5.1. Workforce strategies
Workers in sensitive settings
Healthcare workers should monitor personal health and not present for work when unwell with acute respiratory infection symptoms, including fever/chills, headache, cough, sore throat, shortness of breath or runny/stuffy nose.
Specific department recommendations remain in place for people working in sensitive settings. These are places where there are many people vulnerable to the severe effects of COVID-19, including:
- residential care facilities, including aged care, disability, and other services
- other care facilities
- healthcare premises, including when health care services are provided in people’s homes.
Anyone who has COVID-19 or symptoms of COVID-19 should avoid working in sensitive settings for at least 7 days.
If you are a close contact and work in a sensitive setting, such as hospitals and aged disability care facilities, you should check with your workplace about testing and other precautions before returning to work.
Healthcare and other sensitive settings should follow Department of Health recommendations for testing staff who are symptomatic, COVID-19 cases, recovered cases, or contacts.
Masks should continue to be worn by staff in sensitive settings.
Healthcare worker vaccination
Health facilities should implement a COVID-19 staff vaccination program that is in line with current Department of Health guidance, see . Workers in sensitive settings are particularly recommended to keep their vaccination status up to date.
Work options for higher-risk workers
Service providers should identify any healthcare workers in the higher risk population, including pregnant workers. Managers should consider offering these workers duties in settings with reduced risk of exposure to patients with confirmed or suspected COVID-19. In all cases, refer to health service guidelines and apply clinical judgement when determining work restrictions. Seek advice from the organisation’s occupational health and safety team.
Consider these work options:
- Redirect the worker to care for patients who are not confirmed or suspected to have COVID-19.
- Redirect into non-clinical or clinical roles that do not have contact with patients who have confirmed or suspected COVID-19.
- Arrange alternatives such as working from home, teleconferencing or videoconferencing.
- Ensure shared offices and other spaces occupied by this group meet any density and physical distancing requirements and consider department advice relating to ventilation.
Staff education and training
Staff should be trained in basic infection prevention and control practices and procedures relevant to their roles and settings, including:
- standard precautions and transmission-based precautions
- hand hygiene
- environmental hygiene
- waste and linen management
- outbreak management
- safe and appropriate use of PPE.
Safe staff amenities
Health services staff must have access to safe facilities to take meal breaks, use bathrooms, and access training and other necessary activities without compromising physical distancing and infection prevention control measures.
In situations where staff are permitted to return early from isolation, they should not take breaks with other staff.
Food services staff
Any staff appropriately trained to use the required PPE may enter a COVID-19 patient care area, including food services staff. However, non-essential staff should be restricted from entering COVID-19 patient care areas where possible.
Local facility processes will detail how meals and beverages are delivered to patients in COVID-19 patient care areas, based on PPE availability, staff training and workflow considerations.
Unused food items should be discarded.
Disposable crockery and cutlery are not necessary. Standard precautions should always be used when handling used crockery and cutlery. Crockery and cutlery can be washed using a domestic dishwasher (on the highest temperature) or a commercial dishwasher on the 75°C setting. If a dishwasher is not available, wash with hot water and detergent, rinse and leave to dry.
Food trolleys that have been used in any COVID-19 clinical areas should be cleaned and disinfected before reuse.
5.2. Isolation, cohorting, zoning and patient movement
Single room isolation is recommended for the treatment and care of patients with confirmed and suspected COVID-19.
The priority room allocation for single room isolation of confirmed or suspected COVID-19 patients should consider the following, according to facility resources:
- Single room with ensuite facilities, negative pressure air handling, with or without a dedicated anteroom.
- Single room with ensuite facilities without negative pressure air handling.
- Single room without ensuite facilities and without negative pressure air handling
- Cohorted room.
Special arrangements may be required for patients or residents with cognitive impairment.
If ensuite facilities are not available, a dedicated toilet or commode should be allocated. Bathroom exhaust fans should always be turned on.
Note: Avoid the use of rooms that are positively pressurised with respect to corridors.
Cohorting is described as grouping individuals with the same condition or same laboratory-confirmed infection in the same location (a room, ward section or building).
