Guidance

Infections of concern in adult social care settings: A–Z

Published 28 October 2026

This content is owned and managed by UKHSA.

This section explains how common infections spread, how to recognise the signs and symptoms, and the steps that can be taken to prevent and manage them, helping to keep people accessing care and support, staff, and visitors safe.

It covers some of the infections most likely to affect the health, wellbeing, and safety of people living, working, and visiting adult social care (ASC) settings.

These infections have been included because they are frequently reported and can have a significant impact on people accessing care and support, staff, and visitors. Understanding how these infections spread, how to recognise them, and how to prevent and manage them can help reduce the risk of infection in ASC settings.

The infections listed is not an exhaustive list. Other infections, including seasonal, emerging, and less common infectious diseases, may also occur. Staff should remain alert to signs of infection and follow current local and national guidance when managing infection risks.

Acute respiratory infections

What you need to know

Acute respiratory infection (ARI) is defined as the acute onset of one or more of the respiratory symptoms. Common ARIs include flu, COVID-19 and respiratory syncytial virus (RSV). The common symptoms of ARI are listed at People with symptoms of a respiratory infection including COVID-19.

For information on how to prepare for and respond to infection caused by ARIs, see Infection prevention and control in adult social care: acute respiratory infection - GOV.UK

Blood borne viruses (BBV)

What you need to know

The 3 most common BBVs relevant in ASC settings are hepatitis B, hepatitis C and human immunodeficiency virus (HIV).

Some BBVs can remain in the body for a long time or even for life. However, treatment can reduce the risk of transmission and help people stay healthy.

BBVs are not spread through everyday contact and do not pose a risk during normal social interactions. In ASC settings, good IPC practices should be followed for everyone, including safe handling of sharps, personal care items such as razors, management of wounds, and cleaning of blood or body fluid spills.

Information about a person’s BBV status should be treated as confidential and only shared with people who need the information to provide care or carry out their role safely. Unnecessary sharing of information can be stigmatising and may breach confidentiality.

People living with BBVs should be treated with dignity and respect and should not experience stigma or discrimination.

People accessing care and support

Encourage people accessing care and support to use their own personal care equipment (for example, toothbrushes, razors, and nail clippers) and medical devices (for example, insulin pens, and blood glucose monitors).

Encourage people accessing care and support to tell care and support workers if they have any cuts or wounds so they can be attended to. Encourage people to tell care and support workers if there has been a body fluid spill, so they can be cleaned safely.

Exposure incidents

Following a risk assessment, all care and support workers identified as at risk of having contact with blood or bloodstained items should be offered and encouraged to receive vaccination against hepatitis B. ASC providers are responsible for paying for this and provide access to Occupational Health services (or alternatives such as GP services) if needed.  

Post exposure prophylaxis (PEP) should be followed where required.

Care and support workers and any other staff who may come into contact with blood or body fluids should receive training on how to report and manage blood-borne virus (BBV) exposure incidents.

Sharps safety

Sharps safety is critical. Always use safer sharps devices These are designed to reduce the risk of needlestick injuries and other sharps injuries. Examples are retractable needles, sheathed needles and needless systems. For more information on Preventing exposures (including sharps injuries) see standard infection control precautions

What you need to do

Follow standard infection control precautions at all times.

Further information on BBV

Bloodborne viruses (BBV) - HSE

What bloodborne viruses are - HSE

Bloodborne viruses (BBVs) in healthcare workers - GOV.UK

Green Book on immunisation hepatitis B chapter

Hepatitis B and C testing: people at risk of infection NICE

Managing the risk of needlestick or sharps injuries - HSE

Clostridiodes difficile (C.difficile)

What you need to know

Clostridioides difficile infection (CDI) is caused by a bacteria that can lead to severe diarrhoea, which can be life-threatening. This infection often, but not always, affects people who have been taking antibiotics. It can usually be treated with a different type of antibiotic.

It is important to consider the possibility of CDI, in ASC settings. Early recognition of symptoms, including persistent diarrhoea, fever or high temperature, nausea, loss of appetite and abdominal pain is important so that people can be tested, receive prompt treatment and appropriate IPC measures can be put in place.

C. difficile produce spores, which can survive in the environment for a long time and are difficult to remove. Good cleaning and disinfection are important to reduce the risk of infection spreading.

People accessing care and support

Encourage people accessing care and support to stay away from others whilst they have diarrhoea symptoms and for 48 hours after their symptoms resolve. For example, until 48 hours after a formed stool has been achieved (types 1 to 4), or until bowel habit has returned to baseline (use the Bristol Stool Chart to help identify the stool type).

