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Outbreaks

Outbreaks can occur at child care centres due to infectious agents being brought into the centre and then transmission occurring. The goal of outbreak management is to break the train of transmission and prevent further spread of illness. When notified of the cluster of illness, the assigned public health inspector will determine if the cluster is an outbreak or not. If it is an outbreak, the inspector will require control measures be started and provide the centre with an outbreak number. The outbreak number should be referenced on all communications regarding the outbreak especially any samples/swabs that are submitted too the lab for testing. If determined to not be an outbreak, the inspector may still recommend outbreak precautions to prevent an outbreak from being declared in the future.

There are two classifications of outbreaks:

  • Enteric (Gastrointestinal) which usually involves symptoms of nausea, vomiting and diarrhea
  • Respiratory which usually involves symptoms of fever, cough, runny nose, sore throat etc. 

Many precautions are the same or similar regardless of classification though some may vary.

The Simcoe Muskoka District Health Unit (SMDHU) provides a checklist for respiratory outbreaks  and enteric outbreaks to assist the centre in implementing. outbreak measures.

Outbreak measures

Isolation and pick-up of ill children

  • Where ratios allow, children should be removed from the classroom when it is identified that they are ill and kept away from the other children until parents/guardians can come pick them up.  If ratios don't permit removal of children from the room, an area of the room should be dedicated for caring for the children in isolation. 

Exclusion

  • Ill staff/children  are to be excluded from the centre as per the Common Childhood Illness Brochure or center policy.
  • Respiratory outbreaks - ill staff'/children are to be excluded from the centre until fever-free and symptoms have been resolving for at least 24 hours AND the child/staff are well enough to participate in programming. If influenza is the cause of the outbreak, the exclusion period will increase to a minimum of 5 days from the onset of symptoms unless all symptoms have been completely resolved for at least 48 hours.
  • Enteric outbreaks - ill staff/children are to be excluded from the centre until symptoms have been complete resolved for at least 48 hours.

Hand Hygiene & Respiratory Etiquette

  • Effective hand hygiene is an excellent way to reduce transmission of illness
  • Hand hygiene education should be built into programing to help children remember to wash their hand more regularly and effectively
  • Follow hand hygiene directions when washing hands with soap and water or alcohol-based hand rub.
  • Help children to remember respiratory etiquette for coughs and sneezes which includes using disposable tissues, coughing/sneezing  into elbow and practicing hand hygiene after coughing or sneezing. 

Enhanced Cleaning & Disinfection

  • The centre must switch to their outbreak disinfectant. This disinfectant must be effective against Norovirus to be considered an outbreak disinfectant.
  • Be sure to review the manufacturer's directions for the outbreak disinfection with staff for safe use.
  • Recommendations for routine cleaning can be found under the infection prevention & control tab. During an outbreak or increased illnesses period, the cleaning then disinfection in the centre should be increased to daily for all affected classrooms and increased from weekly for any unaffected classrooms.  Additional staff may be necessary to assist with the increased cleaning then disinfection demands.
  • Follow the directors for how to clean up bodily fluids if there is vomit, diarrhea or a large blood spill requiring clean up.

Difficult to Clean Toys/Surfaces

  • Any toys that cannot be easily cleaned then disinfected should be removed from play for the course of the outbreak.
    • This will not only help with decreasing transmission but will alleviate some of the work your staff are required to complete during an outbreak.
    • This includes plush toys and dress-up as well as soft furnishing that require laundering
  • Furniture items that cannot be laundered after each use, such as cloth couches, should be removed from the room for the duration of the outbreak.
  • Carpets can harbour disease but can be steam-cleaned or removed from the classroom.

Sensory & Natural Play

  • Sensory and natural play items are often composed of things that cannot be cleaned then disinfected
    • Shared sensory bins are an ideal location for germs to spread from child to child
  • Water is an excellent habitat for germs to thrive. Therefore, during an outbreak, water play should be discontinued.
  • Group sensory play should be suspended for the duration of the outbreak.
  • If the centre has questions or concerns about specific sensory play activities during an outbreak, they could consult with their inspector. 

Classroom Intermingling/Social Gatherings

  • During the course of an outbreak, classrooms (including staff) should cohort (group together and not mix with other classrooms), and be kept separate to prevent transmission between classrooms
    • Staff should not provide coverage in multiple rooms to prevent further spread of illness.
    • Children should not visit other rooms for purposes of transitions. 
  • Off-site field trips and centre tours should be rescheduled for after the outbreak.
  • Supervisors should consider cancelling in-person staff meetings during an outbreak.

Diapering/Toileting

  • During enteric outbreaks, cloth diapers should not be used, and staff may want to consider the use of gloves when diapering and/or toileting.
    • Remember, gloves do not replace good hand hygiene, hands must be washed before gloves are put on and after gloves are taken off. 

Communication with Parents

  • Ensure parents and families are kept up to date on the outbreak and its progress
  • Outbreak signs are to be posted at entrances to notified parents, families and visitors upon entry.

Communication with Public Health Inspector

  • The supervisor (or designate) is required to provide the public health inspector with regular updates regarding the progress of the outbreak. Updates on ill staff or children must be recorded on the line list and submitted daily.  A second staff member should be familiar with outbreak in order to provide updates to the inspector in the absence of the supervisor or designate. 

Outbreak Resources

Routine Surveillance Sign

Enhanced Surveillance sign 

Respiratory Outbreak

Outbreak Checklist 

Respiratory Line List for Staff and Children - Fillable Electronically

Respiratory Line List for Staff - PDF

Respiratory Line list for Children - PDF

Respiratory Outbreak Sign

Enteric Outbreak

Outbreak Checklist

Enteric Line List for Staff and Children - Fillable Electronically

Enteric Line List for Staff - PDF

Enteric Line List for Children - PDF

Enteric Outbreak Sign

Filling Out a Line List

Each line list is available for download as an Excel document. When using this version, the first page in the document provides you with some reminders for line list completion. Complete the second page, enter the name of your centre, the date the outbreak was declared by SMDHU, the outbreak number provided by SMDHU (should start with 2260), and the case definition provided by SMDHU.

The case definition is a sentence that describes who you should be adding the line list, your inspector will help you determine this. Pages 3 and 4 are the actual line lists, complete all possible columns. 

Ensure the line list is updated whenever new information is made available (new person is sick, line listed person has recovered and/or returned).  When you submit the line list, DO NOT email it directly to your inspector.  Instead, send via the secure email transfer line that was provided to you. If you do not have a link, please contact your inspector to obtain one.

If you are unsure about any piece regarding line list completion, reach out to your inspector for assistance. 

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