Common Contagious Diseases to look out for in Care Homes
Infection control is critical in care homes because the communal environment—where residents frequently share air, space, food, and equipment—creates an ideal pathway for organisms like viruses and bacteria to spread rapidly, leading to outbreaks. Furthermore, residents are a highly vulnerable population with weakened immunity and underlying health conditions, meaning infections often take hold easily and can quickly lead to severe illness and increased mortality. To mitigate these risks, all care home staff must be adequately trained in infection prevention and control, rapid detection of illness, and effective outbreak management, requiring every facility to have a robust, tested outbreak plan ready to deploy to minimise the scope of spread and the harm caused.
Why are diseases and infections so easily spread in Care Settings?
Infections spread easily in care settings due to a combination of vulnerable residents, the close-knit environment, and the nature of the care provided. Residents are often elderly, have underlying chronic conditions, and may have weakened immune systems, making them highly susceptible to infection and more likely to experience severe illness. The communal living environment—including shared dining areas, lounges, and close proximity—facilitates direct person-to-person contact and droplet spread. Furthermore, the frequent, close physical contact required for personal care, the use of invasive medical devices (like urinary catheters), and staff moving between residents can all act as pathways for microorganisms to transmit from one person or surface to another.
Which Infections are Most Commonly Found in Care Homes?
The most commonly reported infections in care homes generally affect the respiratory, urinary, and gastrointestinal tracts, along with the skin. Key pathogens include Norovirus, Influenza, and organisms that cause Urinary Tract Infections (UTIs) like E. coli.
Norovirus (Viral Gastroenteritis)
Norovirus is a highly contagious virus that causes gastroenteritis, resulting in inflammation of the stomach and intestines. It is the leading cause of epidemic gastroenteritis outbreaks in care homes and is often mistakenly called the "stomach flu" (it is unrelated to influenza).
How to Spot it?
Symptoms typically have a sudden onset and include:
- Vomiting (often violent and projectile
- Watery, non-bloody diarrhoea
- Stomach cramps and pain
- Sometimes a low-grade fever, headache, and muscle aches.
The illness is usually short-lived, lasting 1 to 3 days.
How it Spreads?
Norovirus is extremely contagious and requires as few as 100 virus particles to cause infection. It spreads primarily through the faecal-oral route:
- Direct person-to-person contact with an infected person (e.g., caring for them).
- Touching contaminated surfaces (the virus can survive for days or weeks) and then touching the mouth.
- Aerosolisation of vomit particles, which can contaminate surrounding areas.
How to stop the spread of Norovirus?
- Hand Hygiene: The most effective measure is thorough hand washing with soap and water for at least 20 seconds; alcohol-based hand sanitizers are not effective against Norovirus spores.
- Isolation: Isolate symptomatic residents in their rooms for the duration of the illness and for at least 48 hours after symptoms resolve. Cancel all group activities and communal dining.
- Environmental Cleaning: Use a bleach solution or a disinfectant known to be effective against Norovirus spores for cleaning and disinfecting contaminated surfaces.
- PPE: Staff must wear gloves and gowns when caring for ill residents.
COVID-19
Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. While often mild in healthy individuals, it can lead to severe complications like pneumonia and even death in vulnerable residents.
How to Spot it?
In the elderly, symptoms are often:
Fever, chills, cough, sore throat, runny nose, muscle/body aches, headache, and fatigue.
How it Spreads?
COVID-19 is transmitted primarily through droplet transmission when in close contact (proximity) or through direct interpersonal contact (touch). Transmission can also occur through aerosols and through indirect contact.
Infection control precautions are therefore based on limiting and avoiding transmission from contact, aerosol and droplet routes, as well as environmental cleaning.
How to stop the spread of COVID-19?
- Vaccination: The most important measure is the annual COVID booster vaccination for all residents and staff.
- Isolation & Cohorting: Place symptomatic residents in private rooms or cohort them (group residents with the same infection together).
- Infection Control: Implement droplet precautions (surgical mask) in addition to standard precautions for staff interacting with ill residents.
Influenza (The Flu)
Influenza is a highly contagious viral respiratory infection that targets the nose, throat, and lungs. While often mild in healthy individuals, it can lead to severe complications like pneumonia and even death in vulnerable residents.
How to Spot it?
In the elderly, symptoms can be subtle or atypical:
Classic Symptoms: Fever, chills, cough, sore throat, runny nose, muscle/body aches, headache, and fatigue.
Atypical Symptoms in Elderly: Anorexia, new or increased confusion/mental status changes, low-grade or no fever, and worsening of existing chronic conditions (like heart failure or breathing problems).
How it Spreads?
Influenza spreads primarily through respiratory droplets produced when an infected person coughs, sneezes, or talks. These droplets travel short distances (up to 6 feet) before settling on a surface or the mucous membranes (eyes, nose, mouth) of another person. It can also spread via contact with contaminated surfaces.
How to stop the spread of Influenza?
- Vaccination: The single most important measure is the annual influenza vaccination for all residents and staff.
- Isolation & Cohorting: Place symptomatic residents in private rooms or cohort them (group residents with the same infection together).
- Infection Control: Implement droplet precautions (surgical mask) in addition to standard precautions for staff interacting with ill residents.
- Antiviral Medication: During an outbreak, administer antiviral medication to all affected and exposed residents and potentially non-ill, unvaccinated staff (chemoprophylaxis) to stop the spread.
