Acute Care Outbreak Q&A
- What happens once an outbreak is declared on my unit or at my site? Who declares it?
VCH Public Health in collaboration with Infection Prevention and Control (IPAC) will declare an outbreak. They will advise on steps that need to be taken. By declaring an outbreak, VCH Public Health and IPAC trigger specific actions that can prevent further spread of the disease.
After an outbreak or enhanced surveillance has been declared, your unit or site’s leadership will activate their site Emergency Operations Centre (EOC).
For more information, see the Acute Outbreak Process on PHC’s COVID-19 site.
- How is PHC ensuring staff are well and without symptoms before coming to work?
All staff, including medical staff and contracted staff, working on the outbreak unit must be screened for symptoms prior to the start of their shift and at least once part way through their shift. Screening must be documented and maintained by the unit.
Staff on all clinical units must complete a self-check when they start their shifts; staff in non-clinical sites must complete a self-assessment for COVID-19 symptoms (see daily event in your Outlook calendar) at the start of their work day if they plan to work on-site.
Screeners should be placed at all entrances to control staff and visitor access and ensure protocols are followed.
- What are the cleaning and infection control protocols if we have a positive COVID-19 case on our unit/in our facility?
- IPAC will notify Environmental Services (EVS) of the outbreak status and the need for enhanced outbreak level environmental cleaning measures, which includes dedicated EVS staff member(s) for the outbreak unit and increased waste collection.
Among many other measures, the unit will ensure that patient charts are cleaned every shift using approved cleaning products.
The most up-to-date outbreak cleaning protocols can be found in the Outbreak Toolkit.
- Where can I find information about an outbreak in an acute care setting?
- To learn more about what happens when there is an outbreak in an acute care setting, check out the Acute Care Outbreak toolkit.
- What’s the protocol to test patients and staff if an outbreak occurs?
- Any staff (including medical staff, contracted staff and volunteers) associated with the outbreak unit who develop COVID-19 symptoms are required to seek testing. Staff who are symptomatic, with or without a pending COVID-19 test, may not work.
All staff, including medical staff and contracted staff, working on the unit must be screened for symptoms prior to the start of their shift and at least once part way through their shift. Screening must be documented and maintained by the unit.
Staff must assess patients two times a day for COVID-19-like symptoms. If a patient becomes ill, they must immediately be isolated under droplet and contact precautions (in a single room if possible) and have samples collected for COVID-19.
For asymptomatic staff and patients, testing may occur as well with details dependent on the context of the outbreak.
- In CST Cerner, where can we find consistent documentation and communication for patients on droplet and contact precautions?
- On the top banner bar towards the right-hand side there is an area for precautions. The three precautions are: contact, droplet or airborne or combination of the three transmission-based precautions. Some of those precautions are initiated automatically at the triage stage if certain risk factors are in place.
For example, if at triage, a patient has respiratory symptoms and a fever, that will automatically trigger droplet and contact precautions. However, when you're doing your admission orders, you may have checked off those precautions as well. Therefore, it will appear like there are two orders in the system.
When the patient is removed from droplet and contact precautions, it's necessary to highlight both those orders under the order section and cancel both of them otherwise, it will disappear from the banner bar.
Take a moment to check what's on the banner bar and understand why it's there. If you don't understand, there's always the reference card or you can use the Spectrum app to identify what is the reason for the precautions. Be sure to check at the patient’s door to make sure that that sign is consistent with what's on Cerner.
If there's inconsistency, ask another member on the clinical team to resolve the inconsistency. And if the patient doesn't require that level of precaution, please discontinue all those associated orders on Cerner. If they require additional precautions, you have to put on additional orders. The banner bar on Cerner is dynamic and changes as the orders change.
- How will we know when the outbreak is over on our unit?
- The estimated end date of an outbreak is 28 days from implementation of outbreak control measures or symptom onset of the last lab-confirmed COVID-19 diagnosis on the unit, whichever is later. Guidelines are being updated as we learn more about the virus and may change. Also, variables specific to each facility will be taken into consideration and may impact this timeline.
Your unit should consider a debrief meeting, led by VCH Public Health, to evaluate the management of the COVID-19 outbreak and make recommendations to further COVID-19 outbreak management guidance. Remain alert for possible new cases in staff and clients.
- I’m worried I may bring the virus home to my family. How can I ensure that I don’t?
- Regular hand hygiene and cleaning of surfaces in your home will help prevent transmission of COVID-19. In addition, if you are in a direct care role, bring your uniform or work attire to work and change prior to your shift. After your shift, change back into your street clothes and put your uniform/work attire in a plastic bag. Your uniform/work attire should be washed separately in hot water.
- What can I say to families who are upset by visitor restrictions?
- We understand that the current rules are upsetting for families and caregivers. If you are speaking to a family member who is upset, empathize with their concerns and remind them that the rules are in place as a precautionary measure to keep patients, staff and physicians safe.
There are additional talking points available to assist you with these conversations on the COVID-19 website.
- Who do I include in my outbreak management team?
- After the declaration of an outbreak, you need to activate your site’s Emergency Operations Centre (EOC).
The EOC membership should include:
- Senior Medical Director Pandemic Response
- IPAC Medical Director
- IPAC Practitioner(s)
- PHC Outbreak Management Director
- Medical Microbiologist / Lab
- Site Leader
- Site Physician
- HEMBC Liaison
- Supply Chain
- Laundry Services
- Food Services
- Risk Management
- IPC Surveillance
- Access and Flow representative
- Pharmacy representative
- Public Health (PH) representative
- Occupational Health and Safety (H&S) representative
- What do I do if my staff are scared to come to work during an outbreak on my unit?
- If you have staff scared to come to work, please refer them to OH&S for support. In addition, Human Resources has a list of staff willing to work in outbreak zones. If you are experiencing staff shortages due to an outbreak on your unit, contact HR.
- What should I do when the outbreak on my unit has been declared over?
- Consider convening a debrief meeting, led by VCH Public Health, to evaluate the management of the COVID-19 outbreak and make recommendations to further COVID-19 outbreak management guidance. Remain alert for possible new cases in staff and patients.
- As a leader, what additional tools are available to help me support my staff?
- You can find more resources in our Leaders Resource section of PHC’s COVID-19 website.
- Will I need to order special equipment or supplies? If so, who will advise/help with this?
- Facilities Management and IPAC can help you determine if your unit needs additional equipment or supplies.
If you need to reach PHC’s Infection Prevention and Control Team (IPAC), please call local 69357. Do not contact individual IPAC team members.