Management of an Outbreak

The Victoria Mews Assisted Living Facility (VMALF) shall implement this policy and procedure in the event of an outbreak of communicable diseases at the facility. The rapid detection of an outbreak will ensure prompt action is taken to isolate infectious residents and commence containment measures to prevent further spread among the residents, staff and visitors.

Upon the identification of an increase in communicable diseases in the facility, which is an elevation above the facility baseline for an illness/disease. This could mean two or more of the same illness/disease is identified within a 48-hour period.

The diseases this policy applies to, but is not be limited to include: Influenza, Chickenpox, Measles, Multi-drug Resistant Organisms(MDROs, ie: MRSA, VRE, KPCs) upper respiratory infections/pneumonia, urinary tract infections, rashes, Scabies/Lice, Tuberculosis, Covid-19, conjunctivitis, gastroenteritis, ie: C.difficile, Salmonella, Shigella and Campylobacter. Refer to NJSHSS list of Reportable Communicable Diseases. Once identified and reported by staff to the leadership team, ie: Director of Nursing (on-site Infection Prevention Nurse), CEO, Medical Director, and the contracted, certified IP Consultant, the following protocol will be followed:

I. Confirming that an outbreak exists-confirming the diagnosis:

a. A confirmation of an outbreak shall be established by the leadership team and concurring with governing agencies, ie: the NJDHSS.

b. This may be defined as the occurrence of two or more of the same illness/disease in a 48hr. period.

c. The outbreak shall be evaluated based on the factors of time, place and person.

d. A case definition for the outbreak shall be established with input from the clinical staff.

e. Surveillance shall be done for case finding and additional cases in the residents and staff.

f. A log shall be maintained of all cases, both for residents and staff.

g. Staff who are sick shall be taken off duty, until they are medically cleared.

II. Containment of the Outbreak- The Initiation of Transmission Based Precautions and Use of Personal Protective Equipment (PPE):

a. Resident Placement:

  • Residents who have been diagnosed with a communicable illness will be asked to remain in their rooms, separate from other residents and will be restricted from group activities and communal meals. This includes restrictions from the Physical Therapy Room, TA activities, trips in the community and exercise classes.
  • Staff will be following the Centers for Disease Control (CD) protocols for Transmission Based Precautions depending on the transmission of the illness, ie: Contact, Droplet or Airborne. Residents shall remain on precautions until their symptoms have resolved and they are medically cleared.

b. Use of Personnel Protective Equipment (PPE):

  • Staff will be using PPE for direct resident care and contact. This will include the use of: gloves, cover-gowns, masks and goggles when indicated. Staff will be instructed on the donning and doffing of PPE equipment. An isolation cart, containing PPE supplies shall be placed outside the resident’s room.

c. Hand Hygiene:

Staff shall adhere to the VMALF policy on Hand Hygiene #IP002. This includes the following protocols:

  • Hands shall be washed meticulously for 15-20 seconds before and after resident contact and care.
  • Hands shall be washed with soap and water or a waterless alcohol-based hand sanitizer. A waterless alcohol-based hand sanitizer cannot be used if the resident has C. difficile, staff must wash with soap and water.
  • Hands should be washed or a waterless alcohol-based hand sanitizer should be used when gloves are removed.
  • Staff and visitors shall “clean in and clean out” of the resident’s room.

III. Reporting of the Outbreak to Outside Agencies-Reporting to the Department of Health:

a. Upon identification and confirmation of an outbreak, the leadership team shall notify the local health department and Trenton, if indicated of the outbreak and control measures taken. This shall be the responsibility of the Executive Director and Director of Nursing.

IV. Environmental Cleaning and Disinfection of the resident (s)room (s) and common areas:

a. The Housekeeping Department and Environmental Services Department shall be notified of the outbreak and resident locations to ensure that the resident’s room and common areas where the resident (s) have been cleaned and disinfected based on CDC cleaning and disinfection guidelines.

b. The Housekeeping Department shall be using disinfecting agents that are EPA approved, hospital-grade disinfectants that are effective against HBV, HCV and HIV or Tuberculocidal.

c. All disinfectants will be used based on the manufacturer’s guidelines for use (IFUs) and follow the contact time for cleaning and disinfection to occur.

d. High-touch areas shall be cleaned and disinfected on a daily and as needed basis as determined by the onsite Infection Prevention Nurse, IP Consultant and Housekeeping. High-touch surfaces will include, but not be limited to:

  • Doorknobs
  • Handrails
  • Keyboards
  • Patient Care Equipment, ie: PT equipment, BP cuffs, stethoscopes, glucometers, thermometers, shower chairs, commodes
  • Cabinet knobs
  • Bathroom fixtures
  • Showers
  • Walkers
  • Wheelchairs
  • Communal kitchen areas
  • Communal dining areas
  • Laundry rooms

e. Housekeepers and staff who are cleaning and disinfecting the environment and patient care equipment are to wear PPE, i.e.: gloves, cover-gowns, masks and goggles when indicated.

f. Once the outbreak is declared over the resident’s room shall be terminally cleaned and disinfected.

V. Staff Education

a. All staff shall be educated on the outbreak protocol. Proof of education, i.e.: content and sign-in sheets will be kept on file. Departments to be educated will include: Nursing, Housekeeping, PT, TA, Dietary, Marketing and administration.

b. The education will include the transmission of the illness, control measures to follow, cleaning and disinfection of patient care equipment and the environment and hand hygiene.

VI. Communication with Administration and Reporting of the Outbreak:

a. The leadership team, including the Director of Nursing, the Executive Director and other departments shall meet on a regular basis to discuss the status of the outbreak, i.e.: case identification, mitigation of spread with control measures and reporting to outside agencies, i.e.: the NJDHSS, both the local and Trenton office if indicated.

b. Leadership shall be kept advised of the Infection Prevention protocols used and if additional guidelines shall be implemented.

c. There shall be a log of resident and staff cases to quantify the outbreak.

VII. Quality Improvement

a. A summary of the outbreak findings shall be presented to the Infection Prevention Committee, Safety and Quality Committees and Governing Board.

b. All reports regarding the outbreak shall be included with committee minutes.

c. There shall be an ongoing evaluation and summary of the outbreak status done by the leadership team.