COVID-19 guidance for prison settings
- 2.5 Show version history
- 24 May 2023 (Latest release)
- Public Health Scotland, ARHAI Scotland
- Coronavirus (COVID-19)
- Health protection
Purpose and scope
This guidance aims to provide a clear, concise, and accessible overview of the public health measures that should be taken to prevent and manage COVID-19 in prison settings.
Using this guidance
This guidance recognises that prisons are the living quarters for the Scottish prison population but that they also have healthcare services operating within them. Infection Prevention and Control guidance differs for these two areas within prisons.
The guidance supports, but does not replace:
- individual expert clinical judgment
- local response arrangements
The guidance supports maintenance of agreed health protection principles and national policy in line with the Public Health etc. (Scotland) Act 2008 including:
- exercising functions to encourage equal opportunities
- observance of equal opportunities requirements
Employers should consider specific conditions of each place of work and follow the Health and Safety at Work etc. Act 1974 and other appropriate legislation.
The guidance should be read alongside PHS COVID-19 HPT guidance and Management of Public Health Incidents: Guidance on the roles and responsibilities of NHS led incident management teams.
The guidance should also be read alongside other relevant prison specific policy, guidance and legislation such as:
- The Scottish Prison Service Prison Rules and Directions
- Healthcare Directions
The Scottish Prison Service (SPS) produce guidance and other resources to operationalise public heath guidance.
It is important that where the application of SPS guidance differs from national PHS or Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) guidance, reasons for this are documented.
Health protection team contacts
Health protection teams in each health board area are the primary team supporting the control of outbreaks in community settings.
Local services have access to their local HPT for such operational advice. Public Health Scotland, at national level, does not provide this.
Access up-to-date contact information for local HPTs.
Developing this guidance
This is a Public Health Scotland publication.
The guidance has been developed by PHS in collaboration with various stakeholders, including Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland.
The disease COVID-19 is caused by severe acute respiratory syndrome coronavirus 2, also known as SARS-CoV-2.
SARS-CoV-2 is a ribonucleic acid (RNA) virus.
The first cases of COVID-19 in the UK were detected on 31 January 2020.
The World Health Organization (WHO) declared COVID-19 as a pandemic on 12 March 2020.
COVID-19's status as a Public Health Emergency of International Concern (PHEIC) was removed in May 2023. Its status as a global pandemic remains unchanged.
SARS-CoV-2 is spread by respiratory particles. This occurs mainly through close contact with infectious individuals.
Transmission risk increases:
- when people are close to each other (usually within 2 metres)
- when people are displaying symptoms
- when in indoor, poorly ventilated environments that are not regularly cleaned
There is limited evidence of long-range aerosol transmission. Further research is needed to better understand aerosol transmission of SARS-CoV-2 virus.
SARS-CoV-2 virus can survive on surfaces from a few hours to days.
The amount of virus on surfaces is not always enough to cause infection.
SARS-CoV-2 can be transmitted even if the infected person does not have symptoms. This is called asymptomatic transmission.
Infectious and incubation periods
Studies show that the highest risk of transmission occurs a few days before and within the first 5 days after symptom onset but can be up to 10 days after symptom onset.
The average incubation period is between 3 and 6 days, with a range from 1 to 14 days.
The cardinal symptoms, as outlined by NHS inform, are:
- new, continuous cough
- change in or absence of sense of smell or taste
- Symptoms of COVID-19 can vary in severity.
- Some people have:
- sore throats
- general weakness
- muscular pain
- acute respiratory distress syndrome and other complications
Mortality is an unfortunate potential outcome in those with severe disease.
Although applicable to a small portion of the prison population, atypical symptoms of COVID-19 are more likely to present in:
- older adults
- very young people
- people with underlying health conditions
- immunocompromised individuals
These atypical symptoms can include:
- increased confusion
- reduced appetite
- vomiting and diarrhoea
- shortness of breath
- excessive sleepiness
- difficulty in breathing (this is an important symptom to be aware of in older adults)
Most people recover quickly, usually starting to feel better in a few days. Some people take longer and symptoms can affect the whole body.
SIGN has produced a booklet for anyone with ongoing signs and symptoms of COVID-19.
NHS inform provides a variety of useful information on long-term effects.
General prevention measures
This section outlines a range of measures that are recommended to reduce transmission of SARS-CoV-2.
Prisons are strongly advised to continue to follow and regularly review the implementation of COVID-19 mitigation measures to minimise transmission of SARS-CoV-2 and other infections.
Advice on enhanced COVID-19 infection and prevention control (IPC) measures for community health and care settings is available in the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings. Additional measures may need to be introduced when there are localised clusters or outbreaks. The health protection team (HPT) / Incident Management Team (IMT) will advise in these instances.
Refer to NHS inform for general advice on COVID-19.
Evidence for vaccination across adult age groups shows protection against:
- symptomatic disease
- infection (including in healthcare workers and in care home service users)
- hospitalisation due to severe illness and mortality
Vaccination also plays a role in reducing transmission.
View a summary of the most recent data on real-world effectiveness, schedule and other relevant information in the Green Book, chapter 14a (COVID-19).
COVID-19 vaccinations and boosters offer the best protection against the virus. Where possible, staff and service users should be assessed for vaccine status and offered COVID-19 (and other) vaccinations at the earliest opportunity.
The Joint Committee for Vaccines and Immunisation (JCVI) provides details on the groups that are to be prioritised for vaccination.
Refer to The Green Book, chapter 14a (COVID-19) for the most up to date advice.
Find more information about vaccination boosters on NHS inform.
