respiratory infection (ri) outbreak guidelines · how respiratory infection (ri) spreads - droplet...
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Respiratory Infection (RI)
Outbreak Guidelines
for Residential Care Settings
October 2017
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Recognize
Early recognition of RI infection outbreak
Report
Prompt reporting of outbreak to CD Unit, the IH facility ICP,
and other appropriate people
React
Swift reaction with appropriate outbreak control measures
Ready
Be ready. Be prepared at the beginning of outbreak season with
the right supplies. Use Routine Practices and good hand
hygiene at all times to prevent outbreaks before they start.
Objectives
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Respiratory Infections (RI) are illnesses
that affect the lungs
Symptoms: cough and fever
Can be caused by bacteria (like
Whooping Cough/Pertussis) or viruses
(like the Coronavirus or Influenza)
Influenza or “The Flu” is very serious.
Recognize – What is Respiratory Infection (RI)?
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How Respiratory Infection (RI) Spreads
-
Droplet – Germs spread via droplets when coughing or sneezing enter the body through the nose, mouth and eyes
Indirect contact – Touching eyes, nose or mouth with unwashed hands after contact with contaminated surfaces
Shared equipment that is not cleaned after each use (e.g. thermometers, pulse oximeters)
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Recognize and Report
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Two with Flu! If you notice two or
more people with cough and fever in the same week, it may be a Respiratory Infection (RI) Outbreak.
Report it to your supervisor!
Recognize
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Respiratory Infection (RI) Case Definition
New or worsening cough
and
Fever >38 degrees or temperature that is abnormal for the person
Additional symptoms may include muscle and joint aches, fatigue, runny nose, sore throat and headache
Note:
Some people may not develop a fever or have an altered temperature due to age, immune status or medications.
A temperature less than 35.6°C or greater than 37.4°C in the elderly may be an indication of infection.
The MHO may need to be consulted if you have an unusual cluster of illness in your facility that does not meet the case definition. Discuss this with the CD Unit or your ICP, if an IH facility.
Recognize
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Recognize
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Respiratory Infection (RI) Outbreak Definition
Two (2) or more cases of RI occurring in a unit/facility area
within a 7 day period
amongst residents and/or staff
New: Outbreak Management
IH Residential Facilities
• Managed by the facility ICP
• The ICP will consult with
the MHO as per the RI
Outbreak Guidelines
Private & P3 Residential
Facilities
• Managed by the CD Unit
• The CD Unit will consult
with the MHO as per the RI
Outbreak Guidelines
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If you think there is an RI outbreak happening in
your facility:
IH Residential Facilities: contact your facility ICP
Private & P3 Residential Facilities: call the CD
Unit
(1-866-778-7736)
New: Report
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After hours, call the MHO directly @ 1-866-457-5648.
ALL Facilities must still report the outbreak to the
IH Communicable Disease Unit
Complete the IH RI and GI Outbreak Report Form
and send to the CD Unit
Email: [email protected] or Fax: (250) 549-6310
For IH Residential Facilities: send a copy to your
ICP.
Report
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Report: Revised Form
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Report: Initial
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Total staff who are hired to work in OB area, not per shift.
Initial Report: Example
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The MHO must declare the RI Outbreak
MHO will designate the RI outbreak as one of the following:
Scenario A
More severe respiratory illness known or suspected to be due to Influenza
Scenario B
More severe respiratory illness known or suspected to be due to a non-influenza viral or bacterial cause
Scenario C
Milder respiratory illness, known or suspected to be due to other non-influenza viral cause (i.e. the common cold)
Outbreak Declaration
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Still preferable to declare outbreak within one section
or floor of facility if possible
All cases need to be within one section/floor
Attempt to cohort staff and residents as outlined in RI
Outbreak Guidelines
Consult with IH facility ICP or with the CD Unit for
private and P3 facilities
Update: Declaring an Outbreak
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In preparation for outbreak season, facility should
create OMT – set up by the Director of Care or Most
Responsible Person at facility
Members can include MHO, IH facility ICP, CD
Specialist, facility administrator or Director of Care,
Charge Nurse, housekeeping, food services rep
Purpose is to review outbreak control measures so
outbreak can be over ASAP
New: Outbreak Management Team
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Notify the following partners of the outbreak:
Community Care Licensing Officer
CIHS Administrator on Call
Manager, Care Coordinator or designate
Medical Director of the facility and other physicians
Staffing office
Hospitals/facilities where residents have recently
transferred
Other service providers
Patient Transport Services, lab services, BC
Ambulance, haemodialysis units, oxygen service
provider, pastoral care, etc…
Report
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Daily Reporting to the CD Unit is Required
During the Outbreak.
