wear appropriate PPE. The prisoner or detained individual should be offered a surgical face mask (Type II or IIR) to be worn during transportation, if tolerated, to minimise the dispersal of respiratory droplets. Staff at the receiving destination must be informed that the patient has possible or confirmed COVID-19.

Question 8

8. Staff

Accepted Answer

This guidance is for HMPPS directly employed or other staff. Healthcare workers should follow Managing healthcare staff with symptoms of a respiratory infection or a positive COVID-19 test result.

8.1 Staff with symptoms of respiratory infection, including COVID-19

If a member of staff develops symptoms of a respiratory infection including COVID-19, however mild:

staff with symptoms should take an LFD test as soon as they develop symptoms and take another LFD test 24 hours after the first test
symptomatic staff should stay away from work and conduct the LFD tests at home
staff should only come into work if both LFD test results are negative
for those who test positive the guidance on ending self-isolation early through additional testing remains the same (see section 8.2)
if they develop symptoms while at work, they are advised to put on a surgical face mask (Type II or IIR) immediately, inform their line manager and return home

8.2 Staff who have tested positive for COVID-19

To avoid passing on the virus, staff who receive a positive LFD or PCR test result should follow the advice regarding staying at home and avoiding contact with other people from the day they test positive or develop symptoms (day 0). There is no need to take a confirmatory PCR test after a positive LFD test result. Staff with COVID-19 should follow the guidance for People with symptoms of a respiratory infection including COVID-19:

The likelihood of a positive LFD test in the absence of symptoms after 10 days is very low. If the staff member’s LFD test result is positive on the 10th day, they should continue to take daily LFD tests, and should not return to work until a single negative LFD test result is received.

Managers can undertake a risk assessment of staff who test positive between 10 and 14 days and who do not have a high temperature, with a view to them returning to work depending on the work environment.

The likelihood of a positive LFD test result after 14 days is considerably lower. If the staff member’s LFD test result is still positive on the 14th day, they can stop testing and return to work on day 15. If the staff member works with prisoners or detained individuals who are especially vulnerable to COVID-19 (as determined by the organisation), a risk assessment should be undertaken, and consideration given to redeployment.

8.3 Symptomatic staff who have tested negative for COVID-19

Given the high-risk setting, it is important to interpret negative results in symptomatic staff with caution.

Staff who test negative on a COVID-19 test but continue to feel unwell should re-test with an LFD test after 24 hours, staying away from work during this time.

If the second LFD test is also negative, they can return to work if well enough to do so.

If either test is positive, they should follow the guidance in section 8.2 Staff who have tested positive for COVID-19.

Staff should only return to work when they feel well enough to do so as other respiratory infections may be a cause of symptoms.

Further guidance on management of acute respiratory illness in prisons and places of detention is available.

8.4 If a staff member is identified as a contact of a case of COVID-19

Staff who are contacts of confirmed cases can continue working. They should comply with all relevant infection control precautions and PPE should be worn properly throughout the day. They do not need to undertake any additional testing.

If the staff member works with people who are at higher risk of becoming severely unwell if they are infected with COVID-19 (seek clinical advice as necessary), a risk assessment should be undertaken, and consideration given to redeployment during the 10 days following their last contact with the case.

Consideration should be given to how to ensure staff can deliver safe care during the 10 days after being identified as a close contact of someone who has tested positive for COVID-19. This includes applying the measures known to reduce risk such as distancing, maximising ventilation, PPE and cohorting. This should be built into local risk assessments for responding to infectious diseases and ensuring safe staffing levels are maintained.

Routine contact tracing is not currently being undertaken in PPD settings. However, if an OCT advises contact tracing should be re-instated during an outbreak this can be undertaken by local leads for the prison or PPD.

If the staff member develops symptoms of COVID-19, they should follow the guidance for staff with symptoms of respiratory infection, COVID-19.

Question 9

9. Routine testing for COVID-19 in PPDs

Accepted Answer

9.1 Asymptomatic prisoner testing

Asymptomatic testing of prisoners is not currently recommended.

OCTs remain able to recommend the short-term re-introduction of asymptomatic prisoner testing in outbreak situations if required.

Prison Governors or Directors may receive advice from local HPTs that recommends specific or temporary asymptomatic testing (for example reception testing) depending on local circumstances, such as for higher-risk individuals or those in routine close contact with them. This would be as part of an ongoing local public health led risk assessment.

Reverse cohorting units (RCUs) have been stood down. All prisons should have the capacity to reinstate an RCU at pace should this be required for public health management or on the advice of the HPT (for example if levels of infection in the community rise substantially and/or a new variant of concern is identified).