Services should aim to vaccinate residents before admission to the prison setting, or as soon after admission as is feasible. Sometimes vaccination may not be possible if there is a sudden need for admission or due to medical exemption. Vaccination should not delay admission.
Vaccination of staff and residents, has altered the COVID-19 mitigation measures, making these less restrictive – for both vaccinated and unvaccinated people. When vaccination uptake rates are not satisfactory, this presents a potential risk to everyone in the setting.
Vaccination is strongly recommended, including of those who are pregnant, breastfeeding or planning a pregnancy, where the safety profile for COVID-19 vaccination remains good.
Additional sources of information for the COVID-19 vaccination are available.
Public Health Scotland
We provide materials to promote the COVID-19 immunisation programme to:
Workforce education materials
Access these on the Turas Learn site.
NHS inform provide information about:
- the vaccine
- invitations and appointments
- after the vaccine
- leaflets and other languages and accessible formats
Advice for contacts
Routine identification of contacts of COVID-19 cases is no longer undertaken nor indicated.
Those with symptoms or confirmed COVID-19 should:
- follow the NHS inform stay-at-home guidance
- inform other household members or people they have had contact within the previous 48 hours that they are symptomatic or have tested positive.
This ensures that contacts are vigilant of respiratory symptoms that may develop.
Definition of a contact
There is no formal definition of a contact.
The transmission risk for any respiratory illness, including COVID-19, increases with length of exposure and proximity to the infected individual.
The risk is also greater in indoor, crowded settings compared to outdoor activities or well-ventilated indoor environments.
Individuals at the highest risk of infection are those who have spent significant time with a case, such as household members, overnight contacts and prison cell mates.
Find out more information about what to do in the event of contact with a COVID-19 case for:
Physical distancing is no longer required for staff, service users or visitors. Some health and social care services may choose to continue with physical distancing measures. Particularly if there is a risk of overcrowding.
The Scottish Government guidance for safer workplaces and public settings remains available.
See the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings for more information on physical distancing in specific circumstances.
Those who are isolating should keep a 2 metre distance from other service users and staff, where possible.
The HPT or IMT may recommend a temporary reintroduction of physical distancing as a control measure during an outbreak.
Personal protective equipment (PPE) and face coverings
PPE is used to provide the wearer with protection against risks associated with the care tasks they are doing. All staff undertaking a procedure should assess any likely exposure to blood or bodily fluids and ensure PPE that provides adequate protection is worn.
Staff within health and care settings should continue to apply Standard Infection Control Precautions (SICPs) at all times to minimise transmission of infectious organisms. This applies specifically to prison settings also.
Additionally, transmission-based precautions (TBPs) – in other words, enhanced precautions – should continue to be applied when caring for individuals who have a suspected or known infection or colonisation.
The National Infection Prevention and Control Manual (NIPCM) provides more details on SICPs and TBPs to be applied depending on the route of infection.
A poster from the NIPCM describes the safe methods for donning and doffing PPE.
Staff should undergo regular PPE training.
Face masks and face coverings
There is a difference between face masks and face coverings.
Face mask - definition
The use of the term 'face mask' means surgical or other medical grade masks.
For example, fluid-resistant surgical masks (FRSM) used in certain health and social care situations.
Face covering - definition
The use of the term 'face covering' means something that is made from cloth or other textiles that covers the mouth and nose, and through which you can breathe.
For example, a scarf.
Face masks - use
Continuous use of face masks in health and social care settings, including prisons, is no longer required nor advised routinely. This is due to the effective combination of natural and vaccine immunity in protecting populations at this stage of the pandemic and the risks that covering the face can present to social interaction, particularly for vulnerable individuals.
The Scottish Government extended use of face masks and face coverings guidance in healthcare and social care settings has been withdrawn (DL  11). In the absence of this guidance, health and care settings are advised to follow the IPC guidance on the appropriate use of PPE for SICPs and TBPs precautions as detailed in the NIPCM:
- chapter 1 – standard infection control precautions
- chapter 2 – transmission-based precautions
- Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings
Local HPTs can support complex risk assessment, when needed.
If a staff member or resident cannot tolerate a face covering or a face mask when this is indicated, a local risk assessment must be completed and other mitigations considered, such as change in work role.
Face coverings - use
Residents are encouraged to wear face coverings if they are in a crowded area.
If there is an outbreak in the prison, face coverings will likely be advised as an outbreak measure and will also apply to outdoors if different household cohorts are present.
This is in line with advice for the general population available in Scottish Government guidance on staying safe and protecting others.
If a staff member or resident cannot tolerate a face covering or a face mask when this is indicated, a local risk assessment must be completed and other mitigations considered, such as change in work role.
Hand, respiratory and environmental hygiene
Follow hand and respiratory hygiene advice in the National Infection Prevention and Control Manual (NIPCM).
Ensure that workplaces and work areas are cleaned regularly.
Follow the advice on safe management of the care environment in the NIPCM.
Further advice is available on NHS inform's COVID-19 general advice pages.
Good ventilation in indoor spaces can reduce the transmission risk of SARS-CoV-2 and other respiratory infections.
Maximise fresh air entering a room through:
- natural ventilation – opening windows, vents and doors (excluding fire doors)
- mechanical ventilation systems – minimising the recirculation of air in rooms and throughout buildings
Maintain the safety and thermal comfort of service users and service providers by ensuring adequate room temperatures.
The UKHSA COVID-19 ventilation of indoor spaces guidance advises to keep room temperature to at least 18ºC as temperatures below this can affect health.
This is especially applicable to those who:
- are 65 years or older
- have a long-term health condition
For information on using fans - see the NIPCM SBAR on portable cooling fans (bladed and bladeless) for use in clinical areas.
