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Infection Outbreaks Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} prevents, identifies, escalates and manages suspected or confirmed infection outbreaks in its domiciliary support service in Wales. This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016, The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, and the Welsh Government statutory guidance for providers and responsible individuals. In particular, this policy supports the requirements to have effective infection control policies and procedures, to maintain satisfactory standards of hygiene, to minimise the spread of infection, to manage general and clinical waste appropriately, and to notify Care Inspectorate Wales (CIW) of the outbreak of any infectious disease without delay and in the required manner.

This policy must be read and applied alongside current Public Health Wales guidance, including advice from the Public Health Wales AWARe / Health Protection Team, current infection prevention and control guidance for health and social care settings in Wales, and any disease-specific guidance issued by Public Health Wales, Welsh Government, local health boards or local authorities.

Infection outbreaks pose a significant risk to vulnerable service users, and effective management is essential to protect health, minimise disruption to care services, and ensure regulatory compliance. This policy sets out preventative measures, early detection strategies, and emergency response procedures to control and contain infection outbreaks swiftly and efficiently.

2. Scope

This policy applies to:

• All care staff, including care workers, managers, and coordinators, involved in providing direct care or overseeing infection control.
• Service users who are at risk of infection or affected by an outbreak.
• Family members and external professionals involved in the care and support of service users.
• Public Health Wales, local authority infection control teams, and healthcare professionals who may assist with outbreak management.

It covers:

• Definitions and types of infection outbreaks.
• Infection prevention and control (IPC) measures.
• Early detection and monitoring of infections.
• Staff responsibilities and reporting requirements.
• Response to suspected or confirmed outbreaks.
• Collaboration with healthcare professionals and regulatory bodies.
• Staff training and competency in outbreak management.

For domiciliary support services, outbreak management must take account of the fact that care is delivered in individuals’ own homes and that staff may visit more than one individual in a day. The service will therefore focus on safe staff deployment, staff cohorting where possible, safe travel between visits, correct use and disposal of PPE, hand hygiene before and after each care episode, cleaning of reusable equipment, communication with individuals and representatives, and early escalation where an infection risk may affect the safe delivery of care.

3. Principles of Infection Outbreak Management

3.1 Definition of an Infection Outbreak

For the purpose of this policy, an outbreak means either:

• Two or more linked cases of the same or similar infectious illness among individuals receiving care and/or staff within a short period of time;
• A higher than expected number of cases of an infectious illness among individuals receiving care and/or staff;
• Two or more cases of COVID-19, influenza, RSV or another acute respiratory infection where there is a suspected link between cases;
• A single case of a serious, high-consequence, unusual or notifiable infection where urgent advice is required from Public Health Wales, the individual’s GP, NHS 111 Wales, the local health board, the local authority or another appropriate health professional; or
• Any situation where {{org_field_name}} is advised by Public Health Wales, a health protection professional, a GP, a district nurse, a local authority, a commissioner or CIW that outbreak precautions or reporting are required.

Types of infection or communicable disease that may require outbreak precautions or escalation include, but are not limited to:

• acute respiratory infections such as COVID-19, influenza, RSV and pneumonia;
• gastrointestinal infections such as norovirus, suspected food poisoning and Clostridioides difficile;
• skin infestations or infections such as scabies, impetigo and MRSA-related concerns;
• vaccine-preventable or notifiable diseases;
• and any other communicable disease or infection risk identified by Public Health Wales, the local health board, the local authority, a GP, district nurse or other health professional.

3.2 Infection Prevention and Control (IPC) Measures

Prevention is central to reducing infection risk and avoiding outbreaks. {{org_field_name}} will maintain infection prevention and control arrangements that are suitable for a domiciliary support service and proportionate to the needs and risks of individuals receiving care. These arrangements include:

Hand hygiene: Staff must clean their hands before and after every care episode, after removing PPE, after contact with body fluids, after handling waste or laundry, after using the toilet, before preparing or assisting with food and drink, and whenever hands are visibly soiled. Staff must use liquid soap and water where required, including when hands are visibly dirty or where diarrhoea and vomiting illness is suspected. Alcohol-based hand rub may be used where appropriate and where hands are not visibly soiled.

PPE: Staff must use PPE in line with current Public Health Wales and organisational guidance, the individual’s risk assessment and the task being undertaken. PPE may include gloves, aprons, fluid-resistant surgical masks, eye/face protection or respiratory protective equipment where this is required by current guidance or risk assessment.

Respiratory hygiene: Staff must support individuals, where appropriate, to follow respiratory hygiene, including covering coughs and sneezes, safe disposal of tissues, hand hygiene and ventilation where this can be achieved safely and comfortably.

Cleaning and decontamination: Staff must clean and decontaminate reusable care equipment between use and must follow the individual’s care plan, risk assessment and infection control procedures for cleaning frequently touched surfaces where this forms part of the agreed care and support.

