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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Infection Outbreaks Policy

1. Purpose

This policy outlines {{org_field_name}}’s approach to the prevention, identification, and management of infection outbreaks to ensure the safety and well-being of the people we support, staff, and visitors. The policy aligns with CQC regulations, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 – Safe Care and Treatment, and Regulation 17 – Good Governance. It ensures a robust response to infection outbreaks while maintaining high standards of infection prevention and control (IPC).

2. Scope

This policy applies to all staff, including full-time, part-time, bank, agency, and volunteers at {{org_field_name}}. It also covers visitors, contractors, and external healthcare professionals entering the premises.

3. Legal and Regulatory Framework

{{org_field_name}} will manage infection prevention, infection outbreaks and associated risks in accordance with applicable legislation, regulatory requirements and statutory guidance in England, including:

• Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Regulation 9A – Visiting and accompanying in care homes, hospitals and hospices, which requires residents to be facilitated to receive visits unless there are exceptional circumstances. Any precautions or restrictions introduced because of infection risk must be necessary, proportionate, individually considered and the least restrictive means of managing the identified risk.
• Regulation 12 – Safe care and treatment, including Regulation 12(2)(h), which requires the provider to assess the risk of, prevent, detect and control the spread of infections, including healthcare-associated infections.
• Regulation 15 – Premises and equipment, insofar as the cleanliness, maintenance, suitability and safe use of the premises and equipment affect the prevention and control of infection.
• Regulation 17 – Good governance, which requires effective systems and processes to assess, monitor and improve the quality and safety of services and to assess, monitor and mitigate risks relating to the health, safety and welfare of people using the service.
• Care Quality Commission (Registration) Regulations 2009, including the requirement to notify CQC of incidents and events where the relevant statutory notification criteria are met.
• Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance, which must be taken into account when determining how the service complies with the relevant registration requirements.
• Health and Safety at Work etc. Act 1974, which places duties on employers in relation to the health, safety and welfare of employees and others who may be affected by the service’s activities.
• Control of Substances Hazardous to Health Regulations 2002 (COSHH), including the assessment and control of exposure to biological agents and other hazardous substances.
• Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) where a reportable occupational disease, dangerous occurrence or work-related exposure to a biological agent meets the statutory reporting criteria.
• Current Department of Health and Social Care (DHSC) and UK Health Security Agency (UKHSA) infection prevention, outbreak management and disease-specific guidance applicable to adult social care services in England.

Where national or local health protection guidance is updated, {{org_field_name}} will follow the current requirements and advice applicable at the time of the outbreak.

4. Identifying an Infection Outbreak

{{org_field_name}} will maintain systems to recognise possible infection outbreaks promptly so that appropriate risk assessment, reporting and control measures can begin without unnecessary delay.

An outbreak will generally be suspected where two or more cases of the same or a similar confirmed or suspected infection occur at approximately the same time and there is reason to believe that the cases may be linked to each other or to transmission within the service.

For an acute respiratory infection (ARI), including COVID-19, influenza, respiratory syncytial virus (RSV) and other viral respiratory infections, an outbreak should be suspected where there are two or more positive or clinically suspected linked cases within the same care home within a five-day period. The service must consider whether transmission within the care home may have occurred.

When assessing whether cases are likely to be linked, the service will consider, as appropriate:

• when symptoms began;
• whether the affected people had contact with each other during the relevant infectious period;
• whether they live in or use the same area of the home;
• whether they have staff members in common;
• whether there is another known source of infection; and
• whether the cases are more likely to represent separate infections acquired outside the home.

Signs that may indicate an outbreak include an unexpected increase in residents or staff experiencing similar symptoms, including fever or a high temperature, respiratory symptoms, vomiting, diarrhoea or unexplained rashes, or an increase in confirmed diagnoses of the same or a related infection.

