Infection prevention and control
There are a range of key practices that providers should consider in relation to hygiene and the prevention and control of the spread of infection.
The provider must undertake appropriate and thorough cleaning of the premises prior to reopening where necessary, including areas that may have been closed or out of use for a number of weeks. This may need to be undertaken in conjunction with the owner or manager of the premises.
All cleaning should be carried out in accordance with COVID-19 – guidance for non-healthcare settings (which includes advice on, amongst other things, detergents/ cleaning products) and Infection Prevention and Control in Childcare Settings guidance.
This should be an extension of the cleaning regime normally used in childcare settings, with touchpoints such as table-tops, chairs, doors, light switches, banisters, equipment sinks, and toilets cleaned more regularly. There should be routine cleaning and disinfection of touchpoints such as door handles and hard surfaces as detailed in the table below. This should include equipment for staff use (e.g. telephones, desks, handles, keyboards, door handles, kettles, and tables).
Careful consideration should be given to the cleaning regime for sensory rooms and soft play areas, to ensure safe use.
Settings must ensure their cleaning practices for toys and soft furnishings reflect the requirement at each protection level:
Table 1: enhanced cleaning requirements by protection level
Level 0 and below
Level 4/Stay local
Soft furnishings (such as throws and bedding) should be laundered in accordance with usual cleaning schedule.
Soft furnishings (such as throws and bedding) should be laundered frequently - as a minimum weekly.
Soft furnishings such as throws and bedding should be used for individual children. If shared they should be laundered between use. If individual, they should be laundered frequently and as a minimum weekly.
Toys and equipment that children access should be cleaned daily or, if groups of children change during the day, on a sessional basis
At least twice daily cleaning and disinfection of frequently touched objects and hard surfaces.
Water and playdough should be replaced daily or, if groups of children change during the day, on a sessional basis.
If soft furnishings (such as throws and bedding) have been used by a child who shows symptoms of COVID, they should be removed and laundered as quickly as possible.
Settings should continue to emphasise the importance of good hand hygiene.
Lead-in time for adapting to change in protection level: as soon as the protection level increases.
Children should be discouraged from bringing items from home to the setting. We recognise however that some children may require a transitional item as a comforter and consideration should be given as to how to safely manage this to ensure children are supported in their transition to the setting.
Table 2: sharing of resources (such as story bags) between setting and home
Level 0 and below
Level 4/Stay local
Settings can share resources between setting and home.
Settings should restrict the sharing of resources between setting and home.
There must be no sharing of resources if there is a positive case in the home or an outbreak in the setting. A cluster or outbreak of COVID-19 occurs when a school has two or more confirmed cases of COVID-19 within 14 days. The local health protection team should be notified. If a plausible transmission link between two or more cases is identified within the school setting, this is indicative of an ‘outbreak’; if not, it is referred to as a ‘cluster’. The outbreak will be ‘closed’ by the local health protection team.
The setting should emphasise to families the importance of good hand hygiene when handling resources that are shared with/by the setting.
Lead-in time for adapting to change in protection level: as soon as the protection level increases.
Evidence on fomite transmission has continued to evolve and Public Health Scotland have now advised that we can remove from guidance the requirement to quarantine items returned from home for 72 hours. Enhanced hand hygiene, as set out later in this section, should be adhered to by all staff, children and families and is a more proportionate way of reducing the risk of fomite transmission. (Fomites are objects or materials which may carry infection.)
If children need to bring school-bags or other personal items to the setting, arrangements should be made to manage storage of these items safely in cloakrooms or other area in order that they are not brought into and used within the children’s play and activity areas.
Outdoor play equipment and resources should be included in any cleaning regime.
Careful consideration should be given to the cleaning regime for sensory rooms and soft play areas, to ensure safe use. Where the school age childcare service has access to a school gym or resource area a cleaning schedule for these areas and equipment within them should be agreed with the school. Soft toys should also be removed or washed after use by each child/cohort.
Surfaces in eating areas should be wiped down and disinfected in between each cohort of children.
Cleaning of staff areas should be an integral part of the overall cleaning strategy. Staff should use their own cup/cutlery and ensure these are cleaned straight after use.
All crockery and equipment used should be cleaned with general-purpose detergent and dried thoroughly before being stored for re-use.
