Outbreak Information, Guidance and Education
This page provides information and guidance to help prepare for, and support people, with common infections which can be linked to outbreaks.
You will find information on prevention, testing and control of infection, including, respiratory and gastrointestinal infections and scabies. You will also find details of the Care Home Outbreak Box for use in outbreaks or suspected outbreaks of gastrointestial or respiratory infection. Some of these infections tend to happen during the Winter months and may be referred to as Winter infections, Winter illnesses or Winter bugs but they can also happen outwith Winter.
Please visit the “Vaccinations and Power of Attorney” webpage to find out more infomation on Care Homes residents consenting to vaccinations and Care Home preperation for a visit by the Vaccination team.
Please visit the East Region Health Protection Service webpage for outbreak notification forms for acute respiratory & GI infections and Scabies.
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 infections and related measures
This short video has kindly been shared by East Region Health Protection Service and covers common respiratory and gastrointestinal infections. These are most common during Winter although they may occur at other times of the year. This video includes:
- How to identify infection and interventions to limit transmission of infections and outbreaks.
- Testing processes and infection outbreak management
Scabies
What is Scabies?
Scabies is a contagious (infectious) skin condition caused by the mite Sarcoptes scabiei var. hominis; it can be found in many areas, including, Care Homes and schools.
Groups most likely to be affected
Groups most at risk are those with a weakened immune system, elderly people and people who are disabled (particularly those with neurological disorders).
Typical Scabies
Signs and Symptoms
Infestations normally affect skin folds, such as:
- Between fingers
- On the:
- Wrist
- Elbows
- Knees
- Around the buttock or breast creases
The main symptom of scabies infestation is intense itching of affected areas, particularly at night. There can also be a pimple-like skin rash or tiny raised lines caused by the mite burrowing into the skin to lay eggs.
Transmission
Transmission normally only occurs with prolonged direct contact with an affected person, though can be spread indirectly via the sharing of clothing, towels or bedding.
Crusted (Norwegian) Scabies
Is a severe form of the disease.
Signs and Symptoms
- The skin develops thick crusts containing large amounts of mites/eggs.
- Often persons with crusted scabies do not have the usual signs and symptoms making the disease harder to diagnose.
Transmission
Crusted scabies is highly contagious either from direct or indirect contact and requires quick, aggressive treatment to prevent outbreaks.
Outbreaks
Outbreaks are most common in the winter and tend to occur in populations in close, prolonged contact, such as children in school/nursery (and their parents) and nursing home residents.
Please visit the East Region Health Protection Service webpage for outbreak notification forms for Scabies. Please remember it is a Care setting’s/service’s responsibility to proactively implement control measures as per guidance immediately and independently in response to symptomatic residents.
Incubation Period
Symptoms can appear 3 to 6 weeks after the initial infection.
However, these can occur earlier (1 to 3 days) in a reinfested person.
Exclusion Period
24 hours after first treatment.
Period of Infectivity
During incubation and infestation.
24 hours after treatment has commenced, individuals are no longer infectious.
Guidance and supporting materials
Scabies Back to Basics Webinar
Please view the video of the Scabies Back to Basics webinar (please note this is a download) available on the National Infection Prevention and Control Manual website.
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 infection), a blue folder (respiratory infection) 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 Infection
- 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 Infection
- **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
Useful Links and Resources
Useful Links and Resources
- Vaccination – Information on Power of Attorney
- East Region Health Protection Service – Formerly Health Protection Team (HPT)
- Infection Prevention and Contol Care Home Team (IPCT)
- NHS Inform Homepage – if you need more general information
- Antimicrobial Resistance and Healthcare Associated Infection Scotland (ARHAI)
Updated April 2026 AP and HS
