AHPPC statement on national principles for end-to-end best practice managed quarantine arrangements for international travellers

Quarantine for international arrivals to Australia – including hotel quarantine and other highly controlled settings – has been Australia’s first line of defence against COVID-19. It continues to play a vital role in Australia’s public health response. The Australian Health Protection Principal Committee (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 End-to-End Best Practice Managed Quarantine Arrangements for International Travellers (the Principles) are intended to bring together existing AHPPC guidance to set nationally agreed benchmarks for managed quarantine programs across Australia.

The AHPPC will periodically review the Principles to ensure they reflect emerging evidence and the latest expert medical advice.

End-to-end best practice arrangements

1. The priority for managed quarantine is to minimise the risk of COVID-19 transmission and protect the Australian community. This is consistent with Australia’s current strategy to manage COVID-19 consistent with public health management of other infectious diseases in line with the Post-Vaccination Phase of the National Plan to transition Australia’s National COVID-19 Response.
2. 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.
3. End-to-end best practice managed quarantine arrangements should use a system-based risk managed approach which 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

4. Managed quarantine programs require strong and transparent governance arrangements that include escalation mechanisms. This includes clear chains of command and decision-making processes, with cross-agency coordination, and strong communication.
5. Operational plans should be regularly updated in line with the best available advice. Information management systems should support record keeping and reporting, and information sharing to enable shared learnings. Recording and sharing comprehensive information on transmission events and incursions assists to identify weaknesses and optimise best practice arrangements.
6. Continuous monitoring and evaluation of managed quarantine is essential for guiding national policies, protocols and procedures.
7. 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.

Infection prevention and control (IPC)

8. Quarantine programs must use a systematic risk management approach to minimise the risk of transmission of SARS-CoV-2 and apply effective controls 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.
9. 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 (PPE), in line with jurisdictional requirements.
10. 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

11. Testing, screening and surveillance for international arrivals and workers involved with managed quarantine programs should align with national guidelines endorsed by the AHPPC.
12. Requirements for managed quarantine staff may align with national guidelines endorsed by the AHPPC and expert sub-committees, noting that states and territories have different arrangements in place. This includes requirements regarding:
    • daily routine testing of quarantine workers
    • 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.

13. To minimise transmission risk, international travellers or other high infectious risk quarantine residents should be quarantined separately from other lower risk residents. This may involve designating different facilities or zoning through allocating separate areas in a facility (i.e. designating floors for international or other high risk travellers). Where possible, staff should be allocated to specific zones.
14. 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.
15. It is mandatory for all quarantine workers to receive COVID-19 vaccination. This includes those directly employed in quarantine facilities under Commonwealth, state or private arrangements. This also includes anyone who works in places of high infection risk related to the international border (i.e. red zones). Jurisdictions may implement additional requirements for vaccination status for quarantine workers.

Site selection

16. 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:

• 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.
• Selecting 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 of 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.
• Equipping facilities to support the needs of people with underlying health conditions and impaired function, and considering these needs when allocating appropriate accommodation.

17. Ensure managed quarantine facilities are close to international ports of entry and hospital services that are capable and prepared to manage quarantined individuals and COVID-19 cases.
18. Consider the vulnerability and cultural needs of both quarantined individuals and the local population of the quarantine facility.

Airflow and ventilation

19. Managed quarantine programs should give consideration to airflow and ventilation requirements in other settings within the quarantine program, such as vehicles used to transport individuals to quarantine.
20. Risk management should consider the risk of transmission events related to airflow and air pressure within the indoor environment, as informed by a ventilation assessment and monitoring of indoor air quality. Appropriate mitigations should be applied using the hierarchy of controls.
    • Airflow should be optimised so that it travels from clean areas to potentially contaminated areas, to reduce the risk of staff and occupants being exposed to aerosols. Door openings should be controlled to manage risk.
    • Where engineering measures do not adequately manage risk, additional controls are required. These may include increased distancing, remote monitoring (e.g. CCTV) and/or additional administrative mitigations.
    • Air quality may be optimised by controlling occupancy rates and arrangements (i.e. alternate rooms) to support airflow and ventilation in different parts of a quarantine facility.
21. Managed quarantine programs should give appropriate consideration to heating and ventilation and air conditioning (HVAC) systems used within quarantine sites:
    • Managed quarantine programs should ensure that HVAC systems function as designed and are appropriately serviced in line with relevant standards. Relevant guidance is available through the Australian Health Facility Guidelines (Part D – Infection Control; Part E – Building Services and Environmental Design).
    • Technical guidance on strategies that may be employed in response to airborne infectious outbreaks is also available, however, final recommendations should be based on a site assessment in line with the hierarchy of controls and in line with jurisdictional guides.
    • Best practice guidelines for HVAC hygiene are available via the Australian Institute of Refrigeration, Air Conditioning and Heating.
    • Prior to occupancy, all sites should undergo assessment and inspection to assess ventilation (e.g. checking for damage or leaks).
    • Managed quarantine programs should consider engineering controls to reduce the risk of airborne transmission through aerosols of SARS-CoV-2. This should be based on a site assessment, however, controls may include:
      • increasing the ventilation rate of the HVAC unit
      • optimising air temperature and humidity with consideration of individual tolerance (e.g. 20 – 25⁰C and 40 – 60% humidity)
      • upgrading HVAC systems particulate filters, particularly when outdoor air delivery is limited.
    • Administrative controls should also be considered, such as cohorting groups (e.g. by date of arrival) to areas supplied by different ventilation systems.
22. Additional control measures can be used to complement HVAC engineering controls. Managed quarantine programs may consider the use of High Efficiency Particulate Air (HEPA) filters (including portable units) as part of their risk management approach, in line with jurisdictional guidance.

Personal protective equipment (PPE)