Guidance

[Withdrawn] Recommendation 1: reduce physical distancing in low risk areas for elective procedures or planned care

Updated 19 October 2021

This guidance was withdrawn on 22 April 2022

The information in this document has been superseded by Infection prevention and control for seasonal respiratory infections in health and care settings (including SARS-CoV-2) for winter 2021 to 2022.

Where changes are made locally to COVID-19 control measures, organisations are responsible for undertaking appropriate risk assessments, approved through local governance processes, to ensure that patient and staff safety is not compromised. For example, consideration of local factors, such as infection prevalence, patient mix and bed availability, need to be considered for the management of contacts of confirmed cases of SARS-CoV-2.

Context

Physical (social) distancing is one of a number of public health control measures designed to reduce the transmission of SARS-CoV-2 and includes regulating the number or flow of people attending gatherings and maintaining distancing in public or workplaces. Since April 2020, healthcare providers have been required to observe 2 metre physical distancing in all areas, which has meant, for example, that there are fewer beds in inpatient areas.

Recommendation

A reduction of physical distancing from 2m to 1m with appropriate mitigations, such as the continued use of face coverings/masks, in clinical areas where patient admission is planned/scheduled (for example elective surgery or procedures) can be implemented. This reduction in physical distancing will only apply to clinical areas where patients are asymptomatic, not a contact of a suspected/confirmed case of COVID-19 and have a negative test for SARS-CoV-2 and fully vaccinated. Staff working in low risk areas will also need to be fully vaccinated, asymptomatic, and follow the guidance for exposed staff COVID-19: management of staff and exposed patients or residents in health and social care settings.

Providers of healthcare will need to undertake local risk assessments to include the hierarchy of controls, to identify where physical distancing can safely be reduced, and this decision will need to be based upon factors such as the configuration of wards/departments, controlled access, ventilation etc. Health building notes give best practice guidance on the built environment in healthcare including information on optimal spacing and IPC.

Clear information will need to be provided to patients and visitors on the changes to physical distancing prior to planned or elective admission/procedure and on admission, and what this means to them, in order to comply with the duty of candour. Face coverings will still be required. The importance of hand and respiratory hygiene should be emphasised.

Physical distancing of 2 metres remains in place as standard practice in all health and care settings in COVID-19 high risk patient pathways, unless providing clinical or personal care and wearing appropriate PPE.

The Code of Practice on the prevention and control of infection and related guidance (2015) expects providers of regulated activities to have systems to manage and monitor the prevention and control of infection.

Evidence

The Scientific Advisory Group for Emergencies (SAGE) has stated that the effects of distance are evident in contact tracing data and that some recent data suggests risk at one metre is not significantly higher than 2 metres where people are passive and face coverings are worn.

The World Health Organization (WHO) states that physical distancing of at least one metre remains a key infection prevention and control intervention and public health and social measure to reduce the transmission of SARS-CoV-2.

The UK Health Security Agency has consulted a range of clinicians and IPC specialists on changing advice on physical distancing and they are supportive of the change to enable the NHS to increase elective capacity.