Respiratory Outbreak Update,

Transcription

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2 Respiratory Outbreak Update, Annual Toronto Fall LTC IPAC Education Day Nov 2, 2016 Dr. Irene Armstrong Associate Medical Officer of Health

3 Objectives Review respiratory outbreak season in Toronto Highlight what is new & provide a few reminders Discuss steps to prevent, detect, report and manage respiratory outbreaks Provide helpful resources

4 Communicable Disease Reporting Communicable Disease Reporting List

5 Toronto Epidemiology

6 Toronto Epidemiology

7 Toronto Epidemiology

8 Respiratory Outbreaks in Toronto LTCHs, Compared to Previous 5 years Variable Mean (range) # outbreaks (73-199) # cases 1,694 2,470 (1,362-4,005) # cases per outbreak ( ) # deaths (24-109)

9 Toronto Epidemiology

10 Toronto Epidemiology

11 Toronto Epidemiology

12 Immunizations Long Term Care Act and its Regulation states residents must be offered immunizations: Influenza, every fall Pneumococcus, tetanus and diphtheria in accordance with publicly funded schedule Ontario Publicly Funded Immunization Schedule

13 Influenza Vaccine Strains A/California/7/2009 (H1N1)pdm09-like virus A/Hong Kong/4801/2014 (H3N2)-like virus B/Brisbane/60/2008-like virus (B/Victoria lineage) B/Phuket/3073/2013-like virus (B/Yamagata lineage)* Publicly funded vaccines (18 years and older) : o Agriflu o Fluviral o Influvac Fluad for LTCH residents 65 years of age * Quadrivalent vaccine only

14 Immunizations Influenza Vaccine Effectiveness

15 Immunization Influenza vaccination of HCW s In the absence of contraindications, refusal of HCWs who have direct patient contact to be immunized against influenza implies failure in their duty of care to patients. National Advisory Committee on Immunization

16 NEW HCW Influenza Immunization Coverage Rates in Healthcare Facilities - online Flu Shot Rates in Healthcare Facilities

17 Immunizations Pneumococcal polysaccharide 23-valent (Pneu-P-23) vaccine (one dose) is recommended for: All adults 65 years of age and older Residents of long-term care homes

18 Immunizations Additional dose Pneu-P-23 recommended 5 years after first dose, if resident has : Asplenia or sickle cell disease Hepatic cirrhosis Chronic renal failure or nephrotic syndrome HIV Immunocompromised related to disease or therapy

19 Immunizations Tetanus and Diphtheria (Td) Booster every 10 years Adults are eligible for one Tdap (tetanus, diphtheria, pertussis) dose after the adolescent Tdap dose

20 NEW Immunizations Herpes zoster (shingles) vaccine is now publicly funded for persons years old Person born in 1945 can receive the vaccine through a one time catch up program ending December 31, 2016 Vaccine can be ordered from Ontario Government Pharmacy along with routine vaccine orders

21 TB Admission Screening Long Term Care Act and its Regulation states: Each resident admitted to the home must be screened for TB within 14 days of admission (unless resident was screened within 90 days prior to admission and has documented results)

22 TB Admission Screening Purpose: Identify and prevent a person with active TB from entering the facility and potentially transmitting TB to others

23 TB Admission Screening Screening recommendations for residents: Symptom review Chest x-ray NOT TST Screening recommendations for staff: TST at time of hiring Recommendations for TB Screening in LTC & RH

24 NEW Viral Testing

25 NEW PHO Laboratory Testing

26 NEW PHO Laboratory Testing cont d

27 NEW PHO Laboratory Testing cont d

28 Outbreaks Prevention, Detection, Management

29 Preparation/Prevention Review MOHLTC Guide for respiratory infection outbreak management Follow CHIIN Guide for successful staff flu immunization programs Review & update relevant policies & procedures Ensure adequate & accessible supply of PPE Ensure you have non expired NP swabs & kits Know your TPH Liaison

30 Preparation/Prevention cont d Provide staff education: respiratory illness, Routine Practices and Additional Precautions (hand hygiene, PPE); cleaning, sterilization & disinfection; environmental cleaning; and immunization Audit practices (hand hygiene, cleaning) Advise that ill staff should stay home & notify OHS of illness Provide education of residents and volunteers: stay home if ill, respiratory etiquette, hand hygiene Provision of pneumococcal & flu vaccines