There is not a requirement to use fog, mist, vapour or UV (ultraviolet) treatments in childcare settings to help control the spread of coronavirus. Should a provider choose to use one of these it is important these are used appropriately. Any use of these treatments for these purposes should form part of your COVID-19 risk assessment and clear rationale would be required through risk assessment as to whether such devices would be appropriate. Users must be competent and properly trained. These treatments can be used in a larger space or room in addition to enhanced cleaning and disinfecting, but not as a substitute.
Disinfectants applied as a fog, mist or vapour may reach harmful levels during delivery and UV systems may cause eye/skin damage if people enter an area undergoing treatment. People should not enter rooms being treated by UV or disinfectants applied as fog, mist or vapour. Discuss with suppliers what safety features they can provide to prevent inadvertent access to a room during treatment, for example hazard-monitoring sensors.
Locking rooms during the treatment will help to contain the emissions but other measures such as taping of doorway gaps or plastic screening off of some areas of the room may also be required. Good ventilation will also help clear the disinfectant after the treatment if this can be controlled from outside of the room.
Up-to-date guidance on the use of fog, mist, vapour or UV (ultraviolet) treatments is available from the Health and Safety Executive.
Temperature and ventilation
In its advice published on 3 March, the Advisory Sub-group recommended, that greater emphasis should be placed on ventilation, by keeping windows open as much as possible, and doors open when feasible and safe to do so. A card with ventilation advice for everyone at work can be found here: ventilation advice card. Settings may find it helpful to display this to remind staff of how to help ensure effective ventilation.
Settings should ensure that risk assessments are updated appropriately for the season, to consider issues around ventilation and heating/warmth that are relevant to their specific environments. They should consider areas of the setting where air flow (including pockets of stagnant air in occupied spaces) and/or temperature may be problematic, and the strategies that may be used to address these issues and mitigate risks appropriately.
The primary effective method of increasing natural ventilation remains the opening of external doors, vents and windows. All settings must ensure the opening of doors and windows to increase natural ventilation where it is practical, safe and secure to do so, while maintaining appropriate internal temperatures.
Potential approaches to help achieve an appropriate balance of ventilation and internal temperature in the colder months may include:
- partially opening doors and windows to provide ventilation while reducing draughts
- opening high level windows in preference to low level windows to reduce draughts
- refreshing the air in spaces by opening windows, vents and external doors at times which avoid user discomfort (e.g. between sessions or when children are outdoors)
The suitability of solutions will depend on a range of local factors including building type, occupancy patterns and weather conditions.
All settings must ensure as a minimum, that adequate levels of ventilation are provided in line with existing guidance (Care Inspectorate “Space to Grow”, and the Workplace (Health, Safety and Welfare) Regulations 1992).
For all settings, an adequate level of ventilation is likely to be indicated by a CO2 concentration of no greater than 1,500 ppm as measured by a CO2 monitor. Where settings have a CO2 monitor we advise you use this to assess your setting periodically.
For the private and voluntary sector, a minimum temperature of 16 C is required under the Workplace (Health, Safety and Welfare) Regulations 1992.
In local authority settings where School Premises Regulations apply, the minimum ventilation rate in a nursery classroom is 2 air changes per hour and minimum temperature is 17 C.
Keeping doors open (with appropriate regard to safety and security) may also help to reduce contact with door and window handles. However, internal fire doors should never be held open (unless assessed and provided with appropriate hold open and self-closing mechanisms which respond to the actuation of the fire alarm system). The Fire Safety Risk Assessment should always be reviewed before any internal doors are held open.
In her statement to parliament on 3 August 2021, the First Minister stated that there would be a renewed focus on the importance of ventilation in childcare settings to reduce the risk that the virus could be present in concentrated amounts.
We are therefore working with local authorities to ensure that all day care of children services have access to CO2 monitoring, whether via mobile or fixed devices. This is to support the goal of all spaces within settings being assessed for ventilation issues, with a view to remedial action being taken.
The primary role for local authorities will be to purchase devices for all settings in their area. Local authority teams will work with providers known to the authority wherever possible. However daycare of children services that are not funded to provide statutory ELC should contact their local authority to arrange provision of devices. Relevant contacts have been shared in a provider notice, and are included in the co2 chapter of the 'Early Learning and Childcare' guidance document. Services will retain responsibility for the operation of the monitors (including staff training) and for recording relevant information about the assessment of spaces in the setting.
Services should ensure the information gathered as a result of these assessments are used to inform actions to improve ventilation where required. This may include, for example, remedial works where appropriate (e.g. accelerated maintenance to remedy unopenable windows or faulty ventilation) or providing further guidance to users (e.g. on regular opening of windows, etc.).
