Advice for high-risk settings

High-risk settings definition

A high-risk setting is defined as a setting where there:

• are a large number of people who are at risk of severe disease from COVID-19 (for example, due to age or chronic medical conditions), and
• is a higher risk of COVID-19 transmission due to close proximity and difficulties maintaining physical distancing.

High-risk settings include:

• hospitals
• residential aged care facilities
• residential accommodation facilities that support people who require frequent, close personal care and who are at risk of severe disease from COVID-19.

Key information for high-risk settings

Entering a high-risk setting

Staff and visitors entering high-risk settings are recommended to wear a face mask and should follow the facility's guidance for mask use.

Entry screening questions

High-risk settings are recommended to use the following questions to screen all staff and visitors.

These questions are relevant regardless of COVID-19 vaccination status.

1. Do you have any COVID-19 symptoms?
2. Do you live with a person who has tested positive for COVID-19 within the last 14 days?
3. Have you tested positive for COVID-19 in the last 7 days?
4. Have you recovered from COVID-19 in the last week but have ongoing symptoms?

If a person answers yes to any of the above questions, they should not enter the facility before approval from the facility is granted.

Anyone who requires urgent healthcare can enter a high-risk setting at any time to access this care.

Visitors

People should avoid visiting high risk facilities if they:

• have tested positive to COVID-19 within the last 7 days
• are experiencing COVID-19 symptoms
• have tested positive for COVID-19 more than 7 days ago but continue to experience symptoms
• are a household contact and it is less than 14 days after the last time someone in their household tested positive for COVID-19.

If the visit cannot be delayed, approval from the facility should be sought before arrival and entry. A rapid antigen test (RAT) is recommended for household contacts before visiting a high-risk setting.

Residents/clients leaving facilities

• Residents/clients of high-risk settings can leave the setting to attend family gatherings or for other reasons. They should practise COVID Smart behaviours.
• Visitors to facilities and residents/clients leaving the facility are recommend to consider the following measures to reduce risks:
  • outdoor gatherings are recommended where possible
  • COVID Smart behaviours – wear a face mask where one is recommended, physically distance when possible and practise hand hygiene
  • those attending gatherings should not have any COVID-19 symptoms, be a household or high-risk contact, be awaiting a COVID-19 test result or live with someone awaiting a COVID-19 test result.

Strategies to reduce likelihood of transmission in staff

High-risk settings are recommended to limit contact between staff who are working different shifts, where possible.

For example:

• conduct handovers via the phone instead of in person
• minimise staff contact across a facility by cohorting staff to working in certain areas/wings
• minimise staff mixing across shifts by rostering the same staff on together where possible
• limit social contact between staff working different shifts
• hold virtual meetings
• ensure staff working change over shifts are not using the same locker room or shared facilities at shift change over
• have strategies in place to avoid staff spending time together unmasked in tea rooms. This may require rostering of meal breaks and/or staff eating outside if weather permits.

Mask advice for high-risk settings

Visitors and staff entering a high-risk setting should follow the facility’s guidance for mask use.

Staff who work in high-risk settings

What does a staff member need to do if they are identified as a household contact?

The staff member should follow the instructions of their facility or organisation for household contacts.

For more information about what to do in the community, see the information for people exposed to COVID-19.

What does the staff member’s manager need to do?

Refer to the tools used to assess high-risk community sites and consider staffing and risk mitigation issues in relation to that staff member’s return to work.

Staff who are contacts returning to work in a high-risk setting*

Return to work should be overseen by the facility or organisation providing care.

• Staff who are household or high-risk contacts of a person diagnosed with COVID-19 should follow the instructions of their facility or organisation for returning to work
• Risk mitigation measures should be practised by returning staff during the 14 days after the date of exposure. See advice on High-Risk-Community-sites-Staff-return-to-work-advice.
• Staff working in a Clinical Health Emergency Coordination Centre (CHECC) site should follow CHECC guidance in relation to attending work. This includes requirements for:
  • household and high-risk (close) contacts, and
  • moderate risk (casual) contacts among staff.

*This advice should also be followed for providers of home-based care.

Visiting or returning to work in a high-risk setting after having COVID-19*

Staff members who are less than 7 days since their positive COVID-19 test should follow the instructions of their facility regarding permission to return to work.

Repeat testing is not required before returning to work.

For more information see recovering from COVID-19.

COVID-19 exposures in high-risk settings

High-risk settings will activate their COVID-19 business continuity planning and contact tracing following any relevant exposure or outbreak.

ACT Health will continue to support high-risk settings who have exposures or outbreaks.

Tools used to assess COVID-19 exposures in high-risk community sites

Facilities and workplaces should use the ACT risk assessment matrix to assess the risk to clinical and non-clinical staff and residents/clients of high-risk community sites who are exposed to COVID-19 while in that setting.

• High-risk community sites - risk assessment matrix (PDF 238.4 KB) (last updated 17 October 2022)

This individualised risk assessment approach acknowledges the importance of the continuity of healthcare services and considers:

• the personal protective equipment (PPE) the staff member was wearing, and
• the contact the staff member had with the case to determine whether they are a contact.

Actions for staff identified as contacts from a COVID-19 exposure at a high-risk community site

Staff identified as contacts in these risk assessments, or from outside of work exposures, should follow the return to work advice below.

• High-risk community sites – staff return to work advice (PDF 126.2 KB) (last updated 17 October 2022)

Staff who are identified as household or high-risk contacts from a COVID-19 exposure in the community or workplace may be allowed to return to work in the event of workplace shortage with use of relevant risk mitigation strategies.

This should be discussed with your manager or designated contact at your facility.

More information about supporting workplaces following an exposure to COVID-19 is available:

• residential aged care facilities
• disability care services
• other workplaces.

Please refer to the aged care page for more information regarding managing an exposure in aged care settings, including advice on how to manage a resident who is a household or high risk contact.

Please refer to the disability care page for more information regarding exposure in disability care settings, including advice on how to manage a resident who is a household or high risk contact.

Staff should wear appropriate PPE for contact with residents/clients of a high-risk setting who are contacts or cases.

Personal Protective Equipment use during a COVID-19 exposure or outbreak in a facility

During a COVID-19 outbreak, staff will need to wear appropriate PPE to protect themselves from exposure to COVID-19.

Appropriate PPE means:

• P2 / N95 mask
• eye protection (for example, face shield or goggles, not prescription glasses)
• long-sleeved impermeable gown
• gloves.

Adequate supplies of PPE should be available in the event of a COVID-19 outbreak.

Managing COVID-19 in residents/clients of a high-risk setting

Residents/clients who test positive for COVID-19 should receive their usual care.

Those providing this care will need to wear PPE (including P2 / N95 mask and eye protection) to protect themselves and other residents/clients.

The public health guidance for the relevant high-risk setting should also be followed. This includes managing residents/clients in high-risk settings with COVID-19 with additional precautions such as control measures for 7 days after their positive test, or until their symptoms have significantly improved (whichever comes later).

Additional information supporting workplaces is available:

• Public Health Guidance for acute respiratory illnesses in residential aged care facilities
• Public Health Guidance for acute respiratory illnesses in disability residential care facilities

This is public health advice intends to inform responses to a COVID-19 exposure. It is not a requirement under a Public Health Direction.

Managing COVID-19 in home-based disability care settings

See the public health guidance for acute respiratory illnesses in other disability settings for recommended steps someone should take if they’ve had contact with COVID-19 during home-based care with a disability client or provider while infectious.

This is public health advice intends to inform responses to a COVID-19 exposure. It is not a requirement under a Public Health Direction.