6.1 COVID-19 case definitions and triage

6.1.1 Definition of a confirmed case

A laboratory-confirmed (detection of SARs-CoV-2 RNA in a clinical specimen) case of COVID-19.

6.1.2 Definition of a suspected case

An individual meeting one of the following case criteria taking into account atypical and non-specific presentations in older people with frailty, those with pre-existing conditions and residents who are immunocompromised; (further information on presentations and management of COVID-19 in older people and Scottish Government and Appendix 1 :Think COVID:Covid-19 Assessment in the Older Adult - Checklist).

Community definition:

or

or

 

Definition for residents who may require hospital admission:

or

or

or

6.1.3 Triaging of residents being brought into a care home

To aid prioritisation for residents who may be at most risk, admission triage should be undertaken to enable early recognition of potential COVID-19 cases.  Wherever possible, triage questions should be undertaken prior to arrival at the care home.  If the resident has capacity issues this should be undertaken with the individual’s guardian or power of attorney.

The 14 day self-isolation requirement for residents on admission to the care home from the community follows a Protection Level approach as set out by the Scottish Government. This removes the blanket approach for self-isolation on admission to a care home from the community. In Protection Levels 0-2, a risk assessment should be agreed on a case by case basis by the care home manager to determine whether the resident should isolate for 14 days on admission to the care home. Given the diversity of settings, there may be some residential settings where a 14 day period of isolation is more appropriate (e.g. settings with older or clinically vulnerable residents, and communal areas where residents mix); the decision on this is at the care home manager’s discretion subject to local risk assessment as guided by the local oversight group.

In Protection Levels 3-4, the resident will need to isolate on admission for 14 days.

A risk assessment prior to admission should be undertaken to ensure that appropriate isolation facilities are available, taking into account requirements for the resident’s care. Risk assessment can include factors such as presence of COVID-related symptoms, COVID status of household they have come from, resident travel history, resident vaccination status, care home staff vaccination uptake rate, general IPC and PPE training/supplies/usage in the care home.

All admissions from the community, irrespective of Protection Level, should have one negative PCR test within 3 days of their admission date. In exceptional circumstances where testing is not possible before admission then testing on admission to the care home is acceptable and should be considered. Where it is in the clinical interest of the resident and negative testing is not feasible (e.g. resident does not consent, detrimental consequences or it would cause distress), an agreed care plan for admission to the care home will document this. Advice on this process is available from the local Health Protection Team, if needed.

For information on residents being admitted to the care home for respite purposes – see PHS COVID-19 information and guidance for care home settings.

Suggested questions for triage:

If yes, wait until self-isolation period is complete before admission or if urgent care is required, follow the high-risk category.

If yes, follow the high-risk category.

If yes, follow the high-risk category.

If yes, should wait for 10-day quarantine before admission to care home, or if urgent transfer is required, follow high risk category.

The Scottish Government website details quarantine (self- isolation) rules and information on the process for people entering the UK.

If yes, wait until self-isolation period is complete before admission or if urgent care is required, follow the high-risk category.

If yes, provide advice on who to contact (GP/HPT) and follow high-risk category.