Encourage and support people to carry out hand hygiene after going to the toilet and before eating.

The environment used by a person with suspected or confirmed CDI should be cleaned and disinfected at least twice daily, and immediately after any visible contamination, using a chlorine-based disinfectant at 1,000 ppm of chlorine (prepared and used according to the manufacturer’s instructions). In a person’s own home, toilets should be cleaned after each use to reduce the [risk of transmission]. Information on bleach alternatives, can be found in Safe management of the care environment (cleaning and decontamination) section of Standard precaution for IPC

Safe management of the care environment (cleaning and decontamination)

Ensure that people with CDI who are accessing care and support do not share linen (such as towels), toilets or bathrooms, or commodes with others.

People with CDI should not take medication to stop diarrhoea (for example loperamide), unless advised by a healthcare professional. These medicines can stop the body clearing the infection and may increase the risk of serious complications.  

Ensure the person remains hydrated. More information on hydration (drinks/fluid intake) can be found in Fundamentals of care which help prevent infections in adult social care settings

GP’s often prescribe treatment which may vary depending on how mild or severe the symptoms are.

Care and support workers

Encourage care and support workers to stay away from work if known or suspected to have CDI until they have been symptom free for 48 hours. For example, until 48 hours after a formed stool has been achieved (types 1 to 4), or until bowel habit has returned to normal for them.

What you need to do

Follow additional transmission based precautions whilst providing care and support for people with suspected or known CDI for the duration of their symptoms and until they have been symptom free for 48 hours. This includes hand hygiene using soap and water rather than alcohol-based hand rub. Use sporicidal products for environmental cleaning. These can kill tough bacterial spores that can survive normal cleaning and disinfecting

Further information

Clostridium difficile (C. diff) - NHS

Clostridioides difficile infection: how to deal with the problem - GOV.UK

High Consequence Infectious Diseases (HCIDs)

What you need to know

It is unlikely that a person accessing care or support in ASC would be exposed to an HCID as these are very rare events in the UK.

People who are suspected or confirmed as having an HCID will be managed via established pathways in the NHS.  In the unlikely situation where an individual is suspected to have a high consequence infectious disease (HCID), follow managing cases of suspected high-consequence infectious diseases in ASC.

Infectious diarrhoea and/or vomiting 

What you need to know

Infectious diarrhoea and/or vomiting is caused by pathogens (such as viruses, bacteria or parasites) that can spread from person to person, usually through the faecal-oral route (when traces of faeces spread to the mouth).

Diarrhoea and/or vomiting can be caused by infectious or non-infectious agents; however, all cases of new onset diarrhoea and/or vomiting should be regarded as infectious unless good evidence suggests otherwise.

Managing suspected infectious diarrhoea and/or vomiting in adult social care provides information about managing suspected infectious diarrhoea and/or vomiting.

Invasive group A strep (iGAS) and Group A Streptococcus (GAS)

What you need to know

Group A Streptococcus (also known as GAS) is a pathogen that can colonise the throat and skin, particularly patches of dermatitis including eczema and psoriasis, ulcers or wounds. Colonisation is when bacteria, viruses, or fungal pathogens live on or in the body without causing symptoms or disease. It is spread by close contact between people, through respiratory particles that spread through the air and direct skin contact. It can also be spread through the environment, for example, through contact with contaminated dust or objects (such as towels or bedding), or ingestion of food prepared by someone with the infection.

GAS causes a wide range of skin, soft tissue and respiratory tract infections, including tonsilitis, pharyngitis (‘strep throat’), scarlet fever, impetigo, cellulitis, septic arthritis and pneumonia as well as non-focal bacteraemia. Non-focal bacteraemia means bacteria are present in the blood, but the source of the infection is unknown. Further assessment is then needed to find the cause and provide the right treatment if there is non-focal bacteraemia. Occasionally these infections can be extremely severe and progress very rapidly.

Invasive GAS (iGAS) infection refers to severe GAS infection. It occurs when GAS invades a normally sterile body site, such as the blood or deep tissue. This type of infection is much rarer than strep throat or scarlet fever.

Reporting cases or outbreaks of GAS or iGAS

Both iGAS and scarlet fever are Notifiable diseases. Suspected iGAS cases must be notified urgently to HPTs to allow contact tracing, as close contacts are at greater risk of developing iGAS infection.  Any suspected outbreaks must be reported to the UKHSA local HPT and CQC.

