Provincial guidelines
- Recommendations for the control of respiratory infection outbreaks in long-term care homes
- COVID-19 Guidance: Long-Term Care Homes, Retirement Homes, and Other Congregate Living Settings for Public Health Units
- Recommendations for the control of gastroenteritis outbreaks in long-term care homes
Outbreak basics
What is an outbreak?
An outbreak is generally an increase in the number of infections above the number normally expected for that setting over a defined period of time. The Ontario Ministry of Health and Long-Term Care defines outbreaks as:
| Type of Outbreak | Suspect Definition | Confirmed Definition |
|---|---|---|
| Respiratory | 2 cases within 48 with an epidemiological link (e.g., same unit/floor) OR more than one unit having a case within 48 hours | 3 or more cases within 48 hours with an epidemiological link (e.g., same unit/floor) OR more than 2 units having a case within 48 hours OR 2 cases with one being lab-confirmed |
| Influenza | 1 lab-confirmed case of influenza | 2 cases within 48 hours with an epidemiological link (e.g., same unit/floor) one being lab-confirmed |
| COVID-19 | 1 lab-confirmed case in a resident where the source of acquisition is thought to be from within the home or cannot be determined | 2 or more residents with an epidemiological link (e.g., unit/floor) each with a positive PCR or rapid antigen test within a 10-day period |
| Enteric | If an outbreak is suspected, notify Southwestern Public Health to support with the investigation and management. | 2 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 definitions for outbreaks
Outbreak case definitions are a set of criteria for determining who should be classified as a case. The definition is developed based on the clinic information and epidemiological information related to time, place and person.
| Type of Outbreak | Case Definitions |
|---|---|
| Respiratory, influenza, COVID-19 |
The outbreak case definition varies with the outbreak under investigation. Please refer to the Infectious Diseases Protocol, 2018 (or as current) for guidance in developing an outbreak case definition as needed. For COVID-19 outbreak definitions for high-risk settings, please refer to the novel coronavirus appendix. The outbreak case definitions are established to reflect the disease and circumstances of the outbreak under investigation. The outbreak case definitions should be developed for each individual outbreak based on its characteristics, reviewed during the course of the outbreak, and modified if necessary, to ensure that the majority of cases are captured by the definition. The case definitions should be created in consideration of the outbreak definitions.
Helpful links:
|
| Enteric |
Symptoms must not be attributed to another cause (e.g., medication side effects, laxatives, diet or prior medical condition) and are not present or incubating upon admission and at least one of the following must be met:
Helpful Links: |
Outbreak Reporting
If you suspect an outbreak, contact Southwestern Public Health to discuss outbreak management and control with a member of the Infectious Diseases team.
| Monday - Friday 8:30am - 4:30pm | After hours, weekends and holidays |
| St. Thomas Site: (519) 631-9900 ext. 1232 | 1-800-922-0096 ext. 0 |
| Woodstock Site: (519) 421-9901 ext. 3500 | 1-800-922-0096 ext. 0 |
Outbreak control measures and line lists
Control Measures
Every LTCH should evaluate and update their outbreak policies and procedures annually in accordance with evidence-based practices or prevailing practices. LTCHs should also ensure staff are educated on outbreak management and control.
Use the following resources to implement outbreak control measures:
- Outbreak Control Measures
- Management of Residents with Respiratory Symptoms
- Management of Residents with Enteric Symptoms
- Quick Reference to Outbreak Control and Management
- Resident Transfer Algorithm During Outbreaks (refer to page 77)
Line Lists
Monitor and track cases using the following line listing forms:
Lab testing guidelines
Call us to discuss outbreak specimen collection.
- Respiratory Viruses (including influenza)
- Order swabs
- Gastroenteritis –Stool Viruses
- To order additional enteric outbreak kits, please call SWPH at 1-800-922-0096 and ask to speak to a member of the Infectious Diseases Team
Test Requisitions
- COVID-19 & Respiratory Virus Test Requisition (respiratory outbreaks)
- General Test Requisition (enteric outbreaks)