Outbreaks within residential aged care facilities are common, causing considerable morbidity and distress, increased hospitalisations and mortality and impacting negatively on staff, resources and consumers. An outbreak can be defined as:
"The occurrence in a defined population of more cases of a disease than expected".
This definition assumes that there is already an understanding of the normal rates of infection for the population in question which isn’t always the case if robust surveillance activities are not in place. Therefore, a second potential outbreak definition for the residential aged care setting is the following:
"When there are two or more linked cases of the same infectious agent or disease there may be an outbreak."
Early identification and control of infectious diseases can minimise the potential for an outbreak. In the event of an outbreak, notification to relevant stakeholders and implementation of appropriate control strategies will facilitate outbreak management.
Preparedness
The new Australian Aged Care Quality Standard (3)(g) highlights the specific requirements for outbreak preparedness for accreditation compliance in the publication Guidance and Resources for Providers to support the new Aged Care Quality Standards. This particular requirement has become a significant focus of the Quality and Safety Commission Assessors.
For you to be able to demonstrate compliance in infection control you will need to be able to articulate how you have prepared for outbreaks along and provide evidence, for example:
- Good infection control practices to prevent outbreaks and to reduce the size and length of an outbreak.
- A knowledgeable Outbreak Coordinator who can direct a response as soon as an outbreak is suspected. Your Infection Control Outbreak Coordinator should receive education annually on best practice.
- An outbreak management plan, such as for gastroenteritis or influenza, that explains how the facility will prepare for, identify and manage any outbreaks.
- Evidence of how the organisation has educated the workforce on outbreak management and their roles and responsibilities.
- Care and service plans that identify consumer infections and any transmission-based precautions implemented by the workforce.
- Relevant details of how a consumer’s infectious status is clearly and sensitively communicated if care is shared.
- A current and readily available list of reportable infectious diseases and contacts at relevant state or territory government departments that can help prepare for, identify and manage an outbreak.
Outbreak Response
The outbreak response will differ according to the nature of each outbreak and many steps are taken more or less simultaneously. However, there are some key principles that will apply to any outbreak situation as follows:
- Determine evidence of suspected outbreak
The first key principle of outbreak management is to recognise an outbreak and establish that it actually exists. Then establishing a case definition for cases in the outbreak to assist with determining further infections.
- Implement additional precautions immediately
Precautions should commence as soon as the first resident shows symptoms of suspected infection. Residents who are particularly at risk due to immunosuppression or comorbidities, or those that have been in contact with the affected resident/s in the preceding days need to be identified and observed.
- Report the suspected outbreak
Notification to the Public Health Unit is a legal requirement and will assist in managing the outbreak.
- Formation of an outbreak management team
Formation of an outbreak management team which is appropriate to the size and staffing of the facility should be in place as part of preparedness planning.
- Collect specimens to confirm outbreak
The collection of specimens will confirm the presence of an outbreak and the causative organism. This in turn informs the infection control measures necessary to limit transmission.
- Monitor outbreak and update PHU
Once the case definition has been created, all those who fit the case definition (staff and consumers) need to be identified and line-listed. The Public Health Unit will assist with managing the outbreak and usually declare when the outbreak is considered over.
- Debrief
A debrief provides the opportunity to identify strengths and weaknesses in the outbreak response and areas for improvement. All staff members involved in an outbreak should be invited to participate in a debriefing session.
Contact Critical Success Solutions to see how we can assist you in educating your staff on Outbreak Management.
Critical Success Solutions | https://criticalsuccesssolutions.com.au/
