Download Outbreak Identification and Management Policy

OUTBREAK IDENTIFICATION
& MANAGEMENT POLICY
PURPOSE: To standardize the action steps needed (a) if an outbreak of healthcare-associated
infections (HAIs) or adverse events occur that are above the background rate or (b) when an
unusual microbe or adverse event is recognized. The goal of any outbreak investigation is to
identify probable contributing factors and to stop or reduce the risk for future occurrences.
Healthcare-associated outbreaks are often multifactorial and may be associated with:

Lapses in infection prevention or clinical practices

Contaminated or defective products or devices

Colonized or infected healthcare personnel

Patients or visitors who have, or are harboring, an infectious disease
In ambulatory care settings, post-discharge surveillance is critical to identify clusters of infections
or outbreaks.
POLICY:
DEFINITION
An outbreak is defined as two or more cases over the usual (i.e., endemic) number of cases of
healthcare-associated infections, usually produced by the same organism; however, a single case of
an unusual organism (e.g., postsurgical Group A Streptococcus infection) may constitute an
outbreak.
RECOGNITION OF A SUSPECTED OUTBREAK AND NOTIFICATION
Most outbreaks are recognized by observant healthcare personnel and infection preventionists.
Any personnel who becomes aware of a possible outbreak or cluster of infections will immediately
report this to their manager and the designated infection preventionist. The ASC medical director
and the ASC administrator should also be notified. An outbreak investigation team should be
identified and an investigative team leader identified.
INITIAL INVESTIGATION
Outbreaks generally do not unfold in a linear or orderly manner. Thus, not all of the actions
described below will be applicable to all situations and many of the steps may occur
simultaneously. The investigative team shall do the following:
1. Confirm the presence of an outbreak, which might include laboratory confirmation. The lab
may need to be instructed to save isolates of the involved organism(s) for further study
(e.g., antimicrobial sensitivity typing, phage typing, serotyping, etc.)
2. Alert key partners about the investigation, which might include the notification of
appropriate state and local entities
3. Perform a scientific literature review
4. Determine if immediate control measures are needed and implement accordingly
5. Establish a preliminary working case definition which may be refined during the
investigation
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6. Develop a methodology for case finding, which might include a review of the charts, lab
results, information obtained from medical providers and or involved patients or families;
survey for additional cases linked to the outbreak and for the onset of new cases
7. Prepare an initial line list and epidemic curve (case number by date of onset); include
patient, operating room number, date and type of procedure, date of infection onset, site
culture results, surgeon, and any other pertinent information
8. Observe and review potentially implicated patient care activities, such as hand hygiene,
surgical scrub preparation, re-useable instrument/equipment reprocessing, etc.
9. Consider whether environmental sampling or additional facility testing (e.g.,
operating/procedure room air changes and air flow) should be performed
10. The presumptive hypotheses for the mode of transmission of the organism and other
circumstances will be developed; procedures for testing the hypotheses will be outlined
11. If necessary, refine the case definition, continue case finding and surveillance, and refine
control/prevention measures to prevent further or future illness
12. If the cause of the infection is not evident as a result of the above investigation, seek expert
consultation
13. Consider whether an analytical study, such as a cohort or case control study, should be
performed
COMMUNICATION DURING AND AFTER AN OUTBREAK
The investigative team leader will ensure that the medical director, attending physicians, facility
administrator, nursing administrator, facility risk management, public relations representative,
healthcare personnel, and others as needed will be kept abreast of developments and findings and
should be queried regularly on any additional thoughts or insight they might have. Decisions about
whether to notify patients about an outbreak must be made on a case-by-case basis. Decisions
regarding personnel cultures, work restrictions, or the impounding or quarantine of patient care
items should be carefully vetted and communicated.
CONCLUSION OF INVESTIGATION
The investigation is continued at least as long as there are cases of the infection occurring above the
endemic level. A final written report of the investigation that outlines findings and
recommendations should be prepared by the investigation team. The report should be presented to
the committee charged with overseeing the infection prevention program, all attending physicians,
and healthcare team.
REFERENCES
Association for Professionals in Infection Control and Epidemiology, Inc. (2009). APIC Text of
Infection Control and Epidemiology, 3rd Edition.
Bennett, G. & Kassai, M. (2011). Infection Prevention Manual for Ambulatory Surgery Centers. ICP
Associates: Rome, Georgia.
DISCLAIMER: All data and information provided by the Oregon Patient Safety Commission is for informational
purposes only. The Oregon Patient Safety Commission makes no representations that the patient safety
recommendations will protect you from litigation or regulatory action if the recommendations are
followed. The Oregon Patient Safety Commission is not liable for any errors, omissions, losses, injuries, or
damages arising from the use of these recommendations.
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