1. Outbreak Management Guidelines
QUEENSLAND HEALTH GUIDELINE FOR THE MANAGEMENT OF
OUTBREAKS OF COMMUNICABLE DISEASE IN HEALTH FACILITIES (2009)
Executive Summary
1.0 INTRODUCTION
2.0 OBJECTIVES
3.0 INSTITUTING THE OUTBREAK PLAN
4.0 OUTBREAK CONTROL TEAM - COMPOSITION
5.0 OUTBREAK CONTROL TEAM - TERMS OF REFERENCE
6.0 OUTBREAK CONTROL TEAM - PROCEDURE
7.0 COMMUNICATION AND REPORTS
8.0 ROUTINE REVIEW
Attachments:
1 Other Communicable Diseases of public health importance
2 Duties of the Chairperson - Outbreak Control Team
3 Checklist of Outbreak Control Team Tasks
4 Dealing with the Media
5 Outbreak Notification Report
6 Outbreak Management Checklist
Executive Summary
1. This Outbreak Plan (the Plan) provides guidance on managing outbreaks of communicable
disease (whether notifiable or not) in health facilities.
2. The Plan is intended to ensure prompt action to recognise an outbreak of communicable
disease, eliminate the source and stop further spread, prevent recurrence, and ensure
satisfactory communication between all concerned.
3. The responsibility for making a decision to convene an Outbreak Control Team (OCT) will
depend on the circumstances of the cases and the environment in which the outbreak
occurs. Decisions regarding health facility outbreaks ultimately lie with the relevant Health
Service District Executive. Therefore, facility specific outbreak management plans must be
developed. In reality, the practical responsibility for such plans usually rests with the
Infection Control Team/Coordinator.
4. Communication with relevant stakeholders is a key element of this Plan. The Plan places
responsibility on the Chairperson of the OCT to determine when to communicate the
existence of an outbreak with the local Population Health Unit.
5. The local Population Health Unit must be informed where the outbreak involves any of the
following:
• Notifiable disease
• Where the impact of the outbreak gives rise to a broader public interest e.g. members of
the public are recalled for ‘look back’ investigations.
6. Facilities are to correspond with CHRISP regarding any outbreaks (refer to section 3.0 for
outbreak definition). This is particularly important where there are implications for state-
wide policy development or adjustment particularly in the areas of infection control and
sterilizing.
• An Outbreak Notification Report form is to be utilised when notifying CHRISP of any
facility outbreaks (Attachment 5).
7. At the conclusion of the outbreak a final report should be circulated as follows:
• Health facility: all OCT members, Health Service District Executive, other facility based
managers/clinicians as appropriate,
• Population Health Unit and CHRISP (where appropriate).
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2. 1.0 Introduction
• This Plan provides guidance for dealing with outbreaks of communicable disease (whether
notifiable or not) in health facilities.
• Outbreaks of healthcare associated infections are generally the responsibility of that facility’s
Infection Control Committee. However, outbreaks of notifiable diseases may require the
involvement of the Population Health Unit. An Outbreak Management Checklist may be
utilised to guide facilities in the management of outbreaks (Attachment 6).
• Under the Public Health Act 2005 and Public Health Regulation 2005, laboratories notify the
chief executive or delegate (public health medical officers are delegated for this purpose) all
laboratory-confirmed notifiable conditions. Similarly medical officers and directors of hospitals
are required to notify the chief executive or delegate of clinical and provisional diagnosis of
notifiable conditions. A complete list is available from:
http://www.health.qld.gov.au/ph/documents/cdb/notif_conditions_rpt.pdf
• Non-notifiable diseases may also cause outbreaks of public health importance, and a list of
some of these is given in Attachment 1.
• In order to meet the objectives of the Plan, there will be circumstances that require
collaboration at a local level between Health Service Districts and Population Health Units,
such as agreements for the provision of sufficient, suitably qualified support staff to undertake
pivotal roles in the outbreak investigation.
• Facility-specific outbreak management plans should be reviewed on a regular basis. The
review cycle should be in accordance with the relevant facility’s internal policy but should be at
least every 3-5 years.
