How to Manage an Infectious Outbreak 

It can be a very stressful and lonely job managing a care home, nevermind when you have an infectious outbreak.  
 
Managing infections in a care home can be an uphill struggle. There's so many factors to think of, the safety of the service users, the rotas and staffing levels, whether or not to continue accepting visitors, purchasing more PPE, isolating service users who can no longer understand the need to isolate, who to notify and when to report an outbreak.  
 
In this article, we cover all you need to know including (click the sentence to head straight there): 
 
 
 
Lets get straight to it! 
 
What is an infectious outbreak? 
 
According to Public Health England (PHE) an infectious outbreak is where more than one person has the same infection. Ultimately, if the infection has spread to another person, it constitutes as an outbreak. Many people will no doubt remember that it used to be more, however currently, it only takes two people to make an outbreak.  
 
Who needs to know? 
 
Public Health England) have a list of infections which you must inform them if one of your staff have it. On the list includes COVID, Legionella, Tuberculosis among many others. We've made attached the UK government's downloadable poster here: PHE Notifiable Diseases Poster 
 
When you experience an outbreak, you should inform: 
 
Your local authority,  
PHE if needed,  
And your community infection team 
 
 
How To Manage Visitors During An Outbreak? 
 
There are some main things to consider when liaising with families and friends, their top five concerns are: 
 
Is my loved one infected? 
Am I at risk of becoming infected too? 
How many people have it? 
Are staff spreading it? 
Are you going to stop me from visiting? 
 
Part of managing an outbreak is also managing the needs of the service user's families and friends. What can be very useful is writing down the answers to these questions, prior to making any phone call letting people know there's an outbreak within the home. You can use these questions to deliver your message. For example stating that there is an outbreak and if their loved on is infected. Then moving onto if the family is a risk i.e. when did they last visit the home and what symptoms they may experience. If they do experience them, they should contact their G.P. You can then explain how many people have been infected and what you're doing to limit the spread. This brings you on nicely to explain how you are going to manage visits from loved ones and professional as part of your infection prevention plan, minimising people within the home.  
 
Despite informing families and friends about the outbreak, you should still maintain confidentiality. This includes not sharing: 
 
Who is infected, i.e. which service users and which staff members, 
Who started the infection,  
How long it will last for - as there is real answer to this question, 
Who's on antibiotics and who's not, 
Who has gone to hospital or who has unfortunately passed away.  
 
When you realise you have an outbreak, ensuring you call families and friends is very important, however it is very time consuming too. What can be a useful way to manage this is by asking key family members to cascade this information to their sibling and other families members so you don't have to. It's also a good idea to try and minimise the amount of families trying to call the home during this period. Explain to them you will call their lead family member and on a certain day. If they know you're calling to update them, hopefully they won't be calling you. 
 
Family members may benefit from speaking directly to a senior carer or a nurse rather than the administrator or the manager. This is because they will no doubt have questions which relate specifically to their loved one. These could be around having enough toiletries, enough clothing, whether they are managing their new mobility aid etc. As the manager, you may not know the answers to these questions, however your staff will. Providing your senior staff with an answer sheet to read off when calling is another good way to ensure you're giving out a consistent message. Any other questions from the family can be answered by the senior member of staff.  
 
Finally having physical notices on the entrance door is also very useful. Highlighting to everyone that you're only accepting visits from professionals at this time; just in case you've forgotten to call a family member or friend.  
 
But What About Palliative Patients? 
 
This is an important question, should you prevent family members from visiting their loved one at the end stage of the person's life? This ultimately is made of two choices, 
 
Is it safe for the family to visit 
Do the family want to visit 
 
Some family members may not visit their loved one if they are also at a high risk of harm from the infection, or they live with someone who is. This can include people who are undergoing cancer treatment, living with someone who has an autoimmune disease, or has a newborn baby. To answer the first point, are the family safe, you should call your local infection prevention team to discuss what the infection is and if you need to prevent all visitors or if exceptions can be made. From here you can inform the family. If the family are safe to visit and they wish to, limiting the amount of visitors, where possible, is helpful. Asking the visitors to stay in the service user's room and your staff supplying them with a large flask of tea or hot water for coffee will help minimise the disruption to your staff.  
 
Is It Illegal To Prevent Families Entering My Care Home? 
 
In short, the answer is no. Your role as the manager is to safeguard the people inside the home against harm. Whether this is a threat from a member of staff, a visitor or anyone else.  
 
During an outbreak, you will no doubt be supporting people who are at an increased risk of harm, or even death, if they catch an infection. By preventing families from entering the home, you are doing your job in minimising the spread of infection, and therefore safeguarding the service users from harm.  
 
However, your service users do have rights and part of providing appropriate care, is providing access to social, religious and culturally significant people. Depending on the advice of your local infection prevention and control team, a total ban on visitors may not be the best policy. Instead, ensuring people are isolated within a specific area, making PPE available, putting up signs so people know which areas not to enter etc, can give you the best of both worlds.  
 
