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National Infection Prevention and Control Manual

National Infection Prevention and Control Manual

Winter preparedness campaign 2025

Every winter health and care providers experience additional demand for services due to an increase in seasonal viruses. These include:

These infections can spread quickly in areas such as hospital wards or care homes causing service users (for example patients and residents) and staff to become unwell. 

Below you will find key infection prevention and control actions and supporting tools you can use in your winter planning preparations and during outbreaks and incidents.  These should be used alongside the content of the National Infection Prevention and Control Manual (NIPCM) and Care Home Infection Prevention and Control Manual (CHIPCM).

It includes:

  • winter planning preparation and communications
  • incident and outbreak management
  • seasonal review and improvement

It is essential that infection prevention and control is included within local winter plans.

Health and care organisations should assess local preparedness for the winter period and identify local actions needed to help relieve pressure points across the organisation to:

  • prepare, plan and engage with staff before winter season starts 
  • implement lessons learned from the previous winter season
  • improve data quality and reporting to support local and national assurance and understand when escalation is appropriate
  • have an approach that acknowledges and responds to pressures across the organisation

 

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.  

Ensure ordering of supplies takes into account potential increase in product demand over winter period as well as seasonal holiday period and closures.

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.

Apply Standard Infection Control Precautions in all care settings, at all times, for all individuals

SICPs may be not be enough to  prevent cross-transmission of specific infections so you might also need to 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 

Get vaccinated, get protected

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

Stay at home until at least 48 hours after norovirus symptoms have stopped

  • 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.

To stop the spread of infection, avoid unnecessary contact with others

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.
  • 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. 
  • Ensure staff have access to appropriate training on patient placement and assessment for infection risk.

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.

Hand rub alone is not effective against norovirus

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

Keeping your hands clean is key to stopping the spread of infection

  • 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.
  • Make sure staff have access to appropriate training on hand hygiene

Respiratory and cough hygiene

  • Staff should promote respiratory and cough hygiene helping those who need assistance with this, for example elderly and children.
  • Provide service users with disposable tissues, plastic bags for used tissues and access to hand hygiene facilities as necessary.
  • Encourage service users with 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.

Cover your mouth and nose while sneezing, coughing, wiping and blowing your nose

  • 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) 

PPE should be disposed of after use into the correct waste stream which is healthcare waste or domestic waste.

Perform hand hygiene after removing PPE.

Advise visitors to wear PPE if they are performing direct care. 

Make sure staff have access to appropriate training on PPE.

Care equipment and environment

  • Make sure staff are aware of 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.
  • Environmental and equipment decontamination may need to be increased when there is a known or suspected infection in the care area.
  • There may be a need to update local cleaning schedules where increased frequency of environmental cleaning is required.
  • If a patient or service user is suspected or known to have an infection, or where they are colonised with a transmissible pathogen, a Terminal clean of their room should be undertaken following transfer or discharge, or once the patient or 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. Contact your local infection prevention and control team (IPCT) if you think there may be an outbreak emerging in your area. 

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.

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.

References