V1.5 11.01.2021

1

PHE North West Pathway for Testing in Acute Respiratory Illness (ARI) Care Home Outbreaks

Contents

PHE North West Pathway for Testing in Acute Respiratory Illness (ARI) Care Home Outbreaks .... 1

Background .............................................................................................................................. 2

National Testing Service / Pillar 2 PCR and Lateral Flow Device Testing (DHSC)........................... 3

Symptomatic criteria: ............................................................................................................... 3

Key points: ............................................................................................................................... 4

PHE Care Home Testing Pathway .......................................................................................................... 6

Governance:............................................................................................................................. 6

Stage 1: Detection of a new outbreak ....................................................................................... 7

Stage 2: Arranging test swabs (round one whole home testing) ................................................. 8

Stage 3: Care home carries out swabbing .................................................................................. 8

Stage 4: Reporting of results ..................................................................................................... 9

Stage 5: Repeat testing for negative residents and staff (round two testing) .............................. 9

Stage 6: Reporting of round two results .................................................................................. 10

Stage 7: Testing symptomatic residents between days 7 and 28 .............................................. 10

Stage 8: Day 28 whole home testing (day one of pillar 2/DHSC routine testing) ........................ 11

Appendix 1: Pathway algorithm for PHE NW ARI Care Home Outbreak Testing ........................ 12

Appendix 2: Pathway algorithm for PHE NW Round Two COVID-19 Testing only ...................... 13

Appendix 3: ILOG Request Form ............................................................................................. 14

Appendix 4: PPE Requirements for Collection of Nose and Throat Swabs ................................. 14

Appendix 5: Escalation of Issues ............................................................................................. 17

Appendix 6: Frequently Asked Questions ................................................................................ 18

Appendix 7: Relevant Guidance .............................................................................................. 19

V1.5 11.01.2021

2

N.B. This pathway went live on 1st December 2020.

Background

On 15th April 2020, the Department for Health & Social Care published its COVID-19 action plan for adult

social care. At the point of notification of a COVID-19 outbreak all symptomatic care home residents in the

North West have been offered COVID-19 testing via the Public Health England (PHE) testing pathway since

April 2020.

Since the week commencing 20th of July 2020, this offer was extended to whole home COVID-19 testing at

the point of notification of a possible or confirmed COVID-19 outbreak. This has included all residents and

asymptomatic staff (symptomatic staff should be isolating at home and therefore accessing testing via the

NHS online portal). Any residents or staff who test negative in the first round may be offered a further test

on day 4-7.

On 5th November 2020, Guidelines on the Management of Outbreaks of Influenza-Like Illness (ILI) in care

homes was published. This highlighted how COVID-19 and Influenza testing should be used in suspected

ARI outbreaks.

Aim: To test all residents and asymptomatic staff for COVID-19 and to test the most recently

symptomatic residents for Influenza A and B (up to a maximum of 5 residents) if influenza is clinically

suspected. This will be offered at the point a risk assessment by a CICN/LA team (or the HPT out of hours)

has determined there is a possible care home outbreak of ARI in the care home.

1. An outbreak of Acute Respiratory Illness (ARI) is: Two or more cases that meet the clinical case

definition of ILI or COVID-19 (see page 3) arising within the same 14-day period in people who live

or work in the care home.

• Round one COVID-19 testing (day 1): all residents and asymptomatic staff in a care home with a

new outbreak (+/- testing of up to 5 most recently symptomatic residents for Influenza A and B)

• Round two COVID-19 testing (day 4-7): any residents or staff who tested negative in round one

• If an outbreak is suspected or confirmed, the offer of COVID-19 testing should be made to the

whole home, including all units and sites. If this is not feasible, this should be discussed with the

PHE HPT before triggering the testing pathway.

• Residents who become symptomatic after round two of COVID-19 testing while the COVID-19

outbreak is still ongoing (i.e. within 28 days of symptom onset in the most recent case) can be

tested for COVID-19 as a symptomatic individual via this testing pathway as part of the outbreak

response.

