Identifying and reporting an enteric outbreak in long term care and retirement homes

Assess if you have an enteric outbreak

An enteric outbreak exists when you have:

• Two or more cases meeting the case definition with a common epidemiological link (e.g. specific unit or floor, same caregiver) with initial onset within a 48 hour period.

Case definition:

Symptoms must not be attributed to another cause (e.g. medication side effects, laxatives, diet or prior medical condition) and at least one of the following must be met:

• Two or more episodes of diarrhea (i.e. loose/watery bowel movements) within a 24-hour period

OR

• Two or more episodes of vomiting within a 24-hour period;

OR

• One or more episodes of diarrhea AND one or more episodes of vomiting within a 24-hour period.

If yes, report to Ottawa Public Health

Notify Ottawa Public Health (OPH) at 613-580-2424, ext 26325 from 8:30 am to 4:30 pm or 3-1-1 outside regular business hours, on weekends or statutory holidays

When an enteric outbreak is confirmed by OPH, fax the Enteric Outbreak Line Listing to OPH at 613-580-9649 on a daily basis, until the outbreak is declared over by OPH.

Identify pathogen

• Collect stool samples from symptomatic residents as directed by OPH
• Ensure samples have two resident identifiers on the sample bottle and requisition (for example, name and date of birth)
• Ensure samples are kept refrigerated
• Call OPH to pick up and deliver the samples to the Public Health Ontario Laboratory

Implement outbreak control measures immediately

• Do not wait for confirmation of pathogen involved
• Isolate ill residents
• Exclude ill staff
• Wear appropriate personal protective equipment (PPE) when providing care to ill residents
• Ensure adequate and frequent hand washing
• Notify internal and external partners of outbreak (including volunteers)
• Ensure staff within the facility are aware of the outbreak
• Post signs at the facility entrances and affected units
• Enhance environmental cleaning and disinfection (at least twice daily)
• Modify activities on affected units as appropriate
• Discuss any transfers or new admissions of residents with OPH
• Keep visitors and volunteers to a minimum
• Ensure active surveillance for new cases and report all new cases on the daily line listing to OPH

Termination of an enteric outbreak

Upon consultation with OPH, declare an outbreak over if there is no new case 48 hours after the last case is symptom free.

Note: Norovirus outbreaks are declared over five days after the onset of the last case.