Find out practical steps on improving ventilation in the HSE ventilation in the workplace guidance.
Advice for people at highest risk
Some individuals are at higher risk of severe illness if they are infected with SARS-CoV-2, even when fully vaccinated.
This includes those with a weakened immune system.
View the Scottish Government COVID-19 advice for people who are immunosuppressed.
Scottish Government ended the highest-risk list of individuals in Scotland on 31 May 2022.
View further information on COVID-19 and pregnancy on:
COVID-19 vaccines are recommended in pregnancy.
Providing care for residents
Providing care for residents
This section covers providing care for residents during the COVID-19 pandemic.
Staff should remain vigilant to residents developing any respiratory or COVID-19 symptoms.
If a resident is unwell - contact the NHS prison healthcare team.
If they need urgent ambulance or hospital care – call 999.
Tell the call handler that the unwell person may have COVID-19.
Residents who have had contact with a COVID-19 case
Contact tracing is no longer indicated routinely.
Find out more in the advice for contacts section.
Residents who have been in contact with a COVID-19 case and who are asymptomatic do not need to self-isolate or test – exceptionally they may be advised otherwise by the HPT/IMT.
Residents should be advised to notify staff if symptoms develop.
Prison managers should check there is no one else with symptoms and that all NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings are in place.
Where appropriate, management can communicate with residents when a new case of COVID-19 has been identified in their area. This is to promote symptom awareness and provide advice for other residents.
Residents who are symptomatic or have a positive COVID-19 test
Prison residents should self-isolate immediately for at least five days if they are a confirmed COVID-19 case. Day one is the day after symptom onset or the day after a positive test (whichever was earlier). Advice should also be sought from prison healthcare staff, if there is clinical concern.
Residents with symptoms suggesting possible COVID-19 should be placed into isolation separately from their household cohort. Isolation alone in their own single cell is sufficient.
See managing self-isolation in prison settings for more information.
Some residents may also be eligible for specific COVID-19 treatments. Find out more about COVID-19 treatments on NHS inform.
Table 1 outlines the testing requirements for symptomatic residents in prison.
Symptomatic residents should be tested by PCR.
Symptomatic residents who decline PCR testing are required to isolate for a minimum of 5 days from symptom onset and be re-assessed.
Managing self-isolation in prison settings
When a prison resident is symptomatic and PCR negative
Isolation can be discontinued if the PCR test result is negative and:
- they are feeling well
- have not had a fever for 48 hours, without the use of medication (such as paracetamol)
If fever continues, further clinical assessment is advised and possible further testing, e.g. for flu.
If respiratory symptoms lead to suspicion of an outbreak and COVID-19 testing is negative, other organisms may need to be considered and tested for.
The local HPT should be notified and can discuss further testing with their local laboratory service if needed.
Positive PCR test result
If a resident's PCR test result is positive, self-isolation in their cell should continue for a minimum of 5 days from symptom onset. Positive cases can isolate together as a cohort.
Offer residents entering isolation the option to inform a family member/next of kin.
Providing care in prisons
If cells with en-suite facilities are not available for self-isolation, then access to hot water and showers must be ensured for personal hygiene.
Those in isolation must continue to have access to health and care including prescribed medication.
Maintain symptom vigilance during the self-isolation period. This includes for signs of deterioration or mental health problems.
Outdoor exercise in prisons
Access to outdoor exercise should continue during the self-isolation period. This is provided the resident feels well enough.
The frequency and duration of exercise is determined by a local risk assessment that considers:
- staffing levels
- ability to maintain physical distancing
- presence of an outbreak
Transferring from prison to hospital during self-isolation
Residents may need to go to hospital during their self-isolation period.
Staff must inform the ambulance service and ward staff in advance that the individual has respiratory symptoms or confirmed COVID-19 and of the need for self-isolation on arrival.
Escorting staff should wear PPE in line with the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings
Escorting staff must follow hospital IPC procedures. If they are asked to wait in an area away from the prison resident, they should inform their prison Duty Manager. The Duty Manager will risk assess and advise as required. Special IPC precautions will be needed by escort staff in hospital areas of higher risk, such as Intensive Care Units. This should be discussed with the local IPCT.
Residents can end self-isolation if they meet all of the following criteria:
- five full days of isolation completed
- have been without fever for 48 hrs without use of medication (such as paracetamol)
- no longer feel unwell
When other symptoms have resolved, a cough or change to taste and smell is not a sign of ongoing COVID-19 infection. Further testing is not usually needed. These symptoms can persist for weeks in people who have had recent COVID-19. However, cough and fever can be symptoms of other infectious and non-infectious conditions and may require GP investigation if they do not improve.
On some occasions, the HPT may extend self-isolation. See the section on symptom vigilance and self-isolation during an outbreak for further information.
Guidance on discontinuing IPC precautions in community health and care settings for COVID-19-positive service users can be found in the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings and from the local HPT.
Measures for staff
To reduce the spread of SARS-CoV-2, staff should follow measures in this guidance.
Plan ahead to prepare for extra demands on staffing needs due to outbreaks or staff absence.
This is known as resilience planning.
It should include:
- encouraging a high uptake of COVID-19 vaccine and annual flu vaccine amongst all staff
- a regular review of resources needed to support residents when they are unwell or in self-isolation
- time and resource required to follow NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings – this includes:
- PPE use
- good hand hygiene and cough/respiratory etiquette
- increased cleaning
- staff cohorting
- training updates
- guidance review
Workplaces and their staff should risk assess the infection risk, both within and outwith the workplace.