• Staff members who become symptomatic after round two of COVID-19 testing and while the

outbreak is still ongoing (i.e. within 28 days of symptom onset in the most recent case) should

immediately self-isolate and get tested for COVID-19 via the NHS online portal.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/879639/covid-19-adult-social-care-action-plan.pdfhttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/879639/covid-19-adult-social-care-action-plan.pdfhttps://www.nhs.uk/conditions/coronavirus-covid-19/testing-and-tracing/get-an-antigen-test-to-check-if-you-have-coronavirus/https://www.gov.uk/government/publications/acute-respiratory-disease-managing-outbreaks-in-care-homeshttps://www.gov.uk/government/publications/acute-respiratory-disease-managing-outbreaks-in-care-homeshttps://www.nhs.uk/conditions/coronavirus-covid-19/testing-and-tracing/get-an-antigen-test-to-check-if-you-have-coronavirus/

V1.5 11.01.2021

3

• If all staff and residents test negative for COVID-19 in round one, round two COVID-19 testing may

not be necessary. A risk assessment should be conducted to determine if COVID-19 is still likely, and

if so, round two COVID-19 testing should be requested following the process in stage 5.

• If there is a single symptomatic positive case of COVID-19 detected from pillar 2 testing, a local risk

assessment should be conducted to determine if there is likelihood of further COVID-19 cases

within the setting. Decisions to activate whole home testing based on a single confirmed COVID-19

case should be discussed with the PHE HPT before submitting the ILOG proforma.

National Testing Service / Pillar 2 COVID-19 PCR and Lateral Flow Device (LFD) Testing (Department of

Health and Social Care)

• The Community Infection Control Team/Local authority equivalent (CICN/LA) or Health Protection

Team (PHE HPT) remain the first point of contact for the care home to report a symptomatic

resident or residents and lead the risk assessment, provide case or outbreak management and

infection control advice to the care home. CICN/LA (in-hours) or HPT (out of hours) will coordinate

COVID-19 testing for the whole home (+/- testing of up to 5 most recently symptomatic residents

for Influenza A and B) when care homes first notify of a resident or residents with symptoms

compatible with ARI, to support immediate public health action.

• SAGE has advised weekly COVID-19 PCR testing of staff (clinical, domestic and kitchen staff,

including any agency staff working in the home or professionals visiting the home) and monthly

COVID-19 testing of residents, in care homes without outbreaks or symptomatic residents. All

testing in care homes without outbreaks is coordinated by the DHSC National Testing Service

(formally known as “pillar 2”) and accessed through registering with the online portal:

https://www.gov.uk/apply-coronavirus-test-care-home

• Weekly COVID-19 PCR testing of care home staff can continue during an outbreak. Round one and

round two COVID-19 PCR testing of staff and residents (see below) will be conducted via outbreak

testing. After this, care home staff can continue to be tested for COVID-19 weekly via Pillar 2.

• DHSC has also requested care homes to undertake 2 Lateral Flow Device (LFD) tests per staff

member per week, in addition to the weekly Pillar 2 PCR testing, ideally at the beginning of the

shift. One LFD test is taken at the same time and day as the PCR test and a second LFD test is taken

midweek between the PCR tests (3-4 days after PCR test). Staff that have worked elsewhere in

another health or care setting since their last shift in the care home or are returning from

annual/sick leave and have missed their weekly PCR test will need to undertake a LFD test

immediately before starting their shift.

• DHSC has organised the implementation of LFD testing and delivery of LFT kits, universal PCR test

kits and supplementing kit with care homes directly. If a single, positive COVID-19 case is identified

in tier 1,2 and 3 care homes via PCR or LFD testing then a risk assessment will be undertaken to

determine actions. However, if a resident or staff member has a positive PCR or LFD test result in

a tier 4 or above care home (all care homes during the period of national lockdown), daily LFD

staff testing should be undertaken for 7 days at the start of each shift, in addition to any regular

https://www.gov.uk/apply-coronavirus-test-care-home

V1.5 11.01.2021

4

and/or outbreak testing and IPC measures advised by the local CICT or PHE NW. This 7-day LFD

testing is one-off help to identify all asymptomatic COVID-19 staff cases and does not need

repeating if the care home gets another positive PCR result.

• All enquiries regarding DHSC Pillar 2 PCR testing and LFD testing should be directed to the national

helpline on 119.

Symptomatic criteria:

Covid-19:

• new continuous cough and/or • high temperature >37.8 • a loss of, or change in, normal sense of taste or smell (anosmia) in isolation or in combination with

any other symptoms

Other symptoms that may indicate COVID-19 in care home residents include:

• new onset of influenza-like illness

• worsening shortness of breath

• delirium, particularly in those with dementia

Influenza-like illness:

• An individual in the home has an oral or tympanic temperature of > 37.8°C AND

• One or more new respiratory symptoms: Cough (with or without sputum), hoarseness, nasal discharge or congestion, shortness of breath, sore throat, wheezing, sneezing OR

• An acute deterioration in physical or mental ability without other known cause

Presentations outside of these symptomatic criteria where the clinician or infection control nurse suspects COVID-19 or other ARI causes should be discussed with the Public Health England North West Health Protection Team (PHE HPT) via 0344 225 0562 before commencing testing.