Outbreaks of both iGAS and GAS infection occur in ASC settings. People accessing care and support who are receiving wound care (in any setting) are most commonly affected by GAS infection outbreaks. Outbreaks can be difficult to identify as there may be a mix of different infections (for example cellulitis, pneumonia, septic arthritis, wound infection) all within the same outbreak. There can also be long gaps (weeks or months) between cases, again making it difficult to spot a connection between them.

Staff who develop symptoms of GAS should see their GP and let them know that they have been working in an ACS setting with a GAS or iGAS outbreak.

People accessing care and support

People accessing care or support should have wounds, skin rashes or other possible GAS symptoms assessed by a nurse or GP. GAS is diagnosed from a skin, wound or throat swab. Wound swabs should be taken before application of any antimicrobial cream or wash. People with suspected or confirmed GAS infection are encouraged to cover any wounds and to minimise contact with other people until after 24 hours of taking antibiotics.

Care and support workers

Care and support workers are encouraged to wear a fluid resistant surgical mask (FRSM) if they have a sore throat when they are providing care activities to people accessing care and support. If they have had contact with a person with a diagnosed GAS infection (either professionally or personally), they should be clinically assessed for possible antibiotic treatment and/or a diagnostic test. They should ensure that any wounds are covered whilst at work.

What you need to do

Follow guidance for standard infection control precautions, in particular correct hand hygiene, correct cleaning of the care environment and care equipment, and appropriate PPE use.

Face masks may be recommended by UKHSA local HPTs for wound care activities where iGAS is known to be present in local populations, if this is required you will be informed by your UKHSA local HPT or IPC team.

Further information

Group A Streptococcus - GOV.UK

Strep A - NHS

UK guidelines for the management of contacts of invasive group A streptococcus (iGAS) infection in community settings

Multidrug resistant organisms (MDRO)

What you need to know

Multidrug-resistant organisms (MDROs) are pathogens that do not respond to common treatments such as antibiotics, antivirals, antifungals and antiparasitics, making them difficult to treat. They can be spread through direct contact (including care activities) and indirect contact (for example, contaminated surfaces or equipment). People accessing care and support in ASC with wounds, medical devices, or weakened immunity, are at higher risk of infection.

For information on how to prevent spread of MDRO and specific IPC measures, see

For information on how to prevent spread of MDROS and specific IPC measures, see Infection prevention and control for multidrug-resistant organisms in adult social care settings

Norovirus

What you need to know

Norovirus, also known as the winter vomiting bug, is a highly infectious virus that causes diarrhoea and vomiting. It can spread very quickly in ASC settings. Transmission occurs primarily via the faecal-oral route (when traces of faeces spread to the mouth) due to poor hand or toilet hygiene, or through contact with contaminated surfaces or people. It can also spread through tiny droplets released when someone vomits. These droplets can settle on and contaminate nearby surfaces and areas.

Although norovirus is more common in winter, infections can occur throughout the year.

Symptoms of norovirus infection are usually mild and last for 1 to 2 days. They include vomiting, sudden forceful vomiting, diarrhoea and fever. Other less common symptoms include headache, tummy pain and body aches and pains.

Outbreaks are common in communal ASC settings such as care homes, supported living and day centres, involving both care and support workers and people accessing care and support. 

People accessing care and support

Most people make a full recovery within a couple of days, but infection can be dangerous for elderly and immunocompromised people.

People with norovirus can become dehydrated, especially if they have diarrhoea or vomiting. Dehydration can make existing health conditions worse and may lead to complications that need hospital treatment. Encouraging people to drink plenty of fluids or use of oral rehydration products can help prevent dehydration

People with norovirus can easily pass the infection to others. They should stay away from other people while they have symptoms and for 48 hours after their symptoms stop.

To help prevent the virus spreading:

• do not share linen, towels, toilets, or bathrooms with others
• clean and disinfect areas used by someone with suspected or confirmed norovirus at least twice a day
• clean and disinfect straight away after any vomiting, diarrhoea or other contamination
• use a chlorine-based disinfectant containing 1,000 parts per million (ppm) available chlorine, following the manufacturer’s instructions
• in a person’s own home, clean the toilet after each use or whenever it becomes contaminated

People receiving care should be able to have visitors where possible. However, providers must also protect other people accessing care, visitors and staff from infection.

Visitors who have symptoms of norovirus should not visit until they have been free of symptoms for at least 48 hours.

Visitors should be told if they may have been exposed to norovirus and advised on the steps they can take to reduce the risk of spreading infection.

