{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:21:55Z","timestamp":1765808515235,"version":"3.44.0"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UKHSA"},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Infection control measures (ICMs) used to mitigate the effects of infectious outbreaks in care homes impact on resident quality of life (QoL). This qualitative proof-of-concept study explored whether the Adult Social Care Outcomes Toolkit (ASCOT) could feasibly support care home staff in recognising and minimising these impacts.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>There were two phases involving online interviews with six care home managers\/deputies from five homes who had managed notifiable outbreak(s) in the previous six months in two regions of England. Phase 1, using an incident analysis approach, explored the impact of outbreaks and ICMs on resident QoL, mapping data to the eight ASCOT domains. Phase 2 assessed the usefulness of using ASCOT to identify, monitor and minimise impacts on resident QoL during infectious outbreaks. Follow-up interviews were conducted with four care homes from phase 1 and six healthcare professionals with ICM responsibilities. Online interviews were analysed using framework analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>Phase 1: three types of outbreaks (COVID-19, norovirus, chest infections) were discussed. All were managed using standard ICMs: isolation, increased cleaning, and staff wearing personal protection equipment. The impacts of these measures on resident QoL were described. Phase 2: two overarching themes identified: (i) ICMs as a personal cost for the greater good and (ii) the potential of ASCOT in minimising impacts of infectious outbreaks on resident QoL as a tool to support care planning and mitigating impacts.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>ASCOT can support planning to mitigate the effects of ICMs for infectious outbreaks on resident QoL.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0316424","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T17:34:22Z","timestamp":1758821662000},"page":"e0316424","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Minimising the impact of infectious outbreaks on resident quality of life: A qualitative proof of concept study using the Adult Social Care Outcomes Toolkit (ASCOT)"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7809-7100","authenticated-orcid":true,"given":"Diane","family":"Bunn","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluseyi","family":"Jimoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Greenstock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammud","family":"Edoo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3597-1061","authenticated-orcid":true,"given":"Ann-Marie","family":"Towers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"pone.0316424.ref001","unstructured":"Berg V. Care home stats: number of settings, population & workforce [Internet]. carehome.co.uk. 2024 [cited 2024 Jul 26]. Available from: https:\/\/www.carehome.co.uk\/advice\/care-home-stats-number-of-settings-population-workforce"},{"key":"pone.0316424.ref002","unstructured":"Office for National Statistics (ONS). Care homes and estimating the self-funding population, England: 2022 to 2023 [Internet]. ONS Website. 2023 [cited 2024 Jul 26]. Available from: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/socialcare\/articles\/carehomesandestimatingtheselffundingpopulationengland\/2022to2023"},{"issue":"11","key":"pone.0316424.ref003","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1016\/j.jamda.2020.09.005","article-title":"Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience","volume":"21","author":"DC Anderson","year":"2020","journal-title":"J Am Med Dir Assoc"},{"issue":"10","key":"pone.0316424.ref004","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1016\/j.jamda.2021.07.027","article-title":"Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence","volume":"22","author":"SH Dykgraaf","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0316424.ref005","doi-asserted-by":"crossref","first-page":"386","DOI":"10.31389\/jltc.109","article-title":"The Lived Experience of Implementing Infection Control Measures in Care Homes during Two Waves of the COVID-19 Pandemic: A Mixed-Methods Study","author":"D Bunn","year":"2021","journal-title":"J Long-Term Care"},{"key":"pone.0316424.ref006","article-title":"\u201cYou\u2019ve got to go along and try to keep it out\u201d: the experience of older care-home residents with infection-control measures during COVID-19.","volume-title":"British Society of Gerontology Annual Conference [Internet]","author":"D Bunn","year":"2022"},{"key":"pone.0316424.ref007","unstructured":"Gov.uk. Notifiable diseases and causative organisms: how to report [Internet]. 