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

Winter preparedness and prevention

Facilities can implement several measures to prevent and prepare for respiratory illnesses, including COVID-19 and influenza.

  • Vaccination
  • Promote and facilitate COVID Smart behaviours
    • Staff and visitors who are unwell should stay at home and get tested for COVID-19. They should stay home until their symptoms have gone or are significantly improved, even if they test negative to COVID-19.
    • Encourage good hand and respiratory hygiene.
    • Support physical distancing where possible.
    • Continue to review your facility’s visitor and mask policies based on the level of risk you are managing in your own setting.
  • Plan for the impacts of respiratory illness in your setting
    • Ensure your outbreak management plan (OMP) is up to date and staff are ready to implement it. ACT Health is available to provide support and advice if needed (outbreak.response@act.gov.au or 02 5124 6320, between 8am and 4.30pm Monday to Friday).
    • Ensure you have adequate supplies of personal protective equipment and testing kits.
    • Plan for workforce shortages.
    • Support residents to have a clinical management plan with their primary care provider in the event they develop an acute respiratory infection to help ensure rapid access to testing and medication if required. A pre-assessment form for COVID-19 and influenza antiviral medication can be found at Antiviral pre-assessment form for COVID-19 and/or influenza (act.gov.au).

Entering a high-risk setting

Staff and visitors entering high-risk settings 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 higher-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.

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.

COVID-19 exposures and 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 continues to support high-risk settings who have exposures or outbreaks.

Risk assessment of exposures in high-risk settings

Facilities and workplaces should 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 using the following tool.

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.

Staff who are household or higher risk 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 higher risk contacts of a person with COVID-19 should follow the instructions of their facility or organisation for returning to work

Risk mitigation measures should be practised in accordance with facility policy. The following tool provides general risk mitigation advice for household and higher risk contacts returning to work.

Staff working in a Clinical Health Emergency Coordination Centre (CHECC) site should follow CHECC guidance in relation to attending work.

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

This risk assessment guidance and staff return to work guidance may be updated over time. Please refer to the website for the most up to date version.

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

Additional information

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 higher-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 higher-risk contact.

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

Public health guidance for the relevant high-risk setting is available:

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

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Acknowledgement of Country

We acknowledge the Ngunnawal people as traditional custodians of the ACT and recognise any other people or families with connection to the lands of the ACT and region. We acknowledge and respect their continuing culture and the contribution they make to the life of this city and this region.

Last Updated: March 18 2024