This is particularly important for small departments where even a few staff absences could have significant impacts on resilience arrangements.
To enable home working, hybrid working and safer office working, follow the Scottish Government advice in COVID-19 safer businesses and workplaces.
Prison staff working in more than one prison
If staff are required to work in more than one prison, a risk assessment should be documented.
During an outbreak, sharing of staff across prisons should cease and staff should only work in one prison at a time to reduce the risk of transmission.
Staff who have contact with a COVID-19 case
Staff who come into contact with a COVID-19 case are no longer automatically required to self-isolate. However, a risk assessment may need to be conducted.
The service manager should check appropriate IPC measures are in place, if the contact occurred in the workplace.
Staff need to be vigilant to COVID-19 symptoms at all times. This is very important during the incubation period after contact with a COVID-19 case.
If symptoms develop, see the measures for staff who become symptomatic or have positive PCR or LFD test.
The service manager should risk assess the placement of staff who may be contacts of a case if there are any extremely vulnerable individuals in the setting.
This includes those who are severely immuno-suppressed. Risk assessment may result in a temporary change to location or tasks of work.
This applies regardless of where contact with a COVID-19 case occurred.
Staff who become symptomatic or have a positive COVID-19 test
Staff who are symptomatic should not attend work.
If symptoms develop at work, they should put on a FRSM and return home immediately.
Staff not eligible for testing
See Table 2 for testing eligibility.
See the stay-at-home guidance on NHS inform for more information. It also provides advice on other actions to take outside of the work environment.
Return to work
You can return to work when you feel better and no longer have a high temperature.
Staff with persistent symptoms should be risk assessed by their line manager when returning to work. This would be part of a return to work interview, as per usual processes. Particular consideration should be given to the placement of staff working with individuals at higher risk of serious illness.
Follow all relevant infection control precautions on your return.
Staff eligible for testing (prison healthcare)
See Table 2 for testing eligibility.
Staff should report the test result to their line manager.
If the test result is negative, they can attend work if they:
- are well enough to do so
- do not have a high temperature
Positive LFD test result
If the LFD result is positive, the staff member should:
- stay at home
- not attend work
- avoid contact with other people for a minimum of 5 days after the day they took the test
Tests should only be taken by staff that are both:
- eligible for testing
Situations should no longer arise whereby staff return positive results even when they are advised not to test, since asymptomatic testing is no longer indicated except under the conditions outlined in Director's Letter (DL) (2022) 32. See Scottish Government social care and community-based testing guidance for more information on testing eligibility.
Symptomatic LFD test positive staff who are not eligible for testing should avoid contact with other people for a minimum of 5 days after the day they took the test, regardless of the presence of symptoms. Follow the advice on NHS inform.
Household members of the case should follow the advice on NHS inform.
Returning to work
The Director's Letter (DL) (2022) 32 outlines the requirements for HSCWs returning to work, in particular if they work directly with service users. Further testing is advised in these circumstances.
Risk assessing return to work when symptoms persist
As outlined in Director's Letter (DL) (2022) 32, if symptoms persist, line managers are advised to:
- undertake a risk assessment, and;
- consider redeploying some staff members until 10 days after their symptoms started
- if staff did not have symptoms, this would be 10 days after the day of their first positive test.
This may apply to staff who work with individuals at higher risk of serious illness despite vaccination.
For HSCWs returning to work, HPTs should have oversight of how risk assessments are being used to inform these decisions. They do not need to undertake the risk assessments.
New staff or agency staff
Service managers need to ensure that new and agency staff are adhering to all processes applicable to service staff, including training and advised vaccination. A documented risk assessment of the use of agency staff can support good governance.
Proof of a negative SARS-CoV-2 test result is not needed prior to starting work.
Staff should not start work if they are symptomatic.
They should follow the >measures for staff who become symptomatic or have positive LFD test.
Infection Prevention and Control
Agency staff should follow the same NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings as permanent staff.
Support all staff to become fully vaccinated as soon as possible to protect service users and other staff.
Vaccination status should not be a barrier to staff starting work in the setting.
Vaccination against COVID-19 is, however, strongly advised and work placements should be risk assessed.
This section focusses on the eligibility for COVID-19 testing.
Vaccination status does not change the relevance of testing.
There are various tests available to detect SARS-CoV-2 (the virus that causes COVID-19 disease).
More information on PCR, LFD and Point of Care Tests (POCT) is available in our COVID-19 guidance for HPTs.
Testing is not mandatory for individuals or staff.
It needs consent or provision made otherwise, for those without capacity.
See Adults with Incapacity (Scotland) Act 2000 principles for more information.
- Purpose of testing
The main purpose of COVID-19 testing has changed from population-wide testing to reduce transmission to targeted testing to support clinical care.
Routine asymptomatic testing is only recommended for specific groups and purposes.
This is in line with the Scottish Government's Test and Protect transition plan.
PCR testing can be used as a diagnostic tool or as part of surveillance.
- Ordering tests
The COVID-19 page on NHS inform provides information on accessing COVID-19 tests for those who are eligible.
The respiratory screening questions in Appendix 3 of NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings should be asked to all admissions/transfers to inform a risk assessment. This is especially important when testing is not possible.
|Status||Symptomatic||Asymptomatic||Asymptomatic but known contact with a COVID-19 case|
|Prison residents||PCR test||No testing required||No testing required|
|Prison residents - admission from the community or transfer from other setting||PCR test prior to or upon transfer||Admission LFD testing advisable, if feasible (e.g. outbreak or vaccine uptake risk assessment)||Admission LFD testing advisable, if feasible (e.g. outbreak or vaccine uptake risk assessment)|
Local HPTs can advise in complex situations.
