In recognition of the current Omicron wave and demand on pathology testing, the following revised protocol has been established to ensure appropriate access to pathology services and ensure that residential aged care facilities (RACFs) are able to access the support and resources required.

To help protect senior Australians from COVID-19, Rapid Antigen Tests (RAT) have now been made available to RACFs to screen workers, visitors or symptomatic residents in aged care environments to help prevent outbreaks or contain the spread of outbreaks.  

RACF staff should have a daily RAT (minimum twice weekly where supply constraints exist) at the commencement of each shift. Visitors should have a RAT prior to each visit. These regimes may be modified due to local considerations such as community prevalence of COVID-19 and the availability of RATs. PCR tests should not be used for asymptomatic surveillance of staff or residents where there has been no exposure or outbreak. 

Any suspected or confirmed COVID-19 in staff, residents or visitors will trigger a risk assessment by the RACF.  A RAT is required immediately for all resident and staff within the facility who had contact with the suspected case.

A symptomatic resident with a negative PCR or RAT should have appropriate infection control procedures maintained whilst testing for other respiratory pathogens (eg influenza) is underway.

In some locations PCR testing may be more immediately available than RAT – where results can also be returned in a timely fashion, this may be used in definite outbreaks or exposure.

Last updated: 08 January 2022
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Trigger for testing for a RACF with an outbreak or exposure

  • Staff who receive a positive surveillance RAT result, who have no symptoms, where there is not a current confirmed outbreak and who have no other known significant exposures, should get a PCR test with staff accessing PCR testing through community testing clinics
  • The positive staff RAT result in those circumstances will not trigger PCR testing at the facility, but will trigger appropriate infection control actions. 
  • Staff who are symptomatic who have a positive RAT result do not need confirmatory PCR. Actions should be taken within the RACF on the basis of this test.
  • A resident who receives a positive RAT, and who is the first case at the facility, will require a confirmatory PCR test if they have no symptoms OR have no other exposures. Whilst awaiting the PCR result, or if the resident is symptomatic,  RAT testing should be undertaken for all residents and staff in the impacted area of the facility based on a risk assessment.  For example this may be a specific wing within the facility or the whole facility where the facility is a small facility or impacted residents have access to other areas.
  • On a receipt of a positive RAT, in a resident, and while waiting on the PCR test results, the RACF should activate their outbreak management plan.
  • If a negative PCR test result is returned for the tested resident, an outbreak response is not required.

How to access PCR testing

  • To access PCR testing, the aged care provider should:

    • In the first instance ask their local pathology provider. 

    • If this is unavailable, discuss with the local health district (LHD) their capacity to provide testing. Current local testing is severely constrained.

    • If this is unavailable, access to the supplementary Sonic in-reach program should be requested via the Commonwealth Department of Health case manager at NSWCOVIDcasemanagement@health.gov.au. The request must include advice on the number impacted residents for testing (see proposed testing schedule for exposure below) and whether the facility has the capacity to swab or needs assistance. Please note requests will be processed in order of receipt, the case manager will advise the facility when collection kits or testing teams are booked.

    • The PHU should also be notified at the same time that the facility's Outbreak Management Plan (OMP) has been activated.

    • Commonwealth funded SONIC PCR testing cannot be requested directly to SONIC by RACFs.

Proposed testing schedule for exposures

At the time of the Sonic in reach request the Department of Health will arrange for a testing schedule as per this document. Where there is an extensive outbreak the PHU may provide additional guidance specific to the risk in that setting.

When one or more pathogens is circulating in the community other significant respiratory pathogens should be considered, including influenza.

Initial testing following positive RAT test in resident (with OMP activated and lockdown/cohorting etc in place):

    1. RAT testing of staff and residents who had contact with the suspected case, to identify the initial extent of COVID-19 presence in the facility
  • If initial RATs negative, then:
    1. Isolate at-risk residents/staff based on the exposure (staff can be assessed in line with Interim Guidance on managing workforce in regards to COVID-19 in aged care | Australian Government Department of Health)
    2. Repeat RATs on staff and residents who had contact with the suspected case on Day 6 and Day 12

  • If initial or subsequent RATs positive, then:

    1. Isolate at-risk residents/staff based on exposures (staff can be assessed in line with Interim Guidance on managing workforce in regards to COVID-19 in aged care | Australian Government Department of Health)
    2. Undertake confirmatory PCR test where the resident is:
      -  the initial case;
      -  at a high risk for health complications; or
      -  requires a PCR diagnosis for the management of clinical care.
    3. RATs on Day 6 and Day 12 for staff and residents who had contact with the case
    4. Consider next steps based on location of and additional exposures arising from this subsequent case. That is, if any new case is contained within the already exposed wing, then may not change overall testing schedule for broader facility. If they are outside of exposed wing, then likely need to broaden/increase further testing. (NB: Likely to result in Outbreak Management Team meeting.)

Where PCR is more readily available than RAT and there has been an exposure in the facility:

  • If initial or subsequent PCRs positive, then:
    1. Isolate at-risk residents/staff based on exposures (staff can be assessed in line with Interim Guidance on managing workforce in regards to COVID-19 in aged care | Australian Government Department of Health)
    2. PCRs on Day 6 and Day 12 for staff and residents who had contact with the case
    3. Consider next steps based on location of and additional exposures arising from this subsequent case. That is, if any new case is contained within the already exposed wing, then may not change overall testing schedule for broader facility. If they are outside of exposed wing, then likely need to broaden/increase further testing. (NB: Likely to result in OMT.)
  • Other general testing considerations:
    1. Any symptomatic residents/staff should remain isolated and have a RAT.  If positive, then PCR testing as per this protocol.
    2. RATs of all facility staff daily
    3. Testing for other respiratory pathogens e.g. Influenza where residents display symptoms of respiratory illness

Testing to close out an outbreak

  • An outbreak may be assessed with RAT of proximate residents on day 6 and day 12.  The actions may be closed on the basis of a RAT. PCR might be used if the outbreak has been complex and local testing capacity allows a timely return of results. Your PHU will provide advice for these situations.

Guidance regarding testing of RACF residents after leave episodes

  • Residents who leave the facility to attend a family gathering and return the same day should on return have a RAT on days 2, 4 and 7 after they return. If well, residents do not need to isolate.  If they develop any signs or symptoms of COVID-19 they should immediately be isolated and have a PCR test. 
  • Residents who do not return the same day should be isolated until they have a negative RAT the day of return with subsequent tests on days 3, 5 and 7 after they return.
Current as at: Saturday 8 January 2022
Contact page owner: Health Protection NSW