Waste: Staff must dispose of general and clinical waste safely and in accordance with the organisation’s waste procedures, local arrangements, the individual’s home circumstances and any advice issued by health professionals or Public Health Wales during an outbreak.

Laundry and linen: Where staff support laundry as part of the care package, they must follow infection control precautions for contaminated laundry, avoid shaking linen, use PPE where required and follow the individual’s personal plan and organisational procedures.

Food hygiene: Where staff prepare, handle or support individuals with food and drink, they must follow safe food hygiene practice, including hand hygiene, safe storage, safe preparation and prompt reporting of any concerns about foodborne illness.

Staff health: Staff must not attend work where they have symptoms of an infectious illness that may place individuals or colleagues at risk. Staff must report symptoms promptly and follow the sickness, absence and return-to-work procedure.

These measures support compliance with Regulation 56 of The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, which requires satisfactory standards of hygiene, appropriate waste disposal and policies and procedures for the control and minimisation of infection.

3.3 Early Detection and Monitoring of Infections

Timely identification of potential infections is essential for outbreak control. {{org_field_name}} ensures early detection by:

• Observing and reporting changes in an individual’s health and wellbeing during care visits, including symptoms such as fever or feeling hot to touch, new or worsening cough, sore throat, breathlessness, diarrhoea, vomiting, new rash, unexplained confusion, deterioration, reduced intake, or any other signs that may indicate infection. Staff must not undertake clinical observations unless this is within their role, training, competence and the individual’s care plan.
• Monitoring staff sickness levels to identify clusters of infection.
• Encouraging service users and families to report symptoms early for rapid intervention.
• Keeping records of reported infections and tracking potential links between cases.

A digital symptom monitoring system is used where possible to log and track infections in real-time, ensuring that preventative action is taken promptly.

The Registered Manager or delegated infection control lead will maintain an outbreak log when two or more linked cases are suspected, or earlier where the infection risk is significant. The outbreak log will record the names of affected individuals and staff, symptoms, date and time symptoms started, visits completed, staff contacts, advice sought, actions taken, PPE or other precautions used, communications with families/representatives and professionals, and whether CIW or Public Health Wales notification was required. The service will also identify individuals who may be at higher risk from infection, such as people who are immunosuppressed, clinically vulnerable, frail, have respiratory disease, or have complex health needs, and will ensure their personal plans and risk assessments reflect any additional precautions required.

3.4 Staff Responsibilities and Reporting Requirements

All staff have a duty to report suspected infections immediately to their line manager or the Registered Manager. Staff must:

• Report service users with symptoms of infection as soon as they are noticed.
• Self-report and refrain from working if they develop symptoms of a contagious infection (e.g., flu, norovirus, COVID-19).
• Follow the organisation’s sickness absence and return-to-work procedures and only return to work when they meet the required return-to-work criteria for the suspected or confirmed infection, taking account of current Public Health Wales guidance, occupational health advice, GP advice or management instruction where applicable. Medical clearance is only required where this is specifically advised or required.
• Document all cases in service user care records and report them to infection control leads.
• Inform the Registered Manager immediately if they have provided care while symptomatic, have developed symptoms shortly after a care visit, or have been advised that they are a contact of a significant infectious disease where this may affect safe working.
• Follow any temporary changes to rotas, cohorting arrangements, PPE requirements or visit order introduced to reduce the risk of spread between individuals’ homes.
• Ensure that any infection-related changes to care delivery are recorded in daily notes and escalated where the individual’s needs, risks or personal outcomes are affected.

Managers must ensure rapid escalation of concerns to healthcare professionals, Public Health Wales, and CIW if required.

3.5 Response to Suspected or Confirmed Outbreaks

If an infection outbreak is suspected or confirmed, {{org_field_name}} follows a structured outbreak response plan:

1. Immediate isolation and containment measures

Where an individual has symptoms of a suspected or confirmed infectious illness, staff will support the individual to follow current public health or clinical advice, including reducing avoidable close contact where appropriate, maintaining hand and respiratory hygiene, supporting ventilation where safe, and using the correct PPE during care.

The Registered Manager or infection control lead will review the individual’s personal plan and risk assessment to determine whether temporary changes are needed to the timing, staffing, order or method of care visits.

The service will not impose blanket visiting restrictions in an individual’s own home. Where there is a significant infection risk, the service will provide advice to the individual and, where appropriate, their representative or family, and will follow advice from Public Health Wales, the GP, district nurse, local authority, commissioner or other relevant professional.

2. Notification and Reporting

The Registered Manager, Responsible Individual or delegated authorised person must determine whether the incident meets the threshold for statutory notification. CIW must be notified without delay and in writing, using CIW Online, where there is an outbreak of any infectious disease at the service. This includes outbreaks affecting individuals receiving care, staff, or both, where the outbreak affects or could affect the safe delivery of the domiciliary support service.

