AHPPC statement on national principles for managed quarantine

Managed quarantine for international arrivals to Australia - including hotel quarantine and other highly controlled settings - is Australia's first line of defence against COVID-19. It continues to play a vital role in Australia's public health response. The AHPPC is committed to continuously improving managed quarantine arrangements, in line with the AHPPC Framework for Continuous Improvement. This includes considering and implementing the recommendations of previous reviews into managed quarantine.

The National Principles for Managed Quarantine provide nationally agreed guiding principles to set benchmarks for managed quarantine programs across Australia. The Principles seek to protect the health and wellbeing of the Australian community, quarantined individuals and workers involved with quarantine.

AHPPC is analysing relevant events where transmission of SARS-CoV-2 occurred within quarantine facilities to identify potential weaknesses in current systems. Using an evidence-based approach, AHPPC is developing solutions and sharing these with states and territories to optimise national arrangements.

In line with the Framework for Continuous Improvement, the AHPPC will periodically review the National Managed Quarantine Principles (initially published 24 December 2020) to ensure they reflect emerging evidence and align with best practices.

National Principles for Managed Quarantine

End-to-end best practice arrangements

• The priority for managed quarantine is to minimise the risk of transmission of COVID-19 and protect the Australian community. This is consistent with Australia's current strategy of suppression with a goal of no community transmission.
• Consistent with the AHPPC statement on continuous learning in managed quarantine for international arrivals, managed quarantine programs should apply a Framework for Continuous Quality Improvement. This should:
  • encourage an environment of constant vigilance
  • apply assurance processes with regular audits against standards for quarantine
  • regularly review controls and their effectiveness
  • share results of audits, evaluations and reviews with all states and territories to enable cross learnings.
• Best practice for managed quarantine should use a system based risk managed approach. This system considers risk of exposure and applies appropriate mitigations throughout the quarantine period. This includes arrival in Australia at international ports of entry, transfers and stays in quarantine facilities, and release from quarantine and return home or other location.

Governance

• Managed quarantine programs require strong and transparent governance arrangements. This includes clear chains of command and decision making processes, with cross-agency coordination and strong communication.
• Operational plans should be regularly updated in line with the best available advice. Governance arrangements should include mechanisms for escalation. Information management systems should support record keeping and reporting, and information sharing to enable shared learnings.
• Continuous monitoring and evaluation of managed quarantine is essential for guiding national policies, protocols and procedures. High quality and comprehensive data collection strengthens managed quarantine decision-making. Effective data collection, validation and sharing should be supported through daily collection of data required for national reporting and sharing of case data for contact tracing purposes. Recording and sharing comprehensive information on transmission events and incursions assists to identify weaknesses and optimise best practice arrangements.

Infection prevention and control (IPC)

• Managed quarantine programs must use a systematic risk management approach to minimise the risk of transmission of SARS-CoV-2. Apply effective controls by using the hierarchy of controls. This is a step-by-step approach to manage risks. It ranks controls from the highest level of protection and reliability through to the lowest and least reliable protection. Risk management plans should use higher level controls where possible.
• Managed quarantine programs should use strong end-to-end IPC processes in line with nationally agreed advice as outlined by AHPPC and its expert sub-committees and jurisdictional standards. This includes comprehensive IPC training for all staff, with regular reviews of practices. All staff should be trained to use appropriate personal protective equipment in line with jurisdictional requirements.
• Minimise the risk of transmission to quarantine workers. All workers should have an adequate understanding of their role and responsibilities in relation to IPC practices, behaviours and reporting requirements, if concerns are identified. Appropriate supervision is required at all times and a strong reporting culture of speaking up for safety and alerting supervisors to concerns should be fostered.

Minimising transmission risk

• Testing, screening and surveillance for international arrivals and workers involved with managed quarantine programs should align with national guidelines endorsed by the AHPPC. These may be supplemented with additional measures, such as pre-emptive contact identification of regular close contacts of workers, to support contact tracing if transmission occurs.
• Requirements for managed quarantine staff should align with national guidelines endorsed by the AHPPC and the Communicable Diseases Network Australia (CDNA). This may include requirements about:
  • routine testing of staff
  • secondary employment in high risk settings
  • testing following employment in the managed quarantine program.

• Ensure staff involved with managed quarantine programs are aware of these requirements.

• Consideration should be given to minimising the risk of transmission among staff, in line with the hierarchy of controls. This may involve moving infected individuals and close contacts to designated areas within the facility or hospital facilities. Designated staff should oversee and care for confirmed cases.
• In line with Australia's COVID-19 vaccine national rollout phases, staff working in quarantine facilities and their household contacts are eligible for vaccination. This includes those employed under Commonwealth, state or private arrangements. All staff should have access to a COVID-19 vaccination and should be strongly encouraged to receive it. Jurisdictions may implement additional requirements for vaccination status for quarantine workers.

Managed quarantine site selection

• Facilities to be used for managed quarantine must be selected against criteria that meet standards for health, safety and wellbeing, as outlined by AHPPC and its expert sub-committees and jurisdictional standards. This includes considering the suitability of the facility for:

  • Establishing and operating IPC processes in line with the hierarchy of controls. This includes environmental assessment of the facility with consideration of airflow and ventilation, with introduction of additional controls to mitigate risk where relevant. Specific mitigations will depend on recommendations of the environmental assessment noting the unique nature of each quarantine facility, and may include controls such as:
    • room spacing (e.g. using every second room in a hotel corridor), sealing above door vents and application of door sweepers or stoppers
    • engineering measures such as scrubbers or changes to building ventilation such as increased air exchanges
    • education and training for workers and arrivals to minimise door openings.
  • Select floor layouts with consideration of door placement and the ability to maintain physical distancing above the standard 1.5m, where possible, including in foyers and common areas.
  • Providing adequate security and monitoring of international arrivals and workers, including using remote means such as CCTV in common areas. Remote observation can support minimising the presence of security staff in close proximity to quarantined individuals, noting that an onsite security presence may also be required.
  • The primary objective in managed quarantine is to minimise the risk of transmission. However, where possible, site selection should also consider optimising wellbeing. Where available, preference may be given to accommodation that:
    • permits access to fresh air (such as balconies and opening windows), where appropriate, in line with jurisdictional guidance
    • rooms that are self-contained apartments with kitchenette and laundry facilities.
  • Adequately separating quarantined individuals from the community. This includes considering commercial businesses operating within the facility and guests other than quarantined individuals staying in the facility. Managed quarantine facilities should be used only for quarantined guests wherever possible.
  • Providing appropriate resources for health care delivery at the facility, for both quarantined individuals and staff. This includes access to equipment for telehealth services. Equip facilities with resources allocated to support those with disabilities, the elderly and the infirm.
• Ensure managed quarantine facilities are close to international ports of entry, and to hospital services that are capable and prepared to manage quarantined individuals and COVID-19 cases.
• Consider the vulnerability and cultural needs of both quarantined individuals and the local population of the quarantine facility.

Health and mental health

• The health, mental health and wellbeing of international arrivals and workers is paramount in all managed quarantine programs. Proactive supports need to be available, in-line with the Advice on mental health screening, assessment and support during COVID-19 quarantine.
• Managed quarantine programs should be able to manage underlying and chronic medical conditions of quarantined individuals. Clinical care should be available through telehealth and onsite when required. Individual states and territories may explore alternative quarantine arrangements (e.g. on-farm quarantine) for certain low risk cohorts in regional or remote locations.
• Managed quarantine programs must have clear escalation processes with the ambulance and hospital sector for a health emergency. Consider separate facilities for positive cases or those with complex needs.