Where an outbreak is suspected:

• the Infection Prevention and Control Lead and Registered Manager must be informed promptly;
• an outbreak risk assessment must be commenced without unnecessary delay;
• appropriate infection prevention and control measures must be implemented immediately and must not be delayed while awaiting external advice where the service can safely initiate those measures;
• relevant cases, symptoms, dates, test results and actions must be recorded;
• the local UKHSA Health Protection Team, community infection control service or other designated local outbreak service must be contacted in accordance with current national and local reporting arrangements; and
• clinical advice must be sought promptly where a resident requires assessment, treatment or escalation of care.

The service will follow any pathogen-specific outbreak definition or control advice provided by UKHSA, the local Health Protection Team or another appropriately authorised health protection professional.

5. Reporting and Escalation

Suspected or confirmed outbreaks must be reported and escalated promptly to the organisations that are required to be informed under current national guidance, local health protection arrangements or legislation.

The Registered Manager, or a person formally delegated by the Registered Manager, is responsible for ensuring that appropriate notifications and communications are completed and recorded.

The service must:

• report a suspected outbreak promptly to the local UKHSA Health Protection Team, community infection control service or other designated local outbreak reporting service, using the reporting route applicable to the geographical area at the time;
• follow any instructions from the Health Protection Team or other authorised health protection service concerning risk assessment, testing, specimens, treatment pathways, infection prevention and control measures or further reporting;
• contact the resident’s GP, NHS 111 or other appropriate healthcare service where clinical assessment or treatment is required, and call 999 in a life-threatening emergency;
• notify environmental health or other relevant local authority services where required or advised, including where a food-related outbreak is suspected;
• inform commissioners, the local authority, Integrated Care Board or other partner agencies where required by contractual arrangements, local outbreak procedures or where their involvement is necessary to manage operational risks;
• make any required CQC statutory notification without delay where the circumstances of the outbreak result in an event that is notifiable under the Care Quality Commission (Registration) Regulations 2009, including a relevant serious injury, death or an event that prevents or threatens to prevent the service from carrying on the regulated activity safely or in accordance with registration requirements; and
• make a RIDDOR report to the relevant enforcing authority where the statutory reporting criteria are met, including where there is reasonable evidence that a diagnosed disease in a worker is attributable to occupational exposure to a biological agent.

An infection outbreak must not be reported to CQC solely because it is described as “serious” or “prolonged”. The Registered Manager must determine whether a specific statutory CQC notification requirement has been triggered by the circumstances and must submit the appropriate notification where required.

All reports, notifications, advice received, decisions and actions taken must be documented and retained in accordance with the service’s governance and record-keeping arrangements.

6. Containment Measures

Outbreak control measures must be based on the infection involved, the route of transmission, the needs and vulnerability of residents, the physical environment and advice from UKHSA, the local Health Protection Team, infection prevention and control professionals or other relevant healthcare professionals.

Measures must be proportionate to the identified risk and reviewed regularly. Restrictions must be removed or reduced as soon as they are no longer necessary.

Resident placement and separation

Residents with a suspected or confirmed transmissible infection should, where appropriate, be supported to stay away from other residents for the period recommended by current national guidance or by the Health Protection Team.

A resident’s own bedroom may be used for infection control precautions. Decisions must take account of the resident’s clinical condition, wellbeing, mental capacity, care plan and individual circumstances.

Cohorting or restrictions on movement between affected and unaffected areas may be introduced following risk assessment where this is necessary to reduce transmission.

Personal protective equipment

Staff must use PPE appropriate to the task and infection risk in accordance with the service’s risk assessment, current national guidance and any specific advice issued during the outbreak.

PPE must:

• be readily available in appropriate sizes and types;
• be put on and removed using the correct procedure;
• be changed between residents or tasks when required;
• be disposed of safely where it is single use; and
• be cleaned and decontaminated appropriately where reusable equipment is permitted.

Gloves, aprons, masks and eye or face protection must not be used automatically as a fixed combination for every infection. The PPE selected must reflect the route of transmission, anticipated exposure and current national infection prevention and control requirements.

Cleaning, equipment, laundry and waste

The service must increase environmental cleaning and disinfection where required by the outbreak risk assessment or professional advice, with particular attention to frequently touched surfaces, shared equipment and affected rooms.

Cleaning and disinfectant products must be appropriate for the organism concerned and used at the required concentration and contact time.

