IPAC IT: Infection Prevention and Control Information Transfer September 22, 2015
• Last season (2014-2015): – Total cases = 1,378 (previous season 1,085) • 1194 Influenza As (previous season 572) • 182 Influenza Bs (previous season (513) – Median age = 66 (previous season 40) – Hospitalizations = 563 (previous season 581) – Outbreaks = 57 (53 influenza A) • Previous season = 23 (5 influenza A; 18 influenza B) – Median staff influenza immunization rate: • LTC = 82 • RH = 77
• Interactive workshop style • New Outbreak Toolkit – Available electronically at www.peelregion/cleanhands – Found in the “Outbreak Control” section • Action cards & notepads • Facilitators & microphones • Group work & construction sound • Prizes
Survey the Landscape
Outbreak Season Reflection In your groups: – Introduce yourself – Discuss: • Challenges with outbreaks • Successes/creative strategies • Things you’ll do differently this outbreak season – Use the flipchart & title it “Outbreak Reflection” – Include your table number for reference 10 Minutes
Group Discussion
Blueprint for Preventing Outbreaks • Sept. 1 is start of the new season • Over the last 5 years: • Earliest influenza A case: Sept. 10 • Earliest respiratory outbreak: Sept. 3 • Public Health preparations include finalizing policy changes, vaccine management, new directives, IPAC education
Planning for Outbreak Season In your groups, answer: – What do we need to do to prepare for outbreak season? – Consider: • What needs to be done to prevent outbreaks? • What can be prepared prior to an outbreak to better manage one when it does occur? – Title your flipchart “Pre-Outbreak Season Planning” & use it to record your thoughts 15 minutes
Planning for Outbreak Season Find the Pre-Outbreak Season Planner in your toolbox.
Planning for Outbreak Season Update and Review Policies and Procedures Education Antiviral Preparation Influenza Immunization Program Gather Tools Communicate It may be helpful to plan when you will start and finish each component!
Planning for Outbreak Season • Did anyone have any other activities that were not listed? • Post your flipcharts on the wall • Update your action cards with great ideas
https://www.youtube.com/watch?v=2Mt8kPZG1oQ
Outbreak Checklist • Outbreak season has arrived! • Your blueprint is the OB checklist – Open the envelope marked “Blueprint for Managing Outbreaks” • This is a DRAFT – we need your feedback! • Please use it throughout the day • Evaluation on back • Give us your feedback! • Leave behind today
Rainbow Springs LTC Sept. 21, 2015 225 residents 6 units 200 staff
Laying the Foundation
Being Concrete in Case Identification As a group: – Use the weekend report & cut outs to decide who is a: • Part of the cluster of symptomatic residents & staff • Not related to the cluster – Use the bristol board template* to separate residents and staff cut outs into the two groups above – Decide if you need to call Public Health * This represents the creation of an internal line list 10 minutes
Being Concrete in Case Identification Who would you put on your internal line list? Internal Line List Not part of the cluster (part of the cluster) Hank Hammer (cough + nasal congestion) Paul Pliers (fatigue only) Nancy Nail (cough) Sarah Shovel (chronic cough) Linda Level (cough + fever) Betty Bolt (cough) Alan Axe (cough & fever) Nurse Jackie (cough + fever) Would you call Public Health? What residents would you report?
Being Concrete in Case Identification Outbreak Scenario You have decided to call your Public Health Nurse to report the cluster of residents & staff with respiratory symptoms. You provide all the information to PHN Jane Wrench. She requests that you complete a Public Health Line List. Before completing a Public Health Line List, you collaborate with PHN Jane Wrench to develop a case definition.
Being Concrete in Case Identification Case Definition: Two or more respiratory symptoms including fever, cough, and nasal congestion, on Sunnyside Unit on or after Sept. 19 Key elements: symptoms, unit, onset date Remember your case definition can change over time throughout the outbreak.