2022 [cited 2023 Oct 6]. Available from: https:\/\/www.gov.uk\/guidance\/notifiable-diseases-and-causative-organisms-how-to-report#list-of-notifiable-diseases"},{"key":"pone.0316424.ref008","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.puhe.2020.07.005","article-title":"Factors associated with influenza-like illness in care homes in Cheshire and Merseyside during the 2017-2018 influenza season","volume":"187","author":"NF Halloran","year":"2020","journal-title":"Public Health"},{"issue":"1","key":"pone.0316424.ref009","first-page":"1","article-title":"What proportion of care home outbreaks are caused by norovirus? An analysis of viral causes of gastroenteritis outbreaks in care homes, North East England, 2016-2018","volume":"20","author":"T Inns","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"8","key":"pone.0316424.ref010","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/S1473-3099(18)30347-5","article-title":"Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes","volume":"18","author":"JA Cassell","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"pone.0316424.ref011","unstructured":"UK Health Security Agency. Management of acute respiratory infection outbreaks in care homes guidance [Internet]. 2024 [cited 2024 Sep 13]. Available from: https:\/\/www.gov.uk\/government\/publications\/acute-respiratory-disease-managing-outbreaks-in-care-homes\/management-of-acute-respiratory-infection-outbreaks-in-care-homes-guidance"},{"key":"pone.0316424.ref012","unstructured":"Gov.uk. Infection prevention and control in adult social care settings [Internet]. 2022 [cited 2023 Oct 6]. Available from: https:\/\/www.gov.uk\/government\/publications\/infection-prevention-and-control-in-adult-social-care-settings"},{"key":"pone.0316424.ref013","unstructured":"UK Health Security Agency. Infection Prevention and Control: An Outbreak Information Pack for Care Homes (The Care Home Pack) [Internet]. 2020 [cited 2023 Oct 6]. 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Available from: https:\/\/www.gov.uk\/government\/publications\/technical-report-on-the-covid-19-pandemic-in-the-uk\/chapter-82-care-homes"},{"issue":"8","key":"pone.0316424.ref016","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-088685","article-title":"VIVALDI ASCOT and Ethnography Study: protocol for a mixed-methods longitudinal study to evaluate the impact of COVID-19 and other respiratory infection outbreaks on care home residents\u2019 quality of life and psychosocial well-being","volume":"14","author":"L Bertini","year":"2024","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0316424.ref017","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1186\/s12877-023-03935-w","article-title":"Registered care home managers\u2019 experiences of responding to the national care home visiting guidance in England during the Covid-19 pandemic; a multi-method qualitative study","volume":"23","author":"J Dixon","year":"2023","journal-title":"BMC Geriatr"},{"issue":"1","key":"pone.0316424.ref018","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1111\/jnu.12855","article-title":"Care-home Nurses\u2019 responses to the COVID-19 pandemic: Managing ethical conundrums at personal cost: A qualitative study","volume":"55","author":"L Birt","year":"2023","journal-title":"J Nurs Scholarsh"},{"issue":"2","key":"pone.0316424.ref019","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamda.2020.11.025","article-title":"Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19","volume":"22","author":"J Bethell","year":"2021","journal-title":"J Am Med Dir Assoc"},{"issue":"2","key":"pone.0316424.ref020","article-title":"Piloting of a minimum data set for older people living in care homes in England: protocol for a longitudinal, mixed-methods study","volume":"13","author":"A-M Towers","year":"2023","journal-title":"BMJ Open"},{"key":"pone.0316424.ref021","first-page":"288","article-title":"Data collection in care homes for older adults: a national survey in England","volume":"0","author":"B Hanratty","year":"2023","journal-title":"J Long Term Care"},{"key":"pone.0316424.ref022","article-title":"Cross-sectional study assessing the feasibility of measuring residents\u2019 quality of life in English care homes and assessing the construct validity and internal consistency of measures completed by staff-proxy","author":"AM Towers","year":"2024","journal-title":"medRx1v"},{"issue":"19","key":"pone.0316424.