New ARI Guidance

 

The National Guidance for the management of Acute Respiratory Infections (ARIs) in Adult Social Care Settings has changed. The previous Covid-19 supplement has been expanded to include all common Acute Respiratory viruses e.g. COVID, flu, RSV, parainfluenza, rhinovirus etc and is now referred to as the ARI Supplement.

Infection prevention and control in adult social care: acute respiratory infection - GOV.UK (www.gov.uk)

 

Summary of key changes are:

  1. Definition of an outbreak – Two or more cases of ARI (including COVID-19, Flu, RSV, rhinovirus etc) within 5 days. This is updated from the previous COVID-19 definition of 14 days and brings it in line with all other viral respiratory infections.

  2. Testing for COVID-19 – For care homes only, test up to 5 residents who developed symptoms most recently, rather than the first 5. This is to be able to identify the cause of infection in the individuals likely to be most infectious. You will no longer need to upload your test results onto the online testing portal.  However, you should keep a record of any test results even if negative or void.

  3. Isolation/exclusion periods– have remained almost the same for COVID-19 i.e. those who test positive should self-isolate/exclude themselves from work for a minimum of 5 days from date of symptom onset (as opposed to the test date) and until they no longer have a fever and are feeling well enough to carry out their usual daily activities and for a maximum of 10 days.  For those who are symptomatic but have not tested or test negative, they should stay away from others until they no longer have a fever and are feeling well.

  4. For any other respiratory viruses, the HPT will advise on recommended Isolation/exclusion (by email and/or verbally, once you have reported an outbreak)

  5. PPE - face masks to be worn when within 1 metre of someone with confirmed or suspected ARI. This is updated from the previous recommendations of 2 metres. Gloves and aprons should only be used subject to risk assessment and only if there is a risk of exposure to blood/body fluids.

  6. Health & Wellbeing - new section on ensuring service user wellbeing while supporting symptomatic individuals to stay away from others. (e.g. ensuring visiting, supporting them to leave their room for fresh air etc.) 

  7. An emphasis that visiting should be maintained (with appropriate safeguards, reductions and risk assessments). Further, more detailed national guidance expected soon

  8. Other changes include updates on: symptoms and symptom monitoring; vaccines; and treatments

  

The Care OBRA has been updated to align with the new guidance. Please continue to use the web-based Care OBRA Tool to report all NEW suspected or confirmed OUTBREAKS of ACUTE RESPIRATORY INFECTIONS (ARIs) e.g. Flu, COVID-19, RSV or unidentified ARI)

You do NOT have to ring or email the HPT before reporting your ARI outbreak (ARI ONLY!) use the link below:

Care Outbreak Risk Assessment (Care OBRA) Tool for Acute Respiratory Infections (ukhsa.gov.uk)

 

After reporting your outbreak via Care OBRA, you will receive an automated Acknowledgement Email and an Advice Email.  If these emails classify your outbreak as High Priority AND it is a weekend or public holiday, you must also call the HPT.

  • You may also use the Care OBRA to report SINGLE CONFIRMED cases of FLU.  If you have a single case of flu (usually only confirmed in hospitalised patients) please check to make sure that you do not have any other suspected cases in your setting.  If so, then report as an outbreak

  • You do not need to report further cases in an existing outbreak or cluster unless you have cause for concern as stated above or have been asked to do so

  • You do not need to report single cases of COVID-19

  • You do not need to report cases that you are certain are UNLINKED to transmission in the setting

  • Do NOT report other types of outbreak e.g. norovirus using the Care OBRA Tool

Please explore our SW Infection Prevention and Control and Winter Readiness Toolkit for lots of useful resources, including links to relevant national guidance and as well as SW Checklists, posters, information sheets etc https://swcouncils.gov.uk/ukhsa-care-home-and-residential-care-guidance/ 

 

Acute Respiratory Infection (ARI) supplement to the infection prevention and control resource for Adult Social Care (ASC) – Public facing guidance - List of updates and new guidance

Poster available here.

Area: Symptoms

Updates:

  • Symptoms of an acute respiratory infection outlined upfront to include COVID-19 and other infections.

  • Revised section on monitoring symptoms to enable providers to escalate appropriately in line with best practice and available support.

  • New section on ensuring service user wellbeing while supporting symptomatic individuals to stay away from others. (E.g. ensuring visiting, supporting them to leave their room for fresh air etc.)

Area: Vaccines

Updates:

  • Updated guidance to be more general and signpost to NHS links to future proof this for future flu, COVID-19, and other vaccination campaigns.

Area: Treatments

Updates:

  • Updated to align with updated pharmacy route for organisations to access COVID-19 tests for those eligible for COVID-19 treatments.

  • This is in line with the transition of responsibility from UKHSA to the NHS for providing COVID-19 tests for COVID-19 treatments.

  • Added detail and links to information on seasonal flu treatments.

Area: Testing

Updates:

  • To be updated to align with updated pharmacy route for organisations to access COVID-19 tests for those eligible for COVID-19 treatments, as above.

  • Provided advice on when further testing for COVID-19 and other acute respiratory infections may be advised/conducted by health protection teams, GPs, or hospitals.

  • Updated advice for care home residents/staff to stay away from others/work for 5 days from the day of positive ARI test to 5 days from onset of symptoms. This is to minimise the risk of extending over the 5 recommended days due to possible delays in accessing testing.

Area: Outbreaks

Updates:

  • Acute respiratory infection (including COVID-19) outbreak definition updated – two or more cases within 5 days. This is updated from the current COVID-19 definition of 14 days. This standardises the definition across ARI viruses, consistent with the latest COVID-19 epidemiology and health protection advice.

  • Updated wording on outbreak measures to make clearer that these are not mandatory but only examples that may be appropriate subject to risk-assessment. This is to ensure measures are risk-based and proportionate.

  • Clarification that up to 5 residents who developed acute respiratory symptoms most recently should be tested, rather than the first 5. This is to be able to identify the cause of infection in the individuals likely to be most infectious.

  • Addition of considerations for administration of flu testing and flu antiviral treatments if advised by the HPT during outbreaks.

Area: PPE

Updates:

  • Updated recommendations on use of face masks for acute respiratory infections to align with existing recommendations for use with COVID-19. PPE remains free for COVID-19 needs only until March 2024, subject to stocks.

  • Clarification that gloves and aprons should only be used subject to risk assessment and only if there is a risk of exposure to blood and body fluids. This is to prevent items being overused, given their environmental impact, and to prevent items being used as a substitute for good hand hygiene.

  • Updated guidance to use face masks when within 1 metre of someone with a confirmed or suspected acute respiratory infection for tasks other than providing them with care or cleaning their room. This is revised down from 2 metres consistent with the evidence, and national and international recommendations.