Guidance

Managing outbreaks in adult social care settings

Published 28 October 2026

This section explains how to recognise, report, and manage outbreaks and incidents in adult social care settings. Effective management helps reduce the spread of infection and protects the health, wellbeing, dignity, and safety of people accessing care and support, their families, and staff.

Key summary

• an outbreak is usually 2 or more linked cases of the same infection that happen at the same time and in the same place
• spot symptoms early to help stop the spread
• report outbreaks quickly and work with partners (e.g. UKHSA local HPT, GPs, IPC teams)
• use the right infection prevention and control measures
• review and learn to improve future response

Call for action

• be alert to symptoms and act quickly if more than one person is unwell
• report outbreaks quickly through the right channels
• follow the outbreak plan and infection control measures
• keep staff, families, and partners informed
• increase cleaning, hygiene, and PPE use
• watch for new cases and act fast
• balance infection control with people’s wellbeing
• after the outbreak, deep clean, review, and update plans
• ensure safer visiting guidance is followed

Managing outbreaks and incidents effectively in adult social care (ASC) settings is essential to protect the health, dignity and wellbeing of people who access care and support, their loved ones, as well as care and support workers, and healthcare practitioners.

People accessing care and support are often vulnerable to the effects of infectious diseases due to their age or underlying medical conditions, and outbreaks can spread quickly in ASC settings, with serious consequences. People accessing care and support and care and support workers are also more susceptible to infections that increase during winter months (respiratory and stomach infections) which can cause serious outbreaks due to close contact in communal ASC settings.

Good infection prevention and control (IPC) practices can help reduce the risk of outbreaks occurring.

This guidance is intended to support ASC providers in England to prevent, identify and manage infectious disease outbreaks. It sets out practical actions, roles and responsibilities, and key principles for working with UKHSA health protection teams (HPTs) and local partners such as local authorities, Integrated Care Boards (ICBs), Infection Prevention and Control (IPC) teams, GPs, pharmacies, and commissioners. The guidance aims to support proportionate, person-centred responses that balance IPC with people’s rights, wellbeing and quality of life.

Outbreaks and incidents are more common in care homes and other residential settings, where people and staff are in close contact with each other. However, they can also happen in domiciliary or home care, where they may be harder to spot. In these situations, keeping records of linked cases in different households can help identify an outbreak.

It is important to be clear when concerns should be raised and who is responsible for coordinating the response. Concerns should also be reported to the UKHSA local HPT or IPC team for advice and support.

Local HPTs can support with conducting a risk assessment for protecting people accessing care and support as well as care and support workers, to ensure safe care can be delivered. They can advise on the management of contacts in all ASC settings if required.

Safeguarding statement

In keeping with the Mental Capacity Act 2005, care and support workers must presume capacity unless assessed otherwise, provide tailored support to enable understanding, and document any capacity assessments clearly. Where a person lacks capacity, decisions or protective measures must be made in their best interests and be proportionate, necessary, and least restrictive, with involvement from relevant professionals and those close to the person wherever appropriate.

Always ensure any information sharing about a person who is infectious is done so in a compassionate but proportionate way.

Outbreak definition

An outbreak is when two or more people have the same infection and are linked in time and place or common exposure. This includes people accessing care and support and care and support workers.

It can also be when the number of infections appears unusual or higher than what is normally seen in an ASC setting (communal setting or domiciliary care). Other situations where outbreak procedures should be followed include:

• when a single case of a rare infectious disease (for example, diphtheria, rabies, polio, botulism) or high-consequence diseases (such as a viral haemorrhagic fever) happens
• when there has been suspected or confirmed contamination (for example, of food, water, medicines, or medical devices)

Recognising an outbreak early

Be alert to signs of infection and any changes in a person’s usual behaviour. Care and support workers are often the first to notice these subtle changes and symptoms of infection in people that they care for even when the person hasn’t said they feel unwell.

If more than one person under your care is experiencing similar symptoms it may indicate spread, even where there may be no obvious links. This also applies to domiciliary care, where people may not share living spaces but may be exposed to infection in the community. Rota patterns, sickness data and call logs may be useful to monitor and detect outbreaks and act early.

