Current Outbreaks

Outbreaks

What is a facility outbreak?

A facility outbreak is usually defined as two or more cases of illness with similar symptoms within 48 hours and in a specific unit or ward, etc. in the same facility.

Types of facility outbreaks:

Enteric / (Gastroenteritis, institutional outbreak)

An enteric outbreak exists when you have at least two or more cases with vomiting and/or diarrhea occurring within two days (48 hours) in a specific unit or ward, etc. in the same facility.

Symptoms of an enteric illness:
  • Two episodes of diarrhea
  • Two episodes of vomiting
  • One episode of each within 24 hours.

Respiratory / Respiratory infection, institutional outbreaks

A respiratory outbreak exists when you have at least two or more cases of acute respiratory tract illness occurring within 48 hours in a specific unit or ward, etc. in the same facility.

Symptoms of a respiratory illness:
  • Fever/abnormal body temperature (a temperature less than or equal to 35.5°C OR greater than or equal to 37.5°C)
  • Cough
  • Runny nose/sneezing
  • Sore throat/hoarseness
  • Nasal congestion
  • Headache
  • Chills

If you are unsure if your facility has an outbreak, please call our Outbreak Team at 519-258-2146 ext. 1444 or after hours at 519-973-4510. Early identification of an outbreak can lower the number of people who get sick.

Disease Outbreak Manual

Contact Numbers and Helpful Links

Just the Facts:
Filling Out the Public Health Lab Requisition, Windsor-Essex County Health Unit

Failure to fill out the lab requisition properly could result in rejection of the sample, or cause a delay in test result reporting. Leaking specimens will not be processed!

Section 1

Physician: Dr. S. Wajid Ahmed

Phone: 519-258-2146 Fax: 226-783-2132

The name of the family or facility’s doctor can be entered here as well, and they will also receive a copy of the results.

Agency: Windsor-Essex County Health Unit

1005 Ouellette Avenue, Windsor, ON N9A 4J8

Section 2

Must be completely filled out.

If the patient is from a Long-Term Care Home, please write the name of the home in this section. Remember to include the outbreak number for this outbreak (if known).

Section 3

Tests Required

Enteric – stool specimens

Respiratory – nasopharyngeal specimens: Influenza A, B (Flu) Virus Detection

Direct test for Influenza and RSV if suspected. Direct test will apply to the first few specimens only in an influenza outbreak.

Unless otherwise ordered by the Windsor-Essex County:

All samples must be transported to the Public Health Lab in London, Ontario in approved packaging by calling the Health Trans Courier 519-791-0515 after 8 a.m.

Examples of approved packaging: a soft-sided cooler bag, or a box that is sealed and labelled, SPECIMENS.

Section 4

All applicable boxes must be filled in.

Comments:

Attention: Outbreak Team.

Just the Facts:
Taking a Nasopharyngeal (NP) Swab, Windsor-Essex County Health Unit

Photographic instruction on taking a nasopharyngeal swab

Respiratory virus packs normally contain materials sufficient for 4 to 6 swabs for culture of respiratory viruses such as influenza virus, parainfluenza virus, and respiratory syncytial virus.

The following will be needed:

  • Masks, goggles, gowns, and gloves
  • Cotton swab
  • Plastic swab with fibre tip
  • Viral transport medium
  • Pen

Instructions

  1. Call the Health Unit to ensure that an outbreak number is assigned to the specimen and that the Public Health Lab is notified.
  2. Put on your personal protective equipment (mask, goggles, gown, and gloves).
  3. Position person with bed raised to 45 degrees or in a comfortable position.
  4. Clean nares with the cotton swab.
  5. Estimate the distance the swab will need to be inserted into the nose, by ensuring the distance from the tip of the earlobe to the tip of the nose. As a rule of thumb, the swab will need to be inserted approximately half of that distance (see picture).
  6. Incline person’s head as shown in picture and gently insert the swab into the nostril to the previously determined mark.
  7. Rotate swab 3 to 5 times as tolerated and leave it in place for a few seconds to absorb the material.
  8. Withdraw swab and insert into transport medium provided. Break swab shaft evenly at the scored line and cap vial tightly. Don’t forget to label specimen container.
  9. Complete requisition form with all pertinent information.
  10. Use sealable bag to transport specimen to the laboratory:
    • Place transport medium in sealable bag.
    • Seal bag by removing blue strip to reveal adhesive.
    • Place requisition in outer pocket.
    • Refrigerate specimen immediately.

