Outbreak Reporting & IPAC for Congregate Living Settings
Alerts, warnings and urgent notices are sent on an as-needed basis from Public Health to area health care providers. Advisories are kept for 3 months.
Under the Ontario Health Protection and Promotion Act (HPPA), Hamilton Public Health Services is required to follow up with reports of suspected and confirmed gastrointestinal and respiratory outbreaks.
Infection prevention and control (IPAC) practices are essential in keeping residents, staff, caregivers, and visitors of congregate living settings, including long-term care homes and retirement homes, safe. These settings are especially susceptible to the spread and impact of microorganisms/germs due to the:
- Home’s physical characteristics (i.e., often shared dining spaces, group activities, occasionally shared sleeping spaces and washrooms)
- Characteristics of their residents (i.e., people with varying levels of health needs, often have weakened immune systems)
Under the Ontario Health Protection and Promotion Act outbreaks of respiratory and gastrointestinal infections in institutions are reportable to the local Medical Officer of Health.
When an outbreak is suspected, report it to Hamilton Public Health Services. A Public Health staff member will offer support and assistance to facility staff with the declaration and management of an outbreak in collaboration with the facility to prevent the spread of the illness.
Steps for Early Identification of Outbreaks
Screen residents daily for respiratory and gastrointestinal symptoms
- Respiratory symptoms include: runny nose or sneezing, stuffy nose, cough, congestion, sore throat or hoarseness or difficulty swallowing, fever or abnormal temperature, chills, difficulty breathing, loss of appetite, malaise, muscle pain or headache
- Gastrointestinal symptoms include: at least two unexpected episodes within 24 hours of diarrhea (loose/watery bowel movements) and/or vomiting
Screen staff, visitors, and returning residents upon entry/re-entry for symptoms and/or possible exposures
When to Report Outbreaks to Public Health
- Two cases of acute respiratory illness occurring within 48 hours, with a common epidemiological link (such as same unit or floor); or
- One laboratory-confirmed case of COVID-19 or influenza
- Molecular testing remains the preferred test for symptomatic individuals associated with a highest risk setting. Ideally, rapid antigen tests should not be used for symptomatic clients, however, if they are used, parallel molecular testing should be done to confirm results
- Symptoms of gastrointestinal illness occurring in two or more residents within 48 hours, with a common epidemiological link (such as same unit or floor)
General Directions for Outbreak Management
- Follow IPAC best practices (see Infection Control Measures section) to reduce further transmission of illness
- Refer to the Ministry of Health and Long-term Care outbreak management documents:
- Recommendations for Control of Respiratory Infection Outbreaks in Long-Term Care Homes
- Ministry of Health COVID-19 Guidance for Public Health Units: Long-Term Care Homes, Retirement Homes, and Other Congregate Living Settings
- Appendix 1: Case Definitions and Disease Specific Information Disease: Diseases caused by a novel coronavirus, including Coronavirus Disease 2019 (COVID-19), Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS)
- Recommendations for Control of Gastroenteritis Outbreaks in Long-Term Care Homes
- Start an outbreak line list for residents and staff
- Submit outbreak line listing to Hamilton Public Health Services Infectious Disease Program via
- Fax 905-974-9847; or
- Use the CityShare link provided by your Public Health Inspector
- Consult with Hamilton Public Health Services before collecting outbreak specimens for laboratory testing (NP swabs for respiratory symptoms, stool samples for gastrointestinal symptoms)
- Maintain regular contact with Hamilton Public Health Services to review the outbreak status (new cases, hospitalizations, deaths, emerging challenges, etc.)
Regular Business Hours Reporting
Call 905-546-2063 or Fax 905-546-4078
After Business Hours Reporting
Call 905-546-2063 and ask to speak with the infectious disease public health inspector on-call.
- How to Hand Rub (PHO)
- How to Hand Wash (PHO)
- Your 4 Moments for Hand Hygiene (PHO)
- List of hand sanitizers authorized by Health Canada
Personal Protective Equipment
- Putting on PPE (PHO)
- Taking off Full PPE (PHO)
- Recommended Steps for Putting On and Taking Off Personal Protective Equipment (PHO)
- Recommended Steps for Putting On and Taking Off Personal Protective Equipment (Hamilton Public Health Services and St. Joseph’s Healthcare Hamilton)
- COVID-19 Guidance: Personal Protective Equipment (PPE) for Health Care Workers and Health Care Entities
Cleaning and Disinfecting
- Cleaning is the physical removal of dirt and microorganisms from a surface by wiping or scrubbing with soap and water, whereas disinfection kills microorganisms using a chemical solution. Both are important elements of infection prevention and control. Some products can only be used for cleaning, some products can only be used for disinfecting, while some can be used for both. Review the manufacturer’s instructions to understand how best to use the product (i.e., how long it must stay wet on a surface, mixing, and safety instructions)
- High-touch surfaces have frequent contact with hands and therefore are areas where microorganisms are likely to settle. For this reason, they require cleaning and disinfection on a routine basis. Examples of high-touch surfaces include: doorknobs, call bells, bedrails, light switches, toilet handles, hand rails, and keypads
- Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings, 3rd Edition, 2018 (PHO)
- Chlorine Dilution Calculator (PHO)
- Key Elements of Environmental Cleaning in Healthcare Settings – Fact Sheet (PHO)
- List of disinfectants with evidence for use against COVID-19
- List of hand sanitizers authorized by Health Canada
Construction, Renovation, Maintenance and Design
- Public Health Ontario – Construction, Renovation, Maintenance and Design (CRMD)
- Public Health Ontario - Heating, Ventilation and Air Conditioning (HVAC) Systems in Buildings and COVID-19
- Public Health Ontario - Use of Portable Air Cleaners and Transmission of COVID-19
Outbreaks of illness in congregate living settings can be life-threatening for residents and staff, and very stressful for caregivers and family members. For the health and well-being of residents, it is essential to control and contain outbreaks as quickly as possible. Everyone has a part to play. Follow the steps below when visiting a resident in a facility that’s in outbreak:
Check-in at the Front Desk and/or Nursing Station
- Infection control measures often change when facilities are in outbreak. Staff at the front desk or nursing station will provide you with information on control measures that are needed during your visit. They can also answer your questions.