Complete Section B of the IH RI and GI Outbreak
Report Form daily
Fax to the CD Unit at 250-549-6310 or email to
IH Facilities: Send this form to facility ICP as well.
Daily Reporting
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Daily Reporting
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NEW: Report daily please!
Daily Reporting: Example
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Notify PHSA Labs
Nursing Staff to Complete PHSA(BCCDC) ILI
Outbreak Laboratory Form and FAX to
1-604-707-2607 prior to sending samples
Form found on Quick Reference Guide: RI
Outbreak in Residential Care Settings
Form also on Inside Net: Com Dis – RI Outbreaks –
Forms & Tools
React: Lab Specimens
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Specimens collected are documented on this form
Collect & Send Specimens
Collect specimens – nasopharyngeal swabs from cases
within 48-72 hours of symptom onset and send to
BCCDC same day if possible
Form found on Quick Reference Guide: RI
Outbreak in Residential Care Settings
Form also on Inside Net: Com Dis – RI Outbreaks –
Forms & Tools
React
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IH CD Unit (C09768) is entered in the ADDITIONAL COPIES TO: field
Enter “Respiratory Outbreak” under Test(s) Requested
How to Collect Nasopharyngeal Swabs
Wear gloves, mask and eye protection
Clean resident’s nose if discharge present
Incline head - insert swab to a depth of 2-3 cm into nostril. Swab around inside of nostril and along nasal septum a minimum of 6 times
Place swab into the transport media - tighten lid securely
Label container with full name and date of birth
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Routine Practices and
Droplet Contact Precautions
PPE – gloves, gown, surgical/procedure
mask and eye protection.
Remember – the outside of your PPE is
contaminated, so remove it and wash
your hands BEFORE leaving the
room/area.
Hand hygiene & respiratory hygiene
(cover your cough)
React – Control Measures
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Ill Residents
Symptomatic residents to stay in room if possible and serve meals in room
Well Residents
Well residents may be out of their room, however, will be asked to stay within their “neighborhood”
Activities
Discontinue group activities in outbreak location
Immunization
Offer influenza vaccine to all unimmunized residents and staff
React – Control Measures
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New: React – Control Measures
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IH Residential Facilities
Consult with facility ICP
The ICP will consult with
the MHO
Private & P3 Residential
Facilities
Call the CD Unit
The CD Unit will consult
with the MHO
Restrictions Around Admissions/Transfers
• Depends on the Scenario: MHO must be consulted for
Scenario A and B outbreaks
• All repatriation/admission requests from acute care go
through the facility
Staff
Preferable to cohort staff to work only in the affected area and keep residents contained within that area, then declare the outbreak in that area alone as opposed the entire facility
OR
Staff should be cohorted to work with either symptomatic residents or asymptomatic residents for the duration of their shift
OR
Staff should work with asymptomatic residents first, then with symptomatic residents
AND
Healthcare persons entering the facility during an outbreak (such as lab staff or physicians) must work in the non-affected areas of the facility or with well residents first
Update: React – Control Measures
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Staff (con’t)
Staff with RI illness must be excluded from work for
duration of acute symptoms or 5 days, whichever is
longer
Visitors & Volunteers
Limit visit to family/friend only
Post signage at facility entrance indicating outbreak and reinforcing hand hygiene
Visitors/volunteers not immunized should be offered
masks in resident care areas
React – Control Measures
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Food Services
Wash dishes in hot water and detergent
Enhanced cleaning
Increase frequency of cleaning for commonly touched surfaces
Provide sufficient receptacles for safe disposal of contaminated items such as tissues
Clean all equipment between residents
React – Control Measures
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React – Specific Control Measures
Scenario A
More severe illness known or suspected to be influenza
