Understanding and managing infection in adult social care
Information resources to support understanding of health protection hazards in adult social care settings in England.
Introduction
Adult social care (ASC) spans a broad and complex landscape of regulated and non-regulated services, delivered across diverse settings such as care homes, supported living, domiciliary care, and day centres.
Aim of this resource
This resource aims to promote a clear and consistent awareness and understanding of the legal and public health arrangements surrounding infectious diseases in ASC settings for non-specialists. It aims to explain key health protection terms and concepts, improving understanding and confidence in interpreting information and supporting the consistent application of existing guidance on specific infectious hazards.
Who this resource is for
This resource is designed for anyone who needs to understand health protection in ASC, including policymakers, providers, commissioners, and other stakeholders. It also provides simple explanations of infectious disease management and the terminology used in these settings.
UK Health Security Agency (UKHSA) guidance and resources complement existing legal and regulatory requirements and should be read alongside them.
The legal and regulatory context
Guidance on the regulatory requirements for ASC service providers in England is available on the Care Quality Commission’s website (CQC) website, including Regulation 9A , which sets out providers’ responsibilities to ensure individuals’ rights to receive visitors and be accompanied are respected, based on an assessment of their needs and preferences.
Regulation 9A: Visiting in care homes during outbreaks of infection
UKHSA has published ‘Supporting safer visiting in care homes during infectious illness outbreaks’ which outlines principles to support the safe planning and management of visits during infectious disease outbreaks. This guidance also signposts the relevant legal and regulatory context for visiting in ASC settings and provides operational advice to support Regulation 9A. It reinforces the requirement that visiting, both into and out of settings, should be actively facilitated and recognised as a fundamental aspect of care, wellbeing, and human rights.
These principles emphasise that visiting restrictions should only be implemented where risks cannot be sufficiently mitigated, and must be proportionate, risk-based, and time-limited. It supports health protection teams (HPTs) and ASC managers to carry out risk assessments, apply appropriate infection prevention and control (IPC) measures, and facilitate safe, meaningful visits; for all people accessing care and support, their families, and friends.
Tenancy and obligations to individuals who access care and support in care homes
The Competition and Markets Authority (CMA) provide advice for care home providers to understand their responsibilities under consumer law to residents. Information about the CMA can be found on their website. Additional information is published: Consumer law advice sets out obligations for care homes.
Control of Substances Hazardous to Health (COSHH)
Information about health and safety at work and associated legislation, as well as regulations around the Control of Substances Hazardous to Health (COSHH) can be found on the Health and Safety Executive’s (HSE) website.
Domiciliary care
Information on domiciliary care (also known as home care) registrations in England can be found on the CQC website.
The Health and Safety Executive (HSE) provide guidance on safety for people who provide care in people’s own homes.
Notifiable diseases and organisms
It is important to distinguish between notifiable diseases and notifiable organisms. A notifiable disease is reported based on a suspected illness in a person. By contrast, a notifiable organism is reported when a specific microorganism is confirmed through laboratory testing. Medical practitioners report notifiable diseases, while laboratories report notifiable organisms.
Notifiable diseases are specific infectious diseases that may pose a risk to public health and are subject to legal reporting requirements. Under the Health Protection (Notification) Regulations 2010, registered medical practitioners (doctors) are required to report cases of people who have or are suspected of having a notifiable disease to the Proper Officer of the relevant Local Authority, who must then disclose the fact of the notification and its contents to UKHSA. For more information see Notifiable diseases and how to report them.
The system for reporting a notifiable disease is a critical public health tool which informs local and national surveillance of serious infectious diseases. Notification allows UKHSA to take prompt public health action to prevent and control infections.
A separate reporting system also exists when certain infectious organisms are identified in a laboratory. Laboratories in England that process human samples are legally required to report specified infectious diseases and confirmed ‘notifiable organisms’ to UKHSA. Notifiable organisms are microorganisms (often called germs) such as certain bacteria, viruses and fungi, that are important for public health surveillance. Reporting helps UKHSA monitor infection trends, identify outbreaks, and take action to prevent the spread of infection. For more information see Notifiable organisms and how to report them.
