CH357. Visiting the Home During an Outbreak of Infectious Disease(s)

Visiting the Home During an Outbreak of Infectious Disease(s)

Introduction

{{org_field_name}} recognises that it could be required to apply some restrictions on visiting with any further local or national outbreaks of Covid-19 or other infectious illnesses, although it is now generally agreed that any further outbreaks should not result in a total ban on visiting as was applied during the earlier part of the Covid-19 pandemic, and that every person living in the home should always have the right to some in-person access and the support that comes from it.

{{org_field_name}}’s visiting policies are in line with its legal requirements to enable visiting and accompanying under Regulation 9A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission guidance, Visiting Someone in a Care Home (last updated April 2024).

This policy and procedures have been written in line with the guidance Supporting Safer Visiting in Care Homes During Infectious Illness Outbreaks, from the UK Health Security Agency, and will be updated in response to any new or updated official local or national guidance in the event of an outbreak of infectious disease(s).

The aim of this policy is to ensure that:

the health and wellbeing of people living in the home, visitors and staff is protected
the risk of infection is reduced to as low as possible
people visiting are able to take appropriate precautions to keep everyone safe
people living in the home, their visitors and advocates are actively involved in making decisions about visiting
people’s wellbeing is promoted by facilitating visits even in difficult circumstances
proportionate and accurate advice is given for the situation.

Visiting the home

With any outbreak of an infectious disease {{org_field_name}} will notify and seek advice from the local Health Protection Team (HPT) on the precise measures to take, which will depend on the nature and severity of the outbreak.

{{org_field_name}} requires its visitors to follow the home’s outbreak management and infection control procedures when visiting.

It might also need to restrict movements out of {{org_field_name}}, but it will keep access to open areas and gardens which are assessed as suitable for visiting purposes during an outbreak.

{{org_field_name}} will always allow visiting because, for example the person might be suffering severe distress or is terminally ill. Visitors will be asked to take the infection control precautions that apply when visiting.

In organising any arrangements, {{org_field_name}} will carry out a risk assessment of the impact of the outbreak and of the feasibility of alternative visiting arrangements, which will not increase the infection risks. {{org_field_name}} understands that it might need the advice of the local Health Protection Team and Local Authority to carry out the risk assessment and to act on its outcomes.

{{org_field_name}} understands that if the outbreak appears contained the outbreak control restrictions will be lifted unless the HPT advises otherwise. This should mean that outbreak measures will only be in place for the minimum period required before normal visiting arrangements can resume.

Procedures

In the absence of specific national guidance or local HPT instructions for an outbreak, the following general procedures will be followed.

People who live in the home and visitors are advised that there is an outbreak in the home. The information will be accessible and appropriate to the intended audience.
The risk to the visitor should be explained to them and to the person (as appropriate), especially if the person is symptomatic.
People and visitors will be given accessible information on hand hygiene, personal protective equipment and any other measures that may reduce the risk of onward transmission, as appropriate.
Visitors should not come to the home if they have symptoms of any infectious illness or if they consider themselves to be infectious for any reason, unless there are exceptional circumstances, such as end-of-life care. They should stop visiting for any required exclusion period, eg 48 hours after a stomach bug.
Social gatherings such as parties that bring together groups who would not normally socialise together should usually be postponed until the outbreak is over.
Visitors should not normally visit multiple people during outbreaks. When this is necessary — eg, a relevant professional making “rounds” — they should as far as possible visit individuals considered most likely to be infectious last (for example, individuals with recent onset of symptoms). Appropriate infection prevention and control procedures should be used for each individual visit.
Visitors providing services other than health or social care, such as hairdressers or entertainers should usually be postponed until the outbreak is over.
Even in exceptional circumstances, visiting which is required for compassionate or health and safety reasons will continue. This includes:
- when a person is approaching the end of life — this does not require a specific terminal diagnosis
- when there would be distress or harm resulting from not having a visitor
- when there are safeguarding concerns by family, provider, regulator, commissioner or any advocate
- visits from healthcare professionals which, if delayed, would be detrimental to the person
- visits from social workers which, if delayed, would be detrimental to the person
- visits for religious or spiritual reasons
- essential maintenance staff, for example, heating or water supply
- visits from the Care Quality Commission.
It may be appropriate to reduce or postpone specific visits if a visit poses a significant risk to the health, safety or wellbeing of someone on the premises and this cannot be mitigated through other precautions.
In very exceptional circumstances, it may be necessary to consider stopping most visits (for reasons other than on the above grounds of compassion or health and safety) for a limited period. For example:
- when there is risk of severe harm to visitors from the infection
- where an outbreak is not under control and there is current and significant risk of serious harm to visitors, residents and/or the wider population.

Visits Out of {{org_field_name}}

People living in the home should be supported to make proportionate changes to daily activities, taking into account any official public advice. This is particularly important when considering visits to other social care settings such as day centres or another care home, as there may be a risk of the outbreak spreading into another setting. A risk assessment should be taken on an individual basis.

People (and/or their representatives) should be supported to consider the risks and benefits of visits outside of {{org_field_name}}, including:

if the resident is likely to be infectious to others
if the resident is well enough to undertake the visit
the risk of harm to those they are visiting
the risk of harm to the resident (consider other infections circulating in the local population).

When planning visits outside {{org_field_name}}, the following should be considered as part of a risk assessment.

Communication of risk with the person and any friends/relatives accompanying them (as appropriate).
Transport arrangements.
Escort requirements.
Advising the person to avoid crowded places.
Advising the person to avoid poorly ventilated spaces.
Advising the person on hygiene measures such as cleaning hands frequently, tissues, wearing a face covering (as appropriate).

When a person returns from a visit or period away from {{org_field_name}}, it will check any risks of infection and put appropriate proportionate measures in place to control any assessed risks.

Attending Appointments During An Outbreak

To prevent spread beyond the home, if a person has a health appointment, the health provider should be contacted prior to the appointment to risk assess and determine if attendance is appropriate.

Risk Factors to Consider in Planning Outings

{{org_field_name}} plans its out-of-home visiting or outings, including communal outings, by considering common risk factors, including those associated with the spread of infectious illnesses (depending on the current local or national situation), such as:

the purpose and nature of the outing or visit
if it involves being indoors (higher risk) and/or outdoors (lower risk)
if it involves use of private (lower risk) or public transport (higher risk)
if it involves mingling with people whose exposure risk is not known (higher risk)
if it could involve an emergency visit or overnight stay in hospital (considered higher risk)
how much support the person will need from staff or others to make the visit
how far basic infection prevention and control measures can be adhered to (risks will increase with non-adherence)
if there are less risky alternatives to achieving the same purpose as the outing or out of home visit
the amount of time available to plan the outing or visit and to take all the precautions necessary to make it safe
the vaccination status of people who use the services and the people they are visiting
the availability of testing, which might need to be carried out for persons who are eligible for Covid-19 treatments if they become symptomatic
levels of infection in the community.

Training

Staff receive instruction and training in {{org_field_name}}’s visiting policy and procedures, and contingency plans, as part of their induction. When this information is refreshed, the updated policy and procedures will be shared as needed through the appropriate communication channels.

Staff will be promptly advised of any changes to the home’s visiting policies and procedures.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next review date: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.