Outbreak Management Respiratory (ILI) Facility Outbreak Worksheet
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1 Legend Staff=facility staff CDC champion (Lead) =AHS Public Health IPC=Infection and Prevention Control CDC= Communicable Disease Control Name of Congregate Living Facility Homecare= AHS homecare nurse OBM= Outbreak Management OHN = Occupational Health Nurse PPE = Personal Protective Equipment Facility Contact Phone Outbreak (EI) Number Date Outbreak opened (yyyy-mon-dd) Meets case definition for Influenza-like-illness - Acute onset of respiratory illness with fever and cough, AND with one or more of following: sore throat, joint pain, muscle aches, severe exhaustion. (Note: in persons 65 and older, fever may not be prominent) Influenza-like-illness (ILI) Outbreak definition - Two or more cases of ILI within a 7 day period, with common link (e. g. same location or same care giver, and evidence of transmission within the unit or site) North Zone AHS Public Health Contact Numbers NZ CDC Intake Monday to Friday, 08:30-16:30 hrs: After hours Monday to Friday, and Saturday, Sunday and Holidays, call and ask switchboard for Public Health On Call Fax: Initial Reporting/Notification N/A Yes No (provide details) Implement IPC measures (refer to NZ OBM Sheet C) Complete Early Outbreak Recognition Checklist (Form 20654) Complete Public Health Line List - Congregate Living (Form 20593) Contact NZ CDC Intake or local Public Health MOH Physician declares outbreak MOH Physician Name Outbreak not declared; facility on heightened surveillance Comments 20652(Rev ) Page 1 of 7
2 After MOH has declared outbreak in facility you will need to notify other stakeholders (departments). Public Health will be responsible for notifying AHS Workplace Health and Safety (if there is AHS staff), AHS Infection Control (if AHS facility) and Alberta Health. Department Name Phone/ NZ CDC Intake PHOC (public health on call) Local Public Health Nurse (CDC champion) After hours M-F :00 and weekends/holidays 08:00-16: AHS-NZ-OHN OHN-On-Call AHS-NZ-IPC Contact your local IPC Identify facility contacts to notify once Outbreak is declared Department Contact Name /Phone Other Example: housekeeping Linda Sweeperboss XXXX Notify the housekeeper on duty Housekeeping Homecare Dietary (within facility) 20652(Rev ) Page 2 of 7
3 Identify External Facility Contacts to notify once Outbreak is declared Department Contact Name /Phone Comments Example: housekeeping Linda Sweeperboss XXXX Notify the housekeeper on duty EMS Emergency Dept. Admitting Dept. Acute Care Dietary if not in facility Recreation Physiotherapy Homecare MDR (if extra supplies required) Laundry Pharmacy Facility Medical Director Physician 20652(Rev ) Page 3 of 7
4 Outbreak has been declared Facility responsibilities Initial Steps Complete N/A Not Done (details) Implement initial IPC measures (refer to NZ OBM Sheet C and AHS IPC Continuing care manual - Strict Hand Hygiene (education) and appropriate PPE - Restriction of Symptomatic Residents - Staffing (includes volunteers, students) e.g. excluding symptomatic staff from working NZ OBM FAQs sheet - Communication - Signage posted, NZ OBM visitor information sheet - Cancel/Postpone Group/Social Activities and Non-Resident Events Staff aware of responsibilities and protocol during outbreak Education on how to complete daily line list Staff completes daily lines lists and faxes to NZ CDC Facility staff- Completes NZ OBM Antiviral Worksheet Facility must report number of asymptomatic residents prescribed antiviral prophylaxis (names not required) Facility reports number of residents and staff that received this seasons influenza vaccine (names not required) Staff aware must Inform NZ CDC (outbreak lead) by direct voice communication of any transfers out (to acute care/er), deaths on line list (Form 20593) next business day Staff aware must advise EMS, ER/acute care, physician office and receiving facility that resident/patient is coming from a facility under Outbreak Staff aware must contact NZ CDC (outbreak lead) for MOH approval prior to accepting admissions, transfers back to facility including hospital discharges 20652(Rev ) Page 4 of 7
