What are the steps involved in outbreak management?
1-Assess (is it really an outbreak, does it meet the definition of suspect or confirmed?),
- develop case definition
- ask for a line listing
2-Implement IPAC measures (additional precautions and increased surveillance)
3-Declare an outbreak (suspect or confirmed)
-Notify MOH
4-Notify appropriate stakeholders (OMT team/DOC in LTCH, neighboring PHUs, etc)
5-Call OMT meeting
6-Communicate lab results (with ICP of LTCH, etc)
7-Perform ongoing surveillance
8-declare the outbreak over
9-complete outbreak investigation file
https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/reference/resp_infectn_ctrl_guide_ltc_2018_en.pdf
What are the links in the chain of transmission?
1-host
2- Infectious agent
3-reservoir
4-portal of exit
5-route of transmission
6-portal of entry
How can the chain of transmission be broken? Give some examples
- the infectious agent is eliminated or inactivated or cannot exit the reservoir
- portals of exit are contained via safe practices (wearing mask, or covering wounds)
- modes of transmission are removed between objects or people because of barriers and/or safe practices (administrative controls-training, etc and environmental controls-hand hygiene, safe sharps handling, reprocessing, etc)
- portals of entry are protected (skin is disinfected before procedures, PPE worn by staff)
- hosts are not susceptible (immunizations up to date, symptoms are addressed)
What is Listeriosis, and what is the PH significance?
Bacterial infection caused by Listeria monocytogenes
affects immunocompromised, infants, elderly people, and pregnant women
Transmitted via contaminated food:
lunchmeats, cold cuts, unpasteurized fresh cheeses (brie, blue, queso fresco)
long incubation period
can replicate in cold temperatures
congenital/vertical transmission possible- can be fatal for baby, even while mother is symptom-free
antibiotics can stop infection- people should keep an eye out for symptoms
What are the signs and symptoms of Lyme disease?
Early signs/symptoms (3-30 days) are: bullseye rash* joint pain* swollen lymph nodes fever chills headache
later symptoms (days to months later): facial palsy (the Jean Chretien) arthritis and swelling of joints swelling of brain and spinal cord severe headaches and neck stiffness dizziness shortness of breath
What are some control measures for respiratory outbreaks in LTCH?
- additional precautions (droplet/contact)
- cohorting (patients and staff)
- proper hand hygiene
- isolation of symptomatic residents
- increased attention to hand hygiene (can perform auditing)
- increased environmental cleaning
How can climate change affect the spread of vector-borne disease in Canada?
- Increased habitat range of ticks, due to warming: increasing the length of season that they can survive.
- Increased range and abundance of mosquitos due to warming and changing weather patterns/more extreme weather events: making endemic MBD’s more common (WNV, EEE), and making it possible for invasive species like aedes aegypti, and aedes albopictus to survive (bringing new diseases like yellow fever, zika, dengue, chickungunya)
What is the exclusion criteria for S. Typhi (Typhoid Fever)?
Exclude all cases of S. Typhi from food handling, healthcare* and daycare activities until provision of:
3 consecutive negative stool samples collected at least 48 hours apart; AND
- at least 48h after completion of antibiotic treatment (for ciprofloxacin); OR
- at least 2 weeks after completion of antibiotic treatment (for ceftriaxone and azithromycin).5
What is Campylobacter jejuni, its symptoms, and its reservoir?
Symptoms:
- Diarrhea (with or without bloody stool)
- Abdominal pain
- Malaise
- Fever
- Nausea
- Vomiting
Reservoir:
- Poultry and cattle
- Puppies and kittens or other pets
- Swine, sheep, rodents, and birds
What is the difference between an inspection and an investigation?
- Inspection –> visit to determine compliance and to avoid/remedy risks to the public and ensure compliance with acts/regulations (preventive)
- Investigation –> collection of evidence with view for prosecution and to support an offence
Difference between cleaning, sanitizing, disinfecting, and sterilizing
Cleaning: physical removal of substances but does not kill microorganisms
Sanitizing process of reducing the number of microorganisms on a surface to a safe level
Disinfecting: process of using chemicals to kill or eliminate a broad range of microorganisms, including bacteria, viruses, and fungi, on a surface (except large numbers of bacterial spores)
Sterilizing: process of using heat, chemicals, or radiation to eliminate or kill all forms of microorganisms, including bacteria, viruses, fungi, and bacterial spores
When are low-level disinfectants used and what do they kill. Provide an example of a low level disinfectant.
