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.