Acute Respiratory Infection

Definition

Acute Respiratory Infections (ARI) include illnesses such as influenza, COVID-19, respiratory syncytial virus (RSV), and other viral or bacterial infections that affect the respiratory tract. They are commonly spread through droplets produced when an infected person coughs, sneezes, or talks.

Further information: Preventing Infection Workbook - Page 69

Mode of Transmission

• Droplet transmission (within 1 metre of an infected person, though droplets can sometimes travel further.)
• Contact with contaminated hands, surfaces, or equipment.
• Aerosol-generating procedures (AGPs) can increase risk of airborne spread.

General Symptoms Include

• Cough, sneezing, runny nose, sore throat.
• Fever, headache, muscle aches, tiredness.
• Breathing difficulties in severe cases.

Standard Infection Control Precautions (SICPs)

SICPs should be applied at all times, including:

• Hand hygiene before and after patient contact.
• Respiratory hygiene and cough etiquette.
• Use of appropriate PPE (gloves, apron, mask, and eye protection if risk of splashing).
• Safe waste and linen management.

Additional Transmission-Based Precautions

• Isolation: Patients with suspected or confirmed ARI should be isolated in a single room where possible. Cohorting may be considered during outbreaks.
• Signage: Clear signage should be displayed on the patient's door to advise staff and visitors.
• PPE: Surgical masks should be worn within 1 metre of a coughing/sneezing patient. FFP3 masks are required when performing AGPs.
• Environmental cleaning: Enhanced cleaning of frequently touched surfaces with appropriate disinfectants.

What tests should be taken?

It is important to obtain viral swabs from symptomatic residents and/or staff for the management of respiratory illnesses. This will help in the diagnosis of the respiratory illnesses and ensure the correct treatment is given. The General Practitioner will advise on the swabs/tests and treatment provided.

Key Principles to Reduce Spread

Communication

• Care home should inform the Health Protection Team (AWARe) if they have a confirmed or suspected case of an acute respiratory illness of significance requiring isolation.

• If the home is classed as having an outbreak, it should be closed to admissions and outbreak management procedures followed.

• Contact the Health Protection Team - All Wales Acute Response Service (0300 0030 032) for advice and guidance.

• If transfer to hospital is required, inform the ambulance service and hospital department that the resident has respiratory illness symptoms.

• Liaise with the Health Protection Team regarding outbreak policies and management.

Hand Hygiene 

• Clean hands regularly with liquid soap and warm water, or with alcohol hand rub if hands are visibly clean.

• Ensure all resident rooms are equipped with liquid soap and disposable paper towels.

• Encourage and assist residents with respiratory and cough hygiene.

• Visitors must clean hands on entering and leaving the care home.

Isolation

• Good ventilation is important - open windows regularly (e.g. 10 minutes every hour) to help remove microorganisms from the air.
• Symptomatic residents should be cared for in a single room, keeping bedroom doors closed if safe.
• Residents with the same confirmed virus may be cohorted in designated areas (e.g. separate floors/wings) to minimise spread.
• Staff must wear appropriate PPE (Fluid-resistant surgical mask, eye protection, gloves, apron) when caring for affected residents.
• PPE stations should be set up outside resident rooms.

• Isolation periods vary depending on the virus - seek advice from the HP team.

Decontamination

• Resident's room should be cleaned daily with appropriate disinfectant.
• Reusable care equipment must be cleaned between residents.
• Cleaning and disinfection should follow Welsh Standards.
• Wash affected linen as infected laundry.
• Once isolation is complete, room should undergo a deep clean before reuse.
• All equipment must be disinfected before removal from the room.
• In the event of an outbreak, carry out a deep clean of all affected areas as per outbreak policy.
• Staff uniforms should be laundered at 60°C at home (or as agreed by the care home).

Note - Staff should not wear uniforms to or from work in the Care Home

Staff Exclusion

• Staff with symptoms of influenza-like illness or COVID-19 should not attend work until clinically recovered and meeting current NHS/Welsh Government guidance.

Visitors

• During an outbreak or incident of a virus in a care home, visiting should remain as open and flexible as possible, with visiting restrictions only being implemented after a risk assessment.
• Ensure visitors are aware they are dealing with an outbreak.
• Visitors with symptoms should be advised not to enter care settings.
• Those visiting must follow hand hygiene and PPE requirements.

Resources 
NHS Flu Care Homes Poster:Flu-care-home-poster.pdf

References and Further Guidance Links: 
Public Health Wales ARI:ARI - Acute Respiratory Infections - Public Health Wales