Key points:

• This process is not obligatory and local systems that are already in place to carry out whole home

care home COVID-19 testing during an outbreak can be continued. However, it can be used when

local systems do not exist or as an alternative if preferred.

V1.5 11.01.2021

5

• COVID-19 outbreak testing (with 2 rounds of whole care home testing, using this pathway) is

offered at the point of notification (two or more residents/staff meeting the symptomatic criteria

or testing positive within a 14-day period). If new cases of COVID-19 occur 28 days after the onset

of symptoms in the most recent case this would be considered a new outbreak and testing of all

residents and staff would be undertaken via Pillar 1 at the point this new outbreak was notified.

• Symptomatic residents arising after round two of COVID-19 testing and before the outbreak is

declared over (28 days after the symptom onset in the most recent case) will also be tested by this

pathway (see stage 7)

• Negative test results should not result in local infection prevention and control measures being

lifted. These measures should continue due to the current national situation of sustained

transmission of COVID-19 in the community. CICN/LA systems should ensure IPC measures are

being implemented as appropriate.

• Care home staff who test negative for COVID-19 must still self-isolate if they develop symptoms at

any time and seek advice from the care home manager with support from the Infection Control

Team/ Public Health England. Care Home staff must also self-isolate if they are identified as a

contact of someone with COVID-19.

• It is understood that there may need to be changes to this pathway over time. If local arrangements change or you have any other feedback please send this to the PHE North West health protection

team via ICC.NorthWest@phe.gov.uk with the subject heading ‘Care Home Testing Feedback and

Questions’.

mailto:ICC.NorthWest@phe.gov.uk

V1.5 11.01.2021

6

PHE Care Home Testing Pathway

Governance: In hours (Monday – Friday, 9:00 – 17:00)

• Any suspected cases or outbreaks will be managed by the Community Infection Prevention and Control Teams or other Local Authority equivalent (CICN/LA). The CICN/LA will have responsibility for managing the issue including the testing pathway and communication of results to care homes as well as completing and returning the Minimum Data Set (MDS) to PHE North West.

• The CICN/LA is responsible for escalating health protection issues of concern by phone to PHE. This may include a high attack rate, high mortality rate or unusual presentations.

• When issues are escalated by phone PHE are responsible for reviewing the risk assessment with the CICN/LA, providing advice, agreeing future actions and agreeing the lead organisation for the situation.

Out of Hours (Monday – Friday after 17:00, Saturday-Sunday as per local arrangements)

• Out of hours arrangements vary by local systems, with some areas providing local cover over the weekend.

• When new cases or outbreaks arise out of hours, at a time when CICN/LA systems are not in place, PHE will assume responsibility for providing infection prevention and control advice until handing over to CICN/LA systems the next working day.

V1.5 11.01.2021

7

Stage 1: Detection of a new ARI outbreak

1. Detection may occur through any of the following routes:

a. Care home notifies PHE Health Protection Team (HPT)

b. Care home notifies local Community Infection Prevention and Control Nurses /Local

Authority (CICN/LA) contact

c. PHE HPT receives notification of infectious diseases form from a registered medical

practitioner

d. PHE HPT receives escalation of a positive COVID-19 result from the NHS Test & Trace system

(through PHE/NHS laboratory testing (formally known as pillar 1) or DHSC National Testing

Service testing (formally known as pillar 2)

2. The team receiving the notification of a suspected case or outbreak must ensure correct infection

prevention and control measures are immediately in place as per current North West and national

guidelines. Care homes should be advised not to wait for test results before implementing these

measures.

3. CICN/LA (in-hours) or PHE HPT (out of hours) to contact home and document*:

a. Total number of residents in home

b. Number of residents who meet symptomatic criteria and date of onset of symptoms (or

date of lab result if asymptomatic positive)

c. Total number of staff working in the home

And also, if the PHE North West Care Home ARI Outbreak Testing Pathway is being used: Advise

care home swabs will be sent from PHE lab either the same day (in-hours) or next working day (out

of hours)

*This is in addition to the usual minimum dataset if not already documented

4. Determine if an outbreak is occurring, i.e. has there been two or more symptomatic or new

confirmed ARI cases (residents or staff) within the past 14 days?

a. If there is a single symptomatic case only, a local risk assessment should be conducted to

determine if there is any suspicion of an outbreak. If there is no indication of an outbreak,

consider testing the symptomatic case using locally arranged processes. If there are no local

processes available, the PHE pathway can be used to test the individual for COVID-19 by

selecting the appropriate box on the ILOG proforma. Note that this will not be considered

