What to do when a respiratory outbreak may be starting in a care home

Recognise a possible outbreak without delaying individual care

Two residents develop a new cough within a few days. A third seems confused and has stopped eating. The home does not yet know whether the illness is influenza, COVID-19 or another respiratory infection. The first response has two tracks: assess each unwell person and identify whether the cases may be linked within the home. A manager should not wait for a laboratory label before seeking clinical advice or taking proportionate infection control action.

Check each person’s condition. Ask staff to record onset, symptoms, observations within their competence, changes in function and any urgent clinical concern. Older residents may not show the same symptoms or be able to report them clearly. If someone has signs of serious illness, use the appropriate urgent clinical pathway. This page is about the service response and cannot decide whether an individual needs hospital care, testing or treatment.

Create a simple case line list for the health protection conversation. Record the affected resident or staff member, unit or room, symptom onset, current condition, relevant test information and known contact pattern. Keep it secure and share it only with those who need it. The purpose is to see whether illness may have spread within the setting, not to create a public list of names. Include the first day of symptoms rather than only the day someone reported them.

UKHSA’s England reporting guidance describes a new acute respiratory infection outbreak for its service as two or more people in a setting with symptoms starting within five days of each other, where the cases could be linked by spread within the setting. It says to report if in doubt about linkage. It also asks for a single confirmed flu case. These are operational reporting criteria for the current service, not a reason to ignore an ill resident before a second case appears.

Use the correct health protection reporting route

Find the reporting route for the home’s region. As checked on 27 September 2026, the UKHSA online outbreak service is available in East Midlands, East of England, London, South East, South West, Yorkshire and the Humber, and West Midlands. Settings in other regions should telephone their local UKHSA health protection team or community infection control team according to local arrangements. The list can change, so the provider should check the live page at the time of use.

Do not use the online new-outbreak form to update an outbreak that has already been reported. The UKHSA page directs updates to the local health protection or community infection control team. Keep the reference or contact detail from the first report so the next shift knows how to send new information. If the manager cannot access the online service or is unsure whether a cluster qualifies, contact the local team rather than allowing a technical problem to delay advice.

The UKHSA care-home outbreak guidance is written for health protection and community infection control professionals. It says care homes should inform the health protection team or other local partner of a suspected outbreak in a timely way. The team uses the information for a local risk assessment and can advise on investigation and control measures. The care home should bring a clear timeline and practical questions rather than try to perform that specialist assessment alone.

Prepare what the team is likely to need. How many residents and staff are unwell? When did symptoms start? Which units are affected? Are there severe cases or hospital admissions? What is the home’s staffing position? Can symptomatic residents be supported away from others? What personal protective equipment and infection control supplies are available? Has a new admission or transfer been planned? State what is known and what remains uncertain. A first report can be updated as information improves.

Apply infection control measures while advice is developing

Use the home’s standard infection prevention and control precautions immediately. Reinforce hand hygiene, respiratory etiquette, appropriate personal protective equipment, safe cleaning, linen handling and care equipment management. UKHSA and DHSC’s acute respiratory infection supplement should be read alongside the broader adult social care infection control resource. The manager should check the current guidance and local advice because the precise measures depend on the situation.

Support symptomatic residents to stay away from others where possible, while protecting wellbeing and essential care. A care home is a person’s home. Moving a resident with dementia into an unfamiliar room may cause distress and may be impractical. Health protection advice can help the service decide how to reduce contact between affected and unaffected areas. Avoid treating every resident as interchangeable or applying a blanket measure without considering individual needs.

Review staff movement. Where the layout permits, minimise staff moving between areas with and without symptomatic residents. Make sure all workers know which precautions apply before entering a room. If a worker develops symptoms, follow current staff advice and local policy. A staffing plan that depends on symptomatic staff continuing normal work is fragile and can increase transmission risk. Arrange cover, brief agency staff and check that they can use the required protective equipment correctly.

Check cleaning and shared items. Door handles, mobility aids, dining spaces and equipment that travels between rooms may connect units even when residents do not meet. Assign cleaning responsibility and confirm supplies are available. A written schedule should reflect the actual outbreak area and be understood by the people doing the work. Record a supply shortage or equipment fault and escalate it. Infection control cannot be shown by a policy document if the materials needed to follow it are absent.

