(GI) Infection Outbreak Guidelines

Gastrointestinal (GI) Infection
Outbreak Guidelines
for Health Care Facilities
September 2015
Objectives
 Recognize
 Early recognition of GI infection outbreak
 Report
 Prompt reporting of outbreak to CD Unit and other
appropriate people
 React
 Swift reaction with appropriate outbreak control measures
 Ready
 Be ready. Be prepared at the beginning of outbreak season with
the right supplies. Use Routine Practices and good hand
hygiene at all times to prevent outbreaks before they start.
2
9/24/2015
Recognize – What is Gastrointestinal (GI) Infection?
 Gastrointestinal (GI) Infections are
illnesses that cause diarrhea and
vomiting
 Can be caused by bacteria (like
Salmonella) or viruses (like Norovirus)
 Most common cause of GI outbreaks in
Residential Care is Norovirus
3
9/24/2015
How GI Illness Spreads
Direct contact – Touching mouth (or food)
with unwashed hand after direct contact
with infected person (or their vomit or stool)
Indirect contact - Unwashed hands after
contact with contaminated object or shared
equipment that is not cleaned after each use
Possible aerosols created during vomiting or
toilet flushing get in your mouth
-
Ingestion - Eating or drinking contaminated
food or drink
4
9/24/2015
Recognize
Diarrhea or Vomiting
 If you notice three or more
residents or staff with diarrhea
or vomiting in four days, it may
be a Gastrointestinal (GI)
Infection Outbreak.
 Report it to your supervisor!
5
9/24/2015
Recognize
Gastrointestinal (GI) Outbreak Definition
Three (3) or more cases of GI infection within the same setting
(e.g. unit, ward, wing or facility) in a four (4) day period
6
9/24/2015
Recognize
7
9/24/2015
Rule Out….
Rule out other causes…
Check over the resident/patient’s chart to see if illness
may be attributed to laxative use, a new medication, diet
or a prior medical conditions
8
9/24/2015
Recognize
Note: If there are one or two cases of GI infection but
the outbreak definition has not yet been met, the facility
should still implement some control measures, including:
 Segregation of symptomatic residents
 Use of Routine Practices and Contact Precautions for
direct patient care
 Hand Hygiene!
 Increase monitoring and recording of GI symptoms in
residents and staff
9
9/24/2015
Report
If case definition is met, then the facility
must declare a GI Infection outbreak.
10
9/24/2015
Report
Report the outbreak to the
IH Communicable Disease (CD) Unit
Call 1-866-778-7736
Complete the IH RI and GI Outbreak Report Form
and sent to the CD Unit
email cdunit@interiorhealth.ca or fax to 250-549-6310
11
9/24/2015
Report - Initial
 ADD SLIDE OF REPORT FORM
12
9/24/2015
Report - Initial
Total number of
beds
(filled & unfilled)
If outbreak is
confined to
one unit that is
physically
separated and
has separate
staff, fill out
this section
Number of people
who meet case
definition on day
outbreak is declared
Total number of
residents (not beds)
13
9/24/2015
Report
Notify the following partners of the outbreak:
 Facility Licensing Officer
 Infection Control Practitioner (if one is
assigned)
 Manager, Care Coordinator or designate
 Medical Director of the facility and other
physicians
 Other service providers
 HandyDART, lab services, BC Ambulance,
haemodialysis units, oxygen service provider,
pastoral care, etc…
14
9/24/2015
Daily Reporting
Ongoing Daily Reporting to the CD Unit is
Required.
Complete Section B of the IH RI and GI Outbreak Report
Form daily
Fax to the CD Unit at 250-549-6310 or email to
cdunit@interiorhealth.ca
**New Field**
Total Number of Vacant Beds
(Report number of beds vacant and unable to fill due to outbreak
measures)
15
9/24/2015
Daily Reporting
16
9/24/2015
Daily Reporting
17
Please ensure your
math adds up!
9/24/2015
React – Lab Specimens
Notify PHSA Labs
 Nursing Staff to Complete PHSA(BCCDC) GI
Disease Outbreak Notification Form and FAX to
1-604-707-2607 prior to sending samples
 Form found on Quick Reference Guide: GI
Infection Outbreak Guidelines for Health Care
Facilities
18
9/24/2015
 Outbreak Identification
instructions on back of
form – Facility/ward or
‘neighborhood’/year
 Specimens collected
are also documented
on this form
19
9/24/2015
React – Lab Specimens
Collect & Send Specimens
 Collect specimens – stool and/or vomitus from cases
within 3 days of symptom onset and send to BCCDC
same day if possible
 Form found on Quick Reference Guide: GI
Infection Outbreak Guidelines for Health Care
Facilities
20
9/24/2015
 IH CD Unit (C09768) is
entered in the
ADDITIONAL COPIES TO:
field
 Facility OUTBREAK
IDENTIFICATION Number
is written on lab
requisition
21
9/24/2015
React – Control Measures
Routine Practices &
Additional Precautions
 Routine Practice and Droplet Contact
Precautions until asymptomatic for 48
hours
 PPE – gloves, gown, surgical/procedure
mask and eye protection.