‘outbreak testing’ at this stage and will not result in whole home testing.

b. If an outbreak is suspected (multiple symptomatic cases) or there are now 2 or more

confirmed cases within a 14-day period, continue the pathway to arrange whole care home

testing.

c. If new positive COVID-19 cases have been detected from recent routine whole home

testing via Pillar 2 PCR/LFD DHSC testing (i.e. tests were conducted in the past 5 day),

progress to round two COVID-19 testing by selecting the appropriate box on the ILOG

proforma. (see appendix 2 ).

d. If positive COVID-19 cases have been detected in staff only from routine weekly staff

testing, progress to round one whole home testing

V1.5 11.01.2021

8

Stage 2: Arranging test swabs (round one whole home testing)

Care home requests for testing will be processed by CICN/LA contacts (in-hours) or PHE HPT (out of hours)

Monday – Sunday, 09:00 – 17:00. Requests outside of these hours will be logged and handed over to

either the CICN/LA (in-hours) or PHE HPT (out of hours) day team for follow up the next day.

1. CICN/ LA (in hours) or PHE HPT (out of hours) to complete ILOG request form and email to PHE

Laboratory Manchester AND COVID19ilogs.NorthWest@phe.gov.uk

a. PHE HPT requests should copy in CICN/LA team email address

b. CICN/LA requests should copy in COVID19ilogs.NorthWest@phe.gov.uk

c. Do not include patient identifiable information on the ILOG form. This is not required to

complete the ILOG request.

2. PHE Laboratory Manchester will reply all to requester with ILOG number

3. PHE Laboratory Manchester will arrange for an appropriate number of swabs (one for each member

of staff and each resident declared) to be couriered to the care home. In addition, the swabs sent will

include up to 5 swabs to be used to swab recently symptomatic residents for Influenza A and B and

these will be clearly marked as such.

Stage 3: Care home carries out swabbing

1. Care home staff will carry out nose and throat swabbing of residents. Care home staff (clinical,

domestic and kitchen staff, including any agency staff working in the home where this is practically

possible) should self-swab. Swabbing instructions will be included with test kits. It is important that

only swabs from the PHE laboratory are used for testing via this pathway. DHSC or “pillar 2”

testing uses a different swab, which cannot be substituted for testing through the PHE laboratory.

2. For care homes who are unable to carry out swabbing of residents themselves, CICN/LA systems

may need to offer alternative methods.

3. The PPE requirements for swabbing are as outlined in table 2 of the national guidance (appendix 4)

a. Gloves (single use)

b. Disposable plastic apron (single use)

c. Fluid resistant (type IIR) surgical mask (single or continuous use)

d. Disposable or reusable eye protection (single or continuous use)

4. Care Homes should identify the most recently symptomatic residents and swab up to 5 of these

residents with the swabs marked for this purpose. These swabs will also be tested for Influenza A

and B.

5. Swabs are appropriately labelled, packaged and sent back with the courier to PHE lab for testing.

Please remind the care home to ensure the ILOG is added to all forms and check the completeness

and accuracy on both the form and specimen pot, including ensuring the name/DOB and patient

address fields are completed. Wherever possible, care homes should collect all swabs needed for a

mailto:COVID19ilogs.NorthWest@phe.gov.ukmailto:COVID19ilogs.NorthWest@phe.gov.ukhttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878750/T2_poster_Recommended_PPE_for_primary__outpatient__community_and_social_care_by_setting.pdf

V1.5 11.01.2021

9

full round of testing (even if it takes up to 24 hours to collect all samples required) before calling the

courier to collect the samples.

Stage 4: Reporting of results

Results will only be reported from CICN/LA to the care home Monday-Friday, 09:00 – 17:00. Results

received outside of this time will be reported to the care home by CICN/LA the next working day.

1. The CICNs/LA will be informed of the results (both positive and negative). The COVID-19 results

feed into SGSS results which go through to Test & Trace.

COVID-19 and influenza test results will be sent to CICN Teams on a daily iLOG line-list

spreadsheet. The PHE HPT will also contact the CICN team by telephone in the event of there being

any positive influenza results for a care home to enable early activation of antiviral pathways and

provide support if required. If the HPT are unable to make contact by this route the HPT will follow

up by email to both the CICN team and the LA SPOC to ensure that the notification is received in a

timely manner. At the point of notification, the HPT will advise on whether antiviral prescribing is

recommended, so that further action can be taken with the Care Home.

