Buffet or self service options for food are not recommended. Provide alcohol-based hand rub for residents to use prior to and after eating.
Residents should not be participating in food preparation during an outbreak. Please contact the OPH outbreak investigator assigned to the outbreak at your facility if you have any questions at or visit OttawaPublicHealth. Outbreaks of illness sometimes occur in health care facilities and can be a stressful time for families and staff.
Outbreaks are most often caused by common viruses that produce symptoms of gastroenteritis, such as nausea, vomiting and diarrhea, or respiratory illness, such as fever, cough and sore throat. These viruses are generally spread from person to person, or by touching contaminated surfaces, objects or equipment and then touching your eyes, mouth or nose or handling food or drink.
For the health and well-being of everyone, it is important to implement measures to control the spread of infection as soon as possible. The information below is available in other formats. Contact Ottawa Public Health at to request the document in an accessible format. Label each container with the client's name, Date of Birth and date the stool sample was collected.
Samples that are incorrectly filled out, or packaged improperly will be discarded by Public Health Lab. Symptoms must not be attributed to another cause e. Notify Ottawa Public Health OPH at , ext from am to pm or outside regular business hours, on weekends or statutory holidays. Upon consultation with OPH, declare an outbreak over if there is no new case 48 hours after the last case is symptom free.
Enteric outbreak line listing for staff [PDF kb]. If possible, print the signs in colour and post, facing outwards, at the main entrance and all other public entrances. We are experiencing an outbreak [PDF kb].
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As a result, parts of the site may not function properly for you. We recommend updating your browser to its most recent version at your earliest convenience. Skip to Content. Facebook LinkedIn Twitter Email. Quick Links. Activities in long term care and retirement homes during an outbreak It is important for long-term care homes and retirement homes to assess and modify activities during the course of enteric and respiratory outbreaks to reduce the risk of transmission of infection amongst residents and staff.
Do all activities have to be cancelled during an outbreak? Serogrouping and serotyping categorize bacteria on the basis of certain markers on the surface of the bacteria. Although serogroup or serotype information often can provide enough information to identify a possible outbreak, especially when the cluster is localized, further subtyping is often needed to separate background illnesses, unrelated to an outbreak, from those connected to a common source.
DNA fingerprinting methods are more specific than serogrouping or serotyping, and bacteria that share the same DNA fingerprint are more likely to share a common source: the more rare the fingerprint, the higher the likelihood that the illnesses are connected in some way.
PulseNet is a national molecular subtyping network of public health and food regulatory agency laboratories. By reviewing the PulseNet database, health officials can identify clusters of illnesses caused by bacteria with the same DNA fingerprint at the same time, even if the ill persons are spread across many different health jurisdictions. This is especially useful when the number of illnesses in any one county or state is not large enough by itself to signal a possible outbreak 5.
Often, the initially recognized illnesses reflect only a small part of the total outbreak. Finding additional ill persons is key to helping understand the size, timing, severity, and possible sources of the outbreak. Early in an investigation, health officials usually develop a case definition to help determine which ill persons will be included as part of the outbreak.
Case definitions may include details about the. Multiple case definitions might be used in an outbreak investigation, each with a different purpose. For example, one case definition might be for confirmed illnesses and another for probable or suspected illnesses.
Generally, case definitions start more broadly and are updated and refined over the course of an investigation as new information becomes available.
The number of illnesses that meet the case definition is called the case count. Using the case definition, investigators search for more illnesses related to the outbreak. They do this by. Health officials monitor the progression of an outbreak by keeping track of who became ill, when they became ill, and where they live.
Investigators use a graph called an epidemic curve or epi curve that displays the distribution of the number of illnesses occurring across a selected period 7. The pattern of the epidemic curve can help investigators determine whether ill persons were most likely exposed to the same contaminated source during a short period e.
Investigators also use maps to denote where ill persons live so that they can see whether and how the outbreak is spreading within an area or community. A hypothesis is a reasonable suspicion of a vehicle as the contamination source for an outbreak and is based on specific facts and circumstances. Health officials use a process for developing and then testing a hypothesis to identify the source of the outbreak.
The number of possible outbreak vehicles and the number of potential points of contamination can be enormous, especially for enteric pathogens transmitted through foods or ingredients. Hypothesis generation is an iterative process in which possible explanations are continually refined or refuted. Pathogens that cause acute enteric disease outbreaks can spread by contaminated food or water, direct contact with an ill person, or direct or indirect contact with an infected animal or its environment.
When investigating the illness source, health officials first need to decide on the likely mode s of transmission. When exposure to a contaminated food is suspected, health officials must consider the considerable number of foods and ingredients that might be the source or vehicle of infection.
They may also need to consider the ingredients used in the foods that ill persons report eating. Health officials interview the ill persons to find out where and what they had eaten and other exposures during the days or weeks before they became sick.
The focus of the investigation is then further narrowed to the specific foods or other exposures reported by many of the ill persons. These interviews are called hypothesis-generating interviews. This period varies by pathogen. Which foods or other exposures they ask about depends on what health officials have learned so far in the investigation. If several ill persons had attended a single restaurant, hotel, or catered event, for instance, interviews will focus on the menu items prepared, served, or sold there.
If no obvious place of exposure is identified, investigators might use a standardized questionnaire, also known as a shotgun questionnaire. This type of hypothesis-generating questionnaire includes questions about a long list of food items or open-ended questions that review each meal a person ate during the days before illness began 8.
It typically also includes questions about grocery shopping locations, restaurant dining or attendance at events where food was served, dietary restrictions and use of dietary supplements, travel history, animal contact, and recreational water exposures. From the interviews, health officials create a short list of the foods, drinks, or other exposures that many of the ill persons had in common.
Exposures that none or few ill persons reported are considered less likely to be the source. Health officials then look at other information e. On the basis of the information they gather, health officials develop a hypothesis about the likely outbreak source. However, shotgun interviews can only identify potential vehicles that are included on the questionnaire.
If this approach does not lead to any testable hypotheses about the outbreak source, intensive open-ended interviews might be better suited to elucidating hypotheses that are not included in structured questionnaires. A dynamic cluster investigation process can help to quickly identify a hypothesis.
In this process, initial ill persons in the cluster are interviewed by using a detailed exposure history questionnaire. As new exposures of interest are indicated during interviews, the initial ill persons are systematically reinterviewed to assess these new exposures uniformly. Newly identified ill persons also will be uniformly asked about these exposures. This approach is particularly helpful in identifying new or unusual exposures not listed on standard shotgun questionnaires.
Investigating illness subclusters can provide crucial clues about an outbreak source. If multiple unrelated ill persons ate at the same location of a restaurant or purchased food or groceries from the same store location within days of each other, it suggests that the contaminated food item most likely was served or sold there.
A useful method for generating hypotheses in multistate outbreaks includes rapid and thorough investigation of restaurant or store clusters. Subcluster investigations can identify specific food vehicles and provide detailed information about such items for trace-back investigations. A trace-back determines and documents the producer, manufacturer, supplier, and distribution pathway s for the food item s of interest. A key goal in a trace-back is to determine whether there is a supplier or other point in the distribution chain in common.
Generating a plausible hypothesis is often challenging and can take substantial time for several reasons. First, interviews of ill persons highly depend on their ability to recall events.
The time from illness onset to knowing the ill person was part of an outbreak is typically 2— 4 weeks for outbreaks that rely on DNA fingerprinting Browser Compatibility Notification.
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