5 During ILI Outbreak Required steps Completed N/A Not done (details) Complete and fax daily Public Health Line List Congregate Living (Form 20593) Staffing: Cohort staff as much as possible, recommended work flow is from well residents/patients to ill residents/patients to minimize transmission Staffing during ILI (non-influenza) Remain asymptomatic, IF symptomatic consult MOH for recommendation Staffing: review additional precautions and PPE required Staff aware must Inform NZ CDC (outbreak lead) by direct voice communication of any transfers out (to acute care/er), deaths on line list (Form 20593) next business day Staff aware must advise EMS, ER/acute care, physician office and receiving facility that resident/patient is coming from a facility under Outbreak Staff aware must contact NZ CDC (outbreak lead) for MOH approval prior to accepting admissions, transfers back to facility including hospital discharges Infection control measures in place for all ILI Outbreaks (includes confirmed influenza) Strict Hand hygiene observed Appropriate PPE e.g. for most respiratory outbreaks, In addition to routine practices initiate contact and droplet precautions. Enhanced Cleaning: More than once daily (minimum) frequency of cleaning and Disinfecting high touch surfaces (e.g., doorknobs, light switches, call bells, handrails) in client/ resident rooms, care areas and common areas such as dining areas and lounges Resident room: resident or family assumes responsibility to cleaning/disinfecting items that housekeeping do not support Cancel facility Personal services e.g. hairdresser, foot care 20652(Rev ) Page 5 of 7
6 Confirmed Influenza Completed N/A Not done (details) Staffing during a confirmed Influenza outbreak: All staff present can continue to work if: Asymptomatic and immunized greater than14 days prior to outbreak Asymptomatic not immunized or immunized less than 14 days prior to outbreak receive immunization and antiviral prophylaxis for 14 days after immunization. Asymptomatic- Refuse/or unable to receive immunization, must continue antiviral prophylaxis for duration of outbreak Staff Restrictions from work Not immunized or immunized less than 14 days prior to outbreak/ asymptomatic agree to immunization, decline antiviral prophylaxis are excluded for 3 days from last day of working at outbreak site, may be reassigned for 14 days to another site if asymptomatic Not immunized/asymptomatic refuse immunization, decline antiviral prophylaxis are excluded for 3 days from last day of working at outbreak site, may be reassigned to another site if asymptomatic for duration of outbreak Symptomatic staff-exclusion e.g. generally 5 days, AHS staff will consult OHN, non-ahs staff as per MOH recommendation Staffing immunization or antivirals Staff are responsible for obtaining their own Rx for antivirals: - AHS through WHS, - non-ahs through family physician Distribute resident antiviral info letter prepared by NZ CDC Complete NZ OBM Antiviral Worksheet (if not done) - Asymptomatic resident, with no change in health status and an advance antiviral prophylaxis Rxnotify pharmacy - Asymptomatic resident with no advance antiviral prophylaxis recommendation must be referred to prescriber - Resident, with any change in health status must be assessed by physician for appropriate diagnosis and treatment recommendation 20652(Rev ) Page 6 of 7
7 Confirmed Influenza - continued Completed N/A Not done (details) Residents symptomatic with ILI (or confirmed influenza) do not qualify for antivirals through public health: notify residents attending physician Seasonal Influenza Immunization if not received prior to outbreak should be arranged with Public Health for both staff and residents Outbreak Declared Over Completed N/A Not done (details) MOH will declare outbreak over, based on time from onset of last reported symptomatic resident for a period of two disease specific incubation period. Complete and submit Public Health Line List Congregate Living (Form 20593) Continue surveillance, report to NZ CDC if there is increase in illness. Outbreak signage can be removed (Rev ) Page 7 of 7
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