Identifying and reporting a respiratory outbreak in long term care and retirement homes

Assess if you have a respiratory outbreak

A suspect respiratory outbreak exists when you have:

• Two cases of acute respiratory infections (ARI) occurring within 48 hours with any common epidemiological link (e.g., unit, floor);

OR

• One laboratory-confirmed case of influenza

A confirmed respiratory infection outbreak exists when you have:

• Two cases of ARI within 48 hours with any common epidemiological link (e.g., unit, floor), at least one of which must be laboratory-confirmed;

OR

• Three cases of ARI (laboratory confirmation not necessary) occurring within 48 hours with any common epidemiological link (e.g., unit, floor);

Case definition:

Clinically compatible signs and symptoms in individuals who are part of an outbreak include, but are not limited to, the following:

• Upper respiratory tract illness (e.g., common cold, pharyngitis);
• runny nose or sneezing;
• Stuffy nose (i.e., congestion);
• Sore throat or hoarseness or difficulty swallowing;
• Dry cough;
• Swollen or tender glands in the neck (i.e., cervical lymphadenopathy);
• Fever/abnormal temperature for the resident/patient may be present, but is not required;
• Tiredness (i.e., malaise);
• Muscle aches (i.e., myalgia);
• Loss of appetite;
• Headache; and
• Chills.

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

Identify pathogen

• Collect nasopharyngeal (NP) swabs from symptomatic residents within 48 hours of symptom onset or as directed by OPH
• Ensure samples have 2 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 laboratory

Implement outbreak control measures immediately

• Do not wait for confirmation of pathogen involved
• Isolate ill residents (5 days or until symptom free)
• Exclude ill staff (5 days or until symptom free)
• 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 a respiratory outbreak

Upon consultation with OPH, respiratory outbreaks can be declared over if there is no new case eight days after the onset of symptoms of the last case

An outbreak may be terminated earlier in consultation with OPH