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Questions and Answers
What is the primary cause of ventilator-associated pneumonia?
What is the primary cause of ventilator-associated pneumonia?
Which of the following professionals are mandated to report communicable diseases under the HPPA?
Which of the following professionals are mandated to report communicable diseases under the HPPA?
Which type of infection can surgical site infections be categorized into?
Which type of infection can surgical site infections be categorized into?
What responsibility do healthcare institutions have under the HPPA regarding outbreak reporting?
What responsibility do healthcare institutions have under the HPPA regarding outbreak reporting?
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What is a key role of Public Health when responding to outbreaks of illness?
What is a key role of Public Health when responding to outbreaks of illness?
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What is the primary goal of surveillance in the context of an outbreak?
What is the primary goal of surveillance in the context of an outbreak?
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Which of the following accurately defines an outbreak?
Which of the following accurately defines an outbreak?
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What is the minimum number of diarrhea episodes within a 24-hour period required to confirm a gastrointestinal infection outbreak?
What is the minimum number of diarrhea episodes within a 24-hour period required to confirm a gastrointestinal infection outbreak?
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In declaring a confirmed respiratory infection outbreak, which of the following conditions must be met?
In declaring a confirmed respiratory infection outbreak, which of the following conditions must be met?
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What does a case definition achieve during an outbreak investigation?
What does a case definition achieve during an outbreak investigation?
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What is the determining factor for declaring a respiratory infection outbreak over?
What is the determining factor for declaring a respiratory infection outbreak over?
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Which situation would NOT constitute a confirmed gastroenteritis outbreak?
Which situation would NOT constitute a confirmed gastroenteritis outbreak?
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How long after the last symptom onset can a norovirus outbreak be declared over?
How long after the last symptom onset can a norovirus outbreak be declared over?
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What is an essential criterion for the symptoms to be classified as gastroenteritis?
What is an essential criterion for the symptoms to be classified as gastroenteritis?
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Which of the following is NOT a factor that influences the time to declare a respiratory infection outbreak over?
Which of the following is NOT a factor that influences the time to declare a respiratory infection outbreak over?
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Which of the following is not a responsibility of the Public Health Unit during an outbreak?
Which of the following is not a responsibility of the Public Health Unit during an outbreak?
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Which member is essential in the Outbreak Management Team for overseeing the handling of cases related to pharmaceutical concerns?
Which member is essential in the Outbreak Management Team for overseeing the handling of cases related to pharmaceutical concerns?
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What is the primary purpose of daily communication between the Public Health Unit and health facilities during an outbreak?
What is the primary purpose of daily communication between the Public Health Unit and health facilities during an outbreak?
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Which of the following control measures is regarded as the single most important procedure for preventing infections during an outbreak?
Which of the following control measures is regarded as the single most important procedure for preventing infections during an outbreak?
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What is a critical task during the Outbreak Management Team meeting related to the outbreak's definition and measures?
What is a critical task during the Outbreak Management Team meeting related to the outbreak's definition and measures?
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Study Notes
Nosocomial Infections/Health Care-Associated Infections & Respiratory/Enteric Outbreaks
- The presentation covers nosocomial infections, health care-associated infections, and respiratory/enteric outbreaks.
- This includes specific examples of these types of infections.
Final Exam Information
- Exam date: Wednesday, December 11th
- Exam time: 3:00 PM
- Course codes: TRSM 2099 AND 2166
- Exam format: Multiple choice and true/false questions.
- Content: Post-midterm material only.
- Number of questions: Approximately 45.
- Important: Book accommodations through the test centre by the school deadline.
Nosocomial Infections/HIAs
- Modern healthcare uses many invasive devices and procedures to treat patients and help them recover.
- Infections can be associated with medical devices such as catheters or ventilators.
