Long Term Care Respiratory Outbreak Worksheet Edmonton Zone

Transcription

1 Long Term Care Respiratory Outbreak Worksheet Edmonton Zone Page 1 This worksheet is provided as an optional tool for use during respiratory outbreaks in Long Term Care facilities in Edmonton Zone. This worksheet is indicated for use by the Infection Control Designate (ICD) for the Long Term Care facility on outbreak. It is intended to help guide the actions of the ICD during a respiratory outbreak. It can also be used to delegate tasks and track progress if several individuals will be completing tasks related to outbreak management. Tasks can be dated and initiated as they are completed. Site can also choose to simply check off the tasks as they are completed. This worksheet is not mandatory, and sites who have developed other tools to guide outbreak follow up can continue to use their own tools. This worksheet is intended as a complement to, not a replacement for, the outbreak manual. The outbreak manual is available online at: The tasks listed in this worksheet are generally applicable to respiratory outbreaks. The Public Health Outbreak Lead and / or the AHS Infection Control Practitioner may provide different or additional recommendations based on the circumstances of each outbreak. Individuals contacted when a task indicates to notify / advise / discuss with site would be dependent on set up at facility. Individuals contacted could include any combination of building nursing staff, site leadership and casual staff. Your judgment and understanding of the key stakeholders is critical to ensure all relevant stakeholders are informed. Note: We have attempted to differentiate between references to sections within this worksheet and references to the outbreak manual. Sections and appendixes in the worksheet are lettered, while sections and attachments in the outbreak manual are numbered. In addition, all references to the outbreak manual will be italicized. Site name: Site address: EI number:

2 Section A: Reporting a Suspected Outbreak Page 2 outbreak. Edmonton Zone ILI case definition: New cough or change in an existing cough PLUS one or more of the following: fever, sore throat, myalgia (muscle aches), arthralgia (joint aches) or prostration (extreme fatigue). Note: This definition is slightly different (more sensitive) than the definition in the provincial outbreak manual. ILI outbreak definition: 2 or more cases of ILI within a 7 day period, with a common epidemiological link (e.g. same location or same care giver, and evidence of transmission within the unit or site). For more information about ILI and outbreak case definitions, as well as on reporting an outbreak, review Section I.3 Case and Outbreak Definitions (p. 14) and Section I.4 Reporting a Suspected Outbreak (p. 15). ICD to assess whether resident cases meet ILI case definition, and whether the unit / site meets ILI outbreak definition. If the case and outbreak definitions are met, ICD to collect the information required to open an outbreak. See Appendix A: Initial GI or Respiratory Outbreak Data Guidance Document for information requirements. Also begin documentation on Case Listing. Note: Try to have all the information available before calling Public Health, but do not delay more than 4 hours after being notified of a suspected outbreak. ICD to call Public Health to report the suspected outbreak. Note: During the week, report via the Outbreak Pager at During weekends and statutory holidays, contact the Medical Officer of Health on call at Outbreaks should generally be reported between 0830 and ICD to ensure that symptomatic residents are isolated in their room and placed on contact and droplet precautions as soon as illness is identified.

3 Section B: Initial Outbreak Control Measures Page 3 You have been advised by Public Health that your site has an outbreak AND No specimens have been collected yet OR specimens are pending. For more information about initial outbreak control measures, see Section I.5 Initial Infection Prevention and Control (IPC) Measures (starting on p. 17). ICD to notify stakeholders that facility is on outbreak. Stakeholders may include: facility management/medical lead/on site staff; corporate Infection Control Practitioner (ICP) if available; WHS; and any others required. ICD to notify AHS Facility Living IPC and request a site visit. ICD to provide front line staff with a copy of Appendix B: Initial Outbreak Control Measures (Site Staff). ICD to reinforce outbreak control measures, including: - Hand hygiene - Restriction and isolation of symptomatic residents - Environmental cleaning - Surveillance and reporting of cases - Communication (including posting outbreak signage) If Public Health has agreed to limit the outbreak to a particular unit or floor, ICD to ensure that all staff (including, but not limited to, night nurses, housekeeping, food service, and OT/PT) are cohorted to outbreak area. ICD to attempt to arrange for immunized staff members to care for symptomatic residents. ICD to determine whether congregate activities will be cancelled, or will continue. Note: Public Health does not require that congregate activities be cancelled at this time in the outbreak, but it may help to limit the spread of the outbreak. ICD to arrange for outbreak specimen collection. Note: Ensure that EI number listed on requisition. Public Health will provide direction on the number and type of specimens. ICD to determine who will complete daily case listing. If ICD chooses to delegate this task to another staff member: review instructions for completing case listing with designate; request a copy of daily case listing; and complete quality checks on information submitted. Daily case listing should be faxed to by ICD to ensure a consistent, timely process exists at the facility for reporting cases of ILI, hospitalization and deaths to the person completing the daily case listing. All of this data must be reported on the daily line listing by ICD to verify that site has an up-to-date list with the immunization status for residents and staff, as well as status of resident orders for Tamiflu.