2. CICNs/LA will contact care home and explain results. Care homes should not contact the laboratory

directly to request results. At weekends and bank holidays, positive COVID-19 and influenza results

will be sent back to the care home via the email provided on the iLOG form. All results (both

positive and negative) will also be sent to CICNs/LA for onward communication with the care home

during normal working hours as appropriate.

3. CICN/LA can either share residents’ results with the residents’ GPs or send the relevant line list to

the care home manager and request the manager to share with the residents’ GPs.

Stage 5: Repeat testing for negative residents and staff (round two testing)

A further round of COVID-19 testing is available on day 4-7 where it is identified that the source of the

outbreak was COVID-19, so for any residents or staff who:

1. Tested COVID-19 negative in round one*

2. Tested COVID-19 inconclusive or invalid in round one

3. Not COVID-19 tested in round one

*If all residents and staff test negative for COVID-19 in round one and there have been no issues of

concern (or the results are suggestive of an influenza outbreak), it may be decided at this stage to cancel

round two testing.

Round two of COVID-19 testing can also be undertaken when care homes identify new COVID-19 positive

results in residents from routine whole home testing via pillar 2, and this testing has occurred within the

past 5 days. In this case, CICN/LA can request the laboratory to commence round two COVID-19 testing

only (see appendix 2 and ILOG proforma). If asymptomatic COVID-19 positive staff members are identified

from Pillar 2 testing, this will not necessarily require whole home testing of all staff and residents providing

the staff member had no breaches of PPE. The member of staff must still be excluded for 10 days from the

V1.5 11.01.2021

10

date of the test, and the positive results should be discussed with the CICN/LA team (or HPT if out of

hours).

Stage 6: Reporting of round two results

This process will follow the steps outlined in stage 4

If a risk assessment at any time agrees this is no longer considered a COVID-19 outbreak, care homes can

immediately re-enter routine testing via pillar 2/DHSC as outlined in stage 8.

Stage 7: Testing symptomatic residents between days 7 and 28

Residents who become symptomatic after round two testing but before the end of the COVID-19 outbreak

(i.e. within 28 days after the onset of symptoms in the most recent case), can be tested for COVID-19 via

this pathway. CICNs/HPT can trigger testing for symptomatic individuals by submitting the iLOG request

form and stating the current iLOG number issued for the initial rounds of testing.

COVID-19 testing during this time should involve the symptomatic individual only, and not the whole

home. If there are concerns about a high attack rate or concerns relating to a possible flu outbreak where

testing may be indicated (including where antiviral medication may be considered as per flu guidance:

https://www.gov.uk/government/publications/acute-respiratory-disease-managing-outbreaks-in-care-

homes ), this should be discussed with the PHE HPT (0344 225 0562).

Results will be reported as outlined in stage 4.

https://www.gov.uk/government/publications/acute-respiratory-disease-managing-outbreaks-in-care-homeshttps://www.gov.uk/government/publications/acute-respiratory-disease-managing-outbreaks-in-care-homes

V1.5 11.01.2021

11

Stage 8: Day 28 whole home testing (day one of pillar 2/DHSC routine testing)

The Department of Health & Social Care will conduct routine COVID-19 testing of care homes not

experiencing outbreaks. This will re-start for residents when it has been 28 days since the onset of

symptoms in the most recent case of COVID-19 i.e. at the point where the outbreak is over. For staff,

weekly COVID-19 PCR testing can commence after round one and round two outbreak testing has been

completed. Staff LFD testing can continue during an outbreak.

Care homes should register with the DHSC portal to arrange COVID-19 testing via this route. From this

point onwards, as long as residents and staff remain asymptomatic, COVID-19 testing will be conducted via

DHSC/Pillar 2. This will involve weekly COVID-19 testing of care home staff and monthly COVID-19 testing

of care home residents. This testing process is available 7 days a week and care homes are encouraged to

use this on the weekends where possible.

The outbreak testing process will begin again if:

1. Two or more residents or staff members have a new positive COVID-19 result during routine testing

within a 14-day period

2. Two or more residents or staff members become symptomatic within a 14-day period

Enquiries regarding the National Testing Service should be directed to 119, or access information online

through the portal: https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested

https://www.gov.uk/apply-coronavirus-test-care-homehttps://www.gov.uk/guidance/coronavirus-covid-19-getting-tested

V1.5 11.01.2021

12

Appendix 1: Pathway algorithm for PHE NW ARI Care Home Outbreak Testing:

Any new symptomatic cases between completion of second round of whole care home testing and declaration of

outbreak being over can be tested for COVID-19 through original ILOG number by requesting further testing

through the ilOG form (see stage 7)

Please note - if wider respiratory testing is required outside of this pathway, this should be discussed with the PHE

NW Health Protection Team (HPT), a risk assessment will be completed, and laboratory requests will be submitted

by the HPT. For arrangements regarding flu test results please see page 9.