Types of Healthcare-Associated Infections (HAIs)
- Central line-associated bloodstream infections (CLABSIs)
- Catheter-associated urinary tract infections (CAUTIs)
- Ventilator-associated pneumonia (VAP)
- Surgical site infections
Central Line-associated Bloodstream Infections (CLABSIs)
- A central line is a catheter placed in a large vein to give medication, fluids, or collect blood samples.
- CLABSI occurs when microorganisms enter the bloodstream through the central line.
- Healthcare providers must follow strict protocols during insertion to ensure sterility and prevent CLABSIs.
Catheter-associated Urinary Tract Infections (CAUTIs)
- A urinary tract infection (UTI) involves any part of the urinary system (urethra, bladder, ureters, kidneys).
- Approximately 75% of hospital UTIs are associated with urinary catheters, which are tubes placed in the bladder to drain urine
- Prolonged catheter use is the most important risk factor for developing CAUTIs.
- Catheters should only be used for appropriate indications and removed as soon as no longer needed.
Ventilator-associated Pneumonia (VAP)
- A ventilator is a machine that helps patients breathe by delivering oxygen.
- VAP is a lung infection that develops in a person on a ventilator.
- An infection happens when germs enter the lungs through the ventilator tube.
Surgical Site Infections
- A surgical site infection occurs after surgery in the body part where the surgery took place.
- Some surgical site infections are superficial, involving only the skin.
- Others can involve tissues under the skin, organs, or implanted materials.
Legal Authority
- The Health Protection and Promotion Act (HPPA) lists reportable communicable diseases.
- These illnesses are reportable for surveillance and public health intervention.
Who Must Report?
- Physicians
- Nurses
- Pharmacists
- Dentists
- Chiropractors
- Optometrists
- Hospital Administrators (Infection Control Practitioners)
- Superintendents of Institutions
- School Principals
- Laboratory Operators
- Physicians signing medical death certificates
Outbreak Reporting
- Healthcare institutions are responsible for monitoring staff and patients for signs and symptoms of gastroenteric and respiratory infections.
- Institutions are required to actively report suspected and confirmed outbreaks to their local public health unit.
- Public Health is responsible for responding to reports of suspected and confirmed outbreaks, and working to prevent and control these occurrences.
- Surveillance is the systematic ongoing collection, collation, and analysis of data with timely dissemination of information.
Goals of Surveillance
- An important goal of surveillance is to ensure early identification of a potential outbreak or an outbreak in its early stages.
Education for Staff
- The role of staff in the surveillance of infections and its importance
- Symptoms of gastroenteritis and respiratory illness
- Criteria for a suspected outbreak
- Procedures for reporting
What is an Outbreak?
- An unexpected increase in disease occurring within a specific population at a given time and place.
Objectives of an Outbreak Investigation
- Confirm the existence of the problem and establish a case definition.
- Determine the extent of the problem in terms of time, person, and place characteristics
- Identify the agent, source, method of spread, and contributing factors
- Implement control measures.
Assessing the Situation: Case Definition
- A case definition outlines the criteria used to identify outbreak-associated cases.
- Residents meeting the case definition are considered cases, regardless of lab tests unless another diagnosis is confirmed.
Declaring an Outbreak
- A respiratory infection outbreak is declared when 2 cases of acute respiratory illness occur within 48 hours in the same geographic location or one lab-confirmed case of influenza.
- A confirmed respiratory outbreak occurs when either 2 laboratory-confirmed cases occur within 48 hours with a common epidemiological link (e.g., similar ward, room) or when 3 ARI cases occur within 48 hours with similar epidemiological link
- A confirmed gastroenteritis outbreak occurs when two or more cases meeting a case definition have a common epidemiological link with an initial onset within 48 hours. (e.g. Same unit, same caregiver)
Declaring an Outbreak Over
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Determining when an outbreak is over depends on several factors, including the causative organism's communicability and incubation, the outbreak's epidemiology, and whether the last case involved a resident or staff member
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Respiratory outbreaks are typically declared over 8 days after the onset of last case (5 days communicability + 3 days incubation), or 3 days after the last sick staff member's last day of work (whichever is later).