 
How To Manage Staff Sickness 
 
Staff sickness, even without an outbreak can be difficult. However, you should already have an action plan in your Business Continuity Plan which CQC would have checked prior to commissioning the home and during inspections. This should give you some information as to what to do during an outbreak.  
 
However, there maybe more things you can do that aren't detailed in your plan, such as: 
 
Providing information on how to maintain a healthy lifestyle. Having a health body and therefore a healthy immune system will minimise the staff members risk of becoming a susceptible hoist to the infection. This is part of the chain of infection theory taught in infection prevention and control sessions.  
Providing staff with training on managing infectious outbreaks. This can be done through e-learning or via Zoom with a live trainer. 
Providing staff with clear information, which is handed over prior to each shift, and is placed in key areas around the home.  
Highlighting and reminding staff how to donn, doff and dispose of PPE (Personal Protective Equipment). 
Providing staff with pocket hand santiser. Please be aware that not all infections are killed by alcohol gel. C. Diff is not killed by using alcohol gel, but removed only by hand washing. 
Set up an infection outbreak cleaning schedule which covers the common touch areas, such as handrails, door handles, light switches etc. 
This maybe the right time to stop and hold off admitting any new service users. 
Having an on-call rota where your staff are happy to come into work if needed on their days off. This can help you quickly fill shifts that need covering.  
Review the rota for consecutive days. Part of infection prevention is minimising the amount of people coming into contact with the infection. You can have a team of staff who only work with the isolated service users and/or ensure staff are on three days in a row, rather than split shifts. This will not only ensure continuity or care, but also minimise the amount of people coming into contact with the infection. 
Having a sickness tracker for your staff is also useful, even without an infectious outbreak. This will help you monitor how many times staff members have been off sick, the reasons why and for how many days. This can help you discover patterns and trends, which could highlight the need for more training and supervision.  
Finally, if a staff member is unwell enough to work or has the signs and symptoms, they should be reminded they will need to be off work for a specific amount of time. Sometimes care homes make this a week. There are a few reasons for this, firstly to allow the person to recover and not re-introduce the infection back into the care home when returning to work. But this method also tends to reduce the amount of sick generally within the care home. Sometimes, you've no doubt been called by a staff member who is unfortunately pretending to be sick, in order to get the day off work. However, the thought of losing a whole weeks' wages, often stops this from happening. If you are thinking of using this system, please do ensure your staff don't show up to work when they are genuinely unwell just to avoid losing a weeks' worth of shifts.  
 
 
Top Tips For Managing Service User Safety 
 
It's very important to keep a close eye on your service users during an outbreak, both to monitor how many are experiencing the infections, but also to monitor for any deteriorating in their health.  
 
We suggest doing the following: 
 
Having an early warning system in place to monitor their physical observations. Infections can significantly raise people's temperatures. 
Having food and fluids charts in place. It's common for people to become dehydrated or reduce their appetite during this period.  
Do more frequent checks on the service user, and ensuring this is documented, either on a separate sheet or in their daily notes.  
Keeping their G.P involved and up to date. This could be by weekly pre-scheduled phone calls or weekly visits by their G.P 
Being prepared to request antibiotics 
Being prepared to take samples of bodily fluids for analysis. Ensuring you have sample bottles ready which the appropriate form.  
 
These small but important steps can help you keep the service users safe. This is in addition to the isolation of service users experiencing the infection, staff wearing the appropriate PPE etc.  
 
 
Having Emergency Systems 
 
It's important to have a system ready to spring into action as soon as you suspect an infectious outbreak is occurring. This system should also include separate emergency provisions that you'll no doubt need. This can include an emergency stock of cleaning products such as chlorine based products, extra PPE including masks, hand sanitisers, extra linen for bedding etc.  
 
In terms of the emergency system, your emergency system should have a policy, procedure, staff memos & posters all ready to go. The last thing you want during an outbreak is to be on the back foot, creating systems prior to them actually being implemented. We suggest you should have the following: 
 
An on-call rota system 
Pre-designed and ready to print memos and posters regarding hand washing, correct donning & doffing of PPE, information about the infection including signs and symptoms, do not enter signs, PPE station signs, templates for emailing your local authority and local infection prevention and control team. There can be more that you have primed and ready to use. 
Have a tracker for staff sicknesses 
Have a track on when staff's infection control training is due and a supplier for that training 
Have a policy and procedure pre-written which can be emailed or shared with staff straight away 
A system and a read-out sheet for staff to call families. The read-out sheet should have the information in the above section: How to Manage Visitors During an Outbreak 
 
We hope this has been useful for you and answered any queries or concerns you've had about managing infectious outbreaks.  
 
Free feel to check out our other blogs for more information about a whole range of topics.  
Tagged as: Outbreaks
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