COVID-19 must be managed in the same way as other infectious diseases for CIW reporting purposes. Individual cases of COVID-19 do not normally require CIW notification unless they meet another notification threshold, but an outbreak of COVID-19 must be reported using the infectious disease outbreak notification process. CIW currently classifies a COVID-19 outbreak as two or more cases.

Public Health Wales / Health Protection advice must be sought where the infection is notifiable, serious, unusual, high consequence, rapidly spreading, affects clinically vulnerable individuals, involves multiple households or staff, or where the service is unsure what action to take. The main Public Health Wales AWARe / Health Protection Team contact point is 0300 00 300 32 or AWARE@wales.nhs.uk

 during normal working arrangements, unless local or updated Public Health Wales arrangements state otherwise.

The local authority, commissioner, GP, district nurse, local health board, occupational health provider and families/representatives must be informed where this is necessary, proportionate and lawful to protect the individual’s wellbeing, maintain continuity of care, obtain clinical advice or meet contractual/reporting requirements. Information must be shared in line with confidentiality, data protection and safeguarding requirements.

All notifications, advice received, decisions made, actions taken and communications must be recorded in the outbreak log and, where relevant, in the individual’s care record.

3. Enhanced Infection Control Actions
   • Increased cleaning and disinfection procedures in affected areas.
   • Dedicated care teams assigned to infected individuals to prevent cross-contamination.
   • Restricted movement of staff and service users, limiting exposure to infection.
4. Review of Personal Plans and Risk Assessments

Where an infection outbreak, suspected infection or infectious disease exposure changes the individual’s care and support needs, risk level or the way care must be delivered, the Registered Manager or delegated competent person will review the individual’s personal plan and risk assessment. This review will consider PPE, visit duration, staffing, timing of visits, medication support, hydration and nutrition, skin integrity, continence support, mental wellbeing, communication needs, escalation arrangements and any temporary changes required to maintain safe care. Any changes must be communicated to staff before the next visit wherever practicable and recorded in the individual’s care records.

5. Continuity of Care and Staffing During an Outbreak

The Registered Manager will assess whether the outbreak affects the safe delivery of care, including staff availability, staff competence, visit timing, travel time, ability to meet commissioned calls, and the needs of high-risk individuals. Where staffing is affected, the service will prioritise essential care, communicate with commissioners and individuals, use contingency staffing arrangements where safe, and notify CIW where the outbreak prevents or could prevent the provider from continuing to provide the service safely.

Where possible and proportionate, staff may be cohorted to support affected individuals or households and to reduce the risk of spread between individuals. Staff must be given clear instructions about visit order, PPE, waste disposal, hand hygiene, equipment cleaning and reporting arrangements.

6. Testing, Clinical Advice and Treatment

Testing will be undertaken only where it is advised or required by current Public Health Wales, Welsh Government, NHS, local health board, occupational health or clinical guidance. The type of test, who should be tested and how results should be acted upon may vary depending on the infection and current guidance.

Staff must not diagnose infection or decide clinical treatment unless this is within their professional role and competence. Where an individual appears unwell or deteriorates, staff must escalate promptly to the GP, district nurse, NHS 111 Wales, emergency services or other appropriate health professional in line with the individual’s personal plan and the organisation’s escalation procedures.

Medication, antibiotics, antivirals or other treatments must only be administered where prescribed or authorised and must be managed in line with the Medication Policy, the individual’s personal plan and staff competence.

7. Post-Outbreak Recovery and Review

Once the outbreak is considered controlled, and taking account of advice from Public Health Wales or other professionals where involved, the Registered Manager will complete a post-outbreak review. The review will consider the source and spread of infection where known, timeliness of reporting, staff compliance with PPE and hand hygiene, adequacy of staffing and supplies, effectiveness of communication, impact on individuals’ wellbeing and personal outcomes, records completed, notifications made, and whether any safeguarding, medication, care planning, training or business continuity actions are required.

Learning from the review will be recorded and used to update risk assessments, personal plans, staff training, infection control procedures, audits and the service improvement plan. Significant findings will be shared with the Responsible Individual and considered as part of the service’s quality assurance and quality-of-care review arrangements.

These steps ensure a swift, effective, and compliant response to outbreaks, minimising harm to service users and staff.

3.6 Collaboration with Healthcare Professionals and Regulatory Bodies

Effective outbreak management requires timely communication and partnership working. {{org_field_name}} will work with Public Health Wales, including the AWARe / Health Protection Team where required, GPs, district nurses, local health boards, local authorities, commissioners, occupational health providers, CIW and other relevant professionals to prevent, manage and review infection outbreaks.