4 Section C: Non-Influenza Pathogen Confirmed Page 4 You have been advised by Public Health that outbreak specimens are positive for a non-influenza pathogen (RSV, parainfluenza, HMPV, entero / rhino, or coronavirus) For more information about pathogen specific recommendations, see Section I.6 Other Respiratory Organisms Commonly Associated with ILI (p. 20) and Table 6: Organisms Commonly Associated with ILI (p. 21). Note: No restrictions or prophylaxis are typically recommended for a non-influenza outbreak. However, Public Health may make recommendations for either on a case-by-case basis. ICD to discuss results with Public Health and determine the outbreak control measures required. ICD to advise site staff, as required, of: - incubation period - period of communicability - length of isolation of affected residents ICD to discuss if there are any indications for further specimens with Public Health and advise site of recommendations. ICD to discuss tentative lift date with Public Health and advise site of date.

5 Section D: All Specimens Tested Negative Page 5 You have been advised by Public Health that all outbreak specimens are negative for influenza and RVP testing. If a resident meets case definition, they would continue to be considered as a case for the outbreak even if they swab negative for all pathogens. Even if all outbreak specimens are negative, the site continues to be on respiratory outbreak until otherwise advised by Public Health. Note: No restrictions or prophylaxis are typically recommended for a non-influenza outbreak. However, Public Health may make recommendations for either on a case-by-case basis. ICD to discuss results with Public Health and determine the outbreak control measures required, including: - Length of isolation for symptomatic residents ICD to advise site staff, as required, of the specimen results. ICD to ensure ongoing management of residents with negative specimens as infectious and as cases in the outbreak. ICD to ensure collection of additional specimens with the EI number for any newly affected residents going forward. ICD to discuss tentative lift date with Public Health and to advise site staff of same.

6 Section E: Influenza A or B Confirmed Page 6 You have been advised by Public Health that at least one outbreak specimen is positive for influenza A or B. For more information about influenza specific recommendations, see Section II Confirmed Influenza Outbreak Management (p. 29) and Section III Post Exposure Antiviral Chemoprophylaxis Guidelines During Influenza Outbreaks (p. 44). ICD to discuss results with Public Health and determine the outbreak control measures required. Also discuss whether any further specimens are required. ICD to advise site staff, as required, of influenza information: - incubation period (1-3 days) - period of communicability (usually 3-5 days, up to 7 days in children) - length of isolation of affected residents (5 days after onset of symptoms OR until they are over acute illness and afebrile for 48 h) ICD to ensure implementation Tamiflu prophylaxis for all residents (regardless of immunization status). ICD to ensure that unimmunized staff members start Tamiflu prophylaxis. See Attachment I.1 WHS Algorithm (p. 43 of outbreak manual) for complete info about staff management and staff exclusion based on immunization status and / or Tamiflu acceptance. ICD to implement restrictions to admissions, transfers and discharges. ICD to ensure that staff notify transport (EMS) and receiving site if a resident is being sent to the ER. ICD to ensure completion of the Risk Assessment Worksheet (p. 24 of outbreak manual, also available on the outbreak website) if an admission, transfer or discharge is being requested due to urgent need. ICD to work with resident physicians to arrange treatment doses of Tamiflu for symptomatic residents. ICD to ensure cancellation all group / social activities. ICD to discuss tentative lift date with Public Health and then advise partners of tentative lift date. Partners may include Bed Hub or Facility Living leadership.

7 Page 7 Section F: Declaring the Outbreak Over outbreak. Although Public Health will provide advice about the tentative lift date for an outbreak, the ICD must connect with Public Health in order to declare an outbreak over. The outbreak cannot be declared over until ordered by the Medical Officer of Health. ICD to review all line listings and confirm: - completeness of resident info - accuracy of resident onset dates - number of hospitalizations and deaths - cumulative staff and resident case totals - last onset date. ICD to notify Public Health if any corrections required to line lists. ICD to connect with Public Health to confirm that outbreak can be declared over. ICD to ensure ongoing high quality surveillance and to contact Public Health if additional cases are seen within 7 days of closing the outbreak. For influenza outbreaks: ICD to discuss with Public Health whether Tamiflu prophylaxis can be immediately stopped, or whether additional doses of Tamiflu may be indicated beyond the end of the outbreak. For influenza outbreaks: ICD to advise Public health of pre-outbreak staff and resident immunization rates. For influenza outbreaks: ICD to ensure that partners (such as Bed Hub and Facility Living leadership) are aware that the outbreak is over and that admissions, transfers and discharges can resume. If any there were any notable successes or challenges during the outbreak, ICD to determine whether to schedule a debrief with the outbreak management team to capture any lessons learned and to provide suggestions for future outbreaks.