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Outbreak Scenario S. marcescens 26.06.2012 • At a multi-disciplinary meeting on the surgical unit concerns are raised regarding a possible increase in wound infections and a suggestion that there may be more Serratia marcescens around than before?? • 5 minutes to consider your first actions: • What further information would you require? • How would you define / declare an outbreak? What is a....... • Cluster • Outbreak • Increased Incidence • How soon do you call an outbreak control group? • Who should attend? • Communications • When to you put control measures in place? The Communicable Disease Outbreak Plan HPA 18th May 2012. Case Definition • 5 minutes to consider a case definition for the possible outbreak described in the first slide. Case Definition • • • • • Clinical Information Microbiology / culture information Location / ward / unit Time Characteristics of those affected The importance of a case definition • Ideally the case definition should be broad enough to include most cases, but not too broad such that the investigation becomes confused. – Confirmed cases – Probable – Possible The Importance of a Case Definition • Case Finding • Ongoing monitoring • Closure of an outbreak Case Finding • 5 minutes to discuss issues around case finding as related to this particular investigation • Share any experiences you may have of case finding • 10 minutes to discuss and describe what descriptive epidemiology tools you would use Timelines • 5 minutes to start developing hypotheses Hypothesis Development • Clinical evaluation – – – – • Epidemiologic concepts Microbiology concepts – – – – Organism’s natural history Known sources Antimicrobial susceptibility Typing Infection control practices – – – – – Signs and symptoms Natural history Diagnostics Case Review – Transmission mechanisms – Transmission dynamics – Transmission containment • • • Hand hygiene Isolation precautions Bloodborne pathogens Environmental measures Multi-drug resistant organisms Environmental Considerations – – – – – Air quality Water quality Food services Sanitation services Infectious waste disposal Further Investigations • Cohort Studies • Case-Control Studies Steps for Outbreak Investigation • • • • • • Establish the existence of an outbreak Define and Identify cases Descriptive epidemiology Hypothesis development Evaluation of Data Implementation of Control Measures / Prevention • Consideration of further investigations