⚕️Care Handbook

Outbreak Management

An outbreak is defined as two or more cases of a similar illness occurring in the same setting within a short period of time. Effective outbreak management prevents harm to residents and staff, limits the spread of infection, and demonstrates compliance with CQC Regulation 12.

If you suspect an outbreak: Notify the registered manager immediately and contact your local Health Protection Team (HPT). Do not wait for laboratory confirmation — early reporting saves lives. The HPT number should be displayed in your care home.

Notification Requirements

Care homes have a legal duty to notify CQC of certain events. Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

  • •Regulation 18: Notify CQC of any event that affects the health, safety, or welfare of people who use the service — this includes outbreaks of infectious disease.
  • •Health Protection (Notification) Regulations 2010: Registered medical practitioners must notify the proper officer of the local authority of suspected cases of specified infectious diseases.
  • •Local Health Protection Team: Always contact your local HPT for advice and support. They can help with risk assessment, testing, and management.

Outbreak Management Plan

Every care home must have an outbreak management plan that is reviewed and tested annually. Below is the framework for managing an outbreak effectively.

1. Recognise & Report

  1. 1Identify potential outbreak — two or more cases of similar illness in residents or staff within 48 hours
  2. 2Notify your line manager and the registered manager immediately
  3. 3Contact the local Health Protection Team (HPT) — they will advise on testing and management
  4. 4Report to CQC under Regulation 18 if the outbreak results in serious injury or death
  5. 5Isolate affected residents as per infection type
  6. 6Record all cases, dates, symptoms, and actions taken in the outbreak log

2. Contain & Control

  1. 1Implement isolation precautions — cohort affected residents if single-room isolation is not possible
  2. 2Restrict admissions, transfers, and discharges as advised by the HPT
  3. 3Restrict visitor access — communicate clearly with families and follow HPT advice
  4. 4Increase hand hygiene compliance — monitor and support all staff
  5. 5Enhance environmental cleaning — increase frequency, focus on high-touch surfaces
  6. 6Ensure PPE is available and used correctly by all staff
  7. 7Separate affected and unaffected residents where possible — dedicated staff, equipment, and facilities

3. Communicate & Coordinate

  1. 1Hold daily meetings with staff — review outbreak status and actions
  2. 2Communicate with residents, families, and visitors — honesty and reassurance
  3. 3Liaise with GPs, community health services, and the HPT regularly
  4. 4Update the CQC via portal notification if outbreaks are prolonged or serious
  5. 5Ensure all documentation is contemporaneous and accurate
  6. 6Share learning with other local care homes if appropriate

4. Stand Down & Review

  1. 1Declare the outbreak over only when advised by the HPT (usually 48–72 hours after the last case)
  2. 2Conduct a post-outbreak review — what went well, what could improve
  3. 3Update the outbreak management plan and IPC policy based on lessons learned
  4. 4Ensure all affected residents have fully recovered before resuming normal activities
  5. 5Share the review findings with all staff
  6. 6Check that all outbreak-related paperwork and reports are filed

Common Care Home Outbreaks

The most common outbreaks in UK care homes are norovirus, influenza, COVID-19, and scabies. Below is key information on each.

Norovirus (Winter Vomiting Bug)

Symptoms: Sudden onset vomiting, diarrhoea, nausea, stomach cramps, mild fever. Can affect both residents and staff.

Transmission: Faecal-oral route, aerosolised vomit, contaminated surfaces. Highly contagious — as few as 18 virus particles can cause infection.

Key Actions:

  • Isolate affected residents in their rooms for 48 hours after last symptoms
  • Enhanced cleaning with chlorine-based disinfectant (1,000 ppm)
  • Suspend communal dining and activities
  • Staff who are symptomatic must stay off work for 48 hours after symptoms resolve
  • Do NOT use alcohol-based hand rub alone — soap and water is essential

Influenza (Flu)

Symptoms: Fever, cough, sore throat, muscle aches, headache, fatigue. Can be severe in older adults and those with chronic conditions.

Transmission: Respiratory droplets, close contact, contaminated surfaces. Peak season is October to March.

Key Actions:

  • Offer annual flu vaccination to all residents and staff
  • Isolate affected residents — respiratory precautions (mask, gloves, apron)
  • Consider antiviral treatment (oseltamivir) for residents and prophylaxis for contacts
  • Enhanced cleaning, especially of shared equipment and surfaces
  • Restrict visitor access during the outbreak period

COVID-19

Symptoms: Fever, persistent cough, loss of taste/smell, fatigue, shortness of breath. May present atypically in older adults.

Transmission: Respiratory droplets and aerosols, close contact, contaminated surfaces.

Key Actions:

  • Follow current UKHSA guidance for care homes (updated regularly)
  • Isolate positive residents according to current guidance
  • Enhanced PPE for staff — FFP2/FFP3 masks as advised
  • Test residents and staff as per current testing guidance
  • Ensure ventilation in communal areas
  • Follow the most recent guidance on restrictions, testing, and management

Scabies

Symptoms: Intense itching (worse at night), rash — typically between fingers, wrists, elbows, armpits, and groin. In care homes, may present as widespread crusted (Norwegian) scabies in immunocompromised residents.

Transmission: Prolonged skin-to-skin contact. Mites can survive on clothing and bedding for up to 3 days.

Key Actions:

  • Treat all affected residents with topical permethrin or oral ivermectin (as prescribed)
  • Treat all close contacts (residents and staff) simultaneously — even if asymptomatic
  • Launder all bedding, clothing, and towels at 60°C
  • Second treatment after 7 days is usually required
  • Notify the HPT if crusted scabies or multiple cases

Outbreak Box Checklist

Every care home should maintain a readily accessible outbreak box containing:

  • •Current outbreak management plan (printed copy)
  • •PPE — aprons, gloves (various sizes), Type IIR masks, eye protection
  • •Chlorine-based cleaning products (1,000 ppm and 10,000 ppm solutions)
  • •Hand hygiene products — soap, paper towels, alcohol hand rub
  • •Clinical waste bags and ties
  • •Patient dignity signage — isolation door signs
  • •Thermometers (dedicated, not shared between residents)
  • •Contact numbers — HPT, CQC, local authority, NHS 111
  • •Resident isolation logs and ABC charts
  • •Staff surveillance forms

Further Reading

⚠️

Important Notice

Care Handbook is a guidance resource only. It does not replace your organisation's policies, formal training, or current CQC standards. Outbreak management guidance changes frequently — always follow your local Health Protection Team's advice and check gov.uk and cqc.org.uk for the most current guidance.