Recognising infection, staff illness, and outbreak response

Preventing infection depends on spotting possible infectious illness early and acting promptly. In care homes, residents often do not show classic symptoms. Older people, those with dementia, or residents with communication difficulties may present with sudden decline, increased confusion, reduced appetite, drowsiness, or changes in behaviour instead of typical signs.

What staff should notice and act on

• New respiratory symptoms: cough, fever, breathlessness, sore throat, increased secretions, or sudden unexplained deterioration.
• Gastrointestinal illness: vomiting or diarrhoea, especially when more than one person is affected.
• Unusual deterioration: new confusion, weakness, poor intake, or increased dependence can be the first sign of infection.
• Staff illness: staff with symptoms should not continue working around vulnerable residents.

Current England outbreak and staff points

Current England ARI guidance advises staff with respiratory symptoms who have a high temperature or do not feel well enough to work to stay off duty until their temperature is normal and they feel well. In a care home, two or more people with acute respiratory infection symptoms starting within five days of each other should prompt outbreak concern and contact with the local Health Protection Team or other local route. Wales, Scotland, and Northern Ireland use their own public health routes, so follow local policy where you work.

Providers should support residents to avoid contact with others when required, follow local or national guidance on isolation or cohorting, and keep visiting policies safe and proportionate rather than imposing blanket restrictions without advice.

What regulators and managers will look for

Good IPC includes spotting illness early, acting on symptom patterns, and keeping symptomatic staff away from vulnerable residents when guidance says they should not be at work.