For more information see Supporting safer visiting in care homes during infectious illness outbreaks - GOV.UK

Care and support workers

Washing hands with soap and water after providing care and support activities will help prevent care and support workers from catching norovirus.

Alcohol-based hand rub is not effective against some pathogens that can cause diarrhoea and vomiting. Care and support workers should stay away from work if they are symptomatic and should not return until they are 48 hours free from symptoms.

What you need to do

Follow additional transmission based precautions whilst norovirus is suspected or known. If an outbreak is suspected seek advice from the  local health protection team.  

Further information

Stop norovirus spreading poster

Norovirus (vomiting bug) - NHS

Norovirus: guidance, data and analysis - GOV.UK

Norovirus: What to do if you catch it and helping to stop the spread – UK Health Security Agency

Scabies

What you need to know

Scabies is a skin condition caused by an immune reaction to the presence of the mite (infestation) Sarcoptes scabiei and their saliva, eggs and faeces. The typical symptoms of scabies is intense itching associated with burrows, nodules and redness, which generally starts 3 to 6 weeks after infestation However, infestation without these symptoms has been shown to be common in older adults living in care homes.

Scabies is usually spread through close skin‑to‑skin contact. It can cause severe itching, especially at night. Follow the advice in Management of scabies cases and outbreaks in communal residential settings - GOV.UK if you suspect people accessing care and support may have scabies.

Tuberculosis (TB)  

What you need to know

Tuberculosis (TB) is an infectious disease caused by bacteria. It is most common in the lungs (pulmonary TB), but it can affect any part of the body, for example, brain, spine and lymph nodes (extra-pulmonary TB).

Refer to section Tuberculosis (TB) Guidance for adult social care settings for information on symptoms and actions to take if TB is suspected in your ASC.

Urinary Tract Infections (UTIs)

What you need to know

A UTI happens when bacteria in any part of the urinary system cause infection. A UTI is an infection of the urinary system, usually caused by bacteria.

Signs to look out for in the person you are caring for include:

• pain or burning when peeing (dysuria)
• needing to pee more often than usual
• new or worse incontinence (wetting)
• fever, shivering, or shaking
• new or worsening confusion

If untreated, bacteria can reach the kidneys and even enter the bloodstream, causing serious infection (sepsis). Sepsis is a life-threatening condition that develops when the body’s response to an infection causes damage to its own tissues and organs. Early recognition and prompt treatment are essential. There is a sepsis modern service framework that highlights the key role of ASC in preventing infection, identifying illness early, getting people the right help quickly, and supporting recovery after sepsis.

It may be difficult to identify a UTI in a person with a catheter, or in a person with dementia 

People accessing care and support

People accessing care or support may develop one of the symptoms listed above. However a slight change in their general health status of a person may also suggest the onset of a UTI. This includes changes in behaviour, becoming confused or agitated or incontinence (or worsening incontinence).

What you need to do

A GP, nurse or other healthcare professional may ask a care and support worker to collect a urine sample from a person with symptoms of a UTI and send it to the local hospital laboratory for testing, usually through their GP.

Care and support workers should work with health professionals to guide assessments before collecting urine. The diagnostic decision tool for suspected UTI in adults over 65 years can help reduce unnecessary sampling and antibiotic prescribing. Report and escalate at the first appearance of symptoms and do not delay a clinical assessment until symptoms become more severe.

In domiciliary care, ASC staff should record any concerns they may have in the care records and escalate to a healthcare professional, either directly or through their manager, in line with local procedures.

Encourage people accessing care or support to stay hydrated. Support people accessing care or support with their personal hygiene.

Antibiotics aren’t always needed and can sometimes cause harm, including adverse effects and drug interactions. The GP will assess and decide if antibiotics are needed. Support people accessing care or support to take any prescribed medication if given.

Testing for UTIs

Do not use urinalysis (dipsticks) as a standalone diagnostic tool and especially for adults over 65 as they are unreliable. Many older adults, especially with catheters, may have bacteria in the urine without an infection: colonisation

Unnecessary urine sampling leads to identifying asymptomatic bacteriuria (bacteria in the urine) or colonisation, which often results in antibiotics being prescribed that the person didn’t need, increasing antimicrobial resistance, extra tests, and costs.

Further information

Urinary tract infections (UTIs) - NHS

Diagnosis of urinary tract infections: quick reference tools for primary care - GOV.UK

Understanding the burden of UTI hospitalisations in England - GOV.UK