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hsdr09190","article-title":"Care home residents\u2019 quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study","volume":"9","author":"AM Towers","year":"2021","journal-title":"Health Services and Delivery Research"},{"issue":"6","key":"pone.0316424.ref024","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1007\/s11136-024-03631-1","article-title":"Exploratory factor analysis and Rasch analysis to assess the structural validity of the Adult Social Care Outcomes Toolkit Proxy version (ASCOT-Proxy) completed by care home staff","volume":"33","author":"S Rand","year":"2024","journal-title":"Qual Life Res"},{"issue":"1","key":"pone.0316424.ref025","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s12955-017-0682-0","article-title":"Developing a proxy version of the Adult social care outcome toolkit (ASCOT)","volume":"15","author":"S Rand","year":"2017","journal-title":"Health Qual Life Outcomes"},{"issue":"5","key":"pone.0316424.ref026","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/j.socscimed.2008.05.015","article-title":"Valuing the ICECAP capability index for older people","volume":"67","author":"J Coast","year":"2008","journal-title":"Soc Sci Med"},{"key":"pone.0316424.ref027","volume-title":"2015 EQ-5D-3L User Guide; Basic information on how to use the EQ-5D-3L instrument, version 5.1. [Internet]","author":"M van Reenen","year":"2015"},{"issue":"6","key":"pone.0316424.ref028","doi-asserted-by":"crossref","first-page":"104870","DOI":"10.1016\/j.jamda.2023.10.020","article-title":"Using EQ-5D for Proxy Assessment of Health-Related Quality of Life in Residential Care Facilities: A Systematic Review of Feasibility and Psychometric Properties","volume":"25","author":"LJ Cheng","year":"2024","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0316424.ref029","first-page":"0","article-title":"Factors associated with care home resident quality of life: Demonstrating the value of a pilot Minimum Data Set using cross-sectional analysis from the DACHA study","author":"S Allan","year":"2024","journal-title":"medRxiv [Internet]"},{"issue":"9","key":"pone.0316424.ref030","article-title":"Measuring quality of life in care homes when self-report is challenging: the construct validity, structural characteristics and internal consistency of the mixed-methods adult social care outcomes toolkit","volume":"52","author":"A-M Towers","year":"2023","journal-title":"Age Ageing"},{"issue":"2","key":"pone.0316424.ref031","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3109\/13668250.2019.1592126","article-title":"Feasibility, factor structure and construct validity of the easy-read Adult Social Care Outcomes Toolkit (ASCOT-ER)","volume":"45","author":"S Rand","year":"2020","journal-title":"J Intellect Dev Disabil"},{"issue":"1","key":"pone.0316424.ref032","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s12955-017-0739-0","article-title":"Validity and test-retest reliability of the self-completion adult social care outcomes toolkit (ASCOT-SCT4) with adults with long-term physical, sensory and mental health conditions in England","volume":"15","author":"S Rand","year":"2017","journal-title":"Health Qual Life Outcomes"},{"issue":"4","key":"pone.0316424.ref033","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1037\/h0061470","article-title":"The critical incident technique","volume":"51","author":"JC FLANAGAN","year":"1954","journal-title":"Psychol Bull"},{"issue":"5","key":"pone.0316424.ref034","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1046\/j.1365-2648.2000.01597.x","article-title":"The critical incident technique and nursing care quality research","volume":"32","author":"JK Kemppainen","year":"2000","journal-title":"J Adv Nurs"},{"key":"pone.0316424.ref035","doi-asserted-by":"crossref","DOI":"10.4324\/9780203413081_chapter_9","volume-title":"Qualitative Data Analysis for Applied Policy Research","author":"J Ritchie","year":"1994"},{"issue":"6","key":"pone.0316424.ref036","first-page":"2061","article-title":"Using framework analysis in applied qualitative research","volume":"26","author":"LJ Goldsmith","year":"2021","journal-title":"Qual Rep"},{"key":"pone.0316424.ref037","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1186\/1471-2288-12-181","article-title":"Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ","volume":"12","author":"A Tong","year":"2012","journal-title":"BMC Med Res Methodol"},{"key":"pone.0316424.ref038","unstructured":"UKHSA. Management of acute respiratory infection outbreaks in care homes guidance [Internet]. 2024 [cited 2024 Oct 17]. Available from: https:\/\/www.gov.uk\/government\/publications\/acute-respiratory-disease-managing-outbreaks-in-care-homes\/management-of-acute-respiratory-infection-outbreaks-in-care-homes-guidance"},{"key":"pone.0316424.ref039","doi-asserted-by":"crossref","first-page":"101047","DOI":"10.1016\/j.eclinm.2021.101047","article-title":"The effect of COVID-19 isolation measures on the cognition and mental health of people living with dementia: A rapid systematic review of one year of quantitative evidence","volume":"39","author":"A Su\u00e1rez-Gonz\u00e1lez","year":"2021","journal-title":"EClinicalMedicine"},{"key":"pone.0316424.ref040","first-page":"1","article-title":"Establishing a set of research priorities in care homes for older people in the UK: a modified Delphi consensus study with care home staff","author":"V