Activities during an outbreak

It is important for long-term care homes and retirement homes to assess and modify activities during the course of enteric and respiratory outbreaks to reduce the risk of transmission of infection amongst residents and staff. Each outbreak is unique and the Ottawa Public Health (OPH) investigator assigned to the outbreak will assist you with outbreak management and activity assessment.

Do all activities have to be cancelled during an outbreak?
No, but some activities may have to be cancelled. You should review your list of planned or scheduled activities to assess whether they can continue based on the likelihood that they can cause disease transmission and, if necessary, modify activities to minimize the risks. 
What criteria need to be considered when assessing whether an activity can continue during an outbreak?

You need to consider the following when assessing if an activity can continue during an outbreak:

  • Outbreak status (newly declared or close to termination)
  • Type of facility
  • Type of outbreak (respiratory or enteric)
  • Areas affected by the outbreak (number of units/floors affected or facility-wide)
  • Type of activity and likelihood of transmission through sharing of objects, air space or touching common surfaces
  • Likely source of exposure to illness (food, environmental surfaces, ill staff, visitors, etc.)
  • Effectiveness of outbreak control measures in place
  • Type of agent(s) identified
  • Number of residents and staff affected and requiring modified activities
  • Health status of residents affected
Do third party services such as physiotherapy, foot care, dental care, etc. have to be cancelled during an outbreak?
Third party services do not always have to be cancelled during an outbreak. Criteria to be considered include the status of the outbreak, types of services being provided, areas of the facility affected by the outbreak (facility-wide, floors, or units), and the health status of individuals receiving the service. Third party service providers must adhere to the outbreak control measures at the affected facility if providing service to residents during an outbreak.
Who can participate in activities during an outbreak?

Well residents (those who are not exhibiting any symptoms) may participate in activities that are considered low-risk for transmission of infection. 

Ill residents should be placed on isolation and must not participate in group activities until they are taken off precautions and are well enough to participate.

One-on-one activities can be provided to ill residents if they are feeling well enough to participate. Any items used during the activity should remain in the ill resident's room or be cleaned and disinfected after use or discarded. Ill residents should be encouraged to remain on their units within the home.

Well staff and volunteers can assist with activities as long as they wear appropriate personal protective equipment (PPE) and practice good hand hygiene.

Where can activities for well residents take place during an outbreak?

Activities can take place on unaffected floors and units.  Only well residents can participate in these activities.

Events scheduled to take place outside the facility should be rescheduled if the outbreak is facility-wide. If well residents participate in off-site activities, high-touch surfaces in the vehicles used to transport them should be cleaned and disinfected after each trip.

What are some examples of individual activities for those who are isolated but feeling well enough to participate?
Activities that include items that can be easily disinfected or discarded following the interaction can take place within the resident's room.
What are some examples of group activities that can be offered for well residents during an outbreak?

Activities that do not involve sharing of objects can continue for well residents, such as, but not limited to, religious gatherings, choirs, sing-a-longs, movies, crafts, group discussions, and trivia games.  Factors to be addressed include seating arrangements (e.g. distance between residents and position of residents) and enhanced cleaning of areas where activities take place. Activities involving shared items that cannot be easily disinfected between residents will likely have to be modified during an outbreak. Examples of activities that may have to be modified or cancelled include: visiting entertainers, bingo, card games, baking, board games, bean bag toss, fitness classes and physiotherapy. 

Food provided during an activity should be served to each resident individually.  Buffet or self service options for food are not recommended.  Provide alcohol-based hand rub for residents to use prior to and after eating.  Residents should not be participating in food preparation during an outbreak.

Does the dining room have to be closed during an outbreak?
No. Eating in the dining room does not count as an activity.  Some facilities may re-locate dining of ill residents to an affected floor if they have the capacity to do so.  During an outbreak, hand hygiene should be performed by all residents prior to entering the dining room.  Tray service is to be provided to ill residents who are isolated in their rooms.

Please contact the OPH outbreak investigator assigned to the outbreak at your facility if you have any questions at 613-580-6744 or visit

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