Winter is coming: infection prevention in care settings

Every winter, respiratory infections test care services harder than almost anything else. The people we support are among the most vulnerable to flu, COVID-19 and RSV, and one unwell colleague on a busy shift can start an outbreak.

This year the early signs are already here. In the week to 4 October 2026, flu positivity rose to 6.5% and COVID-19 positivity to 9.1%. Flu was still at baseline levels, but UKHSA reports that flu activity through September was higher than in the same period of each of the past four winters.

Here is what every care team needs to know before the peak arrives.

1. Get vaccinated: it protects the people you care for

Since 1 October 2026, the free NHS flu vaccine has been available to:

• residents of long-stay care homes
• frontline social care workers without access to an employer-led occupational health scheme, including staff in residential and nursing homes, home care, voluntary managed hospices, and personal assistants paid through direct payments or personal health budgets
• everyone aged 65 and over
• carers who receive Carer's Allowance or are the main carer of an older or disabled person

Vaccination is the single most effective thing you can do. It cuts your own risk and the chance you carry flu to someone frail. Last winter, two in three care home residents had their flu jab, but fewer than one in eight care home staff did.

2. Know what an outbreak looks like

UKHSA defines an outbreak of acute respiratory infection as two or more linked cases with symptoms starting within five days of each other. A single confirmed case of flu should also be reported.

In older people, infection does not always look like a cough and a temperature. UKHSA's guidance lists:

• a temperature of 37.8°C or above with a sudden cough, sore throat, runny nose or other new respiratory symptom
• an acute decline in physical or mental ability with no other known cause

Many older people with flu never reach the fever threshold. In practice, that means watching for subtler changes too: new confusion, a fall, poor appetite or unusual sleepiness. A resident who is "just not themselves today" may be the first case.

3. Report early: don't wait for test results

Report a suspected outbreak to your local UKHSA health protection team or community infection control team as soon as possible. In many regions you can report online, which takes about 10 minutes. UKHSA's advice is simple: if in doubt, report it as an outbreak, and if you cannot test people, don't wait.

Have these ready: your CQC location ID and postcode, numbers of residents and staff, how many are unwell, when symptoms started, any test results and vaccination numbers.

4. Contain the spread

The UKHSA guidance for care homes sets out practical steps:

• Isolate residents with symptoms for at least five days from the start of symptoms and, in larger homes, limit movement between floors or units.
• Cohort staff to affected or unaffected areas where possible, and avoid working at other care homes during an outbreak.
• Keep up standard precautions, such as hand hygiene, respiratory hygiene and correct PPE, whatever your vaccination status.
• Clean more often, for example with a 1,000ppm chlorine-based product on shared surfaces, and keep rooms ventilated.
• Keep visiting going unless circumstances are exceptional. End of life visits should always be allowed.

An outbreak can usually be closed five days after the most recent resident's symptoms began, subject to local risk assessment.

5. Stay home when you're unwell

This is the hardest one in a stretched sector, but staff with respiratory symptoms should stay off work until they feel well and have recovered from their acute symptoms. Managers have a part to play here: a culture where people feel they must work while ill puts everyone at risk.