2.0 Objectives
This document is intended to assist health facility staff in establishing an OCT to ensure prompt
action to:
• recognise and investigate an outbreak of communicable disease(s),
• identify and where possible, eliminate the source,
• stop or limit further spread,
• prevent recurrence,
• ensure satisfactory communication between all concerned, and
• disseminate lessons learnt.
3.0 Instituting the outbreak plan
• To confirm the outbreak, immediate steps must be taken by the facility’s Infection Control
Team/Coordinator to collect further clinical, epidemiological and laboratory information. A case
definition will be established and used to verify known cases and to search for further possible
cases.
• If an outbreak is confirmed, an initial assessment of the extent and importance of the outbreak
will be made and a decision taken on whether to institute the facility-specific outbreak plan and
convene the OCT.
• The decision to convene an OCT will be made by relevant personnel, such as the Chairperson
of the Infection Control Committee or an Infectious Diseases Physician/Microbiologist.
• Factors to be considered in the decision to convene an OCT include:
(a) the type of communicable disease involved
- In the case of possible healthcare associated transmission of a blood borne virus a
critical incident team should be set up - see guidelines at
http://www.health.qld.gov.au/chrisp/ic_guidelines/appendix_P1.pdf
(b) the number of confirmed or suspected cases (outbreak definition)
- large numbers of cases
- two or more cases of a notifiable condition in the same ward/area, within an incubation
period
(c) the size and nature of the population at risk
(d) the likely source
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3. (e) potential impact on service delivery
- involvement of management/Executive is required to implement measures to control
disease spread e.g. closure of wards/beds
- involvement of more than one ward or department.
4.0 Outbreak control team - membership
The OCT will usually be chaired by the Infection Control Committee Chairperson or other
appropriately qualified person (also refer Attachment 2).
The composition of the Outbreak Control Team may include:
• Health Service District Executive member or delegate
• Chairperson Infection Control Committee and/or Infection Control Practitioner/Coordinator
• Manager/clinician representatives from the relevant area
• Infectious Diseases Physician and/or Microbiologist (the Chairperson may choose to contact
the CHRISP Expert Advisory Group [CEAG] for consultation - ph 07 3328 9755)
• Population Health Unit representation, when appropriate e.g. notifiable disease
• Media Relations Officer
• Other relevant stakeholders e.g. Workplace Health and Safety, Support Services, Catering,
Laundry, Sterilizing Services, Pharmacy, etc
• Other individuals, including representatives of other agencies involved in the outbreak may be
co-opted as necessary.
5.0 Outbreak control team – terms of reference
• To review evidence and confirm there is an outbreak.
• To develop a strategy to deal with the outbreak and to allocate individual responsibilities for
implementing action.
• To investigate the outbreak and identify the nature, vehicle and source of infection.
• To implement control measures and to monitor their effectiveness in dealing with the cause of
the outbreak and in preventing further spread.
• To prevent further cases elsewhere by communicating findings to the Communicable Diseases
Branch, Queensland Health, when appropriate.
• To ensure adequate staff and resources are available for the management of the outbreak.
• To consider the potential staff training opportunities of the outbreak.
• To identify and utilise any opportunities for the acquisition of new knowledge about disease
control.
• To provide support, advice and guidance to all individuals and organisations directly involved in
dealing with the outbreak, which may include general community, hospital patients, visitors,
relatives and staff.
• To keep relevant outside agencies, the general public and the media appropriately informed.
• To declare the conclusion of the outbreak and to prepare a final report.
• To evaluate the response to the outbreak and implement changes in OCT procedures based
upon lessons learnt.
6.0 Outbreak control team - procedure
• Chairperson to convene OCT
• Elect Secretariat
- Minutes to be taken of all OCT meetings and subsequently approved. These will record
details of all issues discussed and decisions made.
• At first OCT meeting:
(a) agree on the OCT composition and terms of reference
(b) confirm individual responsibilities (Attachment 3)
(c) review checklist of OCT tasks (Attachment 3)
• At each subsequent OCT meeting, the situation should be systematically reviewed and the
need to obtain further assistance should be formally considered.