Local authorities have been asked to complete their assessments of local authority-controlled schools and ELC settings by the October half term – wherever possible, and subject to sufficient supplies of CO2 monitors being available for purchase. Additional funding is being made available to support this work.
Where it is not possible to keep doors and windows open, and centralised or local mechanical ventilation is present, systems should wherever possible be adjusted to full fresh air. If this is not possible while maintaining appropriate internal conditions, systems should be operated to achieve statutory requirements as a minimum. Where ventilation units have filters present, enhanced precautions should be taken when changing filters. Ventilation systems should be checked or adjusted to ensure they do not automatically adjust ventilation levels due to differing occupancy levels. HSE guidance on ventilation systems can be found on the HSE website.
Enhanced hand and respiratory hygiene
Arrangements should be implemented for enhanced hand and respiratory hygiene by adults and children in the setting.
Where possible, disposable paper towels, kitchen roll or hand dryers should be used. Where this is not practical, individual towels must be available for each child, and these must be laundered each day. There are a range of resources available from the NHS to encourage children with handwashing. NHS Education for Scotland (NES) has produced a video to demonstrate the correct way to wash your hands, called Washing hands with liquid soap and warm water.
Antibacterial hand gel is not recommended for children when soap and water is available. A Health Protection Scotland 2018 SBAR (Situation, Background, Assessment, Recommendation) on hygiene requirements in outdoor nurseries in Scotland states that the use of alcohol-based hand rubs (ABHRs) and non-AHBRs should be discouraged in children under the age of five.
Health Protection Scotland guidance on infection prevention and control in childcare settings advises that if there is no running water, hand wipes can be used. If wipes are being used in situations where running water is not available, it is recommended that hands are washed with soap and water at the earliest opportunity.
School age childcare services must ensure that handwashing facilities are accessible for children. They may wish to have a supply of antibacterial hand gel available to staff at the entrance to the setting. Staff should ensure enhanced hand hygiene measures are in place including washing their own hands and the hands of all children:
- ensure all staff and children frequently wash their hands with soap and warm water for 20 seconds
- handwashing should take place:
- on arrival at the setting
- before and after eating
- after using the toilet
- at regular intervals throughout the day
- when moving between different areas (e.g. between different rooms or between inside and outside), where the handwashing facilities are not near the entrance to the outdoor play area the service may wish to have a supply of hand gel at the door for children
- encourage children not to touch their face
- where appropriate, supervise children washing their hands and provide assistance if required
- never share water in a communal bowl when washing hands
- always dry hands thoroughly
- clear signage regarding the washing of hands after using the toilet should be displayed. Where appropriate, this should be agreed with the building owner or manager
- avoid using personal items (e.g. mobile phone)
- staff and children should cover the nose and mouth with a disposable tissue when sneezing, coughing, wiping and blowing the nose.
- dispose of all used tissues promptly into a waste bin, and ensure that bins are emptied regularly of waste
- If you don’t have any tissues available, cough and sneeze into the crook of the elbow and wash hands at the first opportunity
Guidance from Food Standards Scotland (FSS), which includes a risk assessment tool and checklist should be followed. Any setting wishing to provide a breakfast service should follow this risk assessment tool and checklist. Further advice around mitigating any issues identified by the risk assessment can be requested from the local environmental health team. Additionally, this Q&A from FSS may be useful. Assist FM have also produced updated catering advice.
It is advised that certain public health measures are implemented where practicable. This includes physical distancing, where measures fall into two broad categories:
- increasing separation
- decreasing interaction
It is essential that a holistic approach is maintained in caring for children and that care providers are alert to the range of emotions that many of the children attending during the pandemic may be experiencing. This means that it is important for everyone to anticipate children’s emotional needs when planning for staffing requirements as there may be additional challenges helping children navigate this difficult time. This will also be an anxious time for many of the staff too and it is essential that their health and wellbeing is considered.
In order to minimise risks of transmission, staff should remain physically distanced from children where possible. Prolonged periods where adults and children are in close proximity should be avoided, or if this is not possible, they should be limited as far as possible. Providers will wish to consider how the risk of close contact is mitigated. Considerations include taking into account the age group of the children concerned and the particular situation, including whether the contact is taking place indoors or outdoors.
The Strategic Framework for Reopening Schools and ELC states that it is not appropriate for young children or for some children with ASN to maintain the models of physical distancing that would be suitable for most older children, either practically or in terms of child development. In particular, it may not always be appropriate or possible to implement strict physical distancing between children or between a child and an adult.
