Home and community diagnostic sampling guidance


  1. Scope of this guidance
  2. Steps once an individual has been identified for home and community diagnostic sampling
  3. Equipment
  4. Personal Protective Equipment (PPE)
  5. Clinical waste
  6. Decontamination
  7. Testing for Covid-19
  8. Closing the visit


Publication approval reference: BC 0063

7 March 2020

Home and community diagnostic sampling guidance

1 Scope of this guidance

This guidance gives details on the procedures and equipment required for home and community diagnostic sampling in those persons who have been identified via NHS 111 as suitable for sampling for Coronavirus (Covid-19) in a community setting.

Home sampling helps to protect NHS emergency departments, primary care settings (such as GP surgeries, pharmacies, dentists and opticians) and ambulance transport for ‘business as usual’.
NHS111 may assess a person is suitable for home sampling if:

  1. The patient meets the case definition for possible Covid-19.
  2. Patient is symptomatic with mild to moderate symptoms but has been assessed as clinically well and suitable to remain at home and self- isolate.
  3. Does not require immediate hospital assessment.
  4. Patient is able to self-isolate. Advice for patients and those living with patients who are self-isolating is available on the GOV.UK website.

The case definition may change over time and the assessment will be based on updated guidance.

This guidance covers:

  • the use of Personal Protective Equipment (PPE)
  • the competent collection of samples, safe packaging and transport of specimens to the laboratory
  • the safe disposal of waste

This guidance does not specify who should undertake the testing. However, they should if they have been adequately trained to do the following:

  • choose the appropriate PPE
  • put on and take off PPE
  • safe disposal and management of waste
  • take the samples
  • safely package samples for transport

The transportation needs of the tester and the associated logistics for samples and waste should be agreed locally, with due consideration of staff safety and welfare.

2 Steps once an individual has been identified for home and community diagnostic sampling

Once a case has been identified as suitable for home and community diagnostic sampling, the home sampling team should be provided with patient demographic and personal details, e.g. age, name, address, telephone contact number and relevant background detail such as current symptoms and those likely to be present at the home.

Care must be taken to ensure sharing of information is done in an approved way that protects patient identifiable information and is GDPR compliant.
The clinician or referring laboratory must email the patient identifiers (minimum name and date of birth) and contact phone number for results and queries to phe.virology@nhs.net.

Further details on how to arrange laboratory testing is available.

Covid-19 acute respiratory disease testing is being rolled out to regional PHE Laboratories commencing 11th February 2020.

Safety is a key priority and a risk assessment should be made on arrival at the property on the suitability to continue to undertake sampling in terms of risk of harm from the patient or family, pets, the property and/or its surroundings.

If on arrival at the person’s accommodation it becomes apparent that the individual’s condition has deteriorated and/or requires immediate treatment or clinical assessment the sampling team should withdraw. They should then dial NHS111 or 999 for conveyance to the acute hospital informing them that the patient fits the case definition for possible Covid-19.

3 Equipment

Sampling teams should have a ‘grab bag’ or box with all necessary equipment which is checked and replenished after each use and before travelling to community test sites.

Sampling teams will need the following equipment in their ‘grab bag’ or box:

  • Advised coronavirus PPE (see below)
  • Alcohol hand rub
  • Hand wipes
  • Specimen collection equipment such as swabs, lab request forms, appropriate specimen packaging
  • Chlorine-based disinfectant (minimum strength of 1,000ppm available chlorine)
  • Appropriate waste collection equipment (category B, UN 3373 standard),
  • Mobile phone.

4 Personal Protective Equipment (PPE)

The following PPE is to be worn by the sampling team:

• Disposable plastic apron
• Disposable gloves
• Fluid resistant surgical face mask (FRSM)
• Eye protection, such as single use goggles or full-face visors must be worn (prescription glasses do not provide adequate protection).

4.1 Putting on PPE (donning)

Before putting on PPE, the sampling team should ensure they are hydrated, ensure hair is tied back securely and off the neck and collar, remove jewellery or pens then perform hand hygiene.

Staff should put on the PPE in the following order:
1. Apron
3. Eye protection
4. Disposable gloves

4.2 Removal of PPE

PPE should be removed in an order that minimises the potential for cross- contamination
Gloves, apron and eye protection should be removed (in that order) and disposed of as clinical waste, ideally into a rigid clinical waste bin.

The bin needs to be in the area where HCW will be putting on and removing PPE for final disposal. After leaving the immediate area, the mask can be removed and disposed of as clinical waste.