Not all notifiable diseases or organisms pose a significant risk to the general population. For example, chickenpox is a notifiable childhood disease which is self-limiting in most people. However, it can cause more severe illness in some high-risk groups.
Care homes and other ASC settings may be informed by a health professional or by a HPT when a resident, or person living, working or connected to the setting, is diagnosed with an infectious disease or identified as carrying an infectious organism. One of the key reasons for sharing this information is to ensure that effective, timely, and proportionate infection control measures can be put in place.
Notification of outbreaks
UKHSA has produced a toolkit summarising the key health protection legislation to support the management of outbreaks and incidents. The toolkit should be read along with the overarching legislation. In addition, for awareness there is the Communicable disease outbreak management guidance: principles to support local health protection systems guidance. This provides health protection organisations in England with principles to support local health protection system responses to outbreaks of communicable disease.
It is important to recognise potential outbreaks promptly, and to implement control measures as soon as possible, to prevent further cases. An outbreak is defined as 2 or more linked cases of the same (confirmed or suspected) infection occurring around the same time and associated with the service or location. Care home providers should inform others of the outbreak or suspected outbreak to obtain support and advice as needed. This may include UKHSA local health protection team, infection control team, local authority or commissioners and CQC.
Care homes, supported living and extra care services can, in some regions, report an outbreak of acute respiratory infection online. Other regions should phone their local UKHSA health protection team or local community infection control team (as per local arrangements) to report.
Understanding infection in ASC settings
Many infectious organisms (sometimes called germs) can be present on a person without them having symptoms or being ill. The medical terms used to describe this are colonisation or carriage. Colonisation can continue for a long time. This is not harmful, and people who are carrying the ‘germs’ can live unaffected by them. Colonisation is common. In 2023, a review of many studies estimated that around one in five individuals living in care homes for older adults in the UK carried meticillin-resistant Staphylococcus aureus (MRSA (1). A 2018 study reported a 2.0% asymptomatic carriage of group A streptococcus (GAS) in adults in higher-income countries, however higher levels of carriage were seen in children (10.5%) (2). Another study found that 1 in 4 individuals carried norovirus in outbreak situations in nursing homes (3).
People with asymptomatic infections may not know they are colonised, and neither will their care team. That is why all staff, in all care settings, must always follow standard infection control precautions. IPC guidance for the ASC sector provides practical support for those responsible for standards in England, helping them prevent and manage infections in adult social care settings.
There are some infections that are especially important in ASC settings, for which UKHSA has published guidance to support their prevention, management and control. These are essential to ensure appropriate and proportionate response measures can be put in place. These include:
- Management of scabies cases and outbreaks in communal residential settings
- Influenza-like illness (ILI): managing outbreaks in care homes
- Infection prevention and control: resource for adult social care
- Infection prevention and control in adult social care: acute respiratory infection
Further information on other infections that may occur in ASC settings can be found on the NHS and GOV.UK pages.
Multidrug-resistant organisms (MDRO)
Multidrug-resistant organisms (MDRO) are organisms that can cause infection (pathogens) which are difficult to treat because they do not respond to common treatments such as antibiotics, antivirals, antifungals and antiparasitic. People can be colonised with MDROs, as explained earlier in this section, without any signs or symptoms of infection. There should not be restrictions on visiting a care setting or an individual leaving the setting because of known carriage of any MDROs. See guidance on Supporting safer visiting in care homes in care homes and seek further IPC advice from your local advisor if required. Further guidance is available on the government website on how to prevent the spread of these pathogens.
Food-borne illnesses
Some infections can be spread through poor food hygiene, storage and preparation. ASC settings must follow infection control and operational policies to manage and reduce the risk of food-borne illnesses. The Food Standards Agency (FSA) has a range of duties in the food system including a role in regulation and as an industry watchdog. Information on food safety responsibilities for businesses can be found on the GOV.UK website. The Food Standards Agency (FSA) provides a food safety management pack for residential care homes; further information is available on the FSA website.