*Pillar 2 testing can be accessed via the Department of Health and Social Care online portal: https://www.gov.uk/apply-

coronavirus-test-care-home

https://www.gov.uk/apply-coronavirus-test-care-homehttps://www.gov.uk/apply-coronavirus-test-care-home

V1.5 11.01.2021

13

Appendix 2: Pathway algorithm for PHE NW Round Two COVID-19 Testing only

Any new symptomatic cases between completion of second round of whole care home testing and declaration of

outbreak being over can be tested for COVID-19 through original ILOG number by sending an email to request

testing to PHE laboratory (see stage 7)

Please note - if wider respiratory testing is required outside of this pathway, this should be discussed with the PHE

NW Health Protection Team (HPT), a risk assessment will be completed, and laboratory requests will be submitted

by the HPT.

*Pillar 2 testing can be accessed via the Department of Health and Social Care online portal: https://www.gov.uk/apply-

coronavirus-test-care-home

https://www.gov.uk/apply-coronavirus-test-care-homehttps://www.gov.uk/apply-coronavirus-test-care-home

V1.5 11.01.2021

14

Appendix 3: ILOG Request Form

iLog Request Form SITUATION REFERENCE NUMBERS (if known)

HP Zone situation number (if known): Current ILOG Number (if an existing outbreak):

REPORTING DETAILS

Request for testing made by: (Name, role and organisation)

Date request form completed:

CARE HOME DETAILS

Care home name, address and postcode:

Care home contact (name):

Contact telephone number:

Care home email address: Please ensure this is a work email address (e.g. an NHS.net account) as it will be used to share results during weekends and bank holidays

CARE HOME INCIDENT DETAILS

Number of COVID-19 positive cases (or symptomatic staff awaiting testing) associated with care home diagnosed in last 14 days:

Number of newly symptomatic residents who require testing:

TESTS REQUESTED

Number of symptomatic residents who require testing:

Number of asymptomatic staff and residents who require testing:

Total number of test kits requested for this round of testing: Please check this number and ensure it is correct for the type of testing being requested – see options below

SELECT WHAT TESTING YOU REQUIRE (Please select only one section) Please note this form is for care home testing only. Any testing requests that sit outside of these standard testing offers will require discussion with the Health Protection Team (Tel: 0344 225 0562) to review the risk assessment and support communication with the laboratory.

Testing for a single case (not linked to an existing outbreak*)

☐ Symptomatic resident only (COVID-19)

*This option should only be selected if this is a suspected single case and no other cases have been confirmed or suspected within the last 14 days.

Investigation of a possible or confirmed outbreak

Round 1 Testing

☐ Round one of whole care home COVID-19 testing (staff and residents) for a new suspected outbreak Please also tick the box below if you require influenza testing:

☐ Round one symptomatic influenza A/B testing (up to 5 symptomatic residents meeting case definition for Influenza-like illness) for a new suspected outbreak

V1.5 11.01.2021

15

Please email to clare.ward@phe.gov.uk; edward.cryer@phe.gov.uk; donna.johnson@phe.gov.uk; shahid.aslam@phe.gov.uk;

COVID19ilogs.NorthWest@phe.gov.uk; PLUS ADD IN LOCAL IPC TEAM.

All of the email addresses above must be cc’ed (whether the pathway is being triggered by a local IPC team or PHE on their behalf out of

hours). This is to ensure that all are aware the testing pathway has been triggered and can document this in their records.

Round 2 Testing

☐ Round two of whole care home COVID-19 testing for repeat testing of negatives 4-7 days after round one testing OR

☐ Round two of whole care home COVID-19 testing for repeat testing of negatives after recent whole home testing via Pillar 2 in last 5 days

Subsequent Testing of Newly Symptomatic Residents

☐ Newly symptomatic resident(s) only during an existing outbreak (COVID-19)

PHE HEALTH PROTECTION TEAM USE ONLY

☐ Request for symptomatic influenza A/B testing (up to 5 symptomatic residents) during an existing outbreak – following HPT risk assessment and discussion with duty consultant

Risk assessment completed Y/N Date

Rationale for testing

Number of symptomatic residents:

Total number of test kits requested (up to 5):

