Preventing the spread of infections like swine flu in care homes

Care homes have to wage a constant fight against infections such as MRSA. Sally Gillen looks at how these measures can be applied to keeping swine flu at bay

When warnings that swine flu would sweep across the UK made headlines in April, many were sceptical. After all, hadn’t we been here before? Panic over Asian bird flu in the end came to little. But three months after the first person was diagnosed with swine flu in Scotland, the numbers of reported cases are rising every day. There are predictions that it will infect between one quarter and one half of the UK population, chances are you already know someone who has the disease.

By the end of August as many as 100,000 cases could be diagnosed with swine flu per day, says the Department of Health. A second more severe wave of swine flu, which has symptoms similar to seasonal flu and can also cause vomiting and diarrhoea, will hit later in the year and may last up to five months. Most cases are mild but 30 people with the virus have died, at the time of publication, in the UK, most of whom had underlying health problems.

Rapid spread

So great are the numbers affected, that the NHS Confederation has warned: “We are dealing with a situation that few working in the health service have ever experienced.” Indeed, a National Pandemic Flu Service in England, consisting of a website and a network of call centres, has been set up to deal with sufferers.

But while the NHS is being stretched, many in the social care sector are busily working on strengthening local plans to deal with such a crisis. Swine flu presents particular challenges for care home providers. Infections and diseases can spread very rapidly around care homes because they are closed communities. Also, those aged 65 and over are defined as a high risk group by the Department of Health. So it is especially important that care home providers have robust plans in place to deal with an outbreak of the virus.

Older people are likely to suffer a more severe illness when they get flu and a more rapid deterioration because of underlying disease, ageing of the immune system, immobility and debility, according to the Health Protection Agency.

Measures in place

Care home providers are prepared to some degree for an outbreak of swine flu, given that they already have measures in place to deal with diseases such as MRSA. Ginny Storey, head of care and clinical governance for Anchor Trust, the largest not-for-profit provider of residential and nursing care in the sector, says cases of MRSA are low in care homes and often those who have it bring it into the home following a stay in hospital. Many people carry it on their skin and it only becomes dangerous when someone has a wound such as an ulcer, she adds. One of the most common groups who contract the disease are older men with urinary catheters.

Nevertheless, there has been an increased focus on hygiene in health and social care settings, which has come about because of the media attention on cleanliness in hospitals. A new code of practice on managing infections in health and social care settings is due to be published any day. But Storey believes that most care homes already have a cleaning regime that will help manage the spread of swine flu. Basic things such as handwashing are vitally important, she says. “Years ago when there were no antibiotics people were scrupulous about handwashing. Since the 1940s people have become less so.”

Other commonsense measures are also important such as:

● Making sure laundry is not left lying in corridors.

● Taking time to clean items such as light-switches and door handles. These are often missed by cleaners but in communal settings like care homes they will be touched by a large number of people.

Care home providers need to manage the impact on the running of the home as well as the serious risk to the health of residents caused by an outbreak of swine flu. Storey says each care home is expected to have a plan on how to cope with staff shortages and other unforeseen emergencies. Councils, which have a duty to devise contingency plans for their area, are now asking to see these plans more frequently.

Co-operation and support

At the heart of planning is co-operation and reciprocal support between care home providers so if, for example, the chef is off sick with swine flu then a nearby home may offer the use of their chef.

Councils and care home providers are planning for outbreaks of the virus around the country. Lancashire Care Association and the county council held a conference earlier this month, which attracted 120 delegates, most of whom were care home providers. On the agenda were topics including business continuity.

Head of social care procurement at Lancashire Council Mike Webster says the council is updating even small homes across the county via e-mail. He adds that to some extent providers are prepared and have business continuity plans. “Flu is the current problem but we have had the fuel crisis in the past and last year gas and electricity cuts in the east part of the county. So care providers have had to deal with similar issues.

“The messages about swine flu seem to be changing every 10 minutes but if we do end up in a crisis then we will need some guidance from the Care Quality Commission because of the regulations around things like minimum staffing levels and CRB checks.”

From the end of August a vaccine for swine flu will be available and one of the concerns had been that priority would be given to NHS staff but social care staff will be recognised as an important group, says Storey. In the coming months, the robustness of local plans to deal with swine flu will be put to the test.



Former director of adult services at Kingston Council Roy Taylor was appointed as National Director for Social Care Flu Resilience by the Department of Health earlier this month.

The role is three days a week and his appointment will run until March 2010. His track record speaks for itself: he has been involved in a pandemic flu working group for three years; worked on contingencies planning for civil emergencies; and was involved in dealing with the aftermath of the London 7/7 bombings in 2005 and the floods last year.

“Handwashing is the single most important measure you can take,” he says. “You need to stand three feet away from someone who is symptomatic to avoid catching the flu. All the hygiene measures in place to deal with diseases such as MRSA will prove valuable now, such as cleaning surfaces.”

Best practice

In his first fortnight in post, Taylor went to several events, some of them organised by councils, to discuss planning. “We are looking to bring together the best practice that already exists in the sector.”

One of the events he attended, organised by Essex Council, was themed around business continuity. “The role of councillors will be critical because swine flu is now on the radar and there is an opportunity for councillors to look at local pandemic flu plans and swine flu plans.”

He says it is important to emphasise to directors of adult social services that robust plans are in place to cope with swine flu. “They are in an unknown area but they are used to coping in unfamiliar circumstances,” he adds.


● Symptomatic residents should be cared for in single rooms if possible.

● Residents’ clothes, linen and soft furnishings should be washed on a regular basis.

● More frequent cleaning of surfaces such as lockers, tables, chairs, televisions and floors may be needed, especially those within one metre of a symptomatic patient.

● Hoists, lift aids, baths and showers should also be cleaned thoroughly between patients.

● Staff should work with symptomatic residents or asymptomatic residents, but not with both.

➔ National Swine Flu Information Line 0800 1513 513

Managing influenza-like illness in nursing and residential homes during the current influenza pandemic (WHO phase 6)

This article is published in the 30 July 2009 edition of Community Care under the headline “Swine flu on the doorstep”

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