Primary school age children are not required to physically distance from each other. Primary school age children should remain physically distanced from staff where possible. It is important however for children to feel secure and receive warmth and physical contact that is appropriate to their needs. Staff will need to be close to the children at times, particularly young children, and should feel confident to do so.
Secondary age children should maintain the appropriate physical distance from adults in the setting in order to reduce risks of transmission.
Settings should develop ways to support children to access toilets safely, promoting privacy and dignity, taking account of physical distancing principles.
Services should implement measures with a view to being able to ease them as soon as it is safe to do so, to ensure the maximum benefit to the child’s experience as soon as is practicable.
Distancing between adults in the setting (including parents at drop-off and pick-up times)
Physical distancing between adults remains a fundamental protective measure that should apply at all times. Individual physical distancing applies to staff, parents (and any other adults who may attend the setting) and any external contractors or delivery people. It is essential that all these groups are taken into consideration.
Following the review of physical distancing in Scotland, the First Minister announced in her statement to parliament on Tuesday 13 July that physical distancing measures will be slowly eased to enable us to operate in a less restricted way. When areas move down to Level 0 on 19 July, where there isn’t already a 1 metre rule in place, the physical distance requirement in indoor public places will reduce from 2 metres to 1 metre. The Advisory Sub-Group on Education and Children’s Issues provided advice at its meeting on 27 July on whether it was appropriate to make this change in childcare settings while Scotland remained in Level 0. The Sub-Group’s advice is that, while Scotland remains in Level 0, settings should continue to adhere to the 2 metres physical distance between adults.
However, when Scotland moves beyond Level 0, the physical distancing requirement for adults in childcare settings will be at least 1 metre. If settings already have 2 metre physical distancing arrangements that work well and do not limit capacity then they may retain these for logistical reasons.
Retaining two metres between adults who do not yet meet the criteria for exemption from self-isolation will help to reduce the risk that they are identified as a close contact. (The definition of a contact is explained in section 8 of Public Health Scotland’s contact tracing guidance.)
All staff rooms, canteens, bases and offices should be reconfigured to ensure the physical distancing rule is able to be maintained. Where there is not sufficient space to support distancing, for example in staff rooms, offices or work areas, risk assessments should be carried out, and consideration should be given to measures such as limiting the number of adults in any one space at any one time, staggering staff breaks, creating additional staff work or welfare areas, use of rotas to manage access to spaces, and the use of face coverings etc.
Learning from outbreaks across a range of sectors suggests that lapses in adherence to physical distancing can occur when staff take breaks from work and mix with colleagues outside or in staff rooms and other social areas. Staff should be reminded that the requirements to physically distance applies at all times, including during breaks and before and after sessions. The only exception to this is for staff who live in the same household, have formed an extended household in accordance with the guidance or where there are health and safety reasons why staff have to come within the required physical distance.
The experience of providers since reopening shows that use of physical distancing will reduce the overall number who need to isolate in the event of a child or staff member becoming ill with COVID-19.
Limiting children’s contacts
Now that we have moved to protection levels, the Advisory Sub-Group on Education and Children’s Issues have recommended that the size of cohorts can vary according to the protection level in which the setting is located.
Although the size of the group can vary with protection level, at all levels consistency of groups is important, and children should remain within the same groups wherever possible.
In protection Level 0 and below, there is no requirement to separate groups when they are outdoors. Settings should make as much use of outdoor space as possible as the risk of transmission is lower outside than it is in indoors. Groups can be mixed when outdoors where that makes it easier to maximise the time children spend outdoors.
The appropriate size of groups will depend on the age and overall number of children and the layout of the setting. The general approach should be to minimise the size of groups where possible. Large indoor groupings should be avoided.
Table 3: cohorting of children
Level 0 and below
Level 4/Stay local
The only restriction on group size is registration capacity.
To limit interactions children should be managed in consistent groups with a maximum size of 56.
To limit interactions children should be managed in consistent groups with a maximum size of 48.
To limit interactions children should be managed in smaller groups, at most equivalent to those in primary school classes – e.g. max 33.
Children should remain within the same groups wherever possible and should not mix freely with children in other groups. To avoid confusing children, this should apply when children are outdoors as well as indoors.
When settings are making decisions about exact cohort size (within the maximum specified above), they should consider the impact on the number of staff required to self-isolate when one or more person in the group tests positive.
Group sizes and the associated transmission risks should be reflected in the setting’s risk assessment. This includes in Level 0 and below where settings should demonstrate that they have considered the risks if they decide not to retain restrictions on group size.