Used on non-critical items, and environmental surfaces
Low - kills Pseudomonas, Staphylococcus, Salmonella
Label may state: “general disinfectant”, “limited disinfectant”, or “hospital disinfectant”
E.g., 100 ppm of chlorine (1:500 bleach solution), quaternary ammonium (barbicide), 3% hydrogen peroxide, 0.5% hydrogen peroxide (enhanced action formulation), or phenols
When are intermediate-level disinfectants used and what do they kill. Provide an example of an intermediate level disinfectant.
Intermediate - tuberculocidal and/or kills most bacteria, fungi, and viruses
E.g., 1000 ppm of chlorine (1:50 bleach solution), 70-90% ethyl or isopropyl alcohol, or 0.5% hydrogen peroxide (enhanced action formulation) with efficacy claims against TB or mycobacteria
How can infections spread in a PSS?
- Spread via the transfer of microorganisms from people, surfaces, or equipment
- Not cleaning, disinfecting, or sterilizing properly
- Reusing single-use tools instead of throwing them away
- Being exposed to infected skin or body fluids
- Using contaminated tools
- Performing procedures that break the skin and not protecting yourself or the client
When should gloves be worn in a PSS and when should they be changed?
- When the service involves breaking the skin’s surface. E.g., tattooing, microblading, ear or body piercing, waxing, etc.
- The PSS worker has open sores, cracks, or cuts on their hands
- Types of gloves include latex and nitrile
- Heavy duty gloves should be worn when handling sharps and chemicals
- Need to be changed between clients, breaks, and if they become soiled or damaged
What should an operator do if their sterilizer fails the spore test?
- Stop use of any tools or equipment that was sterilized since the last negative spore test
- Find all equipment and instruments that were used since the last negative spore test
- Find out the potential risks to clients
- Repeat the biological monitoring test
If the test is negative, re-sterilize any equipment and instruments that were sterilized since the last negative spore test
If the repeat test is positive, stop using the sterilizer and find out if repair and/or maintenance is needed - Following nay repairs and/or maintenance, the sterilize must pass the mechanical, chemical, and biological monitors for at least three full loaded consecutive cycles before use
Incubation period and infectious period of COVID-19?
Incubation - 2-14 days
*Depends on variant- newer strains have shorter incubation periods
Infectious period- up to 48 hours before symptoms, and up to 10 days after symptom onset
Explain routine IPAC practices, and additional precautions, and the principles behind each
-Routine practices are those used with all clients, during all kinds of care, in all healthcare settings, to prevent the spread of microorganisms
-This is based on the assumption that all patients are potentially infectious, even when asymptomatic
-Additional precautions are taken (in addition to routine practices) when patients are known or suspected to be colonized/infected with a particular agent
-These are based on the route of transmission of that agent
List each level of the hierarchy of controls
The hierarchy of controls is s way of determining which actions will best control exposures:
1-Elimination
2-Substitution
3-Engineering controls
4-Administrative controls
5-PPE
What are the exclusion criteria for a child/staff when a child care center is in an enteric outbreak?
-do not return to center until 48 hours after symptoms stop
What is the case definition for an enteric illness in a child care center?
When can an enteric outbreak be suspected? (definition)
-Case defined as 2 or more episodes of diarrhea and/or vomiting within 24 hour period
-Outbreak definition: 2 or more cases with common epidemiological link, and onset within 48 hour period
What is the difference between the case definition for an ARI, Influenza, and COVID-19?
-ARI cases are solely based on symptoms
-Influenza requires lab confirmation
-COVID:
-Confirmed case is PCR+, or RAT+ accepted if facility can not do PCR
-Probable case =symptoms and high-risk exposure
Current isolation and case management guidance for COVID-19 cases?
-Isolate until symptoms improving for 24 hours (48 hours if GI symptoms)
-Wear a tight-fitting mask while in public for 10 days after symptom onset or specimen collection
-Avoid non-essential activities that require removal of mask (dining out)
-Avoid non-essential visits to highest risk settings and individuals (if unavoidable, notify setting of recent diagnosis)
What diseases do Rodents carry?
- Hantavirus (white-footed or deer mice)
- Lymphatic choriomeningitis (mice)
- Leptospirosis (rats)
- Rat Bite fever (rats)
