Management of Gastroenteritis Outbreaks. Approval Signature: Date of Approval: March 4, 2010 Review Date: March 2013

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1 Personal Care Home/Long Term Care Facility Infection Prevention and Control Program Operational Directive Management of Gastroenteritis Outbreaks Approval Signature: Date of Approval: March 4, 2010 Review Date: March 2013 Page 1 of 6 Supercedes: Management of Gastroenteritis Outbreaks Approved February 17, 2004 (DOCs) Approved June 2005 (Executive Directors) 1.0 PURPOSE: 1.1 To promptly identify, communicate and manage possible or real outbreaks of gastroenteritis to prevent further transmission in the personal care homes/long term care facilities (PCH/LTCF), within the Winnipeg Regional Health Authority (WRHA), according to WRHA Policy, Outbreak Management for Infection Prevention & Control # DEFINITIONS: Data Collection: The collection of pertinent information to assist the PCH/LTCF in determining the extent of illness if a communicable disease outbreak is suspected. Diarrhea: Passing of loose (loose stool is defined as that which takes the shape of the container that holds it) or watery stools. (Appendix F). Gastroenteritis: Two or more loose or watery stools above what is normal for the resident within a 24 hour period and/or two or more episodes of vomiting in a 24-hour period; or both of the following: a stool culture positive for a pathogen and at least one symptom or sign compatible with gastrointestinal tract infection (nausea, vomiting, abdominal pain or tenderness, diarrhea). 2.4 Gastroenteritis Outbreak: Two or more persons in a facility who meet the definition of gastroenteritis. The occurrence of cases of residents with gastrointestinal illness in a particular area and period of time, which is in excess of the expected number of cases. Operational Directive: Management of Gastroenteritis Outbreaks_ Approved March

2 PCH/LTCF Operational Directive: Management of Gastroenteritis Outbreaks Page 2 of Outbreak: The occurrence in a facility/unit of cases of an illness with a frequency clearly in excess of normal expectancy. The number of cases indicating presence of an outbreak will vary according to the infectious agent, size and type of population exposed, previous experience or lack of exposure to the disease, and time and place of occurrence. Therefore, the status of an outbreak is relative to the usual frequency of the disease in the same facility/unit, among the same population, at the same season of the year. 2.6 Outbreak Code: The code assigned by Cadham Provincial Laboratory (CPL), at the request of the WRHA, Population and Public Health - Communicable Disease Coordinator. This code is used to identify the specimen(s) as part of a specific outbreak. 3.0 OPERATIONAL DIRECTIVE: 3.1 In the event a gastroenteritis outbreak is suspected and/or confirmed within a personal care home, the procedure for Management of Gastroenteritis Outbreaks shall be implemented. 4.0 PROCEDURE: 4.1 Assess residents for signs/symptoms of gastroenteritis unrelated to an infectious disease process. Take into consideration the individual's normal bowel routine, possible side effects of medication and other circumstances or symptoms that may assist with a diagnosis. 4.2 Collect data using the Gastroenteritis Outbreak Worksheet (Appendix A) when a gastroenteritis outbreak is suspected. 4.3 Notify the Infection Control Professional/designate. 4.4 Review and reinforce Routine Practices including hand hygiene with all staff. 4.5 Implement Contact Precautions if gastroenteritis is suspected Hand Hygiene: Follow Routine Practices Ensure adequate hand hygiene products are available Encourage residents and visitors to perform hand hygiene.

3 PCH/LTCF Operational Directive: Management of Gastroenteritis Outbreaks Page 3 of Personal Protective Equipment Wear gloves if contact with feces, vomitus, or contaminated surfaces is likely. Remove gloves before leaving resident room/space and perform hand hygiene after removal of gloves Wear gown if contamination of clothing is likely. Remove gown before leaving resident room and perform hand hygiene after removal of gown Wear surgical/procedural mask if splash or spray from body fluids (vomitus) is likely. Remove mask immediately after leaving resident room and perform hand hygiene after removal of mask Accommodation/Cohorting/Activities Single room is preferred. If a single room is not available, cohort residents with same organism if possible. If multi- bed room ensure at least a 1 metre space between beds. The affected resident(s) require dedicated toileting Restrict contact between affected and unaffected residents for at least 48 hours after symptoms have resolved. Restrict residents with acute gastrointestinal symptoms to their room as much as possible until symptoms have subsided Minimize communal gathering of unaffected residents. If outbreak continues to spread throughout the facility closing communal areas and cancelling group activities may need to be considered. Residents may have to be restricted to the unit. Consult the infection control practitioner/designate for duration of restriction Equipment Allocate dedicated equipment to infected residents. Clean visibly soiled equipment immediately. Clean and disinfect equipment prior to removing equipment from the room If equipment can not be dedicated ensure equipment is cleaned and disinfected prior to using for another resident.