31 Detection Surveillance is the on-going systematic collection, collation, analysis and interpretation of data; and the dissemination of this data to those who need to know Takes place 24/7, including weekends and holidays Be done for both residents AND staff Helps establish baseline information about frequency and types of information so you can identify deviations May be heightened during respiratory season

32 Detection cont d Staff should be aware of: symptoms of respiratory illness, criteria for a suspected outbreak, and how to report to the ICP (residents) and their OHS (staff) ICP must be aware of all cases and analyze info to determine if actions required Self-screening for visitors, contractors, etcetera

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34 Report suspect or confirmed outbreaks to TPH During business hours: CID-LRCT East CID-LRCT West CDLU After 4:30 pm and on holidays/weekends, call (within City of Toronto) (from outside the City of Toronto)

35 Management Determine if an outbreak exists Review the MOHLTC respiratory outbreak definitions May be determined by the LTCH or in conjunction with public health Unit/ward or facility-wide

36 Confirmed Respiratory Outbreak Definition in a LTCH Two cases of acute respiratory infection (ARI) within 48 hours, at least one of which must be lab-confirmed OR Three cases of ARI occurring within 48 hours in a geographic area (e.g., unit, floor) OR More than two units having a case of ARI within 48 hours Ontario Respiratory infection Outbreak Case Definitions

37 Suspect Respiratory Outbreak Definition in a LTCH Two cases of ARI occurring within 48 hrs in a geographic area (e.g., unit, floor) OR More than one unit having a case of ARI within 48 hours Ontario Respiratory Infection Outbreak Case Definitions

38 Suspect Influenza Outbreak Definition One laboratory-confirmed case of influenza OR Two cases of ARI occurring within 48 hours in a geographic area (e.g., unit, floor) OR More than one unit having a case of ARI within 48 hours Ontario Respiratory Infection Outbreak Case Definitions

39 Management Confirm the Diagnosis Ensure specimen collected in appropriate kit Check expiry dates of swab & kit Ensure proper completion of the OPHL lab requisition: Patient setting Outbreak number Travel history Date of symptom onset Public Health Ontario General Test Requisition

40 Management Create an outbreak case definition Case definition should include: Clinical signs and symptoms Time of onset of illness Location of resident or staff Example: A resident or staff member on unit 2D of ABC LTCH with illness onset from January 15 who is experiencing two of more of the following signs and symptoms: cough, fever, headache, chills, sore throat, lethargy, or muscle aches

41 Management Create a line list & start epi curve

42 Management Implement infection prevention & control measures Contact and droplet precautions Readily available personal protective equipment (e.g., facial protection, gloves, gowns) Ill residents remain in room, if possible Hand hygiene Environmental cleaning Close outbreak-affected area to new admissions Communicate to staff, residents and visitors PIDAC Best Practice documents: spx

43 Establish an Outbreak Management Team Establish multidisciplinary OMT Purpose to direct and oversee all aspects of the outbreak Determine frequency and type of meeting Identify a media spokesperson

44 Management Influenza detected Begin AV prophylaxis Residents Well- AV prophylaxis regardless of vaccine status Ill treatment dose* Well Staff Vaccinated > 14 days no AV Vaccinated < 14 days AV prophylaxis** Un-vaccinated AV prophylaxis Ill staff exclude from work * Do not delay while awaiting test results ** Until 2 weeks after flu vaccine given or outbreak declared over, whichever shorter

45 Management cont d Ongoing surveillance for new cases Monitor status of ill residents & staff Update line list & epi curve Ongoing monitoring of precautions and control measures (audit cleaning & HH) Report any significant changes in nature of outbreak (e.g., hospitalizations, deaths, changes in clinical presentation)

46 Management Declare the Outbreak Over No new cases for the period of communicability plus one incubation period of the causative organism Consider: organism, complications, deaths, last case in staff or resident General rule: 8 days from onset of last case in resident or 3 days from the last day of work in an ill staff person, whichever is longer

47 Questions?