Recovered service user
Discharging a COVID-19 recovered resident to the receiving prison setting before their 10-day self-isolation period in hospital has ended is possible. This should be risk assessed.
See the testing advice outlined in Table 1 for the receiving prison setting.
The testing advice in Table 1 still applies even if the resident is not required to self-isolate on admission to the setting.
|Status||Symptomatic||Asymptomatic||Asymptomatic but known contact with a COVID-19 case|
|NHS prison healthcare staff||Take a LFD test immediately (see advice in DL (2022) 32)||No testing indicated||No testing indicated|
|Prison staff||No testing indicated - follow stay at home guidance on NHS inform for the general population||No testing indicated||No testing indicated|
Some NHS health workers attend community settings as part of their clinical role. The Scottish Government COVID-19: Staff testing in NHS Scotland guidance has more information.
Further information is available in measures for staff who become symptomatic or have positive PCR or LFD test.
For visitors to the setting
Friends and family visitors
No testing advised.
More advice for visitors is available in visiting arrangements in residential settings.
No testing is advised for professional visitors who are not HSCWs.
DL (2022) 32 applies to HSCW professional visitors.
Maintain symptom awareness and continue to follow NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings (including on PPE).
Further information on testing
Symptomatic testing is only retained for eligible groups:
- in table 1 and table 2
- outlined in COVID-19: guidance for HPTs
Testing advice following confirmed COVID-19 infection
If prison healthcare staff or residents have had a diagnosis of COVID-19 either via positive LFD test or positive PCR test – they should not:
- use LFD tests for 28 days
- use PCR tests for 90 days
Day one is the day after symptom onset or the day after a positive test (whichever was earlier) if asymptomatic or displaying other non-cardinal symptoms.
The advice for symptomatic prison healthcare staff or those that have a positive COVID-19 test / symptomatic residents or those that have positive COVID-19 test should be followed if either:
- new symptoms of COVID-19 develop during the time periods defined above
- a positive test is returned after the time periods above
Contact the HPT for advice in complex situations.
Prison context for outbreak management
COVID-19 outbreak management should follow existing, well-established public health principles and practice.
Find out more information in the management of public health incidents – guidance on the roles and responsibilities of NHS-led incident management teams.
Local HPTs lead on the management of outbreaks in the community, when indicated, including prisons and other closed settings, according to their statutory duties under the Public Health Etc. (Scotland) Act 2008.
The local HPT has a duty to support these settings in the management of the outbreak.
They make decisions on outbreak control using a population-based dynamic risk assessment approach. This considers the circumstances of the outbreak, the setting itself, and the individuals involved.
Definition of a COVID-19 outbreak
Two linked cases of the disease over a 14-day period within a defined setting.
Higher risk settings
Prisons are considered as higher-risk settings for outbreak management purposes. This is due to:
- the size of prison estates and their large resident and staff populations
- opportunities for infections to spread quickly throughout the facility due to the communal nature of the setting
- the higher proportion of residents originating from more deprived socio-economic backgrounds, as a risk factor for poorer health
- variable levels of vaccination coverage across the prison population
Staff can contact the local HPT if they need further advice.
Staff shortages can quickly become an issue during an outbreak due to the size and nature of the setting.
Management teams should complete their resilience planning in advance for this eventuality.
Scottish Prison Service input during an outbreak may be useful in finding solutions to staffing shortages, based on a risk assessment approach led by the HPT.
Prisons should review reporting of notifiable disease cases and outbreaks to the Health and Safety Executive (HSE) under RIDDOR processes.
The local HPT should also be notified. Further information is available in the initial assessment section.
If one confirmed resident case arises or two or more linked individuals develop symptoms of COVID-19 within 14 days in a prison, staff should:
- alert the local HPT who will carry out a risk assessment and investigate whether an outbreak is occurring – the level of response to an outbreak from the HPT will be based on the HPT’s risk assessment
- undertake a rapid internal review of the setting's risk assessment and mitigation measures. Consider any improvements to their implementation as a priority – see the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings for IPC guidance
Where indicated, the HPT can review the services’ COVID-19 workplace risk assessment or other outbreak management plan.
These steps should be undertaken collaboratively with the setting and be used to develop an individualised action plan for outbreak management.
Identifying linked cases
The assessment of linked resident cases when considering any potential outbreak should include those individuals who are present in the location where a case has been identified. It should also include residents who have either been transferred from the setting to hospital, or elsewhere, or died within the same time period of 14 days.
Continue with symptom vigilance in staff and residents and robust application of IPC measures.
Local policies can be implemented for notifying a single staff case in agreement with the local HPT.
When investigating COVID-19 transmission in a setting and implementing mitigation measures, this should be decoupled from the identification of staff cases if no links are found.
Declaring an outbreak
Declaring an outbreak is the responsibility of the HPT.
An IMT may be convened and led by the HPT.
If not, support will be provided directly by the HPT.
Asymptomatic residents who were in close contact with a case and are well, should not be tested.
They should be monitored for the development of symptoms.
Testing in this circumstance can lead to unnecessary restrictions and is at the discretion of the local HPT.
A resident with fever and/or new respiratory symptoms should have a PCR sample submitted for SARS-CoV-2 and if indicated, a wider respiratory panel of tests. Residents should be advised of the possibility of wider testing if this is needed as part of outbreak investigation.
This can include influenza and other organisms, in line with local diagnostic laboratory protocols.
PCR is the preferred test for symptomatic residents. LFD tests may also be used to support an initial risk assessment under direction of the HPT during suspected outbreaks.