Remember: Viral transport medium may be stored at room temperature until it is used Always check expiry date on transport  medium before use.

Enteric Outbreaks, Instructions for the collection and transportation of clinical specimens for faeces cultures

Enteric Disease Investigation Multiple Specimen Submission Form, Public Health Ontario

Just the Facts:
Collecting a Stool Specimen, Windsor-Essex County Health Unit

  1. Obtain a stool collection kit and ensure it is current. Check the expiration date. Vials should be filled in order, by colour:  White: virology, Green: bacteriology and Yellow: parasitology
  2. Void feces into a dry container or onto paper that can later be flushed down the toilet. Feces that have been voided into the toilet cannot be used.
  3. Use the spoon from the white vial (attached to the lid). Take about three scoops from different areas of the feces. Areas that have blood or mucous should be sampled. Ensure there are enough feces in the vial to reach the fill line.
  4. Place the spoon back into the bottle. Tighten the cap well.
  5. Next, take samples for the green cap vial, and then the yellow cap vial. Collect enough feces to raise the fluid level in the vials to the fill line. Place the spoon back in the bottle and mix the feces with the liquid. Tighten the cap well.
  6. Ensure all lids are tightly closed!
  7. Long-Term Care Homes should attach resident label to each vial, or print full name and date on container.
  8. Place vials in the Bio Bag provided and seal (remove the blue strip).
  9. Fill out the Public Health Lab Requisition and place in outside pouch. See the “Filling Out the Public Health Lab Requisition” page.
  10. Fill out the black and white labels on the reverse of the pouch. Fill out patient’s name, health number, date specimen collected, date of onset, and tick off appropriate boxes. Include outbreak number if available.
  11. Store in the refrigerator.
  12. Contact the Health Trans Carrier at 519-791-0515 to transport to the Public Health Lab in London, ON in the approved packaging as soon as possible within 48 hours of collection. Examples of approved packaging: a soft-sided cooler bag, or a box that is sealed and labelled, SPECIMENS.

Forms:

Initial Facility Outbreak Report Form

Instruction for Respiratory Line List (Staff)

IMPORTANT: The line list is to be completed daily and faxed by 10:00 a.m. the next day to the Health Unit. This ensures that if a staff member develops symptoms on an evening or night shift (prior to 12:00 a.m.), the necessary information can be added to the line list before it is faxed to the Health Unit at 226-783-2132.

A separate line list must be completed for ill residents.

Name of Facility

  • Fill out complete name of facility

Name of Affected Area (e.g. Unit #)

  • Majority of outbreaks will pertain to the entire facility; if this is the case, write “entire facility”.
  • For large facilities, keeping a separate line list for each unit affected by the outbreak may be useful; if this is the case, specify which unit by a unit number, floor number, building name, etc.
  • If, in collaboration with the Health Unit, it has been deemed that one unit/building alone is in outbreak status, write unit number, floor number, building name, etc. as stated above.

Total # of Staff in Specified Unit

  • Fill out number of staff working in unit/ floor/ building that is specified on above line.

Case Definition

  • This will be defined by the Health Unit based on the symptoms and circumstances obtained from your facility at the beginning of the outbreak.
  • Write definition, on the appropriate line at the top of the line list.

Date

  • Use format: year/ month/ day.
  • Be sure you record the date the information was obtained.

Page

  • Total the number of pages you have for one specific day.
  • Example: on any given day, if you are faxing the Health Unit 2 pages, you will fax ‘page 1 of 2’ and ‘page 2 of 2’.

Full Name

  • Print full name of staff member here
  • Do not use initials

Work Assignment Location

  • Describe unit/ floor/ building that this staff member works on.

Date of Onset

  • Write date staff was placed on the line list.
  • When determining if a facility can be taken off outbreak status, the last date of onset is used.
  • If a staff member has been removed from the line list and then has a relapse, use the relapse date as your new date of onset.