Lead in time for adapting to change in protection levels: as soon as possible but no more than 7 days.
- staff members should work with the same groups wherever possible. While the size of groups may vary across protection levels, limiting the number of children, and the number of groups that a staff member is in contact with is important. Where cover is required for breaks, toileting etc, this should be managed within the staff working with a particular group. If staff are, through necessity, to work with other groups, this should be for limited periods, with appropriate risk mitigation measures adopted. Staff should ensure strict hygiene practices are carried out if they are caring for different groups
- the minimum space standards for school age childcare settings should be in line with the early learning, childcare and out of school care services: design guidance. In addition to this, consideration should be given to what additional space may be required to manage children and staff’s contacts. A flexible approach to the use of all existing spaces within the setting should be considered
- consideration should be given to the removal of unnecessary items in the setting to maximise capacity and decrease the number of items requiring cleaning, while ensuring the children still have adequate resources and furnishings to support quality experiences
- sharing of resources should be minimised. Where resources are used by different groups (e.g. on a rotational basis), cleaning between uses in accordance with requirements must be undertaken
School age childcare providers must keep clear records showing which adults and children spend sustained periods of time together in order to support effective practice in following Test and Protect protocols in the event of an outbreak.
Staff must ensure hygiene practices are carried out, and this is especially important if they are caring for different groups of children. Depending on the delivery model and attendance pattern of children a staff member may care for more than one group of children over the week.
Children who require additional support should be cared for in line with their personal plan which should be kept under review as public health measures evolve.
Limiting staff contact with each other
Just as reducing the number of interactions that children and staff have is a key part of reducing risk in settings, so too is reducing the number of interactions that staff have with each other.
When agreeing staff working patterns, settings are encouraged to maintain as much consistency as possible in the staff who work in close proximity, especially in areas where physical distancing is more challenging. While this may not always be possible, having the same groups of staff working together consistently across each week will reduce the risk of transmission among staff. It will also help to limit the number of staff who might need to self-isolate through Test and Protect.
The Advisory Sub-Group on Education and Children’s Issues has provided updated advice on the use of face coverings, in light of the latest scientific evidence and the advice of the World Health Organisation, which was published on 22 August 2020. A further update was published on 30 October 2020. The advice notes that the volume of evidence supporting the initial scientific position on a key benefit of face coverings (protection of others from infection by the wearer) has grown. There is also emerging evidence to suggest that the wearer of a face covering can be protected to some extent from infection by others.
Considering the changed position on infection and transmission rates in the community, the evidence and experience of settings re-opening between August and October 2020, and recent scientific evidence, the Sub-Group strengthened its advice on face coverings in 2020 to manage the main area of risk within schools and settings, which is adult to adult transmission. The need for compliance should be strongly reinforced, particularly in areas where lapses leading to incidents have been observed by public health teams (e.g. adult-to-adult distancing).
To align with the advice within the guidance for schools, face coverings should be worn in the following circumstances (except where an adult or child/young person is exempt from wearing a covering):
- by adults when they cannot physically distance from other adults and/or children and young people and when moving around the setting and in communal areas such as toilets corridors, offices and admin areas, break rooms (except when eating) and other confined communal areas (including staff rooms and toilets);
- by children of secondary school age (unless exempt) when in communal areas and when moving around the setting;
- by parents and other visitors to the setting (whether entering the building or otherwise), and should be strongly encouraged when parents/carers drop-off and pick-up their children
- in line with the current arrangements for public transport, where adults and children and young people aged 5 and over are travelling on dedicated transport
Face coverings are only one of the measures to suppress COVID-19 and these should not be used to substitute the other measures needed to contain the virus. Therefore, when wearing a face covering, good hand and respiratory hygiene and physical distancing between adults should still be enforced.
Where local decisions on the strengthened use of face coverings are made, it will remain vitally important to consider the potential impact on children and young people, including via the appropriate use of Equality Impact Assessments.
Some children may need additional support/reassurance about the reasons for adults wearing face coverings. The wellbeing and needs of the child should remain a focus of attention.
The use of face coverings could have an impact for children with additional support needs (which includes any level of hearing loss). These impacts should be carefully considered as communication for these children relies on the ability to see a person’s face clearly. This is also important for children who are acquiring English and who rely on visual cues to enable them to be included in play and activities. With this in mind, the wearing of transparent face coverings might be considered appropriate in some situations.
