Guidance

Guidance for NHS clinicians on home isolation of a patient whilst being tested for SARS-CoV-2

Updated 28 February 2020

This guidance was withdrawn on 12 March 2020

This content has been superseded by information in COVID-19: stay at home guidance

1. Background and scope

This guidance provides advice for individuals who are awaiting results from diagnostic testing for novel coronavirus (SARS-CoV-2) and do not require admission to hospital.

Isolation of individuals awaiting results in their own home will be decided on a case-by-case basis by the individual’s clinician(s) and the local Health Protection Team (HPT), following a discussion about the suitability of self-isolation in the home.

2. Suitability of the intended accommodation

The accommodation is not more than 60 minutes away by road from a hospital and, if a multiple occupancy dwelling, that unexposed residents would not be at risk of exposure to the person being self-isolated at home.

Consider whether any other occupants of the same dwelling are particularly vulnerable including chronic illness, immunosuppression, pregnant, infants and those over 65 years.

Ensure that there is a working contact number for the person being isolated, and if there are other people in the same residence that one additional person’s phone number is working.

Ensure that the individual can adhere to the requirements of self-isolation; for children or those who lack capacity, this may mean confirming that the parent, guardian or carer is capable of following and happy to abide by the requirements and recommendations.

A checklist has been provided in this guidance to support the Health Protection Team in their assessment.

For patients living in houses of multiple occupation (HMO), such as university halls of residence, particular considerations are listed in the checklist.

3. Arranging suitable transport between the hospital and home

The overall aim is to ensure others are not exposed to a potentially infectious patient when this individual travels from the hospital to their home or accommodation. The principles are:

• public transport and taxis are not acceptable

• walking home is not acceptable

• if the individual has driven in their own car to the hospital and feels well enough to drive home, this is acceptable

• if the individual is accompanied by someone with their own car and it is determined that the person has already had significant exposure, they may drive the individual home if they are content with this arrangement

If the above transport options are not feasible, the hospital will need to consider admission, adhering to the recommended infection prevention and control guidance for COVID-19. If admission is not possible, then the hospital should request an ambulance to take the individual home, informing the ambulance controller that the individual is under investigation for COVID-19 and therefore infection prevention and control measures must be applied.

4. Instructions for individuals under home care and isolation

Recommendations in the advice leaflets which are marked with an asterisk (*) may be difficult to apply if the person to be isolated is a young child or has other impairments which may impact on their capacity to adhere to guidance. Use professional judgement to decide whether it is appropriate to make each of those recommendations, on a case-by-case basis.

Advise the case, the parent, guardian or caregiver, as appropriate, of the requirements for self-isolation at home. These requirements are listed in the advice leaflets.

Home isolation should only be arranged when the following recommendations can be satisfied.

5. Checklist to assess whether residential accommodation is suitable for home isolation

• patient is considered by clinician to be well enough not to require admission to hospital

• patient and or responsible person have capacity to understand instructions and advice

• at least one working phone number (patient and other member(s) of the household), checked and working

• access to secondary care – no more than 60 minutes’ travel time by road

• if the patient lives in an HMO, can exposure of other residents be minimised sufficiently?

Points for consideration include:

1. can the tested patient be temporarily accommodated elsewhere, to promote self-isolation, pending results (for example if university students)?

2. if the patient needs to stay in their HMO, can their housemates temporarily relocate?

3. if more than one person in the same location (such as university halls of residence) is awaiting their results, can they be cohorted?

4. are any housemates particularly vulnerable (for example immunocompromised), requiring special consideration?

5. if patient and housemates cannot be accommodated separately, what guidance can be issued to both patients and housemates to reduce the chance of transmission?

6. risk assessment made if occupants of the same dwelling are particularly vulnerable to infection, for example, those with a chronic illness, immunosuppression, pregnant, infants and those over 65 years.

5.1 Main criteria

• individual room to sleep in (single occupancy)

• facilities for hand hygiene using soap, water and paper kitchen towel

• sufficient toileting facilities that the patient can have their own, or it will be feasible that shared facilities can be adequately cleaned between use

• sufficient cutlery, crockery and utensils to avoid sharing with other residents*

• sufficient facemasks, tissues, kitchen towel, waste disposal bags*

• sufficient cleaning materials*

• area in which waste or laundry can be temporarily and safely stored securely

• support for getting groceries, prescriptions, and other personal needs

*enough supplies for 48 hours

Written advice provided:

• contact details for designated medical contact provided

• advice for the patient about self-isolation requirements

• advice for other members of the household, if applicable