Marcia McCuaig Public Health Nurse Region of Peel

Outbreak Procedures and Tools

MOHLTC Guides

Respiratory Case & Outbreak Definitions Confirmed Case Definition • Two or more acute respiratory symptoms Note: Each virus and/or outbreak will have unique characteristics and case definition should be developed for each outbreak Confirmed Outbreak Definition: • Two cases of acute respiratory infections (ARI) within 48

hours with any common epidemiological link (e.g., unit, floor), at least one of which must be laboratory-confirmed;

OR • Three cases of ARI (laboratory confirmation not necessary)

occurring within 48 hours with any common epidemiological link (e.g., unit, floor);

Gastroenteritis Case & Outbreak Definitions: Confirmed Case Definition Symptoms must not be attributed to another cause and at least one of the following must be met:

• Two or more episodes of diarrhea (i.e. loose/watery bowel movements) within a 24-hour period

OR • Two or more episodes of vomiting within a 24-hour period; OR • 1 or more episodes of diarrhea AND one or more episodes of vomiting

within a 24-hour period.

Confirmed Outbreak Definition Two or more cases meeting the case definition with a common epidemiological link (e.g. specific unit or floor, same caregiver) with initial onset within a 48 hour period.

Outbreak Checklist

Does an outbreak exist?

Scenario

MORNING ROUNDS:

- Receive report from an RN

- 4 residents ill

- Respiratory symptoms

Collect information

• Symptoms

• Onset dates

– Date of first symptom

• Location of cases

• Staff cases

Analyze information Case #1 – J,M

– Cough and fever – Onset Oct 15 – A – wing

Case #2 – N,S

– Cough and fever – Onset Oct 17 – A-wing -

Case #3 – A,J

– Fever, cough, nasal congestion and sore throat – Onset Oct 17 – A – wing

Case #4 – M, M

– Fever, cough, nasal congestion and sore throat – Onset Oct 17 – A – wing

Line List

Confirmed Outbreak - next steps • Report to Peel Public Health – have outbreak checklist

and line list ready • Obtain Outbreak Number • Specimen collection

• Ensure symptomatic residents are on isolation and

precautions

• Continue surveillance

• Continue control measures

Outbreak progression

Scenario

MORNING ROUNDS

• Report from staff nurse

• 3 new resident cases since Oct 17

• 1 staff case

• Cases located on A-wing, B-wing, and C-wing

Management of Outbreak

• Monitor outbreak on ongoing basis

• Fax line list to Public Health ONLY when new cases are identified

• Lab test results

• For influenza outbreaks additional management may be required regarding antiviral use

Declaring Outbreak Over

• Consult with Peel Public Health

• Depends on the pathogen

– Must wait one infectious period + one incubation period since last new resident case

• Communicate outbreak has been declared over

- To all stakeholders and debrief with outbreak management team