Clear instructions are provided to staff and children and young people on how to put on, remove, store and dispose of face coverings in all of the circumstances above, to avoid inadvertently increasing the risks of transmission. The key points are as follows:
- face coverings must not be shared with others
- before putting on or removing the face covering, hands should be cleaned by washing with soap and water or hand sanitiser if handwashing facilities are not available
- make sure the face covering is the right size to cover the nose, mouth and chin. Children should be taught how to wear the face covering properly, including not touching the front and not pulling it under the chin or into their mouth
- when temporarily storing a face covering (e.g. during sessions), it should be placed in a washable, sealed bag or container. Avoid placing it on surfaces, due to the possibility of contamination
- re-usable face coverings should be washed after each day of use at 60 degrees centigrade or in boiling water
- cisposable face coverings must be disposed of safely and hygienically. Children and young people should be encouraged not to litter and to place their face coverings in the general waste bin. They are not considered to be clinical waste in the same way that used PPE may be
Settings should follow the current public advice that recommends that face coverings are made of cloth or other textiles and should be at least two, and preferably three, layers thick and fit snugly while allowing you to breathe easily.
The Scottish Government continually reviews the current policy position on face coverings in light of emerging scientific evidence and advice. It remains the Scottish Government’s judgement that face coverings provide adequate protection for use in the community and in most workplaces because they are worn in addition to taking other measures, such as physical distancing.
Further general advice on face coverings is available on the Scottish Government website. This includes a poster that provides useful reminders about how to wear face coverings safely.
There should be regular messaging to adults about these instructions, with a clear expectation that face coverings are worn in the relevant areas except for those who are exempt.
Personal Protective Equipment (PPE)
The use of PPE by staff within childcare facilities should continue to be based on a clear assessment of risk and need for an individual child or young person, such as personal care where staff come into contact with blood and body fluids. Following any risk assessment (individual or organisational), where the need for PPE has been identifiedHSE Personal Protective Equipment (PPE) at Work guide appropriate PPE should be readily available and staff should be trained on its use as appropriate. Where the use of PPE is risk assessed as being required, staff should be trained in how to put on and take off PPE (as required by Health and Safety Regulations), and suitable waste facilities provided.
No additional PPE measures are required for general use in school age childcare settings. Staff should continue to follow existing local guidance on the use of PPE.
Examples of this include:
- staff carrying out intimate care should wear a disposable, single-use plastic apron and gloves. Advice is available on glove selection in the National Infection Prevention and Control Manual.
- staff should have access to disposable single use gloves for spillage of blood or other body fluids and disposing of dressings or equipment. Local infection control procedures that outline safety and protocols should be stringently followed and adequate training provided. This includes procedures for putting on and taking off PPE, the disposal of soiled items; laundering of any clothes including uniform and staff clothing, towels or linen; and cleaning equipment for children and young people, such as hoists and wheelchairs.
- hand hygiene is essential before and after all contact with a child receiving intimate or personal care, before putting on PPE, after removal of PPE and after cleaning equipment and the environment. Hands should be washed with soap and water.
In cases of suspected COVID-19, use of PPE should be based on risk assessment. Risk assessments must consider all factors affecting the protection of staff and children including any additional distress and impact on wellbeing the children. The following use of PPE may be considered:
- a fluid-resistant surgical mask should be worn by staff if they are looking after a child who has become unwell with symptoms of COVID-19 and appropriate physical distancing cannot be maintained while doing so
- if the child or young person who has become unwell with symptoms of COVID-19 needs direct personal care, gloves and aprons, fluid resistant surgical mask and eye protection (goggles or a visor) should be worn by staff
- gloves and aprons should be used when cleaning the areas where a person suspected of having COVID-19 has been
Where the use of PPE is being considered within a setting the specific conditions of each individual setting must be taken into consideration and comply with all applicable legislation, including the Health and Safety at Work etc. Act 1974, Personal Protective Equipment Regulations 1992 and the Management of Health and Safety Regulations 1999 which outlines the process of, and legal requirements for, risk assessment.
Specific guidance COVID-19: guidance for first responders has been developed and published for first responders who, as part of their normal roles, provide immediate assistance requiring close contact until further medical assistance arrives. This guidance sets out clearly what a first responder is required to do if they come into close contact with someone as part of their first responder duties. It covers the use of PPE and CPR.