During periods with high prevalence and or during local outbreaks, facilities may consider implementing cohort isolation in a designated COVID-19 care zone.
The goal of cohorting patients and the staff that attend to them is to minimise opportunities for infection transmission. Cohorting minimises interactions between those who are infectious and those who are not.
Cohorting uses three risk categories:
- Confirmed infection – patients with the same confirmed pathogen are grouped together during the infectious period.
- Suspected infection – patients suspected to have an infection caused by the same pathogen are cohorted separately from those confirmed to have the infection and separately to those not suspected of having the infection.
- No identified infection risk – patients not suspected of having the infection, or those deemed to be cleared of a previous infection, are grouped together.
Staff caring for patients with suspected or confirmed infections, where possible, should be cohorted. Each cohort should be assigned to work with either suspected or confirmed patients to minimise the risk of transmission.
Zoning is a technique used to implement and support cohorting within a facility. Zoning is relative to the size of the outbreak and layout of the facility.
Zoning may be difficult to apply in the residential care environment due to issues such as residents moving around the facility, but it remains important to consider how to apply zoning (in whole or in part) in the event of an outbreak.
Zoning may not be feasible in some accommodation settings such as supported independent living or group homes. In these settings, residents have their own room but may share bathrooms, meal and living areas. In evaluating suitability for zoning, consider the needs and behaviours of the patients, the physical layout of the home, and staff capacity to support zoning.
To remain prepared for COVID-19 outbreaks, health services must have an Outbreak Management Plan. A plan must include:
- identified areas that are suitable for use as COVID-19 clinical care zones
- colour coded or labelled floor maps outlining each zone
- instructions on how to implement and manage each zone.
Implementation of zoning requires a coordinated multidisciplinary approach. Zoning should be reviewed regularly, and adjustments made as required. Clear command structures, monitoring procedures and communication pathways should be established when zoning is implemented, scaled up, de-escalated, or stood down.
Zones may be:
- one room (single room isolation)
- a few rooms geographically co-located or separately located in the same area (ward/wing/building)
- an entire ward, wing, or building.
Table 4: COVID-19 care zones
This is an area between contaminated and non-contaminated zones.
It is a staff-only area with no patient access, for example: nurses’ stations, staff tea rooms, meeting rooms, drug rooms, sterile stock rooms or office spaces.
This zone may not be possible or necessary in areas that only include red and amber zones.
|Green zone||This is a patient care area or administrative areas such as office and kitchen, where there are no people with suspected or confirmed COVID-19, and no people recently cleared of infection.|
This is a patient care area with patients requiring quarantine, such as those identified as contacts.
Patients in this zone should remain isolated from each other where possible and not congregate in communal areas.
This is a patient care area used for isolation of patients with COVID-19.
This zone may be a single patient room or multiple patient rooms in one area, or an entire ward.
Patients have confirmed or suspected COVID-19.
Considerations when setting up zones
When planning zones, consider:
- building layout and available space
- availability of single and shared rooms within the ward, wing, or building. Single rooms should be prioritised for patients with significant symptoms
- availability and location of bathrooms and toilets
- the ability of the patient/resident to remain in their room
- workforce capacity to support zoning
- placement of donning and doffing stations in each zone
- access to supplies (for example linen and other consumables) to enable easy access without crossing zones
- availability of mechanical ventilation, and capacity to increase natural ventilation.
Patients with suspected or confirmed COVID-19 should be placed in single rooms with their own bathroom, if possible. If single negative pressure ventilation isolation rooms are available, prioritise their use for patients who have higher transmission risk or who may require aerosol-generating procedures.
Zoning must be accompanied by a robust staff education and training program.
Amber and red zones should:
- be geographically separated from blue zones and green zones if possible
- be decluttered as much as possible. Items and equipment that are not frequently used should be put away in easy-to-clean storage containers, cupboards, or drawers
- have limited number of entry or access points. If possible, the entry and exit points for each zone should be separated and monitored.
Cohort healthcare workers (HCWs), cleaning and catering staff and assign to one zone where possible. Staff should not work across red, amber, and green zones.
All staff working in or entering red zones and amber zones should be trained and competent in the use of PPE, including correct donning and doffing procedures and fit checking. They should have undergone P2/N95 respirator fit testing.
