Resident Isolation, Testing and Incident Management

Objective

To ensure prompt risk assessment and the appropriate implementation of enhanced Infection Prevention and Control (IPC) measures, isolation, and testing in line with current guidance. These actions reduce the onward transmission of infection within care settings.

What is an Influenza like illness (ILI)?

Case Definition of ILI: Influenza like illness is a clinical description based solely on symptoms where the causative organism is not yet known.
(i) oral or tympanic temperature of at least 37.8°C, and acute onset of at least one of the following respiratory symptoms:

• cough (with or without sputum)
• sore throat
• coryza (nasal discharge or congestion)
• dyspnea (shortness of breath)
• hoarseness
• sneezing
• wheezing

Why is Resident Isolation Important?

Isolation helps prevent the spread of microorganisms from symptomatic or infected residents to other residents, staff, and visitors.

Why is Incident Management Important?

Care Home Managers (CHMs) and their teams have a duty of care to prevent the ongoing spread of infection, protecting the health and wellbeing of residents.

Isolation - Key Considerations

Personal Protective Equipment (PPE)

This includes items such as gloves, aprons, face masks, and eye protection that are worn to reduce the risk of spreading infection between staff and residents. Before isolating a resident, it's important to wear the appropriate PPE to protect both the resident and yourself from potential transmission of infectious diseases.
When deciding to isolate a resident, use a risk-assessed approach to balance infection prevention with the resident's overall care needs. Consider:

• How the infection is transmitted (airborne, droplet, faecal-oral, aerosols).
• The environment and layout of the setting.
• The vulnerability of others.
• The resident's clinical condition, e.g. impaired cognition.
• If a resident is likely to wander, full isolation may not be possible. In such cases, every attempt should be made to avoid contact with others in the setting.
• Where safe, residents in isolation can still access outdoor areas via a route around the care home grounds that avoids contact with other residents.
• Communication is key - explain the reasons for isolation to residents and their families, and outline the measures being taken to prevent the spread of infection and protect others.

Visitor Precautions

All care homes should have a visiting policy that includes infection prevention measures to stop infections entering the home.

Visitors should:

• Not attend if they have symptoms of diarrhoea/vomiting, fever, ARI symptoms, or an unexplained rash.
• Remain away from the care home until symptom-free for at least 48 hours.
• Be clearly informed of control measures in place before entry to the care home.

Care Home Managers should:

• Display appropriate notices and hand hygiene posters for residents and visitors.
• Provide alcohol hand rub at entrances to the premises.
• Advise visitors of visiting restrictions as per national guidance.
• Advise on Personal Protective Equipment (PPE )use if required, and support visitors in donning/doffing correctly.

Isolation Procedure and Incident Management

• Ideally, isolate residents in single rooms with en-suite facilities. If unavailable, provide a designated commode.
• Keep room doors closed with isolation signage clearly visible, requesting visitors to seek advice before entering.
• Place a PPE station outside the room (aprons, gloves, masks, eye protection, hand sanitiser).
• PPE must be donned before entry and doffed appropriately, disposing of waste in the room.
• Perform hand hygiene with soap and warm water, drying hands thoroughly with paper towels after exiting the room.

Alcohol hand gel is NOT effective against Clostridioides Difficile (C. diff) or Norovirus. If residents have Diarrhoea and Vomiting (D&V), hands must be washed with soap and water before using alcohol hand gel.

Essential Equipment for Isolation

An appropriate contained PPE station located outside the isolated resident's room should include:

• Disposable aprons, gloves, Type IIR masks, and eye protection (if risk of splashing).
• PPE station outside room.
• Red alginate laundry bags for infected linen.
• Foot-operated lidded bin for infectious waste.
• Soap, paper towels, and alcohol hand rub (where appropriate).
• Cleaning and decontamination supplies (chlorine-based disinfectant for 1,000 ppm solution).

Cleaning & Waste Disposal (refer to Section 9 for more details)

• Clean isolation rooms twice daily with chlorine-based disinfectant.
• Follow the National Colour Coding Scheme - yellow equipment for isolation areas.
• Dispose of infectious waste in the correct colour-coded bags. No double bagging unless outer bag is contaminated.
• Deep clean after isolation ends, or on residents' transfer/discharge/death.

Transfers Between Settings

• Avoid transfers unless essential.
• If necessary, notify ambulance/transport and receiving settings of infection risk in advance.
• Decontaminate transfer equipment after use.

When is a Setting in 'Incident' Status?

An incident is declared when two or more linked cases of confirmed or suspected ARI occur within the same setting, likely spread within the home.
Notify:

• All Wales Acute Response Team (AWARE) - 0300 003 0032 aware@wales.nhs.uk

Maintain a line list of all symptomatic residents and staff, including dates of onset, test results, vaccination status, last contact with communal areas, and relevant clinical details.

Resources 

Incident Aide Memoire for Care Homes (Two or more linked cases of an Acute Respiratory Infection - ARI).Incident Aide Memoire (PDF, 163 KB) 
Incident Management Line List. Powys Care Home Line Listing (PDF, 239 KB) 
Quick Reference For Care Home Pathway V1 (PDF, 915 KB)

References and Further Guidance Links:

Quick Reference Guide: Quick Reference Guide for Care Homes managing ARI or ILI (August 2025)
Infection Prevention and Control Measures for Acute Respiratory Infections (ARI) for Health and Social Care Settings: ARI IPC Guidance FINAL.V4 2025- 2026
National Infection Prevention and Control Manual (NIPCM): NIPCM - Public Health Wales 
HARP Resources: Resources for Healthcare Professionals - Public Health Wales 
Welsh Government's Social Care Guide to Controlling ARIs: Social care guide to controlling acute respiratory infections [HTML] | GOV.WALES