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4. • At final OCT meeting (determined by Chairperson):
(a) review the experience of all involved in management of the outbreak
(b) identify any problems encountered
(c) prepare the final report
(d) recommend any necessary revisions to the facility-specific outbreak management plan.
7.0 Communication and reports
• When an OCT is convened, the Chairperson will inform the:
- Health Service District Executive
- Infection Control Team/Coordinator
- Relevant facility-based managers/clinicians
- Relevant Population Health Unit (if appropriate)
- Senior Director, Communicable Diseases Branch (if appropriate) #
- CHRISP (if appropriate) #
- The general community (if appropriate) usually via a Media Relations Officer
#
Some discretion by the facility or Population Health Unit has been factored into the plan by
placing responsibility on the Chairperson of the OCT to determine when to communicate the
existence of an outbreak with Division of the Chief Health Officer via the Communicable
Diseases Branch.
In the first instance, it is a requirement that the local Population Health Unit be informed,
however, the Senior Director, Communicable Diseases Branch must be informed where the
outbreak involves the following:
- Notifiable disease
- Where the impact of the outbreak gives rise to a broader public interest e.g. members of
the public are recalled for ‘look back’ investigations.
Where the Senior Director is not available, the Senior Medical Officer or the Manager
Communicable Disease Prevention and Control, Communicable Diseases Branch, should be
notified. These staff members, once notified will collaborate and have the responsibility of
informing other key personnel in the Division of the Chief Health Officer, as appropriate.
Contact details:
- Senior Director, Communicable Diseases Branch (ph 07 3328 9723; fax 07 3328 9782)
- Senior Medical Officer, Communicable Diseases Branch (ph 07 3328 9725; fax 07 3328
9782)
- Manager Communicable Disease Prevention and Control, Communicable Diseases
Branch, (ph 07 3328 9741; fax 07 3328 9782)
Facilities are to correspond with CHRISP regarding any outbreaks (refer to section 3.0 for
outbreak definition). This is particularly important where there are implications for state-wide
policy development or adjustment particularly in the areas of infection control and sterilizing.
- An Outbreak Notification Report form is to be utilised when notifying CHRISP regarding any
facility outbreaks (Attachment 5).
• During the outbreak key individuals will be kept informed in accordance with responsibilities
outlined in Attachment 3.
• The OCT should endeavour to keep the public and media as fully informed as possible without
prejudicing the investigation and without compromising any statutory responsibilities and legal
requirements. Media statements and enquiries will be dealt with in accordance with the
principles outlined in Attachment 4.
• Where necessary, the OCT will identify a suitable incident room and establish arrangements for
telephone help-lines to deal with calls from the public and/or the media if appropriate. e.g.
13HEALTH may be utilised to answer calls from the general public
• The final OCT meeting should include a de-briefing session when aspects of the outbreak are
reviewed and lessons learnt identified.
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5. • At the conclusion of the outbreak, a final report will be prepared by the Chairperson on behalf
of the OCT and will highlight:
(a) the results of the outbreak investigation and control interventions
(b) any difficulties or problems encountered
(c) any action required to prevent recurrence
(d) any recommended revisions to the facility-specific outbreak management plan.
• The final report should be circulated as follows:
- Health facility: all OCT members, Health Service District Executive, other facility-based
managers/clinicians
- Population Health Unit and CHRISP (where appropriate).
The final report should be considered a public document and due regard therefore given to
confidential aspects of the outbreak investigation.
• Important recommendations for future outbreak management will be circulated to other Health
Service Districts for information.
8.0 Routine revision
• The facility-specific outbreak management plan will be reviewed by the Infection Control
Team/Coordinator and updated as necessary according to internal policy but at least every 3-5
years.
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6. ATTACHMENT 1
Other Communicable Diseases of Public Health Importance
• Enterohaemorrhagic Escherichia coli (EHEC) infections
• Viral gastroenteritis
Other Significant Organisms of Infection Control Importance
• Multi-resistant organisms e.g. vancomycin resistant enterococci (VRE), carbapenem-resistant
Acinetobacter (CRAB or MRAB), Extended spectrum βeta-lactamase producing organisms
• Clostridium difficile-associated Disease (CDAD)
• Multi drug resistant (Pulmonary) Tuberculosis
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7. ATTACHMENT 2
Duties of Chairperson – Outbreak Control Team
• To declare an outbreak and convene the Outbreak Control Team (OCT).