When a cluster of symptomatic cases arises, it is good practice to submit samples for up to five symptomatic residents to confirm the pathogen.
Additional cases matching the outbreak case definition do not all need to be tested once the pathogen is identified.
There can still be a clinical need to test further cases – for example, to confirm the diagnosis in individuals with other respiratory illnesses or to determine eligibility for some treatments. See COVID-19: guidance for HPTs for more information.
Testing arrangements during an outbreak is at the discretion of the local HPT.
The HPT has autonomy to deviate from the guidance according to local circumstances and risk assessment.
Mass testing is unlikely to be justifiable in most circumstances since it can have unintended consequences. For example, prolonged periods of unnecessary self-isolation.
Any mass testing should be based on a risk assessment by the HPT/IMT. If undertaken, PCR testing is strongly advised, rather than LFD testing, due to increased sensitivity and potential to test for other respiratory viruses. However, when indicated, both may be able to be used effectively in combination, under the direction of the HPT.
Any cases identified should be cared for in line with advice provided in providing care for residents who are symptomatic or have a positive COVID-19 test.
If an asymptomatic resident tests negative but then becomes symptomatic, they should self-isolate. If an outbreak has already been declared and the organism identified, no further testing is likely to be needed.
Consideration should be given regarding the need to inform local microbiology laboratory services where it is anticipated there will be a large volume of samples received.
More information on testing those with recent COVID-19 infection can be found in further information on testing.
Infection prevention and control measures
A number of outbreak management measures are available, as advised by the HPT.
These include, but are not limited to:
- regular monitoring of resident's symptoms
- isolation of cases
- appropriate PPE use
- reinstating of admission testing or where this already exists, its reinforcement
- a temporary closure to new admissions
- enhanced cleaning
- restrictions to visiting
- cohorting of residents and staff
- a temporary reintroduction of physical distancing
- pausing of normal daily activities or services - for example, education, hairdressing etc
See the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings for advice on these measures.
Symptom vigilance and self-isolation
Staff and residents should remain vigilant for development of respiratory or other COVID-19 symptoms and be encouraged to report these immediately. This enables isolation and PCR testing for symptomatic residents to be initiated as early as possible - minimising prolonged transmissions and restrictions.
Barriers to reporting symptoms may exist, such as a desire to avoid isolation or testing.
Residents with COVID-19 symptoms require isolation for a minimum of 5 days from symptom onset, whether they have accepted PCR testing or not. Careful consideration may be needed to extend this further in an outbreak, taking the incubation period into account. Extension of isolation periods must be balanced against the risks that this can cause, for example, loneliness, psychological distress and resident unrest.
In exceptional circumstances, the HPT/IMT leading the outbreak response may advise that contact tracing of staff or residents is undertaken. SPS may be asked to support this.
Table 3a and 3b contains additional considerations for case and contact management during an outbreak. The HPT/IMT will advise on appropriate measures and may deviate from those outlined in Table 3a and 3b, due to their risk assessment.
|Group||Self-isolation period (days)||Management|
|Residents in prison||
10 (some outbreaks)
Minimum of 5 days self-isolation required. Can end after this period if apyrexial for 48 hours without paracetamol or other anti-pyrexials.
Self-isolation of 10 days may be recommended on HPT/IMT advice.
|Prison staff||Based on symptoms||Not required, as per the general population, follow stay at home guidance, as outlined on NHS inform.|
|Prison healthcare staff||
10 (some outbreaks)
Self-isolation of 10 days may be recommended on HPT/IMT advice. This can be shortened with 2 consecutive negative LFDs at least 24 hours apart, starting no earlier than the fifth day after onset of symptoms (or date of test if asymptomatic) - day 0 is the date of onset (or test). See DL (2022) 32.
|Person and place||Self-isolation period (days)||Management|
|Residents in prison||
10 (some outbreaks)
By default, no longer required.
Self-isolation of 10 days may be recommended on HPT/IMT advice.
|Prison staff||N/A||Not required as per the general population.|
|Prison healthcare staff||N/A||Not required, as per the general population. In an outbreak, twice weekly LFD testing can be considered, if advised by the HPT/IMT. See DL (2022) 32.|
If COVID-19 cases start to appear in a wing, prisons may decide to operate household cohorts (see resident cohorting advice) after the admission phase.
If one member of a household cohort becomes symptomatic and is isolated pending PCR test result, increased symptom vigilance is recommended for all members of the household.
During an outbreak, the admission/transfer of residents within or out with the facility should be avoided where possible. A risk assessment should be undertaken to ensure all required IPC measures are in place.
Cohorting may be considered where there is insufficient accommodation to allow cases to isolate in single cells.
Principles for cohorting include:
- cohorting confirmed cases together is possible
- contacts can be cohorted together if indicated by the HPT
- contacts should not be cohorted with cases
- cohorts should be as small as is operationally possible
- those at highest risk from COVID-19 should not be cohorted with others
The IMT may advise for the prison to be temporarily closed to admissions and transfers, e.g. if there are not enough cell numbers to support cohorting during an outbreak.
Wherever possible, teams of staff should be assigned to care for residents in different cohorts.
Movement of staff between cohorts should be avoided.
Exceptionally, staff may need to work between residents with COVID-19 and residents who do not have COVID-19.
Efforts should be made to see the residents who do not have COVID-19 first.
Residents can be assigned to a regime group. These are made up of different households.
They take exercise and domestic periods together. The operation of regime groups may be constrained in an outbreak.
All regime groups are advised to maintain physical distancing and wear face coverings during an outbreak.
If one member of a regime group becomes symptomatic, members of their immediate household cohort or regime group may require isolation and testing. This will be risk assessed by the HPT.
