Control of Gastrointestinal Disease Outbreaks

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Control of Gastrointestinal Disease Outbreaks

• Bruce Gamage
• Infection Control Consultant
• BC Centre for Disease Control

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Objectives

• Outbreak Control
• Decontamination Protocol
• Resources

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Settings

• Care Facilities
• Acute Hospitals
• Schools/Day Care Centres
• Hotel/Restaurant

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Who ya gonna call?

• When 3 or more cases of suspect gastroenteritis
  occur within a 4 day period
• (Start collecting samples!)
• Infection Control Practitioner (if applicable)
• Facility Director of Care (if applicable)
• EHO/ PHI
• BCCDC GI Outbreak Coordinator

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OUTBREAK CONTROL MEASURES(health care)

• Internal
• Confine ill residents/clients to their rooms
  until 48 hours post symptoms.
• Exclude any ill employees from work until 48
  hours post symptoms.
• External
• Advise staff not work at another facility unless
  they are well for a minimum of 72 hours after
  their last shift at an affected facility.

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OUTBREAK CONTROL MEASURES (health care)

• Use transmission based precautions
• Gloves - for providing any direct care
• Gowns when contamination of care givers
  clothing is possible
• Masks when there is a risk of droplet spread of
  infectious material (i.e. cleaning up areas
  grossly contaminated with feces or vomit, caring
  for a resident who is vomiting).
• Review hand hygiene procedures with staff.
• Alcohol Hand Rinses?

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OUTBREAK CONTROL MEASURES (health care)

• Ensure surfaces contaminated by feces or vomitus
  are immediately cleaned and disinfected.
• Implement a program of increased cleaning and
  sanitizing of common touch surfaces such as door
  handles, handrails, and sink/toilet handles.
• The agent of choice for disinfection is household
  bleach diluted 150/ ASHP 116.

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OUTBREAK CONTROL MEASURES (health care)

• Consider
• postponing transfers to other facilities and
  admissions/re-admissions unless medically
  warranted
• limiting the use of casual or part-time staff
  that work at other facilities
• cohort nursing and other staff to limit potential
  spread from ill to well residents/other parts of
  facility
• decreasing or discontinuing group activities and
  outings until the outbreak is resolved.
• Limiting visitors during the outbreak (this does
  not mean excluding family members involved in
  care)

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OUTBREAK CONTROL MEASURES (schools/daycares)

• Children who become ill with nausea, vomiting or
  diarrhea must be removed from the classroom
  immediately.
• Ill children should be sent home as soon as
  arrangements can be made.
• Affected children should not return to school
  until at least 48 hours after symptoms have
  subsided.

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OUTBREAK CONTROL MEASURES (schools/daycares)

• Information on viral gastroenteritis and control
  at home
• Hand washing is most important
• Regular education sessions for staff and students
  on hand hygiene
• Special consideration must be given to the
  cleaning of vomiting or fecal accidents.
• Failing to properly clean contaminated areas
  will contribute to rapid spread and continuation
  of outbreaks.

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CONTROL MEASURES (Restaurants/Hotels)

• Report outbreak
• Identify source
• food handlers restricted from working at least 48
  hrs after the symptoms have cleared
• food discarded other than unopened containers
  (use discretion)
• food exposed, even indirectly, to vomit is
  potentially infectious from aerosol contamination
  
• drinking water or ice cubes, discard
• containers for water or ice cubes must be
  disinfected.
• food can become source if washed with
  contaminated water.

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CONTROL MEASURES (Restaurants/Hotels)

• Role of the environment
• vomiting generates virus-containing aerosols
• environment can be readily contaminated
• food placed on contaminated surface could become
  a source of infection
• contamination of the taps of a wash sink source
  when washing hands.

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EHOs provide recommendations on

• Food service worker hygiene
• Kitchen sanitation
• Proper food cooking and refrigeration practices
• Food safety education (i.e. FOOD SAFE).
• Infection control
• Water supply
• Disinfection
• Sample collection and transport

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Decontamination Protocol

• Accident Clean up
• Wear gloves, gown and mask
• Use paper towels to soak up excess liquid
• Clean with detergent and hot water
• Disinfect with freshly made 150 bleach or 116
  ASHP
• Wash hands using soap and warm running water for
  at least 30 seconds.

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Decontamination Protocol

• If cleaning food preparation areas
• Disinfect with freshly prepared 150 bleach/116
  ASHP
• Dispose of any exposed food (food that has been
  handled by an infected person or exposed to the
  virus by someone vomiting in the area).
• Wash all dishes, utensils and trays in a
  commercial dishwasher preferably with hot water
  rinse (gt82C) or a chemical sanitizer.
• Do not to cross-contaminate dirty to clean dishes

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Treatment of Specific Materials

• Wash linen in a hot water (gt71.1 for 25 mins.)
  and detergent
• Clean Vinyl furniture or mattresses with
  detergent and hot water then disinfect
• Place furniture or cloth mattresses outside in
  the sun for a few hours or disinfect with
  Bleach/ASHP or steam clean (minimum 60C water).

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Treatment of Specific Materials

• Clean carpets with hot water and detergent or
  steam clean.
• Wash non-disposable mop heads in a hot water
  (gt71.1C for 25 mins.) and detergent.
• Clean bathrooms then disinfect with 150 bleach
  solution/ 116 ASHP.

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Other Disinfectants

• QAC - not effective against non-enveloped
  viruses.
• Phenolics - may be effective at 2-4 times the
  recommended dilutions, but not well supported.
• Alcohols studies suggest gt85 ethanol more
  effective against non-enveloped viruses.

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Summary

• Focus on
• Hand hygiene/barriers
• Exclude ill staff
• Confine ill residents/clients
• Clean and disinfect environment.

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Resources

• www.bccdc.org
• Managing Outbreaks of Gastroenteritis in
  Residential Care Facilities,Updated version
  released summer 2003
• A Guide to Laboratory Investigation of
  Gastrointestinal Disease Outbreaks, 2002
• Bruce Gamage, Infection Control Consultant
• bruce.gamage_at_bccdc.ca
• 604-660-6076
• Lorraine McIntyre, GI Outbreak Coordinator
• Lorraine.macintyre_at_bccdc.ca
• 604-660-6079