Shared care equipment must be cleaned and decontaminated between residents in accordance with manufacturer instructions and infection prevention and control requirements.

Laundry and waste arising from affected residents must be handled, stored and disposed of using the precautions appropriate to the infection and current national guidance.

Hand and respiratory hygiene

Staff must perform hand hygiene at the appropriate points of care using soap and water or alcohol-based hand rub as indicated by the infection risk and current infection prevention and control guidance. Soap and water must be used where alcohol-based hand rub is not appropriate, including where hands are visibly soiled and for infections for which handwashing is specifically required.

Residents, visitors and staff must be supported to follow appropriate respiratory and cough hygiene.

Visiting during an outbreak

The starting position during an infection outbreak is that residents must continue to be supported to receive visitors.

The service must not apply blanket or indefinite visiting bans.

Where infection risks are identified, the service must first consider reasonable infection prevention and control precautions that would allow the visit to proceed safely. These may include changes to the location or timing of a visit, hand and respiratory hygiene measures, ventilation, appropriate PPE or other precautions relevant to the infection.

Visiting may only be restricted where there are exceptional circumstances and, despite consideration of other reasonable precautions, the visit would present a significant risk to the health, safety or welfare of a resident or another person on the premises.

Any restriction must:

• be based on an individual and outbreak-specific risk assessment;
• have a legitimate infection prevention and control purpose;
• be necessary and proportionate to the identified risk;
• represent the least restrictive available option;
• take account of the resident’s wishes, care plan, wellbeing and rights;
• involve the resident and relevant family member, representative or advocate where appropriate;
• be recorded, including the reasons for the decision;
• be reviewed regularly and whenever circumstances change; and
• be removed as soon as the exceptional circumstances no longer apply.

Even where exceptional outbreak circumstances require some restrictions, the service must facilitate visits that cannot reasonably be postponed, including end-of-life visiting, subject to appropriate infection prevention and control precautions. Health professionals and CQC inspectors must be enabled to enter where required to undertake their functions, with appropriate information about the outbreak and any necessary precautions.

Residents must not be subject to unreasonable restrictions following visits outside the home.

Communal activities

Communal activities, dining or group events may only be reduced, adapted or temporarily postponed where justified by the outbreak risk assessment or professional advice.

Any such measure must be proportionate, time limited and reviewed regularly, with consideration given to the effect on residents’ wellbeing and to safer alternatives wherever practicable.

7. Staffing Considerations

Staff have a responsibility to report promptly any symptoms of infectious illness or confirmed infection that could create a risk to residents, colleagues or visitors.

A staff member who has symptoms of an acute respiratory infection and has a high temperature, or who does not feel well enough to work, must be supported to remain away from work. They should not return until they no longer have a high temperature, where one was present, and no longer feel unwell.

Before a symptomatic member of staff returns to work, the manager must undertake an appropriate return-to-work risk assessment in accordance with current national guidance and the service’s normal return-to-work arrangements.

Staff do not routinely require COVID-19 testing solely because they have respiratory symptoms. Testing must be undertaken where current national guidance requires it, where the staff member is eligible for COVID-19 treatments, where clinically indicated, or where advised by the UKHSA Health Protection Team or another authorised healthcare professional.

Where a staff member has a confirmed positive COVID-19 test, they must remain away from work for a minimum of five days from the onset of symptoms, or from the date of the positive test if they do not have symptoms. After five days they may return when they feel well and do not have a high temperature. Where respiratory symptoms continue, the manager must undertake a risk assessment before return and seek medical or occupational health advice where necessary.

Staff with vomiting or diarrhoea must not attend work and must normally remain away from work until at least 48 hours after their last episode of vomiting or diarrhoea, unless different exclusion requirements are advised for the identified infection by the Health Protection Team, infection prevention and control service or another appropriately qualified healthcare professional.

Where a different infection is suspected or confirmed, staff exclusion and return-to-work arrangements must follow current pathogen-specific national guidance and any advice provided by the Health Protection Team, infection prevention and control service, occupational health provider or other relevant healthcare professional.