Coordinate testing and clinical treatment through the right teams

Do not improvise a testing programme from an old COVID-19 poster. Testing availability and purpose have changed. The health protection team may recommend specimens or other investigation to identify the likely pathogen and guide outbreak control. Follow current UKHSA advice and the local clinical pathway. A negative result from one person does not automatically prove that no outbreak exists, and a positive result does not answer every question about transmission within the home.

The 2026 UKHSA care-home outbreak guidance discusses pathogen testing and specialist decisions about influenza antivirals. These decisions depend on timing, resident factors and clinical advice. Staff should make information available promptly because treatment windows can be short, but they should not prescribe or promise an antiviral to every resident. The clinician and health protection team need accurate symptom onset and medication information to decide what is appropriate.

Ask the GP or relevant clinical service to review residents whose condition changes. Record when clinical advice was requested, what was advised and who will reassess. A cluster-level outbreak plan should not obscure individual deterioration. One resident may need urgent assessment while another needs monitoring and support in the home. Ensure drinking, nutrition, medicines, comfort and personal care continue safely. Infection control is a means to protect care, not a reason to leave a resident without it.

Communicate with families and representatives in a calm, factual way. Explain what is known, how their relative is doing, how visits are being handled and whom to contact for updates. Avoid naming other residents or sharing medical information that is not theirs. When a person may lack capacity to understand a decision about treatment or restrictions, follow the relevant legal and care planning process. Do not use a generic outbreak announcement as a substitute for a conversation about an individual’s needs.

Make visits and ordinary life as safe as possible

Review visiting arrangements using current guidance and the local outbreak risk assessment. A blanket closure can harm residents and their families. Some visits may be especially important for a resident’s wellbeing, communication or end-of-life care. Work with the health protection team on proportionate measures and explain them clearly. Tell visitors about symptoms and precautions without treating them as an uncontrolled risk merely because an outbreak has been reported.

CQC’s care-home infection control guidance expects providers to consider how outbreaks affect admissions and safe visiting and to maintain infection control procedures. The current visiting standard and related guidance should be checked before any restrictive rule is published. The home should record the rationale for a temporary change, when it will be reviewed and how residents’ individual circumstances were considered.

Keep activities where they can be delivered safely. Residents may still need contact, movement and meaningful occupation. A manager can ask staff to adapt small-group activity, room-based support or outdoor access according to advice and residents’ preferences. Avoid converting a necessary short-term infection control measure into indefinite isolation. Review distress, mobility and other harms that may arise from reduced contact.

For people who leave the home for treatment or essential appointments, share the relevant infection risk with the receiving service. Do not cancel medically necessary care automatically. The clinical team can weigh the need for the appointment against transmission risk and arrange suitable precautions. Record the advice and communicate it to transport and the destination as needed, while limiting disclosure to information necessary for safe care.

Decide on admissions and transfers with a risk assessment

A suspected outbreak can affect new admissions and hospital discharge. UKHSA’s care-home outbreak guidance says partial or full closure to new admissions may be considered after local risk assessment. It describes discussions with hospital discharge teams, commissioners, the person and their representatives. The home should not assume that any report automatically closes every bed, or that a planned admission must proceed because a bed is empty.

Bring practical facts to the decision. Which part of the home is affected? Can a new resident be cared for separately? Is the necessary staffing available? Is the person especially vulnerable? What is the risk of remaining in hospital or another setting? What advice has the health protection team given? Record the decision and its review point. A blanket statement can conceal important differences between an affected unit and a separate area of the home.

Urgent transfers for clinical care should proceed according to medical need. Tell the receiving service about the suspected infection and measures in place so it can prepare. The same applies if another social care provider is involved. A transfer without a proper handover can move risk and can interrupt treatment. If a resident returns from hospital during the outbreak, reconcile discharge instructions with the home’s infection control and care plan before they arrive when possible.

If staffing becomes unsafe, escalate that operational risk separately. A reduction in available workers can make routine medicines, personal care, repositioning or observations difficult. The manager should prioritise essential care, seek cover and notify relevant partners where necessary. A health protection report does not replace the provider’s duty to run the service safely. CQC Regulation 12 includes prevention and control of infection as part of safe care and treatment.