During a surge, organisations should consider having additional staff above baseline numbers, for example:
- runners to support staff in red and amber zones by fetching items such as equipment and linen. This reduces the need for PPE changes
- trained PPE buddy or spotter to observe and support safe use of PPE
- cleaning staff to meet the increased cleaning and disinfection requirements
- staff to manage waste removal for all areas.
- in RCFs, an allied health or leisure and lifestyle staff member to provide activities for residents who are well enough and are in quarantine or isolation.
Considerations when assigning staff to a zone:
- the ability to meet patient care requirements, including for patients with challenging behaviours/behaviours of concern which may require additional staffing
- prevention of staff fatigue associated with frequent changing and prolonged time in PPE, which predisposes to breaches or mistakes
- separate staffing rosters for red and amber zones and non-COVID-19 (green) zones
- HCWs assigned to red and amber zones should be experienced, if possible. They should not simultaneously work in or be assigned to non-COVID-19 areas
- ensuring staff assigned to red and amber zones have skills in applying infection control principles and are competent with the use of required PPE
- the possible need to activate staff surge workforce as per pandemic or outbreak management plan, in response to a potential loss of 50% or more of the workforce.
There should be no shared food, for example, no shared biscuit tins, fruit bowls, chocolates. Food should not be consumed in clinical areas.
Consider staggered meal breaks to reduce staff interaction. Consider recording or logging attendance in the tearoom.
Staff tea rooms must be in a blue zone.
A red zone should ideally have its own designated nursing stations, break areas and bathroom facilities which are not shared with staff from other zones. Consideration should similarly be given to separate outside fresh air and smoking/vaping areas.
If dedicated segregated staff break areas are not achievable, staff break areas should be organised in such a way as to promote physical distancing.
Staff bathroom and toilet facilities in a red zone or amber should not be used if there is no space for safe donning and doffing stations.
Staff returning early from quarantine should not take breaks with other staff.
Designate areas where staff can change out of their work uniform before leaving work if they wish to do so.
Zone entry, exit and traffic flows
Use demarcation signage or floor markings (if there is a lack of structural barriers such as doors) to identify the beginning and end of a zone.
If a zone is an individual room, use signage to identify the zone type and to support staff to select the required PPE.
Wherever possible, establish clear one-way and one-person-only direction of movement along corridors. If this is not possible, use floor markers to designate the desired direction of movement (for example, directional arrows on the floor with left side in and right side out).
When setting up PPE stations:
- Set up donning and doffing stations in areas with the least amount of foot traffic and with sufficient room to don or doff.
- There should be a minimum of 1.5 metres between donning stations, doffing stations, and the patient.
- Clearly mark donning and doffing stations using signage and/or floor markings.
- Assign a donning and doffing station to the entry and exit point of each zone.
Equipment must be cleaned and disinfected between each use according to the manufacturer’s instructions.
- Amber zone – ideally, dedicated equipment should be allocated to each patient. Equipment may be shared within the zone following cleaning and disinfection.
- Red zone – ideally, dedicated equipment should be allocated to each patient. Equipment may be shared within the zone following cleaning and disinfection.
- Green zone – equipment may be shared within the zone following cleaning and disinfection
- Equipment that is used in amber or red should not be taken to a green zone.
Health services should have plans and procedures for:
- patient transfers in and out of red zones and amber zones. Consider internal transfer pathways including ambulance admission, emergency department, specialist diagnostics, operating theatres, and ward admission
- priority allocation of negative pressure and single rooms
- deteriorating patient pathway, that is, Intensive Care Units (ICU), operating theatres, endoscopy, and Coronary Care Units (CCU)
- provision of diagnostics at bedside, where practical. Have a transfer process in place for other diagnostic requirements, including specimen collection.
Where possible, patients/residents should be cared for in single rooms with their own bathroom. During surge periods with increasing numbers of COVID-19 cases, cohort isolation of confirmed cases in shared rooms may be considered.
Confirmed COVID-19 cases with another infection, such as influenza or multi-drug resistant organism colonisation, should be allocated a single room with a dedicated bathroom.