9.2 IRCs routine testing

Asymptomatic testing of new receptions to IRCs is not currently recommended.

No routine resident testing is required but testing may be required for pre-departure testing for deportation according to testing requirements of receiving country and any other considerations regarding advice from travellers domestically.

Outbreak testing and management of contacts will continue as described. Additional testing may be recommended in outbreak situations by the OCT, including the short-term reinstatement of asymptomatic testing on reception.

IRC Directors may receive advice from local HPTs that recommends specific or temporary asymptomatic testing (for example reception testing) depending on local circumstances, such as for higher-risk individuals or those in routine close contact with them. This would be as part of an ongoing local public health led risk assessment.

9.3 Environmental testing

In the absence of routine asymptomatic staff and prisoner or detainee testing, environmental testing measures become even more important, providing an insight into the level of infection in a prison or PPD through asymptomatic transmission.

UKHSA has been working with HMPPS to develop capability in detection of COVID-19 in prisons through monitoring of wastewater. Wastewater analysis measures the concentration of COVID-19 RNA in wastewater as a reflection of infection in the prisoner and/or staff population, and records trends in level of infection in the prison population over time. More than half of all prisons and some IRCs are covered by the wastewater surveillance system in England at this time.

HPTs should consider any alerts received through wastewater surveillance alongside other information including evidence of outbreak in a setting, level of testing, any positive results, other measures and consider if further public health actions are required, included testing of individuals or further IPC measures.

Currently, prisons are being advised when the system detects infection and/or escalating infection in samples collected. An alert triggers an assessment meeting, which include HPTs, the governor or directors of the prison and their healthcare leads. HPTs may wish to consider the following 4 actions in response to an alert from the wastewater surveillance system:

Mass testing

While wastewater surveillance can identify that COVID-19 has been detected, it cannot accurately pinpoint specific prisoner or staff populations affected so individual testing may be advisable to identify force of infection (both those infected and those not yet infected). For reference, the risk definitions of high/medium/low refers to the mean gene copies per litre (gc/l) found within the wastewater sample are:

low = below 1600 gc/l (this is the level of quantification)
medium = between 1600 – 31,622.7 gc/l
high = over 31,622.7 gc/l

However, these values must be interpreted in the context of the setting, ideally as part of the assessment meeting.

Standing up an OCT to coordinate response

To effectively manage the operational response, consideration should be given to the co-ordination of mass testing and IPC measures based on outcomes of testing.

Requesting information from prison on any known cases among staff and/or prisoners

For example number of symptomatic or positive cases; and prison resident vaccine coverage (especially in those at higher risk of becoming severely unwell if they are infected with COVID-19).

Recovery testing

Where a wastewater surveillance is in place, consideration may be given to the need for recovery testing to inform a decision to stand-down an outbreak response. That is, if wastewater indicates low or no risk of infection then it may be possible to not undertake recovery testing.

9.3.1 Caveats for using the wastewater data as a signal of emergent COVID-19 infection

High rainfall can dilute wastewater samples.

Wastewater sampling points have been chosen to sample the greatest proportion of the prison possible, however, this does not necessarily mean the sample covers all areas of the prison. Most samples collected from prison sites will be aggregated over time however some may be single snapshots. Single samples are more influenced by:

flow characteristics (high or low water, rain or laundry contributions)
time of day (people may use the toilets less at certain times of day)
confidence in collecting an appropriate sample

Virus concentration levels do not necessarily reflect infectiousness in the sampled population, however an increase in concentration may suggest that transmission is occurring, and prevalence of infected cases is increasing.

9.4 Asymptomatic staff testing

Asymptomatic testing of staff is not currently recommended.

OCTs remain able to recommend the short-term re-introduction of staff asymptomatic testing in outbreak situations if required.

Prison Governors or Directors may receive advice from local HPTs that recommends specific or temporary asymptomatic staff testing depending on local circumstances, such as for staff who work closely with those at higher risk of becoming severely unwell if they are infected with COVID-19. This would be as part of an ongoing local public health led risk assessment.

Question 10

10. Visitors

Accepted Answer

Guidance on visiting someone in prison is available for social visitors. People with COVID-19 or those with symptoms of COVID-19 should not visit anyone in a prison and should follow the guidance for People with symptoms of a respiratory infection including COVID-19. If a visitor develops symptoms up to 2 days after the visit they should inform the prison.

If a visitor becomes unwell with symptoms of COVID-19 while at the prison, they should go home immediately and follow the guidance for People with symptoms of a respiratory infection including COVID-19.

Further guidance on management of acute respiratory illness in prisons and places of detention is available.

