Preparation and communications

To make sure that your health and care area is ready for winter you should have the correct products, procedures and communications in place to stop infections spreading.  

At all times Standard Infection Control Precautions (SICPs) should be followed. SICPs are the basic infection prevention and control measures necessary to reduce the risk of transmission of infectious agents from both recognised and unrecognised sources of infection.

SICPs may be not be enough to  prevent cross-transmission of specific infections so you might need to also use additional precautions known as Transmission Based Precautions (TBPs) when caring for patients with a known or suspected infection or colonisation.

Further information on SICPs and TBPs can be found in the NIPCM and CHIPCM. 

Make sure that you have the contact details for your local infection prevention and control (IPC) team and NHS board health protection (HPT) team so you can easily get advice and support  on infection control and outbreak management during the winter season.

Communications 

• Ensure key messages around respiratory hygiene, and norovirus are effectively communicated to staff, service users and the public.
• Ensure that all national and local winter planning communications are available and circulated to staff. 
• Provide appropriate communications on IPC and winter planning in in the care area. For example posters and signage in wards and staff kitchen areas promoting hand hygiene and cough etiquette.  
  • Hand hygiene posters - Appendix 1 - How to hand wash and Appendix 2 - How to hand rub. 
  • Use infection alert posters to provide information on precautions to be taken when entering an area or visiting a service user.
  • Have a supply of HAI and disease specific information leaflets to give to service users and visitors.
  • Work with local communications team or staff to issue winter planning communications based on national messaging. This can include social media, websites, staff newsletters, infographics, posters, email signatures, videos and animations.
    • Winter Preparedness Graphics used in this page
  • Promote seasonal vaccinations for flu and COVID-19 to eligible groups using a range of communications materials, messaging and assets and NHS Inform.
    • Winter programme 2024 – seasonal flu and COVID-19 vaccination 

• Remind staff:
  • not to attend work until 48 hours after their last symptom of diarrhoea and/or sickness
  • not to come into work if unwell and to use NHS Inform for further information on norovirus or respiratory infections
  • about their eligibility for seasonal vaccinations
  • to access training to ensure their IPC knowledge is up to date for example from NHS Education Scotland 

• Remind visitors that they shouldn't visit if they:
  • are feeling unwell
  • have symptoms of a respiratory infection 
  • are not yet 48 hours symptom free of sickness and/or diarrhoea
• Direct the public to NHS Inform for further information on norovirus or respiratory infections.

Assessment of infection risk

• Infections can spread easily in busy areas so try to ensure that shared areas, for example waiting areas, are not overcrowded.

• Assess service users for infection risk on arrival to the care area (if possible, before transferring from another care area) and review throughout their stay.
  • Follow your local risk assessment and admission screening policy.
  • Use the Respiratory Symptom Screening Questions: Aide for Health and Social Care Settings.
  • Apply hierarchy of controls to ensure staff and patient safety.
• Service users who present a particular cross-infection risk, for example with symptoms such as diarrhoea, sickness, fever or respiratory symptoms, should be isolated on arrival with appropriate clinical samples and screening undertaken as per national protocols to establish the causative pathogen. 
  • Use transmission based precautions as described in the NIPCM or CHIPCM.
  • Use Appendix 11 for patient placement, PPE and RPE for specific infections.
  • Use the A-Z of pathogens for more detailed information on specific pathogens and their notifiable status.
  • In care homes use the Respiratory and Gastrointestinal resources and checklists.
• Ensure sure staff have access to appropriate training on patient placement and assessment for infection risk.
• Make sure that care areas are well ventilated where possible and if safe to do so.

Hand hygiene

• Make sure there is an adequate supply of hand rub, soap and paper towels available to ensure hand hygiene can be correctly undertaken by service users, staff and visitors.
• Ensure ordering of supplies takes into account potential increase in product demand over winter period as well as seasonal holiday period and closures.

• Hand hygiene using soap and water should be used where a service user has symptoms of a gastro-intestinal infection (vomiting and/or diarrhoea).

• Remind visitors to use appropriate hand hygiene. 
  • Put up hand hygiene technique posters in areas where they are required for example hand rub dispensers at entrance to care area and above hand wash basins.
• Remind staff to undertake hand hygiene at the 5 moments or 4 moments in care homes.
  • 5 moments and 4 moments posters 
• Make sure staff have access to appropriate training on hand hygiene

Respiratory and cough hygiene

• Ensure ordering of supplies takes into account potential increase in product demand over winter period as well as seasonal holiday period and closures.
• Staff should promote respiratory and cough hygiene helping those who need assistance with this, for example elderly and children.
• Provide service users with tissues, plastic bags for used tissues and hand hygiene facilities as necessary.
• Encourage service users showing symptoms of respiratory illness to wear a surgical (TYPE II R FRSM) face mask where it is clinically safe and tolerated by the wearer.
  • Note: FRSM is not required when service user in their room on their own.

• Dispose of used tissues and face masks promptly into a waste bin.
• Wash hands with non-antimicrobial liquid soap and warm water after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretions.
• Make sure staff have access to appropriate training on respiratory and cough hygiene.

