Guidance for healthcare providers: healthcare workers with relevant travel, healthcare or household contact history
Updated 25 February 2020
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This publication is available at https://www.gov.uk/government/publications/novel-coronavirus-2019-ncov-guidance-for-healthcare-providers-with-staff-who-have-travelled-to-china/guidance-for-healthcare-providers-healthcare-workers-who-have-travelled-to-china
By healthcare worker (HCW), this refers to those who work in a healthcare setting within and outside the NHS who may come into contact with patients, including clinical administration staff, and care home staff. This also includes NHS staff where depletion of workforce as a result of a symptomatic case attending work would pose significant operational issues eg laboratory professionals.
1. Recommendations
It is important that the HCW should not attend a healthcare setting if there is a risk they could spread COVID-19. The three main ways through which HCW are at risk themselves are relevant travel, and healthcare or household exposures.
Recommendations regarding return to work for HCW in these categories of potential exposure to COVID-19 are set out below.
Healthcare providers should use their communication systems to message all staff in their organisation, stating that if a HCW has travelled to or transited through a specified country or area and has returned to the UK in the past 14 days, the HCW should:
- notify their line manager and occupational health manager immediately if they have already returned to work
- if not already at work, notify their line manager and occupational health manager before returning to work
The following table sets out the main ways a HCW may be exposed, and recommended actions:
| Type of exposure | Asymptomatic HCW with exposure within the past 14 days | 14 day work exclusion | Other actions | |
|---|---|---|---|---|
| Travel | 1 | Travel to specified Category 1 countries/areas | Yes | Self-isolation at home for 14 days after return to the UK |
| 2 | Travel to specified Category 2 countries/areas | No | Inform line manager and occupational health. No restrictions unless advised by occupational health, employers or local health protection team | |
| 3 | Contact with a confirmed case in any country | Yes | Self-isolation at home for 14 days after return to the UK | |
| Healthcare (in UK and overseas) | 4 | Exposure to healthcare settings (eg working in healthcare, admission or visit to hospital) in specified Category 2 countries/areas | Yes (from last healthcare exposure) | No other restrictions unless advised by occupational health, employers or local health protection team |
| 5 | Contact with a symptomatic possible case whilst wearing recommended PPE with no breaches | No | No restrictions | |
| 6 | Contact with a confirmed case whilst wearing recommended PPE with no breaches | No | No restrictions, but passive follow up for 14 days after last exposure | |
| 7 | Contact with a symptomatic possible case without wearing recommended PPE | No | Exclusion and self-isolation may be recommended in certain circumstances based on a risk assessment by occupational health, employers, or the local health protection team | |
| 8 | Contact with a confirmed case without wearing recommended PPE | Yes | Self-isolation at home for 14 days after last contact (HPT will advise on follow-up) | |
| Household or other setting outside of work | 9 | Contact with a possible case | No | Exclusion and self-isolation may be recommended in certain circumstances based on a risk assessment by occupational health, employers, or the local health protection team |
| 10 | Contact with a confirmed case | Yes | Self-isolation at home for 14 days after last contact (HPT will advise on follow-up) |
All contacts with a confirmed case in the UK will be risk assessed by the health protection team who will advise on exclusions and follow up of those HCWs in line with separate contact tracing guidance. Examples given above are listed as a general rule before such detailed contact tracing can be performed.
Any HCW with with relevant exposure history and compatible symptoms requires clinical assessment, and must notify NHS 111, or NHS direct in Wales, or NHS 24 in Scotland, or Out of Hours GP service in Northern Ireland before notifying their employer.
The ’14 day work exclusion’ relates to work within healthcare premises, and for many staff there could be opportunities for home working that healthcare provider organisations may wish to explore.
2. Self isolation at home
Refer to the advice sheet for home isolation and advice sheet for people who live in the same accommodation as the patient.
3. Occupational health advice
HCWs whose possible exposure does not require exclusion from work should be advised:
- that they can continue to practice or work as normal while asymptomatic*
- that they need to monitor their own health and make phone contact with the healthcare service using standard routes such as NHS 111 (as detailed above) if they become unwell
- they need to inform occupational health and their line manager if they become symptomatic and need be excluded from work
The HCW may use standard routes such as NHS 111 if they become unwell, or providers may choose to provide a direct point of contact.
Occupational health or senior managers may need to reassure work colleagues if they have been in contact with the HCW in work setting.
*Exclusion and self-isolation may be recommended in certain circumstances based on a risk assessment by occupational health or the local health protection team.
4. Return to work for HCWs who have been excluded from work
HCWs can return to work after 14 days if they have never had symptoms, or have had symptoms, tested negative, and their symptoms have resolved. If they are still symptomatic at the end of 14 days, they should be assessed on a case by case basis. Public Health England (PHE) can be contacted for individual advice by their occupational health department.
HCW who initially were not excluded from work, but who subsequently developed symptoms and tested negative, can return to work once these symptoms have resolved. If they develop new symptoms and are within 14 days of their exposure, they need to be reassessed.
5. Household members of HCWs caring for suspected or confirmed COVID-19 cases
Household members of HCWs who are caring for patients with suspected or confirmed COVID-19 do not need to self-isolate and have no restrictions on any of their activities.