Last Day of Work

  • Indicate the last day the staff member worker in the facility before becoming ill.

Influenza Vaccine (Y/N)

  • Influenza vaccine is given annually. Fill in ‘Y’ only if the staff member has received the influenza vaccine for the current year.

Symptomatology

  • Staff must have 2 symptoms to qualify for the line list.
  • Be sure symptoms are normal for staff and are not due to underlying conditions.
  • If a symptom is present, indicate with a check mark in the appropriate box.
  • If a box is left blank, it will be assumed that the symptom is not present.

Samples Taken

  • Indicate that the staff provided a requested specimen sample.

Employed at Other Facilities

  • Indicate whether this staff member works at any other Long -Term Care Facility.

Asymptomatic (24 hrs or 48 hrs)

  • A staff member must remain on the line list until he/she has had no symptoms for 48 hours.
  • If the staff member has had no symptoms for 24 hours, check this box.
  • If on the next day the staff member still has no symptoms, check the asymptomatic for 48 hours.
  • After this box has been checked, a staff member’s name may be removed on the next day’s line list.

Antiviral Use

  • During a confirmed influenza outbreak, your facility may use antiviral medication, please specify with a ‘Y’ in this box.

Completed By

  • Print the name of the person completing the line list in this space.
  • If there are any questions pertaining to the line list, the Health Unit will know who to contact at your facility.

Fax

  • Fax your line lists to the Health Unit daily before 10:00 a.m. This ensures that the Health Unit has time to follow up on any questions pertaining to the line list.

If you have any questions about filling out the line lists accurately, please do not hesitate to contact a member of the Outbreak Management Team at 519-258-2146 Ext. 1444.

Instruction for Respiratory Line List (Residents)

The line list is to be completed daily and faxed by 10:00 a.m. the next day to the Health Unit. This ensures that if a resident develops symptoms on an evening or night shift (prior to 12:00 a.m.), the necessary information can be added to the line list before it is faxed to the Health Unit at 226-783-2132.

A separate line list must be completed for ill staff.

Name of Facility

  • Fill out complete name of facility

Name of Affected Area (e.g. Unit #)

  • Majority of outbreaks will pertain to the entire facility; if this is the case, write “entire facility”.
  • For large facilities, keeping a separate line list for each unit affected by the outbreak may be useful; if this is the case, specify which unit by a unit number, floor number, building name, etc.
  • If, in collaboration with the Health Unit it has been decided that one unit/building alone is in outbreak status, write unit number, floor number, building name, etc. as stated above.

Total # of Residents in Specified Unit

  • Fill out number of residents residing in unit/floor/building that is specified on above line.

Case Definition

  • This will be defined by the health unit based on the symptoms and circumstances obtained from your facility at the beginning of the outbreak.
  • Place definition, when obtained, on the line at the top of the line list.

Date

  • Use format: year/ month/ day
  • Be sure you record the date the information was obtained.

Page

  • Total the number of pages you have for one specific day.
  • Example: on any given day, if you are faxing the Health Unit 2 pages, you will fax ‘page 1 of 2’ and ‘page 2 of 2’.

Full Name

  • Print full name of resident here
  • Do not use initials

Age

  • Fill in age of resident

Gender

  • Indicate male or female

Room #

  • Specify room number and, if applicable, bed number/letter (e.g. 125a)

Date of Onset

  • Write date resident was placed on the line list
  • When determining if a facility can be taken off outbreak status, the last date of onset is used.
  • If a resident has been removed from the line list and then has a relapse, use the relapse date as your new date of onset.

Hospitalizations/Deaths

  • The Ministry of Health and Long-Term Care requires the you report the number of hospitalizations and deaths, regardless of the causative factor.
  • Indicate any new hospitalizations or deaths in the last 24 hours with a ‘Y’ in the box next to the name on the line list. If the person is not included on the line list indicate the hospitalizations or deaths at the bottom of the line list.

Influenza Vaccine (Y/N)

  • Influenza Vaccine is given annually. Fill in ‘Y’ only if the resident has received the Influenza Vaccine for the current year.