4 PCH/LTCF Operational Directive: Management of Gastroenteritis Outbreaks Page 4 of Staff responsible for cleaning contaminated equipment must wear appropriate PPE Environment Increase environmental cleaning using a facility approved disinfectant. Pay particular attention to bathrooms and toilets and to frequently touched areas such as door handles, taps, light switches, call bells, side rails Use separate cleaning cloths and mop heads for cleaning toilets and bathrooms or soiled areas. Discard cloths and mop heads after use. Non disposable cloths and mop heads are put in the laundry and should be washed with detergent in hot water at the maximum cycle length (recommended 71 degrees C for 25 minutes) then machine (hot air) dried If toilet brushes are used, discard after precautions are discontinued Staff responsible for environmental cleaning must wear appropriate PPE Laundry Dishes Follow Routine Practices Follow Routine Practices Garbage Follow Routine Practices. 4.6 The site Infection Control Professional (ICP)/designate shall: Notify WRHA, Population and Public Health Communicable Disease Coordinator, responsible for your facility, of the outbreak to obtain an outbreak code and direction for specimen collection Notify Manager, PCH Infection Prevention & Control Program at Phone # of the outbreak Complete the Manitoba Health Initial Outbreak form (Appendix C) and forward the completed form to:

5 PCH/LTCF Operational Directive: Management of Gastroenteritis Outbreaks Page 5 of 6 WRHA, Population and Public Health - Communicable Disease Coordinator fax # (204) Manager, PCH Infection Prevention & Control Program fax # (204) Manitoba Health fax # (204) Complete the Report of a Suspected Gastroenteritis Outbreak in a Long Term Care Facility form (Appendix B) and the Gastroenteritis Outbreak Worksheet (Appendix A) daily until outbreak is over, indicating new cases only. Forward the completed forms daily to: WRHA, Population and Public Health -Communicable Disease Coordinator fax # (204) Manager, PCH, Infection Prevention & Control Program fax # (204) Collect specimens as required (see Appendix D) Complete the laboratory requisition with all necessary information. Put the outbreak code on the requisition(s) in the clinical diagnosis section. Attach the requisition number and resident name to the specimen container Ensure proper storage of specimens and transport to Cadham Provincial Laboratory as soon as possible. If sending specimen after hours, instruct the transporter to ring door bell at entrance; security will answer and take the specimen to laboratory. 4.8 Drugs/agents, which inhibit gastrointestinal motility i.e.: Imodium, codeine and morphine should be used with caution. However, the decision whether to use or discontinue the use of these drugs/agents is a medical decision. 4.9 Transfers to other facilities Inform the receiving facility of the outbreak when transferring a resident(s) for admission or medical appointment Visitor and Volunteer Control Measures Post signs to notify persons entering the facility of the Outbreak.

6 PCH/LTCF Operational Directive: Management of Gastroenteritis Outbreaks Page 6 of Instruct visitors/volunteers to perform hand hygiene upon entering and leaving the facility Instruct visitors/family care givers on measures to take to decrease the transmission of illness Discourage ill individuals from visiting When the outbreak has ended, the site ICP/designate shall complete the Manitoba Health Final Outbreak Report form (Appendix E) and forward the completed form to: WRHA, Population and Public Health -Communicable Disease Coordinator fax # (204) Manager, PCH Infection Prevention & Control Program fax # (204) Manitoba Health Fax # (204) REFERENCES 5.1 Australian Government, Department of Health and Ageing, Gastro-Info Gastroenteritis Kit for Aged Care. 5.2 Manitoba Health and Healthy Living, Communicable Disease Control Unit (September 2006). Communicable Disease Management Protocol, Clostridium difficile-associated Diseases (CDAD). 5.3 Manitoba Health and Healthy Living, Communicable Disease Control, Enteric Illness Protocol, March WRHA PCH IP&C Manual, Disease Specific Protocol, Diarrhea. Operational Directive Contact: Betty Taylor, Manager, PCH Infection Prevention & Control