Keep one live picture across shifts

An outbreak can change quickly. Maintain a secure line list and a short shift briefing that shows new cases, residents needing clinical follow-up, staff absence, advice from the health protection team, current precautions, supply gaps and the next review time. Name an owner for each action. A shared summary should not replace individual care records, which need the resident’s specific symptoms, treatment and support.

Record the source and time of advice. If a health protection officer changes the approach after test results, the next shift must know which instruction is current. A printed notice from last winter should not compete with live advice. Remove or mark superseded instructions. Brief agency and temporary workers at the start of their shift. Ask someone to check that the plan is being carried out, not merely distributed.

Separate three reporting tracks. The outbreak report goes to UKHSA or the appropriate local health protection team. Individual clinical escalation goes to the person’s health professional or urgent service. CQC statutory notifications have their own triggers and forms. CQC’s notification guidance directs outbreak questions to public health reporting information. A provider should assess any separately notifiable event, such as a death, serious injury or event stopping the service from running safely, on its facts. Do not assume the UKHSA report automatically creates or fulfils a CQC notification.

Protect confidentiality. The line list contains sensitive health information. Give staff access needed for care and outbreak management, use approved systems and avoid distributing names in general messages to families. When reporting to public health teams, provide what is requested through the proper channel. A useful audit trail records decisions and advice without copying every detail into a broad task list.

Review the response and close the loop

Set a daily review rhythm while cases are arising. Ask whether new symptoms have appeared, whether residents are clinically improving, whether staff coverage remains safe and whether the control measures work in the real layout. Share material changes with the health protection team through the route agreed at first contact. Do not submit a second new-outbreak online report merely to update an existing outbreak.

The outbreak end point and any easing of precautions should follow current specialist and local guidance. Do not choose a single fixed date from an old policy. Different pathogens and circumstances may change the advice. Tell residents, staff and families when arrangements change and why. Keep an individual care plan for anyone still recovering even when the wider outbreak response winds down.

Afterwards, examine what happened without treating the number of cases as the only measure of performance. Did staff recognise the first linked cases quickly? Was the reporting route known? Did symptomatic workers leave safely? Were clinical reviews timely? Did the home maintain essential care and residents’ contact with people important to them? Were admissions decisions proportionate and documented? Use the answers to improve the practical plan, supplies, briefings and contact list.

The August 2026 UKHSA adult social care infection resource helps non-specialists understand health protection arrangements. The September 2026 update to the online outbreak service expanded regional availability. These are current operational developments to check again before release. They do not create a separate universal CQC outbreak notification requirement.

A first-shift checklist for the manager

• Arrange clinical assessment for each unwell resident and use urgent care routes when needed.
• Record symptom onset and locations for residents and staff in a secure line list.
• Consider whether cases may be linked within the setting and check the current UKHSA reporting criteria.
• Use the online service only if it covers the home’s region. Otherwise contact the local health protection or infection control team.
• Start standard and situation-specific infection control measures using current guidance.
• Confirm staffing, supplies and essential care can be maintained across the next shifts.
• Discuss testing, treatment, admissions and transfers with the relevant specialists.
• Keep visiting decisions proportionate and review individual wellbeing.
• Brief staff and families with accurate information and protect confidentiality.
• Log advice, owners, next review times and separately assess any CQC notification trigger.

This checklist organises a response. It is not a clinical protocol or a substitute for health protection advice. Use the live guidance and local contact route at the time of the incident.

What Complys may support, subject to product review

A compliance action workflow could help a manager assign contact with the health protection team, staff briefing, supply checks and review of outstanding actions. It could show who owns a follow-up and when it is due. It cannot identify a pathogen, decide clinical treatment, perform public health reporting or determine whether admissions should close. Do not claim that Complys has an outbreak module, integration with UKHSA or automated CQC reporting without product evidence.

Suggested CTA: Ask Complys to demonstrate its current task and evidence workflows using a realistic outbreak scenario. Confirm available features, access controls and limits before making any public product claim.

Related tool opportunity: A locally configurable outbreak contact and action sheet could capture case-count summary, UKHSA route, advice time, staffing, supplies, residents’ needs and next review. It must link to live guidance and avoid prescribing tests or treatment.