See when there is a COVID-19 case or an outbreak has been declared.
Using communal spaces
Sometimes it is possible to manage selected areas of a facility as a separate unit or units, with no shared activities or staff.
Unaffected areas can continue with normal arrangements, with an increased vigilance for any contact links or symptoms in their residents or staff.
Communal areas may need to be more closely supervised to ensure residents who are symptomatic or confirmed cases do not mix with others.
Keep communal areas open for use by residents who are not identified as cases or symptomatic of COVID-19 – this is the default position during an outbreak if it can be arranged by staff.
If outbreak measures prove particularly challenging to implement or staffing capacity is low, communal areas may not be able to be used temporarily.
They should be reopened as soon as practical.
Transfers to and from the prison may be reduced or paused during outbreaks. This is on the advice of the IMT and in agreement with the prison Governor.
Individual risk assessments for transfers during an outbreak should be undertaken and may involve LFD testing (or PCR if the resident is symptomatic).
- service user's tested or presumed COVID-19 status
- size of the outbreak
- spread within the setting
- units which are affected
- physical layout of the building
- vaccination status of the individual and coverage at the setting
Seek support from the local HPT managing the outbreak.
Any resident who is a possible or confirmed COVID-19 case should not be transferred. There are exceptions to this if transferring for medical care or during an operational emergency. Appropriate mitigations should be in place. See managing self-isolation in prison settings for more information on transfers to hospital during self-isolation.
Advise any receiving service, for example a hospital ward or ambulance, of the IPC measures needed for each service user they support.
Resident transfer across services may benefit from a multi-agency approach for challenging service user movements.
This could involve having a conversation between key services when needed.
Reviewing control measures
Control measures should be reviewed by the IMT. This may include a visit to the prison setting by:
- the local Health Board HPT
- IPC team
- Local Authority Environmental Health professionals
- other relevant partners
Declaring an outbreak over
For HPT to declare an outbreak over
There should be no new linked symptomatic or confirmed COVID-19 cases for a minimum period of at least 14 days from last possible exposure to a case, whether in a service user or staff member.
The HPT should also consider whether:
- existing cases have been isolated or cohorted effectively
- guidance on IPC and other interventions is being applied appropriately
Sufficient staff to enable the setting to operate safely using PPE appropriately are needed.
Staff working in the service should enable the return to routine visiting, if this is still paused, once the outbreak has been declared over by the HPT.
Moving between settings
Admissions or transfers to prison settings
Prison settings are advised to consider appropriate admission / transfer processes, depending on local arrangements. As a minimum, the respiratory screening questions in Appendix 3 of NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings should be undertaken and acted upon prior to admission/transfer.
If a resident answers 'yes' to any of the respiratory screening questions - see residents who are symptomatic or have a positive COVID-19 test for information.
Prisons may wish to consider and implement an admission process that cohorts new admissions or transfers (10 days recommended) before they join the general prison population.
Residents can be grouped into a household cohort by day of admission or individual cells, if needed and advised of symptom awareness.
Residents are encouraged to wear a face covering and physically distance, if they leave their household cohort.
COVID-19 vaccination status should also be checked, and vaccinations offered as appropriate, as soon as possible.
Protecting those at highest risk
Residential facilities should also conduct a risk assessment for their facility to determine if there are residents who are at highest risk of severe illness.
Consider whether additional measures are needed to protect these individuals if COVID-19 cases arise in the setting.
Table 1 contains testing advice for residents being admitted or transferred to prison settings.
There may be circumstances when a local risk assessment determines that asymptomatic testing should be undertaken for admission or transfer purposes.
- as an outbreak control measure
- when vaccine uptake rates are sub-optimal
- when there are particularly high levels of SARS-CoV-2 circulating in the community
Symptomatic/COVID-19 positive residents
PCR testing is recommended for symptomatic individuals in prison settings. If a newly admitted resident becomes symptomatic or tests positive, self-isolation should commence in their own cell immediately. They should self-isolate for a minimum of 5 days.
Residents can be released from self-isolation if the test is negative, following clinical assessment for possible other infections.
Contact tracing may be considered, even though it is no longer routinely part of the prison management of COVID-19. Any resident who has shared a cell with a case during the symptomatic period from and including the 48 hours prior to onset of symptoms in the case, is advised to be vigilant for symptoms and report these if feeling unwell.
Meals and healthcare interventions including medicine dispensing should be provided for residents within their cell. TBPs should be applied by staff entering cells during this time.
A risk assessment should be conducted when it is deemed that a symptomatic resident may need to leave their cell, for example, for the purpose of attending a healthcare appointment.
Where all single cells are occupied and cohorting of residents by 'household' is unavoidable:
- Those with possible COVID-19 should not be placed with confirmed COVID-19 residents.
- Possible cases who are still awaiting test results should not be cohorted together.
- Those with confirmed COVID-19 can share double occupancy cells.
Admissions to prison settings from hospital
Residents who have been admitted to hospital for non-COVID-19 related reasons are not required to be cohorted on return if infection control measures are followed throughout their hospital stay, and:
- they are not a COVID-19 case
- they have answered 'no' to the respiratory screening questions in Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings
Confirmed COVID-19 cases who have completed at least 5 days of the 10 day hospital self-isolation period should be clinically assessed before transfer to the prison.
They should be:
- showing signs of clinical improvement
- fever free for 48 hours without using medication such as paracetamol
This is subject to a risk assessment with the support of the HPT. This should consider if there is single cell accommodation available to complete their self-isolation period on return to prison, if needed.
