Infection Control Manual

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2007 Outbreak Management Policy (67 kB)

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Outbreak Management

Key Points
If you suspect an outbreak (two or more cases of the same syndrome / organism) ON FIRST SUSPICION, ward staff should: Record all the cases, noting the time of onset of symptoms in each suspected case, and dates of admission to the hospital and ward Inform the Infection Control Team Isolate the first cases where possible Collect appropriate microbiology specimens after consultation Make a list of those affected with admission dates and date of onset of the infection (Click here for a Contact Tracing Form)

Introduction

Two or more cases of infection with indistinguishable organisms in one area constitute an outbreak and suggest a breakdown in normal hygiene practice. The infections may manifest themselves in patients on the same ward. However, different wards may be involved, the patients having a common source of infection.

It is usually impossible to be absolutely certain that two isolates of bacteria or viruses are the same, so they are generally referred to as indistinguishable.

Commonly detected outbreaks involve:

• Methicillin resistant Staphylococcus aureus (MRSA)
• Aminoglycoside or multiply resistant coliforms or pseudomonads
• Diarrhoeal or respiratory pathogens
• Clostridium difficille enterocolitis
• Legionnaires' disease
• Tuberculosis in AIDS wards

Action to Take in the Case of an Outbreak

Decisions as to what action to take are made in consultation with the Infection Control Team, sometimes with Unit Administration and Consultants involved.

The urgency of a situation is determined by the virulence of an organism, by the nature of the disease involved, and by the vulnerability of the patients concerned.

It may be necessary to close a high risk ward to admissions if isolation is not possible (e.g. more than 2 cases of diarrhoea).

Movement of Staff or Patients

Visiting may need to be restricted. No movement of staff or patients from the outbreak ward is allowed until the outbreak is over, except for discharge home. Nursing staff (permanent, students and agency) should remain permanently attached to the ward if at all possible. Extra domestic cleaning support may be needed.

The microbiologists may wish to screen patients, staff and the environment for a particular organism if an outbreak has occurred.

Most outbreaks are dealt with on a day-to-day basis by the Infection Control Team, but in the case of large, serious or community-associated outbreaks or epidemics, an ad hoc working committee will be formed and will meet daily to determine action. This will be convened by Microbiologists with Consultants in Communicable Disease Control and appropriate administrator, and will co-opt appropriate personnel (eg A/E Consultants, Occupational Health Physicians), depending on the nature of the outbreak and will be rapidly disbanded when the problem is resolved.

For more specific details see policies on Food Poisoning, MRSA, and Tuberculosis

References

Food Safety (General Food Hygiene) Regulations. 1995 Department of Health

Food Safety Act 1990. (c. 16). London.

Report on the Committee of Enquiry into an outbreak of food poisoning at Stanley Royd Hospital . 1986 London HMSO.

Management of outbreaks of foodborne illness. 1994 Department of Health  

Clostridium difficile infection: prevention and management. A report of the Department of Health/Public Health Laboratory Service Joint Working Group. 1994 Department of Health.