The number of confirmed cases that should be cohorted in one room should be based on the room’s capacity. It should be possible to:
- meet bed separation requirement of >2 metres, to accommodate staff movement and equipment and to ensure adequate air circulation
- maintain good air circulation by positioning clinical equipment to ensure that it does not impede airflow
- access an ensuite bathroom
- close doors to the room
- ventilate the room, preferably using a heating, ventilation and air-condition (HVAC) system
- maximise fresh air supply
- increase air exchange to create a negative pressure to adjacent rooms with consideration to exhaust through bathroom
- access individual ventilation hoods if appropriate for the patient population; for example, in ICU settings
- access portable air cleaning units to filter contaminated air
- consider patient/resident population risk factors, for example, aerosol generating behaviours or ability to follow instruction.
Health services should:
- plan for management of surges with increased numbers of presentations in Emergency Departments (ED and Urgent Care wards and the extension of SCOVID/COVID wards (that is, hospital in the home, home quarantine and alternative locations for the care of low-acuity COVID positive people)
- consider strategies for the establishment of ICU outside of established ICU wards (that is, use of operating theatre recovery areas) and management of open ICU wards verses those ICU wards that have single rooms. Prioritise single rooms for aerosol generating procedures
- consider strategies for assigning ventilators and supportive airway management strategies, for example, Continuous Positive Airway Pressure (CPAP)
- develop plans to de-escalate as patients recover or there are reduced number of admissions.
Personal protective equipment for zones
Standard and transmission-based precautions must be always followed. Single-use eye protection must be disposed of when removed. Reusable eye protection should be cleaned and disinfected according to the manufacturer’s instructions and stored clean, dry, and protected from contamination.
Table 5: PPE for zones
|Blue zone||Respiratory protection as determined by organisational policy.|
|Green zone||Respiratory protection as determined by organisational policy.|
|Amber zone||COVID-19 airborne precautions, .|
|Red zone||COVID-19 airborne precautions, .|
Extended use of PPE* is permitted where all patients have the same risk as confirmed cases, and if the patient does not have another infectious condition. (*excluding gloves)
Note: In amber and red zones where there is a mix of confirmed and suspected cases, gowns (if worn) must be changed when moving from care of a confirmed case to care of a suspected case.
Release from isolation
Release from isolation should be considered in consultation with the infection prevention and control team, the treating medical team and where appropriate, the LPHU with reference to department guidance as relevant, see the department's advice.
Patients with COVID-19 who are discharged back to their home environment and health workers who have COVID-19 and are isolating at home should comply with current department advice on duration and conditions of isolation.
Hospitalised patients who are being transferred to another ward or hospital should remain in isolation with transmission-based precautions and appropriate PPE until criteria are met for release from isolation.
People who have recovered from COVID-19 and have been released from isolation based on the criteria above do not require COVID-19 testing if they are hospitalised for a non-COVID-19 related condition.
The transferring health facility should notify ambulance or other transport agencies on the patient’s condition and COVID-19 status to ensure all HCWs involved are aware of the PPE requirement prior to arrival.
All agencies involved in the transport of COVID-19 suspected or confirmed patients should implement their organisations' standard and transmission-based precautions.
Before transporting patients with suspected or confirmed COVID-19, perform a risk assessment on
- the type of vehicle required
- the physical capability of patient/client and whether assistance will be required
- the ability of the patient/client to wear a surgical mask and practice respiratory etiquette (hygiene).
Ideally no other patient should be transported at the same time (for example, no multi-loading). Exemptions to this approach can be applied with high community transmission and demand on the health service.
For suspected or confirmed COVID-19 patients, before entering the vehicle, the driver, clinician, and passenger should perform hand hygiene with ABHR. The driver should follow airborne precautions. Eye protection is not required for drivers as this may obscure vision.
Passengers should wear a surgical mask or respirator, perform hand hygiene, and be educated on respiratory hygiene. Passengers should be provided with a plastic bag, tissues and ABHR.
Whenever possible, drive with windows open and keep the vehicle fan on fresh air (not recirculation).