10.1 Prisoners or detained individuals and visiting

Prisoners or detained individuals who are a confirmed COVID-19 case should not participate in visits. Prisoners with symptoms consistent with COVID-19 (or other acute respiratory infection) should not receive visitors. Further information on symptoms can be found in section 4 of this guidance.

Asymptomatic testing of prisoners prior to visits is not currently recommended.

10.2 Further considerations on visiting

Limiting close contact with other people, wearing face coverings, enhancing ventilation, cleaning hands and other IPC measures can help visits to operate safely.

Where a prison has an outbreak, mixing of wings should be avoided during visits. Wing based visits should be provided where possible. OCTs may advise that visits should be stopped/reduced during an outbreak, due to the risk of infection this poses to visitors. If visits continue, OCTs can advise that visitors are made aware of outbreaks if visiting prisoners from affected wings/areas; this will ensure those who may be at higher risk of becoming severely unwell if they are infected with COVID-19 are fully informed prior to attending. OCTs can also recommend the short-term re-introduction of asymptomatic pre-visit testing of prisoners in outbreak situations.

Question 11

11. Management and reporting of a case or outbreak of COVID-19 in a PPD

Accepted Answer

In current circumstances there will need to be a strong focus on early detection and response to outbreaks; for example through rapid testing of symptomatic prisoners and use of COVID-19 alerts from waste water surveillance where available.

On early signalling via surveillance (testing) systems including response to wastewater signalling, clinical suspicion or confirmation of a case or outbreak within a PPD, the appropriate registered medical practitioner must notify the local UKHSA HPT as soon as possible and provide all requested information, including details of cases.

Following initial risk assessment by the HPT and PPDs, HPTs are advised to convene an incident or outbreak control team (ICT/OCT) in response to notification of a possible or probable incident or outbreak of COVID-19. The multi-agency contingency Prison Outbreak Plan should be followed.

Following the key principles within the multi-agency contingency prison outbreak plan will ensure that:

roles and responsibilities of partner organisations are clearly understood
processes for notification, collaborative work and investigation are in place to enable outbreak/incident investigation and health risk assessment
effective measures are taken to control the outbreak/incident, to mitigate the health risks and to limit the spread of infection

An outbreak is defined as 2 or more linked cases among whom transmission was likely to have occurred within a 14 day period among prisoners or detained individuals or staff in the PPD who meet the case definition for COVID-19 or have a positive test result. The timely collection of accurate data by the partner agencies (HMPPS and NHSE healthcare provider) and sharing of this with HPTs on request is required to inform the OCT.

The role of the ICT/OCT is to ensure the outbreak/incident is appropriately investigated and managed, and to advise the governor or appropriate senior manager of the PPD on measures required to control it, which may impact on operational, logistic and security challenges for the setting.

UKHSA’s National Health and Justice Team will provide advice and support to responding ICT/OCTs, conduct surveillance at national level, share intelligence with key partners, and develop national guidance for use in preventing and managing outbreaks.

Stakeholders responding to outbreaks must work through the formal structure of the OCT as detailed in the multi-agency contingency plan for the management of outbreaks of disease in PPDs. Following a risk assessment based on testing resources along with wastewater surveillance (where available), the OCT will advise on an appropriate testing strategy.

A dedicated protective isolation unit or area for the temporary isolation of cases who are unwell should ideally be designated within the establishment to facilitate better monitoring or provision of health services to these patients.

If whole prison testing has been delivered on day 0, between days 5 to 7 and day 10 after the last known case and no new cases are detected in anyone living or working in the setting on day 10, the OCT can consider standing the outbreak down based on a dynamic Management and reporting of a case or outbreak of COVID-19 in a PPD assessment providing there is confidence that transmission chains have been identified and controlled through mass testing.

During an outbreak there may be a variation of protocol for recording of positive LFD test results. This will only be granted on a case-by-case basis in response to mass testing following an outbreak. Where approval has been granted for not recording negative test results, OCTs will still require the following information, as a minimum, to enable effective clinical assessment of the outbreak situation:

total number of prisoners to be tested
number of refusals to test
number of negative test results
number of tests carried out
number (and details) of positive test results

11.1 Population management during an outbreak of COVID-19 in a PPD

The multi-agency contingency plan for the management of outbreaks of communicable diseases or other health protection incidents in prisons and other places of detention in England describes specific actions required to identify and manage an incident or outbreak. Where an outbreak has been declared, the governor or appropriate manager should inform HMPPS. They will engage with the Population Management Unit; a dynamic risk assessment form should be completed by the governor or manager and the UKHSA Consultant in health protection leading the OCT.

