National principles for modified quarantine

Quarantine arrangements are a matter for state and territories governments and each jurisdiction is responsible for managing its COVID-19 response, such as requiring international arrivals including cruise ship passengers and crew, to quarantine in a hotel or other designated accommodation.  The Federal Government is supportive of states and territories establishing additional or alternate quarantine facilities that meet the principles agreed to by the Australian Health Protection Principal Committee (AHPPC).

Modified quarantine is an alternative to managed quarantine for incoming persons to quarantine safely upon their arrival in Australia. The facility or premises which may be used for the purposes of quarantine or isolation may include a private residence or other short-term rental accommodation services¹, such as holiday houses, where there is limited or no physical contact with other guests. These alternative quarantine premises differ from managed quarantine, for example, hotel quarantine and purpose-built facilities such as the National Centre for Resilience at Howard Springs, as there is no designated on-site staff managing the quarantine.

The National Principles for Modified Quarantine (the Principles) are intended to provide guidance for jurisdictions to set nationally agreed benchmarks for modified quarantine programs across Australia to ensure the risk to the population and individuals involved with alternative quarantine are minimised.

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

 

Modified quarantine arrangements

1. Modified quarantine aims 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 (Phase D) of the National Plan to transition Australia’s National COVID-19 Response.
2. Modified quarantine programs should:
   • ensure an environment of constant vigilance to ensure limited or no physical contact and minimise the risk of COVID-19 transmission to people who may be sharing the private residence or short-term rental accommodation facility.
   • provide clear guidance and links to information for quarantining individuals on best-practice infection prevention control behaviours to minimise risk of exposure and transmission outside the accommodation or within a household if sharing with non-quarantining members.
   • regularly review controls and their effectiveness.
   • share results of audits, evaluations and reviews with all states and territories to enable cross learnings.
3. Modified quarantine arrangements should include a consideration of the risk of exposure and transmission and guidance as to appropriate mitigations that can be applied throughout the quarantine period.

Governance

1. As each state and territory is responsible for managing the COVID-19 response under its public health legislation, quarantine requirements may differ between jurisdictions. More detail on these requirements for each state and territory. 
2. Modified quarantine programs require escalation mechanisms, clear chains of command and decision-making processes, with cross-agency coordination, and strong communication.
3. 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.
4. Continuous monitoring and evaluation of modified quarantine is essential for guiding national policies, protocols and procedures.
5. 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.  

Appropriate modified quarantine facilities

1. Individuals undergoing modified quarantine should have access to appropriate accommodation where they can quarantine safely. Depending on jurisdictional requirements, appropriate modified quarantine accommodation may include:
   • A private residence (this may be shared with others not undergoing quarantine if appropriate separation can be maintained), or
   • Short-term rental accommodation, e.g. hotels, serviced-apartments, holiday houses, which may be staffed by cleaners/housekeeping staff, reception staff, caretaker, etc. Where possible, preference is to be given to those facilities that have separate entries and no shared ventilation.
2. Jurisdictions may require arrivals from areas considered as high risk to isolate in a modified quarantine facility that is standalone or semi-detached with no shared air space.
3. Individuals should avoid undertaking quarantine in a private residence with other non-quarantining persons who are elderly, immunocompromised or have medical conditions that place them at high risk of adverse COVID-19 outcomes.
4. If possible, individuals should avoid quarantining in short-term rental accommodation with shared amenities (kitchen and bathroom). All modified quarantine accommodation must have a separate bedroom for quarantining individuals to isolate in.
5. All modified quarantine facilities must have ready access to testing, and not be located geographically distanced from the nearest testing site.

Infection prevention and control (IPC) guidance

1. Jurisdictions should provide end-to-end IPC guidance for modified quarantine which is communicated clearly to the person or family group (e.g. by referring them to the state or territory website for guidance information, or providing a modified quarantine checklist) prior to their entering into quarantine at their private residence or in short-term rental accommodation.
2. For modified quarantine facilities in short-term rental accommodation with staff, such as serviced apartments, COVID-19 safety plans outlining appropriate IPC guidance should be developed in line with jurisdictional requirements. All accommodation providers and staff (e.g. cleaners, receptionists and building managers) in these facilities should have an adequate understanding of their role and responsibilities in relation to IPC practices, behaviours, and reporting requirements, if concerns are identified.