The vehicle should be cleaned at the end of the journey. Remove any visible contamination with detergent and disinfectant wipes. Clean the seat area, door handles, and any other high-touch areas or areas touched by the patient with detergent and disinfectant wipes.
Patient movement within a facility
Movement of confirmed and suspected COVID-19 patients within a facility should be limited to essential purposes.
If it can be tolerated, patients should wear a P2/N95 respirator or a surgical mask during transfer to another department within the facility. The receiving department should be notified of the patient's infectious status in advance.
Patient transfers within a health organisation should use a route that minimises contact with the general hospital population, including clinicians, for example, a dedicated lift or an external path.
5.3. Other IPC strategies
Principles of physical distancing may be applied in any workplace setting (including non-healthcare settings):
- limit the number of people present in enclosed rooms
- maintain 1.5 metres distance from other people when feasible, except for the provision of direct care
- minimise time in close proximity, and wear a mask if 1.5 metres distance cannot be maintained
- position waiting room chairs 1.5 metres apart or block out interval chairs
- rearrange furniture to limit staff congregation in staff communal areas
- conduct staff interactions at a distance, for example, during ward rounds, shift handovers and meal breaks
- stagger break times to limit levels of staff congregation. Encourage breaks outdoors when possible.
In residential care settings, communal activities may still proceed if physical distancing is maintained. This may mean smaller groups are offered more frequently. During outbreaks, communal activities may need to be suspended.
Aerosol-generating procedures and behaviours
Aerosol-generating procedures (AGPs) may need to be performed during the care of patients suspected or confirmed to have COVID-19. Procedures that are believed to have a potential to generate aerosols or droplets include positive pressure ventilation, bilevel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP), endotracheal intubation, airway suction, high-frequency oscillatory ventilation, tracheostomy, chest physiotherapy, nebuliser treatment, sputum induction, and bronchoscopy.
Procedures that may cause aerosolisation of fluid or tissues that are not from the respiratory tract or lungs are not considered high risk AGPs for transmission of COVID-19.
AGPs should, whenever possible, be conducted in a negative pressure single room or a well-ventilated standard pressure room with a portable air cleaner. Personal ventilation hoods may be considered if a standard room is used.
Patient factors that increase the risk of COVID-19 transmission include aerosol generating behaviours such as:
- shouting or screaming
- coughing or increased work of breathing
- cognitive impairment or inability to cooperate
- refusing to wear, or inability to tolerate, a surgical mask.
Health care providers should complete a patient-centred risk assessment to determine the clinical need to complete AGPs. Consideration should be given to alternative therapy in consultation with treating medical team.
AGPs on suspected or confirmed COVID-19 persons should be performed with a minimum number of HCWs present and where possible, the most qualified person should carry out the procedure.
If feasible, CPAP, BiPAP or nebuliser therapy should be administered by the user themselves to reduce the risk of infection transmission to others. Only essential staff required for clinical care should be present during the procedure.
Airborne and contact precautions should continue to be used for the minimum settle time after the patient has left the room. The room should be left unused for a period after an AGP has been performed. A minimum settle or wait time of 30 minutes is recommended for negative pressure rooms, and up to 60 minutes for a standard room where the number of air changes per hour is not known.
If the number of air exchanges per hour is known, the minimum wait time can be calculated using the CDC Guidelines for Environmental Infection Control in Health-Care Facilities (2003). Airborne Contaminant Removal Table B.1 available at .
Cleaning and disinfection of the procedure room should be undertaken following an AGP except if the procedure is conducted in a designated isolation bedroom. Surfaces in rooms where CPAP, BiPAP or nebuliser therapy are performed should be cleaned and disinfected according to facility cleaning schedules.
While respiratory aerosols may have a wide dispersion range, many of the small droplets fall to the ground or surfaces within 1 metre of the user. In at-home care settings, enhanced cleaning and disinfection after each use should be focused on hard surfaces within an approximate 1 metre radius of where the therapies were performed, in addition to regular cleaning schedules.
Assisting with patient hygiene
Toilet flushing may generate microbe-containing aerosols. Toilet lids should be closed when flushing.
Indoor bathrooms are often poorly ventilated, so prolonged periods of time spent in these environments could increase the risk of infection transmission to carers and staff. Additionally, the wet conditions and humidity may dampen respirators and impair their function.