Pneumonia Vaccine (Y/N)

  • If the resident has ever had the Pneumovax Vaccination indicate ‘Y’.

Symptomatology

  • The resident must have 2 symptoms to qualify for the line list
  • Be sure symptoms are abnormal for resident and are not due to underlying conditions (e.g. Increased shortness of breath due to congestive heart failure)
  • If a symptom is present, indicate with a check mark in the appropriate box.
  • If a box is left blank, it will be assumed that the symptoms are not present.

Samples Taken

  • Indicate that the resident provided a requested specimen sample.

Asymptomatic (24 hrs or 48 hrs)

  • A resident must remain on the line list until he/ she has had no symptoms for 48 Hours.
  • If the resident has had no symptoms for 24 hours, check the asymptomatic for 24 hours box.
  • If on the next day the resident still has no symptoms check the asymptomatic for 48 hours.
  • After this box has been checked, the resident’s name may be removed on the next day’s line list.

Antibiotic Treatment

  • If resident is on an antibiotic, specify with a ‘Y’ in this box.

Antiviral Use

  • During a confirmed influenza outbreak, your facility may utilize antiviral medication, please specify with a ‘Y’ in this box.

Completed By

  • Print the name of the person completing the line list in this space.
  • If there are any questions pertaining to the line list, the Health Unit will know who to contact at your facility.

Fax

  • Fax your line lists to the health unit daily before 10:00 a.m.; this ensures that the Health Unit has time to follow up on any questions they may have pertaining to the line list.

If you have any questions filling out the line lists accurately, please do not hesitate to contact a member of the Outbreak Management Team at 519-258-2146 Ext: 1444.

Instructions For Enteric Line List (Residents)

IMPORTANT: The line list is to be completed daily and faxed by 10:00 a.m. the next day to the Health Unit.

This ensures that if a resident develops symptoms on an evening or night shift (prior to 12:00 a.m.), the necessary information can be added to the line list before it is faxed to the health unit.

A separate line list must be completed for ill staff.

Name of Facility

  • fill out complete name of facility

Name of Affected Area (e.g. Unit #)

  • Majority of outbreaks will pertain to the entire facility; if this is the case, write “entire facility”.
  • For large facilities, keeping a separate line list for each unit affected by the outbreak may be useful; if this is the case, specify which unit by a unit number, floor number, building name, etc.
  • If, in collaboration with the Health Unit it has been decided that one unit/ building alone is in outbreak status, write unit number, floor number, building name, etc. as stated above.

Total # of Residents in Specified Unit

  • Fill out number of residents residing in unit/ floor/ building that is specified on above line.

Case Definition

  • This will be defined by the health unit based on the symptoms and circumstances obtained from your facility at the beginning of the outbreak.
  • Place definition, when obtained, on the line at the top of the line list.

Date

  • Use format: year/ month/ day
  • Be sure to record the date the information was obtained.

Page

  • Total the number of pages you have for one specific day.
  • Example: on any given day, if you are faxing the Health Unit 2 pages, you will fax ‘page 1 of 2’ and ‘page 2 of 2’.

Full Name

  • Print full name of resident here
  • Do not use initials

Age

  • Fill in age of resident

Gender

  • Indicate Male or Female

Room #

  • Specify room number and, if applicable, bed number/letter (e.g. 125a).

Date of Onset

  • Write date resident was placed on the line list.
  • When determining if a facility can be taken off Outbreak Status, the last date of onset is used.
  • If a resident has been removed from the line list and then has a relapse, use the relapse date as your new date of onset.

Hospitalizations/Deaths

  • The Ministry of Health and Long-Term Care requires that you report the number of hospitalizations and deaths to the Health Unit regardless of the causative number.
  • Indicate any new hospitalizations or deaths in the last 24 hours with a “Y” in the box next to the name on the line list. If the person is not included on the line list indicate the hospitalization or death at the bottom of the line list.

Symptomatology

  • Resident must have 2 symptoms to qualify for the line list.
  • Be sure symptoms are abnormal for resident and are not due to underlying conditions (e.g. diarrhea and cramps due to laxative administration).
  • If a symptom is present, indicate with a check mark in the appropriate box.
  • If a box is left blank, it will be assumed that the symptoms are not present.

