The purpose of effective outbreak management is to prevent further transmission of suspected or confirmed infections. Managing an outbreak may seem complex, but with basic measures in place an outbreak can be well managed. Prompt recognition is essential so that control measures can be put in place to prevent further cases.
Outbreaks of infection may vary in extent and severity, ranging from a few cases to large numbers affecting hundreds of people. An outbreak is defined as:
- two or more related cases of an illness that is caused by an infection occurring around the same time, for example, diarrhoea and vomiting
- unexpected deaths that may be due to infection
- a single case of unusual infection
- an incident involving food or contaminated water.
It can be difficult to recognise an outbreak, so staff should be vigilant at all times and learn what an outbreak looks like and how to identify the signs and symptoms of infection displayed by patients. These may vary from:
- unexpected falls and confusion
- skin rashes
- upper respiratory symptoms.
Effective outbreak management is dependent upon good communication between staff, service users and external organisations. Once signs and symptoms have been recognised staff must inform the manager and other colleagues so that appropriate actions can be put in place promptly.
There are several external organisations you must contact in the event of an outbreak, including an environmental health officer and your local public health officer. They will advise you on the next steps your organisation should take to manage the outbreak more effectively. Each patient’s GP will be able to diagnose their symptoms, which should help in the management of the potential outbreak. Family members and patients themselves should be informed of the situation.
The management team must use the information given by staff to decide if there is a true outbreak occurring within the care establishment. A plan of who the management team will consist of should be included in the outbreak policy. If it is deemed that there is an outbreak the management team needs to co-ordinate necessary actions and complete an outbreak checklist.
Diagnosis of the infection will help to decide on the most effective way to prevent transmission. Each infection is unique in its management and seeking expert advice will help to guide the outbreak.
Documentation and policies
Each care establishment should have up-to-date policies and procedures in place for the management of infections and outbreaks. Staff should be aware of these, be able to access them at all times and be trained to understand them.
Managing infections effectively requires good documentation within patients’ case notes, and also within a central location so that all staff can refer to it and provide accurate information to GPs, families and external organisations. An example of a good outbreak record form is enclosed in the Toolkit section of this magazine.
Everyone within the care setting should implement good hand hygiene techniques. This is the single most important preventative method for infection control (see Catch it, Bin it, Kill it – Respiratory and Hand Hygiene Campaign, Department of Health, 2011).
Swift diagnosis of an infection will help in identifying the most appropriate personal protective equipment to use whilst caring for patients and will help to understand how the infection is transmitted from person to person. Increased cleaning should take place using a sodium hypochlorite solution 1000ppm to clean floors and all touch points. Other standard precautions need to be followed such as sharps disposal and clinical waste management.
Isolation can help in outbreak management by reducing the transmission of infections. When deciding whether to isolate an infected service user, it is important to take into account the likely effect on them. Some service users, such as elderly people, may become disorientated and confused by isolation, so this should be avoided unless it is really necessary. Public health officers can always offer further advice on the management of individuals.
A variety of leaflets and posters should be available within the care establishment offering information to visitors, family members and patients. Many of these may be found on the NHS or Department of Health website.
All specimens should be safely contained in an approved leak proof container. This must be enclosed in another container, commonly a sealable polythene bag. Care should be taken to ensure the outside of the container and bag remains free from contamination with blood and other bodily fluids. Further guidance on specimen collection can be obtained from your local laboratory supplying the diagnostic service.
Any planned trips, functions or parties should be discussed with your local public health department before they go ahead to see if there are any precautions needed.
Family members should be informed of any outbreak and educated about what preventative measures they can put in place. In some circumstances it may be appropriate to discourage visitors from attending the care establishment until the outbreak is over. Any visitors who are unwell themselves should not be visiting the care establishment.
During an outbreak, unaffected staff should be designated to work in one area, ensuring patients don’t mix from different areas. This will help to reduce the transmission of infection and subsequently the duration of the outbreak.
Any staff member who becomes unwell at work must be sent home immediately and specimens should be encouraged. For diarrhoea and vomiting outbreaks staff should not return to work until 48 hours after normal bowel habits have returned and vomiting has stopped. For some conditions is may be necessary for the person to be kept away from work until they have a negative stool sample. For other conditions it is important for staff to check before returning to work if it is appropriate to do so.
Use the following items in the toolkit to put the ideas in the article into practice:
- Checklist - Infection outbreak (all providers)66 KB
- Form - Outbreak record (service user details) (all providers)74.5 KB
- Form - Body fluids spillage checklist and audit tool (all providers)59.5 KB
About the author
Suzanne Averill, MSc, RGN, Nurse consultant, Global Infection Prevention, has previously worked for the Health Protection Agency as the International Lead and in commissioning as Head of Infection Control.
This article was first published in the July 2011 issue of Quality & Compliance Magazine.