The risk assessment for showering should consider:
- the level of support or assistance required
- whether the room has sufficient ventilation
- whether the room has sufficient space to provide care without contamination to self
- whether the patient/resident has a clinical need for showering, is physically capable, and can cooperate.
- use a face shield to protect the respirator from moisture splash or spray. Avoid getting the respirator wet
- turn on extractor fans while showering and leave the door open, if possible
- replace PPE after shower.
Alternative methods of providing personal hygiene care should be used when the risk of showering is deemed unacceptably high.
Medical records and patient charts
The risk of contamination of paper health records and subsequent exposure to COVID-19, in the absence of a spill (or similar), is considered extremely unlikely and negligible risk.
Standard precautions apply to the management of all patient charts and medical records. Patient charts and records should remain outside patient rooms.
PPE must be removed, and hand hygiene performed before writing on paper charts or medical records.
Medical records do not need to be quarantined before being returned to health information services.
Outbreak response kits in RCFs
An outbreak response kit should be prepared before any potential outbreak. It should be accessible for staff to use immediately if there is an outbreak.
The kit should include essential documentation that will allow the immediate implementation of an outbreak response:
- the facility’s outbreak management policy and guidelines
- a checklist of essential tasks and notification pathways
- contact details (all hours) of the internal outbreak notification pathways
- contact details (phone/email/weblink) for external outbreak notification
- the cohort and zoning plans for the unit
- outbreak signage.
It should also include equipment and consumables:
- large wipeable container with lid to store kit contents. Consider sealing the kit when not in use to prevent ad hoc use of the outbreak start-up stock.
- surgical masks
- P2/N95 respirators
- impervious / fluid repellent gowns
- nitrile / latex gloves in L, M and S sizes
- protective eyewear: goggles / face shields.
Consider the need for ready access to:
- a supply of large general waste bins and bin liners
- chemical disinfectant approved by the Therapeutic Goods Administration; see .
When deciding how much stock to keep in the kit, consider the facility size, number of residents, and the time that any new orders of stock would take to be delivered.
For more information see:
Care of the deceased
Care of the deceased should follow the health service guidelines and relevant legislation. Routine occupational health and safety guidelines and infection control procedures apply to the management of deceased bodies, with the same precautions in place after death as were in place prior to death.
COVID-19 standard and transmission-based precautions continue to apply when handling the body. At a minimum, contact and droplet precautions should be used.
Avoid unnecessary manipulation of the body that may expel air or fluid from the lungs. Airborne precautions are required if there is a risk of generating aerosols, for example in post-mortem extubation or procedures involving high speed devices.
HCWs handling deceased bodies should wear appropriate PPE: apron/gown, gloves, masks, and face shield/goggles.
If a family member touches the body, they should wash their hands with soap and water immediately afterwards or use ABHR.
When transporting the deceased, the body must be placed and secured in a body bag or wrapping in a manner that prevents the leakage of body fluid or other substance. Double bagging may be required to achieve this.
5.4. Visitor and family strategies
Refer to current Department guidance for advice on entry point screening and restrictions. Everyone should undertake a COVID-19 test before visiting sensitive settings and masks should continue to be worn by visitors.
Visiting suspected or confirmed COVID-19 cases
Visiting a person with suspected or confirmed COVID-19 presents a considerable risk of transmission. The decision to allow visitors to a patient suspected or confirmed to have COVID-19 should be managed on a case-by-case basis in conjunction with the treating medical team and the health service Infection Prevention and Control team. Refer to Department and LPHU guidance as relevant.
It is particularly important for facilities to assist visitors to visit safely. Visitors must use the same PPE protection and infection prevention practices as healthcare workers. Staff should provide instruction, assistance and supervision of PPE selection and use by visitors.
Family as carers in residential care facilities (RCF)
A carer model may be implemented as a continuity of care strategy and for compassionate reasons during an active COVID-19 outbreak at an RCF.
One relative or usual carer per resident may be designated as an Essential Carer (EC) and may be permitted to provide care to their resident on-site at the facility.
For more information see:
Reviewed 17 September 2023