Staying vigilant and responding to COVID-19 symptoms
The whole school age childcare service should be vigilant for the symptoms of COVID-19, and to understand what actions they should take if someone develops them, either onsite or offsite. It is essential that people do not attend a setting if symptomatic. Everyone who develops symptoms of COVID-19 must self- isolate straight away, stay at home and arrange a test via the appropriate method. Their household must also self-isolate.
The key COVID symptoms are:
- new continuous cough
- fever/high temperature
- loss of, or change in, sense of smell or taste (anosmia)
All staff and parents and carers should be advised that anyone with these symptoms should not attend or should be asked to return home. They should also be told to follow Test and Protect procedures.
All staff working in and with settings should be supported to follow up to date health protection advice on household or self-isolation and Test and Protect procedures if they or someone in their household exhibits COVID-19 symptoms, or if they have been identified by NHS contact tracers as a close contact of someone with the virus. Guidance on this is available from NHS Inform, Parent Club and gov.scot.
The National Clinical Director has also written an open letter to parents and carers providing guidance on how COVID-19 symptoms differ from those of other infections circulating at this time of year.
Changes to the rules on self-isolation for contacts of positive cases were made on 9th August. These changes were made because the health risks that arise when people are in contact with others who test positive have changed significantly, most notably due to vaccination. Vaccine uptake is very high, particularly among individuals who are at greater risk of harm from Covid-19, and the vaccines are highly effective at preventing severe disease (with 96% effectiveness against hospitalisation for the Delta variant). Children and young people have a very low risk of health harm from Covid-19, and children and young people with asymptomatic infection are at a relatively low risk of transmitting Covid-19 to adults. This means that the risk environment has changed significantly, and our approach to managing Covid-19 is evolving to reflect that.
Since we moved beyond level 0, close contacts aged over 18 years and 4 months who are double vaccinated - with at least two weeks having passed since the second dose - have been able to end self-isolation – if they take a PCR test that comes back negative.
There is also no blanket requirement for children aged under 5 who are close contacts of positive cases to self-isolate, provided they do not display any symptoms or test positive for COVID-19. This applies regardless of whether the close contact is with a case in the ELC setting, household or elsewhere. Under 5s who are close contacts are encouraged to take a PCR test. This is the advice in the guidance for households with possible coronavirus infection on the Test and Protect website. However, their exemption from self-isolation requirements should not be made conditional on this. This reflects the lower risks of infection and transmission in this age group, the fact that younger children may find it harder to tolerate testing and the significant and sustained educational harms that result from current self-isolation policy. It aligns with the advice of the Advisory Sub-Group and the views of the Chief Medical Officer.
Close contacts for those aged over 5 but under 18 years and 4 months will be released from the requirement to self-isolate subject to a negative PCR test, provided they do not display any symptoms or test positive for COVID-19 . This would mean that close contacts over the age of 5 but under 18 and 4 months will be advised to book a PCR test as soon as possible, and only end self-isolation and return to ELC if they receive a negative PCR test result.
Key points to ensure that parents, carers and staff are aware of are as follows:
- staff, children or young people who develop the symptoms of COVID-19, or who test positive using PCR or LFD tests, must self-isolate immediately in line with NHS guidance
- everyone who develops symptoms of COVID-19 – a new, continuous cough, fever or loss of, or change in, sense of smell or taste - must self-isolate straight away, stay at home and arrange a test via the appropriate method (see below). This applies to adults and children
- with the exception of those aged under 5, people who live in the same household as a person with symptoms must also self-isolate straight away and stay at home. These people should not attend settings
- all close contacts should to take a PCR test. Children under 5 years are encouraged, but not required, to take a PCR test
- parents/carers who are self-isolating while they wait for the results of their PCR test, or who have received a positive PCR test should not leave the house to bring children to or from settings. They should make arrangements for someone else to do this on their behalf or, if that’s not possible, children should stay home with parents/carers
- from 9 August 2021, for those aged 5 and over and under the age of 18 years and 4 months and for adults who have received both doses of the vaccine, the self-isolation for close contacts can end on receipt of a negative PCR test result
- It’s not the responsibility of managers to check whether close contacts who return to work after a negative PCR test have been fully vaccinated. Managers should assume that staff are following the self-isolation advice available on NHS Inform. There is a useful decision aid via NHS Inform
- any contact who has a positive test during their isolation period will be managed as a case and subject to contact tracing