Self-isolation is not required on re-admission to the prison if at least 5 days of self-isolation has been completed in hospital. This is providing the additional criteria for ending self-isolation in prison settings has been met.
Those who have confirmed or possible COVID-19 should not attend court. The court should be informed as soon as possible in these circumstances.
It is the responsibility of the prison establishment to inform any impacted court(s) of a COVID-19 outbreak in their prison.
Any court transfer must follow safe escort and transfer protocols ensuring that IPC measures are fully adhered to as specified in the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings.
Virtual court attendance is advised whenever possible for residents who are symptomatic or COVID-19 cases. HPTs can support prison healthcare staff in facilitating this and ensuring IPC measures are maintained adequately. IPC should not be a barrier to the use of virtual courts.
A risk assessment may be necessary for any court attendance where a breach in the above measures has occurred, whether to an outside court or a virtual one, to determine whether resident isolation or testing may be required.
The local prison and HPT, with support from SPS when needed, will liaise and develop suitable processes for home leave to be put in place during outbreaks. The guidance on Staying Safe and Protecting others from Scottish Government should be followed during home leave as for the general public.
Residents should inform the prison prior to their return or on return to the prison if they become aware that they:
- have been in contact with a confirmed COVID-19 case whilst on leave
- are symptomatic
- are COVID-19 positive
SPS will arrange transport for this process and organise any self-isolation and testing requirements if required.
Escorting residents between settings
Escorting of residents to courts, other prisons, and hospital is routinely carried out by an escort contractor who will follow their own COVID-19 guidance, which is expected to be aligned with this guidance.
In some instances, such as a medical emergency, prison staff may escort a resident to hospital from prison, rather than the escort contractor.
Escorting symptomatic residents
All escorting staff should follow general measures such as physical distancing where possible and hand hygiene. Where staff are required to share transport, FRSMs should be worn. Escorting staff should follow PPE guidance the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings and adhere to SPS operational policy.
In addition, hospital staff may advise on further PPE required, which may be ward specific. Escorting staff would be expected to comply with such requests.
Any vehicle used to transport a possible or confirmed case will need to be cleaned and disinfected using methods outlined for environmental cleaning before and after use.
Escorting services often operate a 'hub' for COVID-19 issues. GeoAmey can be contacted via their Operation Control Centre: 01698 451738. The SPS Escort Monitor Team (SPSEscortMonitorTeam@prisons.gov.scot) should be informed of any issues.
The SPS has no legal authority to detain an individual past their liberation date. Prepare for release in advance and work with key partners to organise this.
Standard pre-release planning should be followed for residents who are not COVID-19 cases. This includes during an outbreak.
For those who are a COVID-19 case and still in isolation, or where there is an outbreak, liaison with key partners and any household setting to which the resident is being released, is essential. Consent of the resident to disclose their COVID-19 status should be sought before disclosure to others. If consent is withheld, other arrangements may have to be made until the period of infectiousness is complete. The local HPT can support this process.
Completion of vaccination course should be offered prior to liberation.
If support with transport or housing is needed, SPS and Local Authority respectively, have roles in supporting arrangements, particularly for individuals who may still be within their infectious period. A case conference before release involving SPS, the HPT and the local authority should be considered for complex cases.
The following measures are good public health practice to minimise COVID-19 risk to the prison population.
Advice for prisons
Implementation of the below measures need to be balanced with the wellbeing of individual residents. SPS should aim to operationalise these measures according to risk assessment.
- ask visitors to consider before their arrival if they have any symptoms of COVID-19 and decline the visit if they do – see triage questions for a suggested approach, which should be asked upon arrival
- ensure that visiting areas are well ventilated where possible
- ensure that visiting areas are cleaned regularly
- ensure that all visitors are informed on arrival of IPC measures to be followed
- provide alternative measures of communication including telephone or video call where visiting is not possible
When there is a COVID-19 case or an outbreak has been declared
Local visiting arrangements should be reviewed if a case or cases arose.
During an outbreak at the prison, pausing visiting may need to be considered.
Advice for visitors
- not visit if they have been identified as a COVID-19 case or aware they have been in contact with a confirmed COVID-19 case or if they have symptoms of an infectious disease
- be strongly encouraged to complete a course of COVID-19 vaccination if eligible - though this is not obligatory for visiting
- perform hand hygiene on entry to the facility and again on leaving the facility
- not touch their face or face covering once in place, wherever possible – individuals may choose to wear face coverings
- observe physical distancing where possible to other residents and staff, if the area is crowded
- remain in areas demarcated for visiting
Death certification during COVID-19 pandemic
Details on death certification during the COVID-19 pandemic were outlined in the Chief Medical Officer (CMO) letter dated 20 May 2020.
This was updated in April 2022.
Alcohol based hand rub
Aerosol generating procedure
Antimicrobial Resistance and Healthcare Associated Infection
Chief Medical Officer
Chief Nursing Officer
Coronavirus disease 19
Fluid resistant surgical mask
Health protection team
Health and social care worker
Health and Safety Executive
Incident management team
Infection prevention and control
Infection prevention and control team
Joint Committee for Vaccines and Immunisation
Lateral flow device - refers to test
Medicines and Healthcare Products Regulatory Agency
National Health Service
National infection prevention and control manual
Polymerase chain reaction - refers to test
Public Health Emergency of International Concern
Public Health Scotland (new organisation formed in 2020, encompassing former Health Protection Scotland)
Point of care test
Personal protective equipment
Severe acute respiratory syndrome coronavirus 2
Standard infection control precautions
Scottish Prison Service
Transmission based precautions
UK Health Security Agency (formerly Public Health England)