Please confirm this request has been reviewed by the HPT Duty Consultant/Team

LABORATORY USE ONLY

Probable mode of transmission (do not edit) NCOV For Laboratory use iLog number issued if it is a new outbreak, iLog number confirmed if it is an existing outbreak

mailto:clare.ward@phe.gov.ukmailto:edward.cryer@phe.gov.ukmailto:donna.johnson@phe.gov.ukmailto:shahid.aslam@phe.gov.ukmailto:COVID19ilogs.NorthWest@phe.gov.uk

V1.5 11.01.2021

16

Appendix 4: PPE Requirements for Collection of Nose and Throat Swabs

Full details on the required PPE can be found in the “How to work safely in care homes” document updated

in November 2020.

PPE required for testing:

• Disposable gloves (single use)

• Disposable plastic apron (single use)

• Fluid resistant (type IIR) surgical mask (single or continuous* use)

• Eye/face protection (single use or reusable face/eye protection/full face visor or goggles)

*Face masks and eye protection can be worn continuously until breaks, at which point they should be

removed and discarded.

A face mask should be discarded and replaced and NOT be subject to continued use in any of the following circumstances:

• if damaged

• if soiled (e.g. with secretions, body fluids)

• if damp

• if uncomfortable

• if difficult to breathe through

Eye protection should be discarded and replaced (or decontaminated if the item is re-usable) and NOT be subject to continued use in any of the following circumstances:

• if damaged

• if soiled (e.g. with secretions, body fluids)

• if uncomfortable.

When removing and replacing PPE ensure you are 2 metres away from residents and other staff

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/880094/PHE_11651_COVID-19_How_to_work_safely_in_care_homes.pdf

V1.5 11.01.2021

17

Appendix 5: Escalation of Issues

Issues regarding test kits only:

Contact the PHE Laboratory on 0161 276 6786 (Monday-Sunday, 08:00 – 20:00)

Health protection issues regarding care homes:

Contact PHE Health Protection Team on 0344 225 0562 (option 1).

Non-urgent feedback of testing process:

Contact PHE HPT via ICC.northwest@phe.gov.uk

mailto:ICC.northwest@phe.gov.uk

V1.5 11.01.2021

18

Appendix 6: Frequently Asked Questions

Can we activate the pathway based on a single case (as per the DHSC protocol)?

The PHE testing pathway is designed for outbreaks, defined as two or more suspected or confirmed ARU

cases. If a care home detects one suspected case, and there is no indication of an outbreak, the individual

should be tested to determine if they are COVID-19 positive. If a single case is confirmed COVID-19

positive, a local risk assessment should be conducted to determine if there is a suspicion of further cases or

an outbreak in the home. Activating the pathway based on a single confirmed COVID-19 case should be

discussed and agreed with the PHE HPT before submitting the request to the laboratory.

How do we manage persistent COVID-19 positive results?

Where staff and residents have tested positively previously, completed their isolation period – those

individuals should not re-join the regular asymptomatic testing for 90 days. If they develop new COVID-19

symptoms in this time, they should isolate and be tested again as this could be a new infection. See full

guidance in section 5 here: https://www.gov.uk/government/publications/covid-19-management-of-

exposed-healthcare-workers-and-patients-in-hospital-settings/covid-19-management-of-exposed-

healthcare-workers-and-patients-in-hospital-settings

Which staff members are included in whole care home testing?

Staff are defined as clinical, domestic, kitchen and bank / visiting staff. Testing should be prioritised for

those who normally live and work in the care home, in order to ensure tests are conducted and sent to the

lab as soon as possible. It is recognised that there may be difficulties in testing all staff at the required time

due to shift patterns, and bank staff may be tested more frequently if they work across several care

homes. A pragmatic decision should be made regarding testing of agency/bank/visiting staff using this

pathway, through their employers or through the NHS portal.

Do we have to test the whole home if only one unit is affected?

The pathway is designed to test the whole care home for COVID-19. This is to ensure any possible positive

COVID-19 results linked to the care home are detected.

Why are you advising testing of symptomatic residents when outside of an outbreak situation through

local pathways, when these were previously covered by the PHE whole care home testing pathway?

This is to ensure an outbreak is confirmed before progressing to whole home testing. The PHE testing offer

is now for whole homes rather than just symptomatic individuals as previously. Therefore, the pathway

should only be activated when there is a confirmed outbreak, which requires two or more symptomatic or

positive cases within a 14-day period.

When local processes are not able to provide testing in this context, the PHE laboratory can be used by

selecting the correct box on the ILOG proforma.