What to look for

During an outbreak, people may be experiencing similar symptoms, such as:

• high temperature (usually 37.8 degrees Celsius or higher)
• diarrhoea and/or vomiting
• unexplained rash
• cough, breathlessness or other respiratory symptoms
• sudden confusion or unexpected falls

These are some of the common symptoms, but others may also occur. Symptoms may be present in care and support workers, and visitors as well as those accessing care.

Recognising outbreaks early means IPC measures can be put in place quickly, helping to stop the spread. If a person accessing care or support is showing symptoms of infection, refer to TBP to start additional IPC measures.

Report any concerns immediately to a care manager and a healthcare professional or GP.

If a notifiable infection is confirmed then it is the responsibility of healthcare professionals to report this, not the ASC setting.

Common causes of outbreaks in adult social care settings

Common causes of outbreaks in ASC settings include:

• acute respiratory infections (for example: flu, COVID-19)
• acute gastroenteritis (for example: norovirus)
• bacterial infections (for example: Group A Streptococcus)
• scabies

What to do if an outbreak happens

Reporting an outbreak

If an outbreak is suspected or confirmed in an ASC setting, it should be reported immediately to the local UKHSA HPT or through local reporting arrangements. For serious food-related outbreaks, causing significant illness, rapid deterioration, or requiring urgent medical treatment or hospital admission, or affecting multiple settings, the local authority must also notify the Food Standards Agency (FSA).

The UKHSA local HPT works with local authorities and other partners to provide specialist outbreak management advice, direct ASC providers to relevant guidance, and connect them with IPC teams and other stakeholders. When contacted, the HPT may request details about affected people and staff, including symptoms, onset dates, vaccination history (such as flu vaccination), and actions already taken. Having this information available will help the team provide timely support and advice.

There is an online tool for reporting outbreaks of ARIs in ASC settings. Your UKHSA local HPT will let you know if this is in use within your region. Let the UKHSA local HPT know if you do not have access to a computer or email.

Data on infections are published nationally and regionally via Statistics at UKHSA or UKHSA data dashboard. However, this data may not be available to determine whether there is an outbreak of a specific infection in an individual ASC setting (for example flu outside of flu season). Therefore, staff should always rely on clinical judgement, staff observations, and existing local reporting systems.

Communication with partners

As soon as an outbreak is suspected or known, the ASC provider is responsible for letting key stakeholders know so the care setting can get the right support and advice. This should include notifying people accessing care and support and their families who may be affected by the outbreak.

In domiciliary care, inform the care provider’s manager or nominated deputy or office team, relevant commissioners, and any other agencies involved in the person’s care. This helps everyone work together and avoids unnecessary duplication of work.

This is also a requirement within the Health and Social Care Act criterion 4, which requires timely communication of infection risks to relevant parties.

Always inform:

• UKHSA local HPT
• GPs of people who are unwell
• local authority public health team and/or ASC link as per local arrangements
• IPC Team if available through your local authority, NHS, or private contract
• Environmental Health if the outbreak is suspected to be food-related
• relatives and other significant people
• hospitals or outpatient departments if people have upcoming appointments
• other care providers if the person is, has been, or will be supported elsewhere (including visiting professionals like hairdresser, podiatrists, or district nursing)
• all staff including agency workers, ambulance staff if people need to be assessed or transferred, and contractors

If medication is suspected as a source of infection, notify:

• Care Quality Commission (CQC)
• Medicines and Healthcare products Regulatory Agency (MHRA) through the Yellow Card Scheme
• local pharmacy or dispensing service (details can be found on the medicine label)
• commissioning bodies (if applicable)

Outbreak response

Once an outbreak is reported and confirmed, care providers should review their outbreak plan alongside guidance from their UKHSA local HPT or other local agency, such as a community IPC Team. It is helpful for ASC settings to maintain a record of affected people, date of onset, symptoms, and any investigations or treatments, so they have this information ready when they contact their UKSHA local HPT.

Where applicable, the UKHSA local HPT will support the local risk assessment and provide targeted recommendations as required including enhanced IPC measures, testing (including how to collect specimens to test for infections), prophylactic treatment if required (which is given to try to stop an infection), and how to seek further support from your local authority and other stakeholders.  Always make sure infection control measures fit the infection, the people at risk, and your environment.