During an outbreak, the service will consider whether staff cohorting or restricting staff movement between affected and unaffected areas is necessary and practicable to reduce transmission.

Staffing arrangements must continue to provide sufficient numbers of suitably skilled and competent staff to meet residents’ needs safely. Where infection-related staff absence threatens the service’s ability to operate safely, the Registered Manager must activate the service’s contingency arrangements and make any statutory or contractual notifications that are required.

Staff must have access to appropriate occupational health advice or an equivalent source of professional advice where this is needed for the safe management of infection, exposure, immunisation or return to work.

8. Testing and Diagnosis

Testing must be undertaken in accordance with current national guidance, clinical advice and instructions from the UKHSA Health Protection Team or other authorised outbreak management service. Routine testing must not be undertaken solely because testing formed part of a previous COVID-19 outbreak procedure.

Where an acute respiratory infection outbreak is suspected, the service must undertake an outbreak risk assessment and notify the Health Protection Team or other designated local outbreak service in accordance with current arrangements.

The Health Protection Team or other authorised service may arrange or advise multiplex PCR or other diagnostic testing for a defined number of recently symptomatic residents in order to establish the cause of an outbreak. Further outbreak testing must only be undertaken where clinically indicated or advised by the Health Protection Team or another authorised healthcare professional.

Residents who are eligible for COVID-19 treatments and develop symptoms of an acute respiratory infection must be supported to undertake the testing required under the current COVID-19 treatment pathway so that eligible treatment can be accessed without unnecessary delay.

Where influenza is suspected during an outbreak, the service must seek advice from the Health Protection Team or appropriate clinician regarding testing and whether antiviral treatment or prophylaxis should be considered.

For gastrointestinal or other infectious illnesses, stool specimens, swabs, blood samples or other diagnostic specimens must only be obtained where clinically indicated or requested by the resident’s GP, another authorised healthcare professional, the infection prevention and control service or the Health Protection Team.

Specimens must be collected, labelled, stored and transported safely and in accordance with the instructions of the requesting healthcare professional, laboratory and applicable infection prevention and control requirements.

All test requests and results relevant to a resident’s care or outbreak management must be documented appropriately and communicated to the relevant healthcare professionals and outbreak management team.

A test result does not authorise care home staff to initiate medical treatment unless that treatment has been prescribed or authorised within the staff member’s lawful scope of practice. Appropriate treatment must be arranged promptly through the resident’s GP, prescriber or other authorised healthcare professional.

The service must continue appropriate infection prevention and control precautions while awaiting test results where an infection is suspected. A negative test result must not automatically result in precautions being stopped where symptoms, clinical assessment, outbreak circumstances or professional advice indicate that precautions should continue.

9. Communication and Family Engagement

• Transparent communication with residents and families regarding outbreaks.
• Regular updates provided via:
  • Letters, emails, or care home website updates.
  • Telephone calls or virtual meetings if required.
• Support for families concerned about visiting restrictions.

10. Reviewing and Learning from Outbreaks

Post-Outbreak Review

• Conduct a lessons learned meeting to evaluate response effectiveness.
• Update infection control policies based on review findings.

Audit and Compliance Checks

• Regular infection control audits.
• Compliance monitoring of hand hygiene, PPE usage, and cleaning protocols.

11. Training and Awareness

Mandatory Staff Training

• Annual infection prevention and control training.
• Scenario-based drills for outbreak management.
• PPE donning and doffing practice.

Ongoing Awareness

• Infection control posters displayed in staff areas.
• Regular reminders via staff meetings and digital communication.

12. Related Policies

• CH12-Safe Care and Treatment Policy
• CH17-Infection Prevention and Control Policy
• CH18-Risk Management and Assessment Policy
• CH23-Lone Working and Staff Safety Policy
• CH27-Staff Supervision, Training, and Development Policy
• CH30-Equality, Diversity, and Inclusion Policy

13. Policy Review

• This policy will be reviewed annually or after any major outbreak.
• Updates will be made in accordance with CQC regulations, UKHSA guidelines, and new best practices.
• Feedback from staff and external infection control audits will inform policy improvements.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.