• To act as Chairperson of the OCT by leading and co-ordinating the response to the outbreak.
• If necessary, to organise an outbreak control centre and appropriate support resources.
• Where appropriate, to arrange for medical examination of cases and contacts and the taking of
clinical specimens.
• Where appropriate, to arrange immunisation and/or chemo-prophylaxis for cases, contacts and
others at risk.
• To ensure communication strategies are developed and implemented (see Section 7.0).
• Prepare a final report on the outbreak.
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8. ATTACHMENT 3
Checklist for Outbreak Control Team Tasks
The principal aim of the Outbreak Control Team (OCT) is to investigate the cause of the outbreak
and to implement action to identify the source, minimise spread and prevent recurrence of the
communicable disease. The following tasks must be undertaken in order to deal effectively with an
outbreak. The step-by-step approach does not imply that each action must follow the one
preceding it. In practice, some steps must be carried out simultaneously and not all steps will be
required on every occasion.
Preliminary Phase
Consider whether or not cases have the same illness and establish a tentative diagnosis
Determine if there is a real outbreak
Establish a single comprehensive case list
Collect relevant clinical or environmental specimens for laboratory analysis
Conduct unstructured, in-depth interviews of index cases
Conduct appropriate environmental investigation including inspection of involved or implicated
premises
Identify population at risk
Identify persons posing a risk of further spread
Initiate immediate control measures
Assess the availability of adequate resources to deal with the outbreak
Descriptive Phase
Establish a case definition (clinical and/or microbiological)
Search for other cases
Collect and collate data from affected and unaffected persons using a standardised
questionnaire
Describe cases by time, place and person
Form preliminary hypotheses on the cause of the outbreak
Make decision about whether to undertake detailed analytical studies
Analytical Phase
Calculate attack rates
Confirm factors common to all or most cases
Test and review hypotheses of the cause
Collect further clinical or environmental specimens for laboratory analysis
Ascertain source and mode of spread
Control Measures
Control the source: animal, human or environmental
Control the spread by:
(a) Isolation or exclusion of cases and contacts
(b) Treatment of cases to reduce infectious period, where possible (e.g. antivirals)
(c) Screening and monitoring of contacts
(d) Protection of contacts by immunisation or chemo-prophylaxis
(e) Enhanced infection control practices by staff and visitors including cleaning and equipment
decontamination procedures
(f) Closure of premises
Monitor control measures by continued surveillance for disease.
Declare the outbreak over.
Evaluation
Evaluate the management of the outbreak and make recommendations for the future
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9. Communication
Consider the best means of communication with colleagues, patients and the public, including
the need for an incident room and/or help-lines
Notify the local Population Health Unit where the outbreak involves a notifiable disease or gives
rise to broader public interest
Activate 13HEALTH
Ensure appropriate information is given to the public, especially those at high risk
Ensure accuracy and timeliness
Include all those who need to know
Use the media constructively.
Prepare written report
Disseminate information on any lessons learnt from managing the outbreak
Further Studies
Conduct further analytical case control or cohort studies
Conduct further microbiological studies
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10. ATTACHMENT 4
Dealing with the Media
• The Outbreak Control Team (OCT) will endeavour to keep the public and media as fully
informed as possible without prejudicing the investigation and without compromising any
statutory responsibilities or legal requirements.
• At the first meeting of the OCT arrangements for dealing with the media should be discussed
and agreed.
• Press statements should be prepared on behalf of the OCT by a small group including the
Chairperson, Infectious Diseases Physician/Microbiologist and Media Officer.
• Press statements applicable to community associated outbreaks will normally only be released
by the Media Officer, following approval by the District Chief Executive Officer of the facility. If
a Media Officer is not available, the OCT will nominate an alternative spokesperson.
• No other member of the OCT will release information to the press without the agreement of the
Chairperson.
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11. ATTACHMENT 5
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12. ATTACHMENT 6
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