Shepherd","year":"2016","journal-title":"Age Ageing"},{"issue":"5","key":"pone.0316424.ref041","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1093\/ageing\/afaa113","article-title":"Commentary: COVID in care homes-challenges and dilemmas in healthcare delivery","volume":"49","author":"AL Gordon","year":"2020","journal-title":"Age Ageing"},{"issue":"1","key":"pone.0316424.ref042","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1186\/s12877-023-04251-z","article-title":"Listening and learning: a qualitative study of Scottish care home staff experiences of managing COVID-19 between March 2020-August 2022","volume":"23","author":"JK Burton","year":"2023","journal-title":"BMC Geriatr"},{"issue":"6","key":"pone.0316424.ref043","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamda.2023.03.033","article-title":"Factors Associated With the Quality of Life of Nursing Home Residents During the COVID-19 Pandemic: A Cross-Sectional Study","volume":"24","author":"M Hoben","year":"2023","journal-title":"J Am Med Dir Assoc"},{"issue":"1","key":"pone.0316424.ref044","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s12877-021-02053-9","article-title":"Care homes, their communities, and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study","volume":"21","author":"F Marshall","year":"2021","journal-title":"BMC Geriatr"},{"issue":"3","key":"pone.0316424.ref045","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afac014","article-title":"Contextual factors influencing complex intervention research processes in care homes: a systematic review and framework synthesis","volume":"51","author":"G Peryer","year":"2022","journal-title":"Age Ageing"},{"issue":"1","key":"pone.0316424.ref046","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1186\/s12913-016-1763-1","article-title":"The acceptability and feasibility of using the Adult Social Care Outcomes Toolkit (ASCOT) to inform practice in care homes","volume":"16","author":"A-M Towers","year":"2016","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0316424.ref047","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1093\/medlaw\/fwac023","article-title":"\u201cThis is no country for old (wo)men\u201d? An examination of the approach taken to care home residents during the covid-19 pandemic","volume":"31","author":"C \u00d3 N\u00e9ill","year":"2023","journal-title":"Med Law Rev"},{"issue":"8","key":"pone.0316424.ref048","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.jagp.2020.04.025","article-title":"Achieving Safe, Effective, and Compassionate Quarantine or Isolation of Older Adults With Dementia in Nursing Homes","volume":"28","author":"A Iaboni","year":"2020","journal-title":"Am J Geriatr Psychiatry"},{"issue":"9","key":"pone.0316424.ref049","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afad146","article-title":"Challenges and improvements associated with transitions between hospitals and care homes during the COVID-19 pandemic: a qualitative study with care home and healthcare staff in England","volume":"52","author":"C Newman","year":"2023","journal-title":"Age Ageing"},{"key":"pone.0316424.ref050","volume-title":"The Discovery of Grounded Theory: Strategies for Qualitative Research","author":"B Glaser","year":"1967"},{"issue":"8","key":"pone.0316424.ref051","doi-asserted-by":"crossref","first-page":"105081","DOI":"10.1016\/j.jamda.2024.105081","article-title":"The Relationship between Nursing Home Staffing and Health Outcomes Revisited","volume":"25","author":"DB Mukamel","year":"2024","journal-title":"J Am Med Dir Assoc"},{"issue":"3","key":"pone.0316424.ref052","article-title":"A systematic review on the causes of the transmission and control measures of outbreaks in long-term care facilities: Back to basics of infection control","volume":"15","author":"MH Lee","year":"2020","journal-title":"PLoS One"},{"issue":"7","key":"pone.0316424.ref053","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/j.ajic.2022.10.009","article-title":"English care home staff morale and preparedness during the COVID pandemic: A longitudinal analysis","volume":"51","author":"J Brainard","year":"2023","journal-title":"American Journal of Infection Control"},{"issue":"4","key":"pone.0316424.ref054","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.jamda.2023.02.004","article-title":"Improving Nursing Home Disaster Readiness Through Implementation Science","volume":"25","author":"SA Bell","year":"2024","journal-title":"J Am Med Dir Assoc"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316424","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T17:34:44Z","timestamp":1758821684000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316424"}},"subtitle":[],"editor":[{"given":"Dominik","family":"Wodarz","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":54,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0316424","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,25]]}}}