Care Homes Strategy for Infection Prevention & Control of Covid-19 Based on Clear Delineation of Risk Zones

This is a holding page for the document Care homes strategy for Infection Prevention & Control of Covid-19 based on clear delineation of risk zones.

We also have a zip file for IPC signage that can be adapted.


These documents are now translated in Portuguese:

Esta é a link para a página de retenção do documento Estratégia para a Prevenção e Controle de Infecções de Covid-19 em Abrigos de Idosos Baseada em Delineamento Claro de Zonas de Risco.

Também temos um arquivo zip para sinalização de prevenção e controle de infecções que pode ser adaptado.


These documents are now translated in Spanish:

Este es un repositorio para el documento Estrategia para la Prevención y Control de Infecciones por Covid-19 en Instituciones de Cuidados a Largo Plazo (ICLP) Basado en la Delimitación Explícita de Zonas de Riesgo. La estrategia también está disponible en la página web del Instituto Nacional de Geriatría de Mexico.

También tenemos un archivo zip de recursos de señalización para la prevención y control de infecciones, que se pueden adaptar.


Document summary

This strategy which went online on 18th April, incorporated as much current UK government guidance as possible, while remaining both consistent and pragmatic. On 15th May, we undertook a mapping of current guidance on infection prevention and control in care homes from the UK Government and Public Health England in order to understand the strengths and gaps, and to show how it relates to our strategy and the rationale for where it differs. We gave some background to this mapping exercise in a blog post on 15th May, and also followed up on this with another blog post on 12th June that discussed more around the issues of asymptomatic transmission in relation to current guidance. Then on 13th July, we finished a more in-depth research document on Gaps in UK Government Infection Prevention & Control (IPC) Guidance for Care Homes and What Was Known When on Asymptomatic and Pre-symptomatic Transmission of COVID-19 – this included a national and international timeline to set out what exactly was discussed when by the UK government, compared to what was known internationally and when.

Our care homes strategy is based around some fundamental aspects of what we believe needs to happen to make care homes safer environments:

1. Understanding that asymptomatic / pre-symptomatic transmission is a major contributor to the spread of Covid-19 in care homes, where the source of this transmission comes from outside (mostly via staff, but also visitors). Note that we have carried out an evidence review of asymptomatic and pre-symptomatic transmission, as well as an evidence review of airborne transmission and the effectiveness of masks.

2. Clear delineation of zones of risk for the entire building, differentiating between contaminated & clean, which is reinforced through staff allocation & rotation.

3. Hand disinfection for all points between risk zones (even where gloves remain on).

It also attempts to add some more pragmatic detail for certain elements – for example, how to practically re-purpose PPE using chlorine, and how to make chlorine dilutions. More recently (October 2020) we have also added some supporting documents that are linked to within the strategy: a ventilation decision tool to help managers make decisions about ventilation of communal spaces, and a more in-depth explanation of non-chlorine disinfectants.

The document is meant as a practical aid for care home managers to be able to implement effective infection control in their particular context. It is acknowledged that there will be a whole range of different types and set-ups of care home depending on the level of care required (e.g. nursing, care, sheltered housing), where each which will need a context-based response. However, the idea here is for managers to be able to use/adapt this document for their own context.


Webinars explaining the document

A webinar (courtesy of the AECB) was held on 23rd April explaining the rationale for this strategy:

There was also a second webinar (courtesy of the International Long-Term Care Policy Network) that was held on 25th May that focused on the issue of asymptomatic and pre-symptomatic transmission (at around 37 minutes into it):


Interviews & references

There were also two BBC interviews on this subject on 21st April – these were on the BBC World Service and BBC News with Victoria Derbyshire. An additional interview was done on 6th May with BBC Radio Ulster (at around 1:08 into it).

More recently on 28th May, The Guardian ran a podcast looking into what went wrong in care homes, and our strategy was mentioned as being a key aspect of how one care home managed to sort out infection prevention and control (at 7 mins 55 secs into it).

Update: since going online on 18th April, our strategy has been discussed and cited at various levels and made it into the following documents and websites:

– Gordon, A.L. et al (2020) Commentary: COVID in care homes—challenges and dilemmas in healthcare delivery. Age and Ageing 2020, p.3.

– Carter, R. (2020) Covid-19: The support UK care homes need to survive. BMJ 2020; 369:m1858, p.2.

– WHO (2020) Strengthening the Health Systems Response to COVID-19. Technical guidance #6: Preventing and managing the COVID-19 pandemic across long-term care services in the WHO European Region (21 May 2020). pp.10-11. WHO, Geneva, Switzerland.

– British Geriatric Society (2020) Managing the COVID-19 pandemic in care homes: good practice guide. p.6. Updated 2nd June.

– The resource database for the Social Care Institute for Excellence (SCIE).

– The list of questions for inspections on the Care Quality Commission (CQC) website (expand the part labelled ‘What good looks like and guidance’ in sections 2, 6 and 8).