11.2 Outbreak control team dynamic risk assessment

Cohorting is a public health strategy for the care of large numbers of people who are ill, potentially infectious, or who are vulnerable and present heightened risk of severe disease if infected. Cohorting involves keeping similar groups together and separate from the other groups to prevent the spread of COVID-19. This may mean compartmentalising PPD establishments into separate areas to make sure the groups can be kept apart.

Plans to implement cohorting should be developed in conjunction with appropriate clinical, infection control and specialist public health advice.

11.3 COVID-19 testing during an outbreak

In outbreak situations, OCTs will undertake a risk assessment and decide whether to recommend whole PPD testing. If activated, whole PPD testing will involve all prisoners or detained individuals and staff being tested.

The recommendation is 3 rounds of LFD testing on the following days:

at day 0 (the first day mass testing is available)
between days 5 and 7
day 10 after the last confirmed or suspected case, to confirm the outbreak is over (recovery testing) based on the dynamic risk assessment of the OCT

The OCT will advise if PCR testing is required to inform outbreak management in the event of a variant of concern.

If a prisoner or detained individual refuses to take part in mass asymptomatic testing in the context of an outbreak, then they should be treated as a presumptive case and advised to self-isolate for 10 days from their last potential exposure.

The OCT will advise whether the short-term reintroduction of asymptomatic LFD testing of prisoners or detainees and staff is recommended, for example on reception in to the prison or IRC.

The OCT may advise that contact tracing is reinstated and carried out via a local nominated lead for the prison or PPD.

The OCT can also recommend the short-term re-introduction of asymptomatic pre-visit testing of prisoners in outbreak situations.

LFD testing should be considered as part of the risk mitigation strategy (in agreement with the ICT or OCT) to enable prisoners to be transferred out of the custodial setting to assist with population management.

During an outbreak, testing of prisoners using LFD tests should also take place:

before release
before a transfer to another prison
before a court attendance if in person attendance is necessary (alternative access via videolink should be enabled where possible)
immediately before and after a period of release on temporary licence (ROTL)
before starting work for essential workers (working prisoners)
before participating in visits

Question 12

12. Transition of prisoners or detained individuals to the community

Accepted Answer

All individuals should be seen by healthcare services as part of normal preparations for release. Prisoners and detained individuals cannot be detained beyond their tariff.

Where applicable, the local authority, UKHSA HPT and HMPPS (including probation) should be made aware of any cases returning to the community who have not received 2 negative tests and are within 10 days of a positive COVID-19 test result. The local authority should be made aware of any cases or close contacts of known cases with no fixed abode. People returning to the community need to be prepared to follow the guidance People with symptoms of a respiratory infection including COVID-19.

Probation services and approved premises/hostels should advise people with any of the main symptoms of COVID-19 or a positive test result, to follow public health advice to stay at home (within the premises/hostel) and avoid contact with other people.

Question 13

13. Limiting the spread of COVID-19 in PPDs

Accepted Answer

Managers of PPDs can help reduce the spread of COVID-19 by regularly reviewing existing control measures, ensuring adherence to good IPC principles and reminding everyone of available public health advice and support. Guidance on mitigations to reduce the transmission of COVID-19 also applies to new variants.

Resources including posters, leaflets and other materials are available.

Everyone can reduce the risk of catching and passing on COVID-19 by:

getting vaccinated
letting fresh air in if meeting indoors, or meeting outside
wearing a face covering in crowded and enclosed spaces, especially when in contact with people they do not live with when rates of transmission are high
trying to stay at home if unwell
taking a test if they have symptoms and avoiding contact with other people if they test positive
washing hands and following advice to ‘Catch it, Bin it, Kill it’

In prisons and places of detention:

staff should wear specified PPE for activities with possible or confirmed cases
remind staff and prisoners or detained individuals to wash their hands with soap and water regularly and to cover their mouths and noses with disposable tissues when they cough or sneeze – individuals should dispose of tissues into a disposable rubbish bag. If they do not have a tissue, remind them to sneeze into the crook of the elbow, not into the hand, and immediately wash hands with soap and water or use hand sanitiser
objects and surfaces should be cleaned and disinfected regularly using standard cleaning products, paying attention to all surfaces but especially ones that are touched frequently
make sure there is adequate ventilation of indoor spaces

While social distancing and other measures in general have been lifted, it may be appropriate to apply some of these measures depending on the risks, if risk assessments suggest doing so. Use of social distancing should be targeted, time limited, and kept under review.

Question 14

14. Reducing the spread of respiratory infections, including COVID-19

Accepted Answer

As we learn to live safely with COVID-19, there are actions we can all take to help reduce the risk of catching COVID-19 and passing it on to others. These actions will also help to reduce the spread of other respiratory infections, such as flu, which can spread easily and may cause serious illness in some people.