The service will seek specialist advice where an outbreak is serious, unusual, notifiable, high consequence, affects multiple households, involves vulnerable individuals, affects staffing capacity, or where the Registered Manager is unsure what action is required. The service will follow advice received from Public Health Wales or other competent health protection professionals and will record the advice, the name and role of the person giving advice, the date and time, and the actions taken.

CIW notification will be completed through CIW Online where the outbreak meets statutory notification requirements. Notification to CIW does not replace the need to seek clinical or public health advice, and seeking public health advice does not replace the need to notify CIW where a CIW notification is required.

3.7 Staff Training and Competency in Outbreak Management

All staff must receive infection prevention and control training appropriate to their role during induction and at planned intervals thereafter. Training will include hand hygiene, PPE selection and safe use, safe disposal of PPE and waste, respiratory hygiene, cleaning of reusable equipment, management of laundry where relevant, recognising signs of infection, escalation and reporting procedures, outbreak response, and staff sickness reporting.

Staff working in domiciliary care will be directed to relevant Public Health Wales infection prevention and control resources, including the current IPC workbook or learning resource for domiciliary care staff where available. Completion of training must be recorded, and managers must check staff understanding and competence through supervision, spot checks, observation, audits or competency assessments.

Additional training, briefings or toolbox talks will be provided when guidance changes, when a new infection risk emerges, following an outbreak, where audit identifies poor practice, or where staff are required to use different PPE or outbreak procedures.

4. Governance, Supplies, Records and Quality Assurance

{{org_field_name}} will maintain governance arrangements to support safe and effective outbreak prevention and response. These arrangements include:

• An identified infection control lead or delegated competent person responsible for supporting IPC practice, maintaining outbreak records and escalating concerns to the Registered Manager;
• Access to sufficient and suitable PPE, hand hygiene products, cleaning materials and other supplies required for safe care delivery, with contingency arrangements where supplies are disrupted;
• An outbreak log to record suspected and confirmed cases, actions taken, advice received, notifications made, communications, staff affected, individuals affected and lessons learned;
• Routine and targeted IPC audits, including hand hygiene, PPE use, care records, waste handling, staff training and compliance with this policy;
• A process for reviewing infection incidents, outbreaks and near misses as part of quality assurance and service improvement;
• Escalation to the Responsible Individual where the outbreak affects or could affect the safe operation of the service, staffing levels, continuity of care, regulatory compliance or the wellbeing of individuals.

4.1 CIW Notification Decision Record

For every suspected or confirmed outbreak, the Registered Manager or delegated person must record whether a CIW notification is required. The record must include the reason for the decision, the date and time of the decision, who made the decision, whether CIW Online notification was submitted, the CIW notification reference where available, and any further action required. Where the decision is not to notify CIW, the rationale must be clear and must be reviewed if the situation changes.

4.2 Confidentiality, Consent and Communication

Information about suspected or confirmed infection must be shared only where there is a lawful and proportionate reason to do so. Staff must maintain confidentiality and follow data protection requirements when communicating with individuals, representatives, families, commissioners, health professionals, Public Health Wales, local authorities and CIW.

Individuals must be informed about infection risks and changes to their care in a way they can understand, taking account of language, communication needs, mental capacity, sensory impairment and any representative involvement. Where an individual lacks capacity to understand or make a relevant decision, staff must follow the Mental Capacity Act 2005 and best-interest decision-making arrangements.

4.3 Acute Respiratory Infections, Including COVID-19, Influenza and RSV

Acute respiratory infections, including COVID-19, influenza and RSV, must be managed in line with current Public Health Wales infection prevention and control guidance for health and social care settings in Wales. Staff must report symptoms promptly, follow current guidance on PPE and respiratory precautions, support individuals with respiratory hygiene where appropriate, and escalate concerns where an individual is clinically vulnerable, deteriorating or at risk of serious illness.

The service will not rely on fixed COVID-19 rules where national guidance has changed. Instead, managers will check current Public Health Wales, Welsh Government, CIW and local health board advice when respiratory infection cases occur, particularly during winter or periods of increased community transmission.

5. Related Policies

This policy should be read alongside:

• Infection Prevention and Control Policy (DCW17)​
• COVID-19 Management Policy (DCW40)​
• Risk Management and Assessment Policy (DCW18)​
• Emergency and Business Continuity Plan (DCW19)​.

6. Policy Review

This policy will be reviewed at least annually, or sooner where there are changes to Welsh legislation, CIW requirements, Public Health Wales guidance, Welsh Government guidance, local health board or local authority guidance, the organisation’s statement of purpose, or following an outbreak, serious infection incident, audit finding, complaint, safeguarding concern or CIW/commissioner feedback. The Registered Manager is responsible for ensuring staff are informed of any changes and that additional training or briefing is provided where required.

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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}}
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