Contact
If you have any questions about this document, contact ASCTeam@ukhsa.gov.uk
References
1. Hasanpour AH and others. ‘The global prevalence of meticillin-resistant Staphylococcus aureus colonization in residents of elderly care centers: a systematic review and meta-analysis’ Antimicrobial Resistance and Infection Control 2023: volume 12, issue 1, page 4
2. Oliver J and others. ‘Group A Streptococcus pharyngitis and pharyngeal carriage: a meta-analysis’ PLoS Neglected Tropical Diseases 2018: volume 12, issue 3
3. Wang J and others. ‘Global prevalence of asymptomatic norovirus infection in outbreaks: a systematic review and meta-analysis’ BMC Infectious Diseases: volume 23, issue 1
Further guidance
- Managing cases of suspected high consequence infectious diseases in adult social care
- Infection prevention and control in adult social care settings
- PPE guide for non-aerosol generating procedures
- Influenza-like illness (ILI): managing outbreaks in care homes
- NHS England: National infection prevention and control manual (NIPCM) for England
- Regulation 12: Safe care and treatment - Care Quality Commission
Glossary
Infection
An infection happens when germs, such as bacteria, viruses, fungi, or parasites enter your body, multiply, and cause harm. Most germs are harmless and can even be helpful, protecting you on your skin, in your airways, and in your digestive system. But some germs can make you sick, causing symptoms like fever, nausea, or vomiting.
Asymptomatic infection, carriage or colonisation
When a person carries an infection without any signs or symptoms of the infection. This is known as ‘asymptomatic infection’ ‘carriage’ or ‘colonisation’ and being a ‘carrier’ or ‘colonised’.
Transmission
This is how pathogens move between individuals or objects, through hands, touching contaminated surfaces, the air, or body fluids.
Fomite
An object contaminated with micro-organisms. Indirect transmission can occur when micro-organisms are transmitted from an infectious individual to another individual through a fomite.
Healthcare associated infection (HCAI) or nosocomial infection
Infections that occur as a result of medical care, or treatment, in any healthcare setting. Also known as nosocomial infections.
Antimicrobial resistance (AMR)
Antimicrobial resistance (AMR) is a global threat which happens when bacteria, viruses, fungi, or parasites become resistant to medicines like antibiotics. In ASC settings, individuals often have complex health needs and frequent antibiotic use, which increases the risk of AMR.
Multidrug-resistant organisms (MDRO)
MDROs are pathogens that are difficult to treat if they cause an infection because they do not respond to common treatments such as antibiotics, antivirals, antifungals and antiparasitics. Examples of MDROs include meticillin resistant Staphylococcus aureus (MRSA) and Carbapenamase Producing Enterobacteriaceae (CPE). For further information on infection control management of MDROs in ASC, visit the UKHSA’s website.
Pathogen or pathogenic
An infectious agent (bug or germ), a microorganism such as a virus, bacterium, or fungus that causes disease in its host.
Standard infection control precautions (SICP)
The basic infection prevention and control measures necessary to reduce the risk of transmitting germs from both recognised and unrecognised sources of infection.
Notifiable diseases and organisms
Notifiable diseases are certain infections that may present a risk to human health. Registered medical practitioners must report a notifiable disease to the UK Health Security Agency.
Notifiable organisms are bacteria, viruses and fungi that cause infectious diseases. All laboratories in England must report a confirmed notifiable organism to the UKHSA.
Outbreak
An incident in which 2 or more people affected by the same infectious disease are linked by time, place, or common exposure or a greater than expected rate of infection compared with the usual background rate for the place and time where the outbreak has occurred.
Personal protective equipment (PPE)
Equipment that is intended to be worn or held by a person to protect them from risks to their health and safety while at work. Examples include gloves, aprons, and eye and face protection.
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