Before quarantine stay

1. Jurisdictions should outline the requirements for suitable transportation to the modified quarantine facility for quarantining individuals.
2. If not travelling to the quarantine location alone in a private vehicle, individuals must wear a mask at all times, practise regular hand hygiene, and maintain 1.5 metres of physical distancing from other people wherever possible.
3. If travelling to the accommodation by private vehicle, windows should be open if possible and air circulation should be set to ‘fresh air’, not ‘recirculated air’ to maximise air exchange in the vehicle.
4. For short-term rental accommodation, including hotels and serviced-apartments, jurisdictions should outline requirements for accommodation providers to establish, at the time of booking, whether a guest(s) will be using the facility for the purposes of quarantine.
5. For quarantine booking registers, jurisdictions should outline privacy and confidentiality requirements, including not discussing details of contacts in quarantine with other patrons, members of the public or the media.
6. Contactless check-in for short-term rental accommodation should be available wherever r possible.

During quarantine stay – minimising risk of exposure and transmission

1. When undertaking quarantine, individuals must isolate themselves and not leave the premises unless for PCR testing or if at risk of harm. Individuals undertaking quarantine must not have visitors while in quarantine and avoid any interactions with people not in quarantine.
   • The COVID-19 Test & Isolate National Protocols provide guidance regarding the use of Rapid Antigen Test (RAT) in certain situations.
2. Jurisdictions should outline the requirements for suitable transportation to testing facilities for quarantining individuals. If leaving the modified quarantine facility for testing, individuals must wear a mask at all times, practise regular hand hygiene, and maintain 1.5 metres of physical distancing from other people wherever possible.

Modified quarantine accommodation with shared amenities

1. If quarantining in a private residence with other non-quarantining household members, it is recommended that other household members are fully vaccinated against COVID-19 if eligible.
2. If undergoing modified quarantine in accommodation with shared entry, individuals must:
   • Perform hand hygiene by either using alcohol-based hand rub minimum 60% alcohol, or hand washing with soap and water prior to entering the complex or before leaving their room and avoid touching high touch surfaces or items.
   • Wear a surgical mask until inside the quarantine premises and keep the door to their personal room closed.

Quarantining individuals are recommended to use stairs rather than a lift to access quarantine premises. When stairs are not an option, they are not to use a lift at the same time as others, are to avoid touching surfaces within the lift and a procedure to clean the lift buttons after use needs to be in place.

1. To minimise transmission risk, people undergoing modified quarantine should be kept separate from other residents in the premises.
   • This may involve designating different facilities or zoning through allocating separate areas in a facility.
   • For modified quarantine in private residences, a bathroom and toilet should be designated for those undergoing quarantine, kept separate from non-quarantining individuals.
   • For modified quarantine in short-term rental accommodation, ablution facilities (including bathrooms and toilets) for guests in quarantine must be kept separate from those of any other non-quarantining guests in the facility.
   • Once residents arrive in their modified quarantine facility, they must not enter common areas (e.g. hallways, kitchen, and laundry). This includes communal gardens, gyms and pools for exercise.
   • Private balconies, courtyards, or gardens can be used if these can be accessed directly from the quarantining individual’s private room and there is adequate separation from balconies of adjoining apartments.
   • If a person undergoing quarantine needs to enter communal areas to access a separate bathroom or toilet, they must wear a mask at all times, perform hand hygiene and avoid touching high touch surfaces.
   • Options for remote management of individuals, for example, telehealth for medical consultation should be considered to reduce opportunities for contact.
   • For deliveries, including food, there must not be any interaction between the deliverer and the individual undergoing quarantine guest.  The door must remain closed until the deliverer has left the area, to maintain a contactless delivery. When collecting the food, individuals undergoing quarantine must wear a surgical mask.
2. Jurisdictions should provide guidance on how to minimise the risk of transmission both within the family group and within the facility for private residence modified quarantine and short-term modified quarantine accommodation providers. This may include establishing buffer rooms around larger family groups and/or establishing maximum occupancy for family rooms and creating a “safe corridor” for symptomatic residents.
3. If common areas are required to access bathroom facilities, adequacy of ventilation and airflow should be assessed in these common areas and natural and/or mechanical ventilation should be modified accordingly.  Where adequate ventilation and air exchange cannot be maintained, a portable high efficiency particulate air (HEPA) filter unit may be considered.
4. Jurisdictions should clearly communicate risk mitigation such as airflow and ventilation requirements to people undergoing modified quarantine as well as providers of modified quarantine accommodation. If quarantining alone in a stand-alone facility, this may include using fans and opening windows to improve ventilation. For individuals quarantining in accommodation with common areas or shared amenities with non-quarantining guests, advice may include:
   • Keep the door closed at all times while remaining in the self-contained room (unless exiting to use kitchen or bathroom facilities)
   • Avoid the use of fans that may blow air from the room into the rest of the house
   • Open windows to improve ventilation into the room (while keeping door closed to rest of the residence)

