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Long Term Care Outbreak or Enhanced Surveillance Q&A

General

What happens once an outbreak or enhanced surveillance measures are declared on my unit or at my facility? Who declares it? 
VCH Public Health in collaboration with Infection Prevention and Control (IPAC) will declare an outbreak or enhanced surveillance measures.. They will advise on steps that need to be taken. 

By declaring an outbreak or enhanced surveillance, VCH Public Health and IPAC trigger specific actions that can prevent further spread of the disease.

After an outbreak has been declared, your facility’s leadership will activate their site Emergency Operations Centre (EOC).

For more information, see the LTC Outbreak Process on PHC’s COVID-19 site. 

What are the key learnings from past PHC outbreaks for preventing COVID-19 transmission in our long-term care homes?
From past outbreaks in our long-term care facilities, we’ve learned that some staff do come to work sick. That’s why it is important that all health-care workers stay home if they are ill. In addition to each individual’s responsibility to prevent outbreaks, we are looking at our spaces and how we interact with those spaces to reduce the risk of transmission. Examples include decluttering our facilities and re-organizing workflows. We are also ensuring our heating, ventilation, air condition systems are up to standard. 
What causes new transmissions of COVID after outbreak measures are implemented? Are you seeing patterns of viral spread or learning new information about sources? 
There are many factors that lead to the transmission of COVID-19 and, as a result, the measures we implement when we have an outbreak are multi-pronged. Unfortunately, none of these measures are 100 per cent effective on their own and that’s why we have to pay attention to all the measures we have in place. 

Even with outbreak measures in place, new cases can occur. This might be due to the incubation period of the virus or new transmission events. Even if all the measures have been successful, it may take some time for us to see the transmission of the virus end. 

When we continue to detect new cases, we revisit our outbreak measures and see which ones we need to augment. Sometimes, it’s reminding staff of basic measures like ensuring they are being very mindful of their symptoms when they come to work. Other measures we will often reinforce are proper hand hygiene and putting on and taking off PPE appropriately. To enable earlier detection of cases, repeat testing of asymptomatic residents and staff may be required. 

The transmission of the virus comes in three forms; via contact, via droplets and through aerosols. Therefore, we have to have all the precautions ready so that no matter what context we are in, we are able to do a risk assessment, and take the appropriate measures for that specific interaction and context.

What do we do if one of our confirmed COVID-19 positive residents or a resident on the outbreak unit is leaving their room for medical appointments or treatment at another facility?
All residents on the outbreak unit should remain in their rooms unless they require essential diagnostic tests and therapeutic treatments that cannot be carried out in the patient’s room.

If the resident does need to leave the facility, contact the receiving facility to advise them an individual with COVID-19 will be coming to their area and that droplet and contact precautions are in place. 

Before the resident leaves their room, educate or assist them to:

  • Perform hand hygiene.
  • Put on a procedure/surgical mask.
  • Put on a clean gown/housecoat or cover with a clean blanket.

Staff who are involved in transporting the patient should wear a surgical/procedural mask, eye protection, gown and gloves as per droplet and contact precautions.

Screen residents for fever and new respiratory symptoms (cough, shortness of breath) when going off site for medical appointments and within one hour of returning to the facility.

For more information, visit the Patient Transfer page of the COVID-19 site

Are all residents restricted to their rooms during an outbreak?
Yes. All residents on the outbreak unit should remain in their rooms unless they require essential diagnostic tests and therapeutic treatments that cannot be carried out in the patient’s room.
Can we admit new residents during an outbreak? 
No. Facilities with a declared outbreak cannot accept any admissions. 
How is cohorting residents determined during an outbreak?
Grouping of residents, or “cohorting,” should be done when possible to separate COVID-19-positive residents from residents who are not affected. Cohorting plans should be made in advance and be centered on robust infection prevention and control practices. The better you plan and include the resident, the better this temporary move will be.

When considering which unit or area to select, try to avoid relocating residents with dementia or memory care needs if possible, since any change in routine may be more difficult for these residents.

Are all group activities cancelled during an outbreak?
Generally, yes.
How many visitors can our residents have during an outbreak?
If there is a declared outbreak at your facility, residents are not allowed visitors, except for compassionate reasons. Compassionate visits are defined as “visits for end of life and critical illness, with anticipated death within 48 hours”. If you have a resident in that situation, there should be a discussion with the resident, their family or support person, and the facility director on whether this type of visit is possible. 
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 if a family temporarily removes a resident from a facility in which an outbreak has been declared? 
Residents who have been temporarily removed from a facility to live elsewhere cannot return to the facility until the outbreak is declared over by the Medical Health Officer. 
What’s the protocol to test residents/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 resident 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.

How will services outside of direct clinical resident care (such as music therapy, spiritual care, etc.) be impacted by a COVID-19 exposure or outbreak?
Other services will be reviewed for each outbreak on a case per case basis to determine how care can be delivered in the setting of an outbreak. The goal is always to deliver the best care possible while considering how we can reduce risk of transmission during an outbreak. This may include limiting the number of staff and services on the unit.  
If there is an outbreak in my facility, what can we do to address the effects of outbreak measures on the physical and psychological well-being of our residents and their families? 
We know the restrictions that have been put in place to limit visitors have been hard on residents and their loved ones. Public health officials and the government are trying to find the balance between the tough measures that are needed to control COVID-19 and the complex needs of residents in long term care. 
How will we know when an outbreak is over in our facility? 
The tentative end date of an outbreak would be 28 days from implementation of outbreak control measures or symptom onset of the last lab-confirmed COVID-19 diagnosis at the facility, whichever is later. Guidelines are being updated as we learn more about the virus and are subject to change. Also, variables specific to each facility will be taken into consideration and may impact this timeline. 

Your facility 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. 

Q&As for Leaders

How do I notify families/caregivers that there is an outbreak in my facility? 
Family communications are drafted and distributed by the Communications & Public Affairs team with your input. You will be responsible for pulling together their contact information. You may want to consider also setting up a hotline for families to call to ask questions and discuss their loved one’s care.
Who do I include in my outbreak management team? 
After the declaration of an outbreak or enhanced surveillance measures, you need to activate their site Emergency Operations Centre (EOC). 

The EOC membership should  include:  

  • PHC Vice President, Seniors Care, Clinical & Operations
  • Senior Medical Director Pandemic Response
  • IPAC Medical Director
  • IPAC Practitioner(s)  
  • PHC Outbreak Management Director
  • Medical Microbiologist / Lab
  • Site Leader
  • Site Physician
  • Facilities
  • Diagnostics
  • Security
  • HEMBC Liaison
  • Housekeeping 
  • Supply Chain
  • Laundry Services
  • Food Services
  • Risk Management
  • IPC Surveillance 
  • Access and Flow representative 
  • HR/Staffing
  • Pharmacy representative 
  • Public Health (PH) representative 
  • Occupational Health and Safety (H&S) representative 
  • Communications
What should I do when an outbreak has been declared over in my facility?
Consider convening a debrief meeting, led by 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 residents.
What do I do if my staff are scared to come to work during an outbreak in my facility? 
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.
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?
You will be advised by Facilities Management and IPAC to determine if additional equipment or supplies are needed.
This page last updated Dec 8, 2020 4:56pm PST