Personal Protective Equipment (PPE) and Respiratory Protective Equipment (RPE)

• PPE and RPE are required to minimise the risk of cross-transmission of infection to yourself and others when providing care. 
• PPE and RPE should be single-use items unless specified by the manufacturer whose decontamination procedures should be followed. 
• Follow appropriate guidance for when and what PPE and RPE to wear when an infection is known or suspected.
  • Appendix 15 Selection of Personal Protective Equipment (PPE) by health and care workers (HCWs) during the provision of care
  • Appendix 11 Aide memoire for Patient Placement considerations and Respiratory Protective Equipment (RPE) or Fluid Resistant Surgical Facemasks (FRSMs) for Infectious Agents
• Make sure there is an adequate supply of all PPE and RPE that it is close to the point of use. 
• PPE and RPE should be changed immediately after each service user and/or following completion of a procedure or task.
• PPE and RPE should be disposed of after use into the correct waste stream which is healthcare waste or domestic waste.
• Perform hand hygiene after removing PPE and RPE.
• Advise visitors to wear PPE if they are performing direct care. 
• Ensure ordering of supplies takes into account potential increase in product demand over winter period as well as seasonal holiday period and closures.
• Make sure staff have access to appropriate training on PPE.

Care equipment and environment

• Environmental and equipment decontamination may need to be increased when there is a known or suspected infection in the care area.
• Make sure staff are aware of their environmental and equipment cleaning schedules and know their specific responsibilities.
• Routine environmental cleaning should follow the guidance in the NHSScotland National Cleaning Specification and Cleaning Specification for Care Homes.
• There may be a need to update local cleaning schedules where increased frequency of environmental cleaning is required.
• Terminal cleans of service users rooms should be undertaken following transfer or discharge, or once the service user is no longer considered infectious.
• Make sure staff have access to appropriate training on management of equipment and environment.

Incident and outbreak management

Norovirus and respiratory viruses can spread very quickly in hospitals and care homes and cause outbreaks. Outbreaks of infections can lead to:

• service users becoming unwell
• patients being in hospital longer than they should be
• ward, bay and care home closures
• staff absences
• increased bed pressures in the care areas

A Healthcare Associated Infection Outbreak can happen when there are:

• two or more linked cases with the same infectious agent associated with the same healthcare setting over a specified time period

• a higher-than-expected number of cases of HAI in a given healthcare area over a specified time period

An early and effective response to an actual or potential healthcare incident, outbreak or data exceedance is crucial.

Care homes 

Please note that depending on local processes, care homes should contact their local IPCT or HPT for support and advice regarding outbreaks in their care areas.

NHS boards 

NHS Boards should follow Chapter 3 of the NIPCM Healthcare Infection Incidents, Outbreaks and Data Exceedance for incidents and outbreaks including for norovirus and respiratory infections.

Chapter 3 includes detailed definitions on outbreaks and incidents.

Local surveillance and reporting systems should be used for recognition and detection of potential healthcare infection incidents and outbreaks. Systems should make use of ‘triggers’ to allow prompt detection of any variance from normal limits.

Closely monitor rates of respiratory viruses including COVID-19 and provide infection prevention and control advice and guidance as required.

• Appendix 13 - NHSScotland Minimum Alert organism/Condition list should be used to establish and maintain local surveillance and reporting systems including development of triggers for clinical areas. 
• Compliance monitoring of SICPs and TBPs

The Healthcare Infection Incident Assessment Tool (HIIAT) should be used by the IPCT or HPT to assess every healthcare infection incident and report all HIIAT assessed Green, Amber and Red reports to ARHAI Scotland through the electronic outbreak reporting tool (ORT).

Incidents assessed as Red, Amber or Green, where ARHAI support is requested, will be reviewed for onward communication to Scottish Government Healthcare Associated Infection Policy Unit.

• Respiratory incidents and outbreaks associated with key respiratory pathogens (COVID-19, influenza and respiratory syncytial virus (RSV)), should be completed within the Respiratory Short Form. However, where IPC measures do not align with the outbreak checklist and NIPCM, or where ARHAI support is requested a full ORT form must be completed. 
• COVID-19 reporting should now align with reporting for other key respiratory pathogens (Influenza/RSV).

The Outbreak Checklist is designed to support staff with the prevention and control of suspected or confirmed incidents and outbreaks in hospital settings.

An incident/outbreak data collection tool template is available to help identify the total number of confirmed/probable/possible exposed cases.

Once the incident is declared over, and in addition to reporting via the electronic outbreak reporting tool (ORT), the IMT/NHS board should decide on the most appropriate format for a report to communicate any lessons learned from completing the Hot Debrief Tool.

• Note: The completed Hot Debrief Tool can be submitted to ARHAI Scotland. This is not mandatory, but for the purposes of sharing lessons learned across Scotland.

Review and improvement

After the winter season has ended it is important for health and care organisations to review how well the season went and include aspects of preparation, communications, outbreak and incident management. This can include measuring against:

• local and national audits
• local and national targets 
• local and national policies
• feedback from staff, service users and visitors

It is important for organisations to celebrate successes and share achievements both locally and nationally.

Areas that can be considered for improvement include:

• staff education and training
• interpretation and application of necessary risk assessments
• control measures 
• application of guidance documents
• application of NIPCM, CHIPCM and appendices
• interdependencies with other departments or organisations
• communications with staff, visitors and service users

The organisations multi-disciplinary team should actively consider learning opportunities presented by HAI data exceedance, incidents and outbreaks and disseminate, escalate, and share all relevant lessons learned via established local and national governance and reporting routes.

The Hot Debrief Tool can assist in sharing of lessons learned.

The results of these lessons learned should be used as recommendations for next years winter season and used as an improvement measure.