Staffed modified quarantine accommodation

1. For staffed modified quarantine accommodation such as hotels and serviced apartments, the risk of exposure and transmission among facility staff, such as building managers, cleaners, maintenance workers, should be minimised.
2. Precautions to the risk of transmission to and between staff should include:
   • Where possible, staff should be allocated to specific zones.
   • Where possible, staff should minimise their duration in common areas, such as hallways, kitchens, and bathrooms. Maintain where possible 1.5 metre physical distancing in these areas. If not possible, then the use of surgical masks by staff should be considered.
   • Modified quarantine programs should stagger staff attendance in common areas. This should include consideration of staff rosters and work schedules.
   • Jurisdictions may consider additional requirements to minimise the risk of transmission between staff. Depending on jurisdictional guidance, this may include having designated accommodation for workers during their assignment, minimising shared lunch and tea rooms, implementing restrictions on the use of public transport and ride-share, and implementing requirements for staff to work at a single modified quarantine site.
3. Testing, screening and surveillance for people and workers in modified quarantine facilities should align with national guidelines endorsed by the AHPPC, noting that states and territories have different arrangements in place.
4. Requirements for workers in modified quarantine facilities should align with national guidelines endorsed by the AHPPC and expert sub-committees. Depending on arrangements in place in states and territories, this may include requirements regarding:
   • daily routine testing of workers
   • workers’ employment across more than one facility, including high risk settings
   • testing following employment in the modified quarantine facility.
5. Jurisdictions should ensure staff working in modified quarantine facilities are aware of these requirements.
6. Jurisdictions should implement requirements for vaccination status for workers in modified quarantine facilities.

Cleaning and disinfection

1. Everyone in the modified quarantine facility should perform hand hygiene regularly.  
2. People undergoing modified quarantine should perform hand hygiene before entering an area used by other people. They are also recommended to perform hand hygiene immediately after taking off a face mask and before touching anything else.
3. Modified quarantine facilities should be cleaned and disinfected regularly.
   • High touch surfaces should be cleaned and disinfected regularly using a household cleaner which contains a disinfectant (e.g. sodium hypochlorite/bleach-based products) or detergent disinfectant that has viricidal properties, if available.
   • Cleaning and disinfection can be done by using a two-step clean (separate detergent and disinfectant products) or a 2-in-1 product (containing both a detergent and disinfectant).
   • High touch surfaces include kitchen benches, tabletops, fridge door handle, appliances, doorknobs, bathroom fixtures, bathroom surfaces, toilets, light switches, remote controls, and bedside tables.
4. Cleaning and disinfection practices should be considered as part of jurisdictional IPC audits.
5. Waste management should follow usual practices, with non-clinical waste disposed of in the general waste stream.
6. People undergoing modified quarantine should handle their own laundry, wherever possible.
   • If separate laundry facilities are not available, linen should be bagged and laundered at the end of the quarantine period (as set by the relevant jurisdiction).
   • Used/soiled linen, blankets or clothing should be placed either in a plastic bag which is then emptied directly into the washing machine and the bag discarded into general waste, or into a plastic laundry basket that is emptied directly into the washing machine and then cleaned and disinfected prior to reuse.
   • The washing machine buttons and dials should be cleaned and disinfected with a cleaning and disinfecting agent.
   • Hand hygiene should be performed after handling the laundry.