Make sure all care and support workers know the details of the outbreak and understand their role. This includes knowing:

• signs and symptoms of the infection
• who is affected
• what control measures are needed

Managers should increase monitoring of IPC practices during an outbreak to keep standards high. Managers should:

• apply additional IPC measures rigorously, these will depend on how the infection causing the outbreak spreads
• promptly identify any new cases in staff, visitors, family, and people accessing care and support and make sure they are kept away from others to stop the spread of infection.
• check if the CQC needs to be notified under Regulation 18
• follow guidance to ensure the safe continuation of visiting in accordance with CQC regulation 9A

Essential considerations in outbreak management

Consider the wellbeing of people accessing care and support, especially if they have dementia, learning difficulties or cognitive impairments for example people who may walk with purpose. If a person lacks capacity, follow the Mental Capacity Act Code of Practice and Mental Capacity Act and Deprivation of Liberty Safeguards. Care and support workers can help people to avoid infection by supporting regular hand hygiene and ensuring that frequently touched surfaces in the areas they use are cleaned regularly.

If a person is being discharged from hospital into a communal care setting during an outbreak, or if they have an infection, always assess any risks with the hospital. If there is an outbreak at the care setting when a person is due to be discharged, this should not stop them from coming home. Decisions should be based on an individual risk assessment that considers the person’s needs and the steps in place to reduce risk.

Raise any concerns and seek advice from IPCTs, local authority public health teams, or UKHSA local HPTs if needed. Always communicate clearly and involve the person and their family or their representatives in any decision made. Toolkit 6: principles for the management of outbreaks in specific settings provides additional information to support care providers in their ASC setting. New admissions to a communal ASC setting during an outbreak should be risk assessed to make sure they can be admitted safely.

Ensure timely access to treatments and therapeutics continue.

Be alert to any deterioration in health of people accessing care and support and seek clinical advice quickly from the person’s GP or NHS 111.

If care and support workers have symptoms of infection, they should get advice from their manager before returning to work. The Health and Safety Executive have information about managing sick leave and returning to work . UKHSA have information about managing specific infectious diseases that is used in young people’s settings, but can be applicable in principle to the ASC sector .

Maintaining safe staffing numbers may become a challenge during an outbreak in ASC settings. If the ASC setting is experiencing operational challenges such as short staffing, contact the local authority commissioner or Integrated Care Board (ICB) commissioner. Their role is to help maintain continuity of care by coordinating emergency support, redeploying staff where possible, and activating contingency plans. Commissioners can also arrange temporary staffing solutions, prioritise essential services, and escalate to regional or national support if local resources are insufficient.

Infection control measures during an outbreak

Keep enhanced IPC measures proportionate, risk assessed, and time limited.

Ensure standard infection control precautions and any transmission based precautions are used correctly.

If someone has or is suspected to have an infection:

• encourage the person to stay away from others for their infectious period, where they are able to do so
• refer them for clinical review if needed
• follow advice from your UKHSA local HPT, GP or IPCT on how to safely support people affected by an outbreak

Review cleaning during an outbreak, making sure to:

• check the strength and effectiveness of cleaning products to ensure they are suitable for the pathogen causing the outbreak. UKHSA local HPT teams or IPC teams may be able to support with this
• increase the frequency of cleaning and disinfection of the person’s immediate environment (for example every 2-4 hours during active outbreaks) including frequently touched surfaces (for example door handles, rails, and light switches) in communal areas or shared spaces
• adjust waste management if extra waste is generated
• use colour-coded cleaning equipment in communal ASC settings, in line with national guidance
• minimise waste handling and follow household waste disposal routes in domiciliary care, unless infectious waste requirements apply
• handle any contaminated linen safely
• separate infectious linen (soiled or contaminated with body fluids) into water-soluble (alginate) bags inside a waterproof (impermeable) bag in communal ASC settings (in domiciliary care alginate bags are not usually used
• do not rinse or shake linen before bagging to avoid aerosol spread
• launder at the highest temperature suitable for the fabric (usually at least 60°C) with detergent, and dry thoroughly
• have enough PPE, hand hygiene supplies, tissues, and toilet paper available and easy to access until the outbreak is over

Remember that PPE is only one part of the Hierarchy of Controls for outbreak management and should be used as the last line of defence when other measures cannot fully control the risk.

Start with measures that prevent exposure at the source, such as:

• hand hygiene
• improving ventilation in shared spaces
• reinforcing cleaning schedules
• cohorting (keeping those affected away from those not affected), and staff allocation to look after affected people, to minimise the risk of spread of infection.