Keep Your Hands Clean
- Wash hands using soap and warm water or use an alcohol-based hand rub (ABHR):
- Immediately when you enter the facility and as you leave
- Before entering a resident’s room and as you leave a resident’s room
- Before and after feeding a resident or providing care to a resident
- Before eating
- After using the washroom
- Anytime you feel your hands need cleaning
Do Not Share Food or Other Items
- Only bring the items you need with you
- Do not share food, drinks, and/or other items with other residents, visitors, or staff
Know How to Use Personal Protective Equipment
- Personal protective equipment (PPE), including gloves, gown, medical mask, and eye protection, is worn to protect yourself from infections. You may need to wear PPE if you might have contact with blood or other bodily fluids when bathing, feeding, toileting, or assisting with other personal care. If you’re not sure what PPE you should use, speak with staff at the front desk or nursing station
- View these videos for more information:
Practice Physical Distancing, Masking, and Cough Etiquette
- Keep two metres away from others as much as possible
- Only provide care to the person you’re visiting
- Follow the facility’s infection prevention and control instructions
- Cough or sneeze into your elbow or a tissue
- Throw away used tissues immediately then clean your hands
Do Not Visit if you are Sick
- Visiting a resident when you aren’t feeling well puts everyone in the facility at risk. Stay home and do not visit the resident if you have any of the following symptoms:
- Fever, cough, runny nose, sneezing, stuffy nose, sore throat, or rash
- Diarrhea, upset stomach, vomiting, or nausea (gastrointestinal symptoms)
- You may visit the home once you have no fever and your respiratory symptoms have been improving for 24 hours or no fever and your gastrointestinal symptoms have been improving for 48 hours.
- Consider wearing a medical mask until respiratory symptoms have fully resolved; for COVID-19 avoid high-risk setting (e.g. LTCHs, RHs) for 10 days after symptoms start. If you must visit, wear a medical mask, maintain physical distancing, visit only in the resident’s room, and inform the high-risk setting of your recent COVID-19 illness.
If a Resident is Sick, Visit the Resident in Their Room Only
- Sick residents should remain in their rooms. Avoid taking a sick resident to any common areas (e.g., dining rooms, lounges) during your visit.
- While visiting a sick resident, follow the facility’s infection prevention and control instructions, such as wearing personal protective equipment (e.g., masks).
- Additionally, after visiting with a sick resident, leave the facility immediately. To protect other residents, avoid common areas (e.g., dining rooms) if possible.
- To protect yourself and others, remember to clean your hands with soap and water or ABHR when leaving the resident’s room and when leaving the facility.
Stay Up-to-date with Your Vaccinations
- Respiratory diseases, such as COVID-19 and influenza, can cause serious health complications and even death among older adults and other high-risk individuals. You can pass these viruses to others before you start to show symptoms. Even if residents have received their vaccinations, studies have shown that immunity wanes over time among older adults. Therefore, to protect yourself and your loved ones, stay up-to-date with your vaccinations.
Follow the Facility’s Infection Prevention and Control Instructions
- Hamilton Public Health Services and the local Infection Prevention and Control Hub works with facilities to prevent and control outbreaks. Follow the facility’s instructions for additional precautions or personal protective equipment (e.g., masks) if required. If followed by everyone, these measures can help control an outbreak.
The HNHB IPAC Hub is a team dedicated to providing congregate living settings within the Hamilton area with high quality IPAC support. They provide training, education, guidance, and resources to staff and caregivers, as well as proactive on-site preparedness assessments and supports during an outbreak.
For more information on supports and resources, visit the IPAC Hub
Looking to connect with an IPAC Specialist? Email [email protected]
Provincial Resources, Guidance Documents and Directives
Public Health Ontario – Infection Prevention and Control Online Learning Portal
Resources and online learning modules for both health care workers and non-clinical staff seeking education and training on IPAC and environmental cleaning.
Public Health Ontario – Infection Prevention and Control for Environmental Cleaning in Health Care
These resources and online learning modules are for individuals seeking education and training on IPAC and environmental cleaning. These items are intended for both frontline environmental service workers and management, as well as infection control professionals working in all health care settings.