Intended for healthcare professionals


Covid-19: NHS relaxes infection prevention and control measures

BMJ 2022; 377 doi: (Published 22 April 2022) Cite this as: BMJ 2022;377:o1029
  1. Gareth Iacobucci
  1. The BMJ

The NHS has relaxed infection prevention and control (IPC) requirements for hospitals and GP practices that were introduced during the pandemic as it seeks to free up capacity to tackle the huge treatment backlog.

Revised guidance from NHS England and NHS Improvement1 published last week says that healthcare providers will no longer be required to adhere to routine physical distancing measures but should carry out risk assessments to determine whether some precautions such as hand hygiene and personal protective equipment (PPE) are required in specific settings.

Isolation precautions for hospital inpatients with covid-19 are also being relaxed. Isolation periods can reduce from 10 days to 7 days if patients have two negative lateral flow tests taken 24 hours apart as well as showing clinical improvement, the guidance states. Inpatients who are contacts of SARS-CoV-2 cases are no longer required to isolate if they are asymptomatic.

In a letter2 to service leaders outlining the changes, NHS England said the revised guidance “takes into account the UK Health Security Agency’s latest assessment of the scientific evidence, and also feedback from local providers on the ongoing impact on capacity that IPC measures are having.”

Providers should plan to return “to pre-pandemic physical distancing in all areas, including in emergency departments, ambulances, and patient transport, as well as all primary care, inpatient, and outpatient settings,” the letter said.

They should also be “returning to pre-pandemic cleaning protocols outside of covid-19 areas, with enhanced cleaning only required in areas where patients with suspected or known infection are being managed,” it added.

Risks should be balanced appropriately “and take into account the impact on capacity and flow given current pressures on emergency care and elective pathways,” NHS England added.

All patients, visitors, and staff “should continue to practise good hand and respiratory hygiene,” including the continued use of face masks, and current triaging and cohorting arrangements outlined in IPC guidance will continue to apply, it said.

Layla McCay, director of policy at the NHS Confederation, said the revisions would free up much needed capacity.

“Health leaders have had to walk a tricky tightrope of following strict guidance that has kept transmission within their services to a minimum while ensuring they stay on track to deliver ambitious targets to recover the elective backlog,” she said.

“On balance, they will welcome this update to the guidance. While coronavirus still presents a very real threat, they appreciate that reducing how long people who have had covid-19 must be isolated once testing negative, and the isolation and distancing requirements for patients who have not tested positive for covid-19 will allow them to deliver even more for patients, providing the rules are kept under regular review.

“With the continued use of PPE and regular staff testing for coronavirus, patients should feel reassured that their healthcare services will continue to be safe to access.”

But Tom Lawton, a critical care consultant and member of the campaign group FreshAirNHS, who has carried out research into hospital acquired covid, said he was concerned about the relaxations, particularly given reports3 that some hospitals have stopped testing asymptomatic patients to relieve pressure on bed availability.

He told The BMJ, “We have to consider the whole system risk [in terms of IPC]. But we are putting the blinkers on by reducing testing and isolation. Hospital acquired infection has been high during omicron. My worry is that the numbers of hospital acquired infections will go up but we won’t know about it. We are going to hide the problem. It may not be as bad with vaccination but it’s still a risk, not least for vulnerable people.”

He added, “Hospitals are supposed to be places of safety. Not having the resources to properly isolate patients is not a reason for not testing. We should do the best we can.”

More broadly, Lawton criticised the NHS guidance’s lack of clarity in stating how covid is spread. “I find it upsetting that more than two years into a respiratory pandemic, we still haven’t properly acknowledged airborne transmission in the NHS,” he said. “The NHS hasn’t followed the science on this.”