Being Concrete in Case Identification Using the case definition: Two or more respiratory symptoms including fever, cough, and nasal congestion, on Sunnyside Unit on or after Sept. 19 As a group: - Determine who is a case, a possible case, not a case. Check off your choice on the cut-outs. – Place each cut-out in the appropriate smaller envelopes (found in the large cut-out envelope) for use later today. 5 minutes
Being Concrete in Case Identification It’s time to complete a Peel Public Health Line List At your tables: – Open envelope marked “Line Lists”. – Each person complete a Line List for staff and resident cases – Notice some fields at the top have been completed for you – Fill out as much as you can with the information that has been provided on the cut-outs 15 minutes Work Together!
Being Concrete in Case Identification Demographics Symptoms Date of Flu vaccination Onset date Date precautions initiated
Being Concrete in Case Identification Work location & last date worked Date of flu vaccination Name Onset date & symptoms
Being Concrete in Case Identification Peel Public Health Line Lists: • Always fill out as much information as you can • Send your Line List daily (M-F) to Public Health even if there are no changes • Additional symptoms can be added. Do not remove symptoms or cases once they have resolved • These are ongoing lists (chronological order) • For residents, complete one Line List per unit • For staff, record all cases on one list
After completing the Peel Public Health Line Lists you fax them to your Public Health Nurse and call her back. Public Health Nurse Jane Wrench has reviewed your Line Lists. She confirms based on the MOHLTC respiratory outbreak definition that…. What do you think? Is your facility in outbreak?
Yes, the Sunnyside unit is in respiratory outbreak! Peel Public Health On-Call Number: 905-799-7700 for reporting outbreaks on evenings, weekends and holidays
PHN Jane Wrench provides you with an outbreak number: 2253- 2015- 999. Together, you discuss what case to take a specimen from: – Decision: Linda Level and Alan Axe • Take a minute to update your Public Health Line List – Hint: The date is September 21, 2015 • Add: outbreak number, date outbreak declared and date of specimen collection for Linda Level & Alan Axe 5 minutes
You have declared the outbreak on Sunnyside, what other outbreak interventions need to be put into place? Refer to the Outbreak Checklist Don’t forget to update your action cards with great ideas!
https://www.youtube.com/watch?v=FMMnJk2Ki5k
Recap from this Morning… • Reflected on the past season • Prepared for the upcoming outbreak season (Pre-Outbreak Season Checklist) • Looked at a tool to help manage outbreaks (Outbreak Season Checklist) • Classified cases, line list, case definition, and declared an outbreak
Building Codes: Requirements for the Perfect Specimen
Requirements for the Perfect Specimen Outbreak Scenario: September 22, 2015 at 9am: PHN Jane Wrench calls to inform you the Public Health Lab has found the following: - Linda Level’s preliminary direct antigen test result is negative for Influenza A and B - Alan Axe’s specimen has been rejected
Requirements for the Perfect Specimen In your groups: – Open the envelope marked “Mr. Axe’s rejected specimen” – Review both the rejected specimen and requisition – Identify the reasons it was rejected (record answers on your notepads) 10 minutes
Requirements for the Perfect Specimen • What was wrong with the specimen? – Specimen: • Expired • Name does not match requisition • Missing date collected – Requisition: • Missing DOB • Requisition did not have outbreak number • No date of collection or onset date • First name does not match specimen Tool in toolbox: Respiratory Outbreaks – Specimen Collection Guide and Sample Respiratory Requisition
Requirements for the Perfect Specimen • Rejected specimen! What next? – Submit a new specimen! – Consult with your Public Health Nurse to decide who would be best to take a specimen from • Who should we choose? – Have there been any new cases? – Any suspect cases become confirmed?
Requirements for the Perfect Specimen Outbreak Scenario: September 22, 2015, 10am Based on today’s surveillance, the charge nurse on Sunnyside reports that Betty Bolt has developed a fever. Since Betty is now a case, you ask the nurse to collect the new NP swab from her.
Requirements for the Perfect Specimen Specimen Labelling After collection, you verify the specimen is labelled correctly, complete with: • the correct name and • date collected . *If you would like to use a label with demographics, be sure not to cover the expiry date. The information must match Name matches the requisition. Swab is not expired requisition
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