Urinary Tract Infection (UTI)
A UTI is a bacterial infection affecting any part of the urinary system, but most commonly the bladder. The bacteria Escherichia coli (E. coli) is responsible for over 90% of all community-acquired UTIs.
How to Spot it?
Similar to influenza, symptoms in older adults are often atypical:
Classic Symptoms: Pain or burning sensation when urinating (dysuria), frequent or urgent need to urinate, passing small amounts of urine, cloudy/foul-smelling urine, and lower abdominal pain.
Atypical Symptoms in Elderly: New or increased confusion or delirium (a common first sign), sudden change in behaviour, unusual aggression, or general malaise.
How it Spreads?
In a care home, UTIs are frequently caused by bacteria, particularly E. coli from the bowel, entering the urinary tract. Risk is significantly increased by:
- Incontinence: Faecal contamination, especially if wiping is not performed from front to back.
- Catheters: The use of indwelling urinary catheters provides a direct pathway for bacteria into the bladder.
- Poor Hygiene: Inadequate hand hygiene by staff during personal care.
How to stop the spread of E. coli (and UTIs)?
- Catheter Care: Adhere to strict aseptic technique for insertion and maintenance of catheters (Catheter-Associated Urinary Tract Infection, or CAUTI, prevention bundles). Only use catheters when absolutely necessary.
- Personal Hygiene: Ensure meticulous personal care, including wiping from front to back after bowel movements for all residents.
- Hydration: Encourage residents to drink plenty of fluids to help flush bacteria from the urinary system.
- Hand Hygiene: Staff must practice excellent hand hygiene before and after providing any personal care, especially involving toileting or catheter management.
Clostridioides Difficile Infection (CDI or C. diff)
C. difficile is a bacterium that produces toxins causing colitis (inflammation of the colon) and severe, watery diarrhoea. It thrives in people whose natural gut flora has been disrupted, often by antibiotic use. It produces hardy spores that are difficult to kill.
How to Spot it?
Symptoms range from mild to severe:
- Watery diarrhoea (three or more times a day for two or more days).
- Abdominal pain and cramping.
- Fever.
- Severe cases can lead to dehydration and life-threatening complications.
How it Spreads?
C. difficile spreads through the faecal-oral route via its highly resistant spores:
- Contaminated Hands: Spores are shed in faeces and are then transferred on the hands of staff, residents, or visitors.
- Contaminated Environment: The spores are extremely resistant to many disinfectants and can survive on surfaces (bed rails, toilets, commodes, call bells) for long periods.
- Antibiotic Use: The main risk factor is antibiotic exposure, which eliminates beneficial gut bacteria, allowing C. difficile to multiply.
How to stop the spread of C. difficile?
- Hand Hygiene: Staff must use soap and water to physically remove the spores from their hands, as alcohol-based sanitisers are ineffective against C. difficile spores.
- Isolation: Place residents with CDI on Contact Precautions in a private room (or cohort) for the duration of the diarrhoea and for at least 48 hours after symptoms resolve.
- Environmental Cleaning: Use a chlorine bleach-based disinfectant (sporicidal agent) for cleaning rooms and equipment, ensuring the correct concentration and contact time to kill the spores.
- Antibiotic Stewardship: Only use antibiotics when clearly needed, and ensure a system is in place to review and reduce antibiotic use to minimise the risk of infection.
MRSA (Methicillin-Resistant Staphylococcus Aureus)
MRSA is a strain of the Staphylococcus aureus bacteria that has become resistant to several common antibiotics, including methicillin. It often lives harmlessly on the skin or in the nose (colonisation), but can cause serious infection if it enters the body through a break in the skin.
How to Spot it?
Most people who carry MRSA (are colonised) show no symptoms. When an infection does occur, it most commonly presents as a Skin and Soft Tissue Infection (SSTI):
- Red, painful, and swollen area of skin.
- Warm to the touch.
- May leak pus or fluid (looks like a boil or abscess).
- Serious infections (e.g., bloodstream, pneumonia) cause fever, chills, and confusion.
How it Spreads?
MRSA primarily spreads through direct contact:
- Skin-to-skin contact with a colonised or infected person.
- Indirect contact by touching contaminated objects or surfaces, especially those frequently touched (e.g., dressings, bedding, medical equipment, or door handles).
- The risk is highest where there are open wounds, invasive devices, or poor hand hygiene.
How to stop the spread of MRSA?
- Hand Hygiene: Staff must practice scrupulous hand hygiene with soap and water or alcohol-based hand rub before and after all resident contact and procedures.
- Wound Care: Ensure that all cuts, wounds, and ulcers are kept clean and covered with a clean, dry dressing.
- PPE: Use gloves and gowns during contact with the resident, their environment, or their body fluids.
- Environmental Cleaning: Routinely clean and disinfect all frequently touched surfaces and shared equipment (e.g., blood pressure cuffs) between residents.
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC3526889/ (December 2012)
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Infection control in care homes is of paramount importance, serving as the primary defense against harm to a highly vulnerable population.
Maintaining Safety and Quality of Care: Robust infection control protocols, such as strict hand hygiene, proper use of PPE, and environmental decontamination, maintain a safe environment for both residents and staff. This upholds the quality of care and minimises disruptions caused by outbreaks (e.g., restricted admissions).
Legal and Regulatory Compliance: Adherence to national guidelines and regulations (like those enforced by the Care Quality Commission, CQC) is mandatory. Effective infection control ensures the care home meets its legal duty of care and avoids sanctions, demonstrating accountability and professionalism.