It is not recommended to use alcohol-based hand rub when caring for people with diarrhoea and vomiting or during an outbreak of diarrhoea and vomiting as it is not effective against all causes of diarrhoea and vomiting. Instead wash hands with liquid soap and water.

Visiting principles

In general, visits should remain proportionate in all ASC settings during outbreaks.

ASC managers and providers should follow the supporting safer visiting guidance   during infectious illness outbreaks.

People have the right to private and family life under the European Convention on Human Rights. Staying in touch with family and friends is important for wellbeing and quality of life. During an outbreak, visits should continue where possible, with steps in place to reduce the risk of infection and keep people safe.

During an outbreak the care provider, with support from the UKHSA local HPT where needed, will carry out a risk assessment so measures can be put in place to facilitate safer visiting. Additional measures can include providing, for example, hand hygiene stations, PPE for visitors, well-ventilated visiting areas, enhanced cleaning of high-touch surfaces before and after visits.

In some cases, where there are significant risks which cannot be managed in other ways, limiting visitors (for example, one per person) may be needed. Consider discussing alternative methods of maintaining contact with individuals, where preferred, such as through support video calls or telephone calls.

Any changes to visiting arrangements must always be:

• proportionate (only as restrictive as necessary)
• risk assessed (based on the specific outbreak and setting)
• time limited (reviewed regularly and lifted as soon as it is safe to do so)

All visitors should clean their hands when they arrive and before they leave the ASC setting.

Visitors should be advised of any other IPC measures that they should take before they visit.

Once the outbreak ends

Communication

The local UKHSA HPT, with local authorities and other partners, can support you in working out when an outbreak can be declared over.

Ensure all care and support workers, people accessing care and their families are aware the outbreak has been effectively managed, declared over and that normal operations and visiting arrangements are able to resume.

Update your local partners as required, such as ICBs and GPs.

Terminal clean (deep clean) - after the outbreak is over in communal settings

A terminal clean (deep clean) is a one-off clean that is carried out once the outbreak has been declared over by either the UKHSA local HTP, IPC team, or ICB. Carry out a terminal clean of the affected person’s rooms and environment  and all communal areas (or the whole setting if widely impacted).

Clean all surfaces, floors, and reusable equipment using hot water and neutral detergent, followed by disinfection where required (e.g., 1,000 ppm of chlorine for toilets and bathrooms). New disinfectants are now available that don’t contain chlorine. In ASC settings, managers can choose the product that works best for the ASC setting as long as it meets the following standards:  EN17126, EN13727, EN14348, EN14476, EN13697, EN14885, EN13704, EN1650, EN1276 and EN13624. These numbers will be on the product information.  These standards can be hard to understand, so always check with the person responsible for buying cleaning products before choosing or using a disinfectant.

Household detergents or bleach can be used if cleaning is needed in homecare settings. Always clean with detergent first before using bleach and follow the product instructions. 

Clean every part of the areas affected thoroughly, from top to bottom and start from cleaner areas and move to dirtier last.

Pay special attention to frequently touched surfaces such as door handles, light switches, and rails.

Soft furnishings and privacy curtains should be laundered, or steam cleaned.

Replace or dispose of any items that cannot be effectively cleaned or are visibly soiled. Always seek permission from the person before disposing of personal belongings.

Clean or replace mattresses, cushions, and pressure-relieving aids as per guidance.

Vacuum carpets and upholstered furniture using HEPA filters, then steam clean.

In domiciliary care it may not be possible to implement a terminal clean and only the waste can be realistically removed. However, advice regarding cleaning and laundry should be given to the person and their family and documented appropriately.

Learning from outbreaks

After an outbreak, ASC care providers should review what worked well and what was difficult. Where possible, this should include people who have been affected. They should use this learning to update their outbreak management plans and improve preparedness for future outbreaks. Debrief and lessons learned sessions can help identify improvements and should focus on learning rather than assigning blame.

There are some helpful frameworks to support learning. The Patient Safety Incident Response Framework (PSIRF) provides a system-based and proportionate approach to learning and improvement. Social care organisations are required to use PSIRF for any healthcare delivered under the NHS Standard Contract; for other social care provision, its principles may still provide a useful approach to learning.