 Remember – the outside of your PPE is
contaminated, so remove it and wash
your hands BEFORE leaving the
room/area.
 Hand Hygiene
22
9/24/2015
React – Control Measures
Symptomatic Resident/Patient placement
Acute
 Single room with toilet & sink or cohort
 Limit movement; patient to stay in room
Residential
 Stay in room if possible and serve meals in room
 Designate toileting facility/equipment for ill resident
 Discontinue group activities in outbreak location
 If acute care transfer or medical appointment
required, notify receiving facility and transport services
23
9/24/2015
React – Control Measures
Restrictions
 Do not transfer well residents into rooms with ill
residents or residents from ill wings into well wings
 Consult CD Unit/MHO regarding closures of units or
facilities and transfers from acute to residential sites
(re-admissions)
24
9/24/2015
React – Control Measures
 Staff
 Staff with GI illness must be excluded from work until at
least 48 hours AFTER symptoms have resolved
 Staff from an affected area may work elsewhere as long as
they have not experienced any vomiting or diarrhea
 Visitors & Volunteers
 Limit visit to family/friend only
 Post signage at facility entrance indicating outbreak and
reinforcing hand hygiene
 Ill visitors/volunteers not to visit
25
9/24/2015
React – Control Measures
 Food Services
 Wash dishes in hot water and detergent
 Cleaning
 Areas contaminated with vomit or feces must be cleaned
and disinfected immediately to a radius of 2 metres
 Increase frequency of cleaning/disinfection of common
touch surfaces such as fixtures in bathrooms, handrails,
sink/toilet handles, elevator buttons, tables, nourishment
areas
 Disinfectant product changed to 0.5% Accelerated
Hydrogen Peroxide solution or a1000 ppm bleach
solution (20 mL household bleach added to 1000 mL
water)
26
9/24/2015
Declaring the Outbreak Over
 Outbreak can be declared over 96 hours (4 days) after
the last case started having symptoms
 The facility self-declares the outbreak over
 For IH facilities, the ICP will set up a debriefing with
staff if necessary to identify gaps and lessons learned
 Notify the CD Unit that the outbreak is over
27
9/24/2015
Declaring the Outbreak Over
Complete Part C of the IH RI and GI Outbreak Report Form
and send to the CD Unit
28
9/24/2015
Report - Final
29
9/24/2015
Ready... for the next time
 Keep specimen collection kits on hand at all
times (see next slide for ordering)
 Ensure you have appropriate disinfectant in
stock and staff are trained in its use
 Keep an up to date “Outbreak Box” with
extra PPE, specimen collection kits,
guidelines and documentation tools
 Provide yearly outbreak education to staff
 Use Routine Practices and hand hygiene
diligently to avoid outbreaks
30
9/24/2015
Form used to order
GI Outbreak kits for
specimen collection
– link to form on
page 9 of GI
Outbreak guidelines.
Ensure that a supply
of specimen
containers is kept on
hand as delivery of
kits takes
approximately two
weeks.
31
9/24/2015
Situation # 1
In the past 4 days 5 residents have come down
with bouts of vomiting and/or diarrhea –
starting and stopping, some multiple episodes,
some just one.
What should you do?
32
9/24/2015
What Should You Do?
1. Pull out your Quick Reference: GI Outbreak
2. Start recording residents and symptoms on the GI
Outbreak Surveillance Tool
3. Review residents charts to see if there are any other likely
causes for the diarrhea and to see which residents meet
“case definition”
4. If there are 3 or more residents who meet case definition,
then declare an outbreak
5. Notify CD Unit, Licensing and other partners
6. Collect specimens
7. Implement control measures
8. Follow the Quick Reference: GI Outbreaks
33
9/24/2015
34
9/24/2015
Outbreak Management Toolkit
 Hosted on the Communicable Disease webpage
 Links to the toolkit will be in the Infection Control
Manual/website
 Information is available in multiple ways
 Links within the Outbreak Guidelines or
 Via the toolkit table of contents
35
9/24/2015
36
9/24/2015
37
9/24/2015