14.1 Vaccination

Vaccination of prisoners and residents should be encouraged. COVID-19 vaccines have been shown to reduce the risk of severe illness for those who have received them. This is especially important given the vulnerabilities of people in secure settings.

Prison staff are strongly encouraged to be vaccinated to protect themselves from the risk of serious illness.

Individuals eligible for booster vaccinations against COVID-19 should be encouraged to take up the offer. Boosting immunity should help to extend protection and may give broader protection against new variants.

Guidance on isolation and testing should be followed even if someone has received COVID-19 vaccinations. This will reduce the risk of spreading infection and help to protect other people.

14.2 Ventilation

Bringing in fresh air to occupied spaces can help to reduce the concentration of respiratory particles, lowering the risk of airborne transmission of respiratory viruses.

Other mitigation measures should be determined by risk assessment and implemented as part of a hierarchy of controls approach. The Health and Safety Executive (HSE) provides information on working safely for employers and employees.

14.3 Infection prevention and control

Staff should minimise any non-essential and avoidable contact with any staff member or prisoner.

Hand and respiratory hygiene are important components of IPC measures and essential to reduce cross-contamination and infection.

Staff use of fluid resistant surgical masks (Type IIR) should be considered to reduce transmission of COVID-19, particularly in poorly ventilated or crowded areas. This is known as source control or universal masking and prevents spread from the wearer. This should also be considered when caring for a person who is at higher risk of becoming severely unwell if they are infected with COVID-19.

Mitigation measures, including PPE, should be determined by risk assessment and implemented as part of a hierarchy of controls approach. For activities requiring close contact with a possible or confirmed case of COVID-19, for example patient assessment, interviewing people at less than 2 metres distance, or arrest and restraint, guidance on PPE is available. Dispose of used PPE as offensive waste. If visibly contaminated with respiratory secretions, it should be disposed of as hazardous waste.

14.4 Principles of cleaning

Regular cleaning can help reduce the risk of spreading infection.

Standard cleaning products such as detergents are adequate to clean routinely.

Respiratory infections such as flu and COVID-19 can be spread from person to person through small droplets, aerosols and through direct contact. Surfaces and belongings can also be contaminated when people with infections cough or sneeze or touch them.

When a person is known or suspected to have an infection, chlorine-based products should be used to disinfect the environment. Products that contain both detergent and chlorine may be used to give a measured dose of chlorine in solution for a one-stage clean and disinfection. Control of substances hazardous to health (COSHH) regulations and the product manufacturer’s guidance should always be followed.

Cleaning and disinfection of frequently touched surfaces is particularly important in bathrooms and communal kitchens.

As a minimum, frequently touched surfaces such as door handles, light switches, work surfaces, remote controls and electronic devices should be cleaned daily. Cleaning should be more frequent depending on the number of people using the space, whether they are entering and exiting the setting and access to handwashing and hand-sanitising facilities.

Suitable hand washing facilities should be available including running water, liquid soap and paper towels or hand driers. Hands should be cleaned after removing PPE or handling contaminated surfaces or laundry.

It is not necessary to wear additional PPE or clothing over and above what would usually be used.

14.5 Waste

Waste visibly contaminated with respiratory secretions from a person with suspected or confirmed infection should be sealed in a waste bag before removal from the accommodation and placed into a waste bin as soon as possible. There is no need to store waste for a time before collection. Dispose of routine waste as normal.

Waste produced by healthcare should follow appropriate guidance in the National Infection Prevention and Control Manual.

Laundry

Wash items in accordance with the manufacturer’s instructions. Use the warmest water setting and dry items completely. If water-soluble (alginate) bags are available, use this to transport laundry from the individual’s accommodation to the washing machine. Used laundry that has been in contact with an unwell person can be washed with other people’s items. To minimise the possibility of dispersing virus through the air, do not shake used laundry prior to washing.

Question 15

15. Risk assessment for staff exposures in the workplace

Accepted Answer

All staff who come into contact with COVID-19 cases – whether or not they are protected by the use of PPE or by other risk mitigation measures – should remain vigilant to the possibility of contracting infection and follow the guidance for People with symptoms of a respiratory infection including COVID-19 if they develop COVID-19 symptoms.

Advice about whether a risk assessment is needed may be sought from the HPT.

The HSE provides advice for workplaces.

This guidance is of a general nature and should be treated as a guide. In the event of any conflict between any applicable legislation (including the health and safety legislation) and this guidance, the applicable legislation shall prevail.

Cookies on GOV.UK

This guidance was withdrawn on 3 April 2023