Are you Prepared for an Infection Outbreak? - Corangamarah
Corangamarah is a 60 bed facility in Colac from within the South Western region of Victoria.
We recently experienced a significant influenza outbreak in our facility. We identified the outbreak quickly when 3 residents in the one wing developed symptoms of a respiratory infection. We do have signs requesting visitors who are unwell to stay away from our facility until they have recovered, but sometimes this advice is not followed. We suspect this is how the outbreak commenced.
The first residents developed a sore throat around the same time. After the sore throat, the residents became more unwell with respiratory symptoms such as cough, shortness of breath and general malaise. All the infected residents became febrile with temperatures hovering around the 38 degree mark.
Once we identified 3 residents with similar symptoms all within the same wing, it was apparent we had a suspected respiratory outbreak.
In Victoria, we are to inform the Dept. of Health Communicable Disease Prevention and Control Unit when a suspected outbreak occurs. It is no longer a requirement to notify the Aged Care Complaints Scheme after a recent communication from Aust. Govt. Dept. Social Services on 24 March 2015.
We made our initial notification with the Communicable Disease Unit and thereafter daily (weekdays) until the outbreak was officially over. We also made contact with our local Shire Environmental Health Officer who advised us that influenza was present in our local community.
An outbreak of respiratory conditions is considered concurrent until at least 8 days post the onset of symptoms of the last resident affected.
Despite a quick response to the onset of symptoms of our residents the spread of the airborne illness was rapid. In total we had 19 residents with flu like symptoms and about 12 staff reported sick with similar symptoms.
Fortunately, most of our residents have single rooms, some with single ensuite bathrooms and some with shared ensuites with one other resident, so we were able to isolate most of our residents. The outbreak was contained in mainly one wing with a few cases in another general wing.
Even with infection control precautions in place such as increased hand hygiene, use of wipes to reduce risk of cross infection in communal areas such as nurses’ stations, use of PPE - (gowns, gloves and masks) for those in direct clinical contact with residents, the spread was rapid.
We took multiplex swabs of nose and throat for several residents and within a few days the first culture of Influenza Type A was identified.
It was unfortunate that the timing of this outbreak was aligned with a delay in supply of the seasonal influenza vaccine for public health facilities. In previous years we have completed the resident vaccination program against influenza by mid- late March. We have had a flu vaccination uptake of around 86% for our residents and around 64% for our staff for most years.
With some difficulty in obtaining a supply we were given a special advance allocation of x 60 vaccinations for our residents and the flu vaccinations were administered mostly in one day.
- To reduce the risk of cross infection, we implemented the following strategies:
- Residents kept in their rooms
- Staff allocations were monitored closely to avoid rostering in other areas once worked in flu affected wing
- Signs alerting visitors at entrances of outbreak precautions in place and to avoid entering facility
- Extra cleaning introduced to reduce risk of cross infection
- Staff were supported with use of PPE, cleaning responsibilities, collection of specimens and waste management with printed information provided and guidance by infection control staff
- Communal dining ceased and group activities ceased until after outbreak conclusion
- Communication to co-located hospital staff to avoid access to facility whilst outbreak in place
- Staff provided with meals and snacks during outbreak to avoid going to hospital cafeteria with other staff and general public
- Volunteers were asked to stay away from the premises for a period of time
As our nursing staff are all Registered or Enrolled Nurses and well trained in clinical care, we were able to care for all 19 of the residents in our facility. None required hospitalisation for their acute illness. A few of the residents needed intravenous fluid support due to their general malaise and lethargy which was managed in- house.
All residents had their temperatures checked frequently to record any spike which may precipitate the flu symptoms.
Medical staff were called to review residents quickly and a few residents were ordered Tamiflu was ordered for a few residents. This is a prescription medication ordered for those who have flu like symptoms for less than 2 days and is given to reduce symptoms and length of illness.
Many of the residents developed bacterial chest infections as well as influenza and required antibiotics to which they quickly responded.
All 19 residents recovered after periods of malaise, lethargy and dyspnoea which extended for around 7-10 days.
Rostering created some difficulties with many staff needing sick leave during the outbreak period. The length of time of the outbreak was just under 3 weeks in total.
It was also made more difficult to manage as the Easter break fell towards the end of the outbreak. Residents’ family members were screened before visiting and were asked to comply with hand hygiene before and after visits. Easter celebrations were slowly re introduced as the residents recovered and the outbreak was declared over.
Bambi Vagg
Clinical Governance Quality and Safety
0 comments