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Outbreak Resources for LTCHs

HomePartners & ProfessionalsLong-Term Care and Retirement HomesOutbreak Resources for LTCHs
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Outbreak Basics
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Outbreak Status Reports
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Provincial Guidelines
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Outbreak Reporting
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Control Measures & Line Lists
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Lab Testing
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Influenza in LTCH
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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 OutbreakSuspect DefinitionConfirmed 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 2 cases within 48 hours with an epidemiological link (e.g., same unit/floor) 3 or more cases within a 4 day with an epidemiological link (e.g., same unit/floor) OR 3 or more units or floors having a case within 48 hours

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 OutbreakCase 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:

  • Recommended Case Definitions for Surveillance of Health Care-Associated Infections in Long-term Care Homes , PIDAC
  • Control of Respiratory Infection Outbreaks in Long-Term Care Homes, Ministry of Health
  • Appendix 1: Case Definitions and Disease Specific Information Disease: Respiratory Infection Outbreaks in Institutions and Public Hospitals, Ministry of Health
  • Appendix 1: Case Definitions and Disease Specific Information Disease: Diseases caused by a novel coronavirus, including Coronavirus Disease 2019 (COVID-19), Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS)
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:

  • 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.

Helpful Links:

  • Recommendations for the Control of Gastroenteritis Outbreaks in Long-Term Care Homes, Ministry of Health
  • Appendix 1: Case Definitions and Disease Specific Information Disease: Gastroenteritis Outbreaks in Institutions and Public Hospitals, Ministry of Health

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:

  • Suspect Respiratory Outbreak Control Measures
  • Confirmed Respiratory Outbreak Control Measures
  • Confirmed Enteric Outbreak Control Measures
  • 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:

  • Facility Outbreak Line List (print and fill version)
  • Facility Outbreak Line List (fillable version)

Lab testing guidelines

Call us to discuss outbreak specimen collection.

  • Respiratory Viruses (including influenza)
  • To order swabs, visit: https://app.smartsheet.com/b/form/77eac0d4a0be4a49b0159c588d08f23f
  • 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)
  • PaLM Webform Users (COVID-19/respiratory testing)
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