The order and procedure of removal of PPE should be:

  1. Remove gloves:
    • grasp the outside of the glove with the opposite gloved hand; peel off
    • hold the removed glove in gloved hand
    • slide the fingers of the un-gloved hand under the remaining glove at the wrist
    • peel the remaining glove off over the first glove and discard
  2. Perform hand hygiene
  3. Remove Apron:
    • Pull straps from behind waist and neck, roll from the inside and place in clinical waste
  4. Remove eye protection:
    • only by the headband or sides and dispose in clinical waste
  5. Remove FRSM:
    • lean forward slightly
    • reach to the back of the head with both hands to untie straps
    • let the mask fall away from your face and dispose in clinical waste
  6. Perform hand hygiene.

Full guidance on the putting on and removal of PPE is available (appendix 3)

5 Clinical waste

All waste associated with possible or confirmed Covid-19, including PPE, is Category B infectious clinical waste and safe disposal is the responsibility of the sampling team and employing organisation.

Arrangements must be made to carry and dispose of waste correctly according to existing local options that comply with Health Technical Memorandum 07-01: Safe management of healthcare waste (‘Management of Category B infectious waste in the community’ p119 and ‘Transporting offensive or infectious waste from patients’ homes’ p125.

Rigid waste bins are required to transport category B waste and are easier for the sampling team to remove and dispose of PPE reducing the risk of contamination.

6 Decontamination

The chlorine-based disinfectant should be used to decontaminate the following items before the sampling team leaves the home:

  • the sample packaging before taking to transport
  • the grab bag or box used to contain the items need carry testing equipment
  • any other reusable item used during home sampling
  • the outside of the waste bin. (Cloths used for decontamination should be placed in the waste bin prior to closure).

6.1 Hand hygiene

This is essential before and after all patient contact, removal of PPE and decontamination of the environment.

If hands are visibly clean an alcohol hand rub is adequate, otherwise use soap and water or hand wipes to remove visible contamination, followed by an alcohol hand rub.

6.2 Equipment

Sampling teams should take only the minimum of equipment into the house. Ideally use single use equipment and dispose of as clinical waste.

If equipment is to be re-used, then it should be decontaminated after use with a chlorine-based disinfectant and according to the manufacturer’s instructions before removal from the house.

7 Testing for Covid-19

If an individual is well enough to self-isolate at home, then local lab testing should only be undertaken for coronavirus.

In limited circumstances the tester may wish to test for additional viruses. This should only be undertaken if the tester would have performed these tests in a primary care setting when coronavirus was not suspected.

Most cases therefore will require a single nose and throat swab for the diagnosis of coronavirus which will be sent to PHE Colindale or identified regional laboratories for testing.

7.1 Samples required

Samples required are:

  • Either a combined nose and throat swab in one collection tube containing universal transport medium
  • or a single swab used for throat then nose
  • or individual nose and throat swabs in separate collection tubes

Guidance may change as the incident progresses so please refer to the up to date guidance regularly.

7.2 How to collect the specimens

The sampling team should have undergone training in the collection of nasal and throat swabs to ensure false negative swabs are avoided.

7.3 Completing the laboratory request form

  • Print off the specific request form for requesting Covid-19 acute respiratory disease testing (E28) direct from the weblink. One form for each sample. Samples without appropriate paperwork will not be tested
  • Label each sample with ID, date of birth and type of sample
  • It is essential that clinician contact phone number for queries and the sharing of urgent results is provided.
  • Provide the name of the local HPT on the form
  • Do not place paperwork (request forms) in the primary container for Category B transport

The laboratory request form is available.

7.4 Transporting the samples to the laboratory

Immediately after sampling the sampling team should package the samples for transporting to the local laboratory (for onward transfer to the PHE laboratory) in accordance with Category B transportation regulations and labelled ‘Priority 10’.
UN 3373 packaging must be used for sample transport and this should be acquired from the local laboratory prior to attending the home for testing.

Further details are available on GOV.UK.

8 Closing the visit

On completing the sampling and prior to removing PPE, the sampling team should ensure the resident(s) understands their responsibilities for self-isolation, including respiratory and cough hygiene and avoiding contact with others until the results are available.

Detail on advice for individuals undergoing testing and home isolation is available on GOV.UK..

The resident(s) should be given the contact details of a designated medical contact. This may be NHS 111, or other local arrangements may be put in place.

The resident(s) should be asked to monitor their symptoms and seek prompt medical advice if their illness is worsening, or if anyone they are caring for has worsening symptoms. If it’s not an emergency, they should call their designated medical contact point using the number that has been provided to them.

If it is an emergency and they need to call an ambulance, they should be asked to inform the call handler that they are being tested for Coronavirus (or are caring for someone being tested for Coronavirus, as appropriate).

The resident should be given information on when results will be available and how will results be notified to them.

Finally, the tester should remove PPE and dispose of in clinical waste as above.

The packaged samples and clinical waste (according to locally agreed waste disposal route) should be removed from the house.

Following handover of specimens to the laboratory, hand hygiene must be carried out.