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For norovirus or unknown agent outbreaks, 5 days after the onset of symptoms (or 48 hours if it's the incubation period) for the last case is the standard.
Health Unit Responsibilities
- Assign an outbreak number
- Notify Public Health Lab
- Facilitate specimen testing by the OAHPP lab
- Report to Ministry of Health, following specific timelines relevant for different types of outbreaks
- Be part of the outbreak management team
- Assist in the investigation, confirming case, declaring outbreak and managing it
- Investigate potential sources (e.g., food, water)
- Offer disease-specific information
- Provide specimen kits
- Communicate with institutions and media
- Provide guidance on declaring the outbreak over
- Provide final outbreak report to the MOHLTC.
Outbreak Management Team
- The team consists of Public Health Unit, Infection Prevention & Control, Occupational Health, Environmental Services, Corporate Communications, Pharmacy Services, Food Services, Diagnostic Laboratories, Patient Care Managers/Physicians, and Senior Management.
OMT Meeting
- Review line list information
- Develop a working case definition
- Review control measures
- Address appropriate signs and placement
- Review the TPH OB Checklist
Communication
- Frequent communication to prevent misunderstandings is required.
- Communication happens between health units, facilities, public health labs, and other relevant institutions on a daily or as needed basis. Also, communication includes advising relevant parties about the outbreak's admission status, related LTCHs or hospitals, health compliance advisors from the Ministry of Health, resident physicians and families, other healthcare providers (e.g., physiotherapists), staffing agencies, emergency medical services (including dispatch), and the coroner's office (if cases of death occur).
Outbreak Control Measures
- Hand hygiene, enhanced environmental cleaning, use of personal protective equipment (PPE), patient control measures, visitor control measures, and staff control measures are common outbreak controls.
Control Measures
- Focuses on hand hygiene, environmental cleaning, and PPE usage.
Staff Control Measures
- Staff with respiratory symptoms should not enter the facility.
- Staff who are ill should report the illness to infection control and/or occupational health.
- Staff with an illness should be excluded from work for 5 days from the date of onset or until the symptoms resolve (whichever is shorter).
- For enteric outbreaks, staff should be off work for 48 hours after symptom resolution.
- Staff working at other healthcare facilities should not work if they have respiratory symptoms.
- Staff should be discouraged from working in other healthcare settings during an outbreak.
- Cohort staff (some staff look after ill residents/patients and some exclusively after well residents/patients), if feasible.
Under What Conditions Can I Work During a Influenza Outbreak?
- Being well is required
- Vaccinated for 2+ weeks
- Vaccinated for less than 2 weeks needs to take antivirals
- Unvaccinated should take antivirals
Resident Control Measures
- New admissions, re-admissions of patients from a hospital, and discharge of residents to private homes require particular consideration
- Reschedule non urgent appointments until the outbreak is controlled
- Urgent appointments may continue with precautions (e.g. PPE).
- Communal activities that combine residents are often discontinued.
- Outside group visits are also usually not permitted, with special considerations to be discussed with Public Health.
- Case residents in outbreaks are usually restricted to their rooms for a certain period of time, with variations depending on the outbreak type.
Visitor Control Measures
- Post notification signs about the outbreak.
- Only allow one visitor per resident and visitors must leave the area after their visits.
- Visitors visiting well residents should not need to wear PPE as long as they can maintain a certain distance from any ill patients.
- Visitors should wear the required PPE when visiting ill residents.
Dirty Hospitals
- A link to a Youtube video.
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Description
This quiz covers key concepts related to nosocomial infections and health care-associated infections (HAIs), along with examples of respiratory and enteric outbreaks. It focuses on the types of infections related to modern healthcare practices, including complications from invasive devices. Prepare for questions to reinforce your understanding of these critical health issues.
