Outbreak Information, Guidance and Education
This page provides information and guidance to help prepare for, and support people, with common illnesses which can be linked to outbreaks.
You will find information on prevention, testing and control of illnesses, including, respiratory and gastrointestinal infections and scabies. Some of these illnesses tend to happen during the Winter months and may be referred to as Winter illnesses or bugs. You will also find information relating to Vaccinations and Power of Attorney.
Further to the resources on this page the NHS Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) team in Scotland have launched a Winter Preparedness Campaign . This contains additional information such as how to prepare for a potential outbreak; essential communications with staff and visitors if they are feeling unwell to help prevent a potential outbreak; and reflective discussions to learn from previous outbreaks.
ARHAI have also developed a page of various visuals (assets) that you can download and use, this includes: images to print off or use on socal media, email signatures and teams backgrounds. You can find these resources on the Winter preparedness campaign assets page.
**Please note**
All documents and links on this page are reviewed (at least) annually, usually in the run up to Winter, please always check that you are using the most up to date version of any document. All documents reviewed October 2025 and updated as required.
The most up to date national information and guidance can be found online within Care Home Infection Prevention and Control Manual (CH IPCM) .
Video: Overview of common illnesses and related measures
This short video has kindly been shared by East Region Health Protection Service and covers common respiratory and gastrointestinal illnesses. These are most common during Winter although they may occur at other times of the year. This video includes:
- How to identify illness and interventions to limit transmission of illness and outbreaks.
- Testing processes and infection outbreak management
Scabies
This infectious mite skin condition can can be found in many areas, including, Care Homes and schools.
Please view the government guidance for Health Protection Teams (HPTs), other community teams and managers of communal residential settings: UKHSA guidelines for the management of scabies cases and outbreaks in communal residential settings
Care Home Outbreak Box – Gastrointestinal & Respiratory
How the boxes originated, information, feedback and questions
The Care Home Outbreak Box (AKA Outbreak Grab Box) was initially suggested by the Midlothian Care Home Support Team (CHST) during Winter preparedness discussions in 2024 and how we may be able to assist Care Homes with outbreaks or suspected outbreaks in a way useful to them.
The opportunity for a box was then discussed at NHS Lothians weekly Operational Group Meeting, which has representatives from NHS Lothian, the four HSCPs, Care Inspectorate and Scottish Care.
It was suggested that we asked the Care Homes if they thought this type of box would be useful and 99% of respondents agreed that it would be a good resource to have access to.
100 boxes were created and offered to all Care Homes in Lothian, in December 2024 these were distibuted by the Care Home Support Team (CHST) in each local authority area. The uptake was very encouraging with the majority of Care Homes accepting a box.
After the initial supply of an outbreak box Care Homes are required to keep information up to date themselves with assistance as required from their CHST. Relevant documents will also be placed on this webpage to assist with updating materials.
The team behind the the Care Home Outbreak Box collated information to gain feedback on the boxes; what worked well and what didn’t work so well in relation to the boxes during an outbreak or suspected outbreak – so that we could ensure they meet the needs of Care Homes.
The responses from feedback were very positive, with 80% of respondents to a survey saying they had used the box and it’s contents and 90% saying they would recommend others to use the box.
If you wish to give feedback on the Care Home Outbreak Box , ask questions or gain more information please do not hesitate to email NHS Lothian Quality Improvement Team for Care Homes and Primary Care Settings or contact your local CHST.
What is a Care Home Outbreak Box?
Although it is recognised Care Homes manage outbreaks of infection well, the idea of the Care Home Outbreak Box (AKA Outbreak Grab Box) is to have outbreak information and resources available in one central point within the Care Home.
The Care Homes outbreak box aims to contain information required during an outbreak and contains guidance and posters on various aspects from PPE to sampling procedures.
It is entirely voluntary if a Care Home chooses to have or use an outbreak box although the East Region Health Protection Service (formerly Health Protection Team (HPT)) do encourage their use during outbreaks or suspected outbreaks.
We do not have any physical outbreak boxes remaining, however, you can download all the materials below.
What is in a Care Home Outbreak Box – downloadable materials
The Care Homes Outbreak Box consists of a label for the boxand the materials below: a red folder (gastrointestinal illness), a blue folder (respiratory illness) and additional information, such as, posters for outbreaks and hand hygiene
Update for Winter 2025/26
All information has been reviewed and where required updated for this 2025/26 Winter season. There are some new items to the box which are highlighted below, please also see the Care Home Managers Letter for information on PCR swabs for this year; this was emailed to all Care Homes in Lothian on October 13th 2025.
**Please note** All items below will open in a new window
Red Folder
Gastrointestinal Illness
- Contact Precauations Poster
- **UPDATED for 2025/26**
Norovirus Specimen Collection Guidance - Bristol Stool Chart
- **UPDATED for 2025/26** Care Home IPC Guidance for Gastrointestinal Infection V3 – includes checklists
- **NEW for 2025/26**
Norovirus – key steps to help stop the spread of infection (poster)
Blue Folder
Respiratory Illness
- **NEW for 2025/26** PCR Flow Chart – When to carry out a PCR test with Care Home Residents
- **NEW for 2025/26** PCR Order Form – To be completed and sent with samples
- Droplet Precautions Poster
- **UPDATED for 2025/26** Care Home IPC Guidance for Respiratory Infection V4 – includes checklists
- **NEW for 2025/26**
Respiratory infections – key steps to stop the spread (poster)
Additional Information
- Donning & Doffing PPE Poster
- WHO 4 Moments of Hand Hygiene Poster
- **NEW for 2025/26** How to Hand Wash – Step by Step Poster
- **NEW for 2025/26** How to Hand Rub – Step by Step Poster
- Outbreak in Progress Door Sign Poster
- **NEW for 2025/26**
ARHAI Visuals for printing, web, email and teams backgrounds
Vaccination – Information on Power of Attorney
Information for Care Home Staff: Power of Attorney for Vaccination
Not all residents with an appointed PoA lack capacity to consent to vaccination. A person may still have capacity for simple decisions like vaccination, even if they cannot consent to more complex treatments such as surgery.
Important:
Verbal consent will be taken from the PoA at the time of vaccination.
When does a resident have capacity to consent to vaccination?
A resident can provide informed consent if they:
- Show consistency in decision-making (e.g. given the same information again, they make the same choice).
- Understand and act on the information given about the vaccination.
- Use this information to make a decision.
- Communicate their decision clearly to the vaccinator.
When a resident doesn’t have capacity to consent to vaccination?
When a resident cannot provide informed consent, they must have:
- A valid Certificate of Incapacity under Section 47 of the Adults with Incapacity (Scotland) Act 2000, specifically covering vaccination or medical treatment/interventions. This can be requested from the GP if needed.
- An acting PoA with welfare powers.
Care Home Preparation Before a Vaccination Team Visit
To avoid delays, staff should ensure the following documents are ready for review by the vaccination team:
- A copy of your full power of attorney document or certificate of appointment for the nurse to review
- The certificate of incapacity under Section 47 of the Adults with Incapacity (Scotland) Act 2000 which is valid for the administration of vaccinations
Useful Links and Resources
Useful Links and Resources
Updated November 2025 AP and HS