- school age childcare setting staff who opt to undertake asymptomatic testing do not need to self-isolate while awaiting results, as long as no symptoms develop unless they are a close contact of a symptomatic and confirmed case, in which case they will need to self-isolate. If their asymptomatic test is positive, the member of staff must isolate until a confirmatory PCR is received, even if they are without symptoms. If their asymptomatic test is negative, they can remain at work unless symptoms develop (however, as set out above, if they are a close contact of a symptomatic and confirmed case, they will need to self-isolate and take a PCR test). If their asymptomatic test is positive, the member of staff must isolate until a confirmatory PCR is received, even if they are without symptoms. If their asymptomatic test is negative, they can remain at work unless symptoms develop but should not consider themselves free from infection and must still adhere to all mitigations
- if the PCR test is positive, the person must remain in isolation until 10 days from symptom onset, or longer if symptoms persist or 10 days from the test date if there are no symptoms. The date of onset of symptoms (or of test, if asymptomatic) is to be considered day 1 of 10
- everyone who tests positive for COVID-19 will be put in touch with the local contact tracing team so that other close contacts can be identified. All close contacts who are in the same household as confirmed cases must self-isolate immediately and take a PCR test
- everyone who needs to self-isolate as close contacts of confirmed cases must continue to do so for 10 days from their last day of exposure to the case, even if they have a negative test result. In a household, the 10 days starts on the date of symptom onset in the first case
- unless otherwise advised by Test and Protect or local Incident Management Teams, where staff do not have symptoms but are self-isolating as a close contact of a person who is a confirmed case, other people in their household will not be asked to self-isolate along with them
Staff can book a test through www.nhsinform.scot, the employer referral portal (for staff only) or, if they cannot get online, by calling 0800 028 2816. Parents and carers can book a test on a child’s behalf.
Settings, other than in those areas detailed in the following paragraph, will also be able to register their symptomatic staff as category 3 key workers under the employer referral portal, to ensure priority access to testing. The nature of this portal is to prioritise tests and appointments over the general public. This route directs individuals through to a Regional Test Centre or Mobile Testing Unit (whichever is nearer). For those who cannot access an RTC/MTU (if they do not have access to a car or live too far away), they can order a home test kit.
For settings in Orkney, Shetland and Eilean Siar, there are different routes to accessing a test in your local areas. School age childcare settings in these areas should liaise with their local Health Boards to ensure priority access to symptomatic testing for setting staff.
Unless staff are symptomatic, they are a close contact of a positive case or are advised to get a test by a healthcare professional, then testing is not a requirement. However, if members of staff are concerned that they have been at risk from infection, then they may request a test whether or not they have symptoms.
Staff should make such requests via their employer, who can book a test for them using the employer portal, or for staff in Orkney, Shetland and Eilean Siar, can advise staff on the testing arrangements with their local Health Board.
If they have been identified as a close contact they must self-isolate and take a PCR test.
If a child develops symptoms of COVID 19 while in the setting, a ventilated space must be available for the child to wait in until they can be collected by their parent/carer. Where space allows, you should prevent contact with any other children in the setting. Ensure that guidance on the use of PPE is followed. Care must be taken however to ensure the appropriate levels of supervision of all children. The symptomatic child may also be asked to wear a face mask or face covering to reduce environmental contamination where this can be tolerated. Read the advice on what to do if someone is symptomatic.
An information sheet titled 'Self-isolation and contact tracing' has been produced for schools and registered childcare settings to provide more detail on these changes.
All staff and parents and carers should be advised that people who have symptoms, or who have household members who have symptoms, should not attend the setting, and should follow advice to self-isolate and book a test.
Advice on cleaning of premises after a person who potentially has COVID-19 has left the school premises can be found in the Health Protection Scotland Guidance for Non-Healthcare Settings. Assist FM have also produced complementary guidance on cleaning in schools.
Staying safe after ending self-isolation
Even if someone is fully vaccinated, they can still get coronavirus and pass it on to others.
Close contacts who end self-isolation, can help protect others by following our guidance on how to stay safe and help prevent the spread.
As well as getting a PCR test, they may also consider:
- limiting close contact with other people outside their household where possible, especially in enclosed spaces
- wearing a face covering in enclosed spaces and where they cannot maintain physical distancing
- limiting contact with anyone who is at highest risk
- not visiting people in care homes or hospitals until 10 days after contact with a positive case, unless essential and agreed with care home or hospital staff in advance
- taking part in twice weekly lateral flow device (LFD) testing
Policy on international travel is updated regularly.
Detailed and up-to-date guidance is available at International travel and quarantine.
Providers should engage with children and their families to ensure adherence to the legal requirements. Local health protection teams are available to offer further support where providers have concerns.