MHO recommends anti-viral treatment & prophylaxis for
residents and unimmunized staff
Exclude unimmunized HCWs (unless taking antivirals)
Restrict admission to and discharges from facility unless
medically necessary - MHO approval required for all
admissions and re-admission/repatriations
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React – Specific Control Measures
Scenario B More severe illness due to non-influenza viral or bacterial cause
(e.g. Human metapneumovirus)
Admissions limited to essential only
Facility must be able to isolate resident
Informed consent of resident/decision-maker/physician required
MHO approval required for all admission and re-admission/repatriations
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React – Specific Control Measures
Scenario C Milder illness due to non-influenza viral pathogens
(e.g. rhinovirus or coronavirus, aka ‘the common cold’)
Provide incoming residents of receiving facility with notice
of outbreak
Should have ability to isolate resident
Informed consent of resident/decision-maker/physician
required
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Outbreaks can be declared over on the morning of the
last designated day of the outbreak.
Scenario A – Declared over after 8 days with no new
resident cases and 4 days after last staff case worked
Scenario B – Declared over after 2 incubation
periods have passed (4-14 days) with no new cases
Scenario C – Facility can self-declare over after 4
days with no new cases
New: Declaring the Outbreak Over
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New: Declaring the Outbreak Over
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IH Residential Facilities
The facility ICP will declare
Scenario A & B
outbreaks over as per the
RI Outbreak Guidelines
The ICP will consult with
the MHO as needed
Private & P3 Residential
Facilities
The CD Unit will declare
Scenario A & B
outbreaks over as per the
RI Outbreak guidelines
The CD Unit will consult
with the MHO as needed
Facilities can self-declare Scenario C outbreaks over as
per the RI Outbreak Guidelines.
Declaring the Outbreak Over
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Complete Part C of the IH RI and GI Outbreak Report Form and send to the CD Unit
IH Facilities: Send a copy to Facility ICP as well.
Final Report: Example
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Immunize!
Keep records!
Provide yearly outbreak education for staff
Keep an up to date “Outbreak Box” with extra PPE, specimen collection kits, guidelines, Oseltamivir PPO’s and documentation tools
Order swabs from PHSA labs
Use Routine Practices and hand hygiene diligently to avoid outbreaks
Ready….. for the next time!
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Form used to order
RI Outbreak kits for
specimen collection
– a link to the form
is in RI Outbreak
guidelines and on
Inside Net (Tools &
Forms)
Ensure that a
supply of specimen
containers is kept
on hand as delivery
of kits takes
approximately two
weeks.
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Outbreak Management Toolkit
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Hosted on the Communicable Disease webpage
Links to the toolkit also in the Infection Control Manual
Access info on the Inside Net as well
Non-IH facilities can access tools on public website
Summary of Changes
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Situation # 1
Today there are two residents who have developed a sudden cough and are feeling unwell. In addition to the sudden cough, one resident has a headache and fever and the other resident has a temperature of 37.5C and is lethargic.
What should you do?
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1. Put symptomatic residents on Droplet Contact Precautions
2. Because there are 2 residents who meet case definition, suspect an outbreak
3. For IH facility, notify ICP who will review & discuss with MHO
4. For non-IH facility, notify CD Unit, who will review & discuss with MHO - MHO declares the RI outbreaks
5. Notify Most responsible person who will call together OMT
6. Send Outbreak Report form to CD Unit and ICP (IH sites)
7. Notify Licensing and other partners
8. Collect specimens
9. Implement additional control measures using Quick Reference guide
10. Record resident/staff cases on Surveillance Tool
What Should You Do?
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QUESTIONS?