Who is responsible for reporting results of care home staff?

The PHE HPT will forward line lists of results to the CICN team. The CICN team will be responsible for

sharing these results with the care home. During weekends and bank holidays, positive results will be

emailed by the PHE HPT to the care home.

https://www.gov.uk/government/publications/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settingshttps://eur01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fpublications%2Fcovid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings%2Fcovid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings&data=02%7C01%7CCharlotte.Simpson%40phe.gov.uk%7C8e19e718b2064663739e08d86cfd2cf0%7Cee4e14994a354b2ead475f3cf9de8666%7C0%7C0%7C637379181917863970&sdata=TdZ0O%2FD%2Bnkp34eEuHZ2atv1mvIsFunEAVfVXVvARH%2Fo%3D&reserved=0https://eur01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fpublications%2Fcovid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings%2Fcovid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings&data=02%7C01%7CCharlotte.Simpson%40phe.gov.uk%7C8e19e718b2064663739e08d86cfd2cf0%7Cee4e14994a354b2ead475f3cf9de8666%7C0%7C0%7C637379181917863970&sdata=TdZ0O%2FD%2Bnkp34eEuHZ2atv1mvIsFunEAVfVXVvARH%2Fo%3D&reserved=0https://eur01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fpublications%2Fcovid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings%2Fcovid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings&data=02%7C01%7CCharlotte.Simpson%40phe.gov.uk%7C8e19e718b2064663739e08d86cfd2cf0%7Cee4e14994a354b2ead475f3cf9de8666%7C0%7C0%7C637379181917863970&sdata=TdZ0O%2FD%2Bnkp34eEuHZ2atv1mvIsFunEAVfVXVvARH%2Fo%3D&reserved=0

V1.5 11.01.2021

19

It can be determined locally whether staff members should receive their results directly from the CICN

team or the care home manager. However, as care home managers will need to understand self-isolation

advice for any positive COVID-19 staff cases, they will need to be aware of the individual results. This does

mean that care home managers may receive results for members of staff before they receive it personally.

In the event a staff member will not consent to this arrangement, they could access COVID-19 testing via

Pillar 2 as an alternative.

Who is responsible for stopping pillar 2 routine COVID-19 testing during an outbreak?

Care homes will be responsible for ceasing Pillar 2 testing COVID-19 for residents during an outbreak and

will need to register to recommence Pillar 2 testing on day 28. This can also be completed via the DHSC

portal. Weekly staff testing can re-commence:

• After round one and round two of COVID-19 outbreak testing or

• Re-commenced according to the normal schedule, if the outbreak is confirmed to be caused by

another respiratory pathogen such as influenza

What actions should be taken if a staff member refuses to be tested?

This testing is not mandatory: it is an offer extended to care homes to facilitate them organising ARI testing

for all residents and staff members in the context of an outbreak. The responsibility for discussing this with

staff will ultimately rest with the care home manager (although the CICNs may provide advice and support

in some cases). A staff member cannot be forced to engage in COVID-19 testing if they do not consent after

the care home manager has explained the rationale, and how testing will support the safety and wellbeing

of all staff and residents. If they decline to be tested, providing they are not symptomatic and are

complying with IPC measures, social distancing and PPE policy, the risk to other staff and patients would

likely be very low. If there is a refusal to comply with these measures, that may raise a significant concern

and it would be appropriate for the care home manager to address this, seeking support if appropriate.

https://www.gov.uk/apply-coronavirus-test-care-homehttps://www.gov.uk/apply-coronavirus-test-care-home

V1.5 11.01.2021

20

Appendix 7: Relevant Guidance

Admission and Care of Residents during COVID-19 Incident in a Care Home

How to work safely in care homes

Personal protective equipment use for non-aerosol generating procedures

Guidance for sampling and for diagnostic laboratories

Getting Tested

Influenza-like illness (ILI): managing outbreaks in care homes

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878099/Admission_and_Care_of_Residents_during_COVID-19_Incident_in_a_Care_Home.pdfhttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/880094/PHE_11651_COVID-19_How_to_work_safely_in_care_homes.pdfhttps://www.gov.uk/government/publications/covid-19-personal-protective-equipment-use-for-non-aerosol-generating-procedureshttps://www.gov.uk/government/publications/wuhan-novel-coronavirus-guidance-for-clinical-diagnostic-laboratorieshttps://www.gov.uk/guidance/coronavirus-covid-19-getting-testedhttps://www.gov.uk/government/publications/acute-respiratory-disease-managing-outbreaks-in-care-homes