Asymptomatic (24 hrs or 48 hrs)

  • A resident must remain on the line list until he/she has had no symptoms for 48 Hours.
  • If the resident has had no symptoms for 24 hours, check the asymptomatic for 24 hours box.
  • If on the next day the resident still has no symptoms check the asymptomatic for 48 hours.
  • After this box has been checked, the residents name may be removed on the next day’s line list.

Antibiotic Treatment

  • If resident is on an antibiotic, specify with a ‘Y’ in this box.

Diagnostic Test

  • Indicate that the resident provided a requested specimen sample.

Completed By

  • Print the name of the person completing the line list in this space.
  • If there are any questions pertaining to the line list, the Health Unit will know who to contact at your facility.

Fax

  • Fax your line lists to the Health Unit daily before 10:00 a.m. This ensures that the Health Unit has time to follow up on any questions pertaining to the line list.

If you have any questions about filling out the line lists accurately, please do not hesitate to contact a member of the Outbreak Management Team at 519-258-2146 Ext. 1444.

Instructions for the Enteric Line List (Staff)

IMPORTANT: The line list is to be completed daily and faxed by 10:00 a.m. the next day to the Health Unit. This ensures that if a staff member develops symptoms on an evening or night shift (prior to 12:00 am), the necessary information can be added to the line list before it is faxed to the health unit.

A separate line list must be completed for ill residents.

Name of Facility

  •  Fill out complete name of facility

Name of Affected Area (e.g. Unit #)

  • Majority of outbreaks will pertain to the entire facility; if this is the case, write “entire facility”
  • For large facilities, keeping a separate line list for each unit affected by the outbreak may be useful; if this is the case, specify which unit by a unit number, floor number, building name, etc.
  • If, in collaboration with the health unit, it has been deemed that one unit /building alone is in outbreak status, write unit number, floor number, building name, etc. as stated above

Total # of Staff in Specified Unit

  • Fill out number of staff working in unit / floor/ building that is specified on above line

Case Definition

  • This will be defined by the Health Unit based on the symptoms and circumstances obtained from your facility at the beginning of the outbreak.
  • Write definition on the appropriate line at the top of the line list.

Date

  • Use format: year/ month/ day
  • Be sure you record the date the information was obtained.

Page

  • Total the number of pages you have for one specific day.
  • Example: on any given day, if you are faxing the Health Unit 2 pages, you will fax ‘page 1 of 2’ and ‘page 2 of 2’.

Full Name

  • Print full name of staff member here
  • Do not use initials

Work Assignment Location

  • Describe unit/ floor/ building that this staff member works on.

Date of Onset

  • Write date staff was placed on the line list
  • When determining if a facility can be taken off outbreak status, the last date of onset is used.
  • If a staff member has been removed from the line list and then has a relapse, use the relapse date as your new date of onset.

Last Day of Work

  • Indicate when the last day before the staff member worked in the facility before becoming ill.

Symptomatology

  • Staff must have 2 symptoms to qualify for the line list.
  • Be sure symptoms are abnormal for staff and are not due to underlying conditions.
  • If a symptom is present, indicate with a check mark in the appropriate box.
  • If a box is left blank, it will be assumed that the symptoms are not present.

Asymptomatic (24 hrs or 48 hrs)

  • A staff member must remain on the line list until he/she has had no symptoms for 48 hours.
  • If the staff member has had no symptoms for 24 hours, check the asymptomatic for 24 hours box.
  • If on the next day the staff member still has no symptoms, check the asymptomatic for 48 hours.
  • After this box has been checked, a staff member’s name may be removed on the next day’s line list.

Samples Taken

  • Indicate that the staff provided a requested specimen sample.

Completed By

  • Print the name of the person completing the line list in this space.
  • If there are any questions pertaining to the line list, the Health Unit will know whom to contact at your facility.

Fax

  • Fax your line lists to the Health Unit daily before 10:00 a.m. This ensures that the Health Unit has time to follow up on any questions pertaining to the line list.

If you have any questions about filling out the line lists accurately, please do not hesitate to contact a member of the Outbreak Management Team at 519-258-2146 ext. 1444

Downloadable Material