For staffed modified quarantine accommodation, jurisdictions should provide clear guidance on:

1. Room cleaning, for example:
   • Room cleaning and disinfection should not be conducted until the guest has departed.
   • Cleaning of rooms while guests are in quarantine is not permitted. 
   • The guest should be provided with cleaning and disinfection items to maintain the cleanliness of the room during their quarantine period.
2. Linen processing, which may include:
   • Fresh linen and towels may be delivered and placed at the guest door on request.
   • A plastic bag should be provided for the guest for used linen and they are to be instructed to leave used linen outside the door. Linen can then be laundered in a hot wash cycle.
   • All staff delivering or collecting laundry to and from a guest in quarantine should wear a surgical mask, protective eyewear and gloves, collect bagged linen and process as per normal procedures, ensuring minimal handling.
   • Hand hygiene must be performed on removal of gloves.
3. Waste management, which may include:
   • Plastic bags should be provided to the guest to facilitate bagging of all waste generated by the guest.  The guest should then leave the tied waste bags outside the door for collection by staff.
   • All staff collecting waste from a guest in quarantine/isolation should wear a surgical mask, protective eyewear and gloves, collect bagged waste, and dispose of waste as per normal procedures.
   • Staff must perform hand hygiene after handling any waste process as per normal procedures, ensuring minimal handling.
   • Hand hygiene must be performed on removal of gloves.
4. Cleaning and disinfection following the quarantining guests’ stay, for example:
   • Rooms that have accommodated individuals (who never tested positive) can be cleaned and disinfected as per the facility’s usual cleaning protocols.
   • These rooms will not have had daily cleaning for an extended time and may require more intensive cleaning than usual, such as steam cleaning carpets, curtains or fabric furniture.
   • Cleaning of rooms for guests who are known COVID-19 positive or who leave prior to completing 14 days quarantine/isolation should be guided by Public Health staff from the relevant jurisdiction.

Personal Protective Equipment (PPE)

1. People undergoing modified quarantine must wear a surgical mask when they are outside their bedroom or entering common areas (e.g. if food needs to be collected from outside the bedroom). PPE use is required in common areas shared with people who are outside the individual’s quarantining family/group.
2. There should be specific policies and procedures based on defined high and low risk of transmission of COVID-19 within the modified quarantine facility with advice for when to use PPE and appropriate PPE to use depending on circumstances. For more information see ‘Guidance on the use of personal protective equipment (PPE) for health care workers in the context of COVID-19’.

Staffed modified quarantine accommodation

1. Staffed modified quarantine facilities should ensure that all staff are trained in when and how to use appropriate PPE including donning and doffing, and undergo regular refresher training to ensure best practice, in line with jurisdictional recommendations.
2. Staffed modified quarantine facilities should establish processes to minimise exposure risk during donning and doffing of PPE. PPE should be disposed of appropriately.

Managing high-risk individuals

1. 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 though allocating separate areas in a facility.
2. In line with jurisdictional guidance, modified quarantine programs should identify individuals who, despite current arrangements, pose a greater risk of transmission events.
   • Risk is based on individual assessments which may consider a range of factors including:
     • the person or groups point of origin
     • family size and dynamics
     • consideration of medical conditions (e.g. immunocompromised individuals may present with higher loads)
     • mental health or behavioural issues
     • treatments (e.g. those requiring nebulisers or CPAP machines).

• Consideration may be given to alternative management options such as transfer to a different facility (e.g. to managed quarantine or a medi-hotel).

Health and mental health

1. The health, mental health and wellbeing of international arrivals and workers is paramount in all modified quarantine facilities. Proactive supports need to be available, in-line with ‘Advice on mental health screening, assessment and support during COVID-19 quarantine’.
2. The health and functional needs of individuals entering modified quarantine (such as people with underlying health conditions, impaired function and disability) should be given due consideration. States and territories may consider providing additional services to support these needs or consider alternative accommodation arrangements.
3. The underlying and chronic medical conditions of quarantined individuals should be managed. Clinical care should be available through telehealth and onsite when required. States and territories may explore alternative quarantine arrangements (e.g. on-farm quarantine) for certain low risk cohorts in regional or remote locations.
4. Clear escalation processes must be in place with the ambulance and hospital sector for a health emergency. Consider separate facilities for positive cases or those with complex needs.

Post-quarantine arrangements

1. Subject to jurisdictional requirements, all international travellers completing modified quarantine may be required to get tested and isolate until they receive a negative test result if they develop symptoms at any time in the 14 days after completing their jurisdiction’s specified quarantine period. The COVID-19 Test & Isolate National Protocols provide guidance regarding the use of RAT self-test in certain situations.
2. AHPPC agrees that all international travellers should get tested at days 16 or 17 following quarantine, if there have been potential exposure sources within the modified quarantine facility, regardless of whether they have symptoms.
   • Options are being explored to support post-quarantine testing at the national level. AHPPC will continue to explore the management of persons post-quarantine to reduce the risk to the community whilst testing is being undertaken.