Outbreak management control measures are to be implemented in consultation with the outbreak coordinator, outbreak management team, the infection and prevention control lead, and advice from local public health authorities. Individual national, state, and territory legislation must be followed.

Standard and transmission-based precautions 

Standard plus appropriate transmission-based precautions are to be implemented as soon as an outbreak or a potential outbreak has been identified or determined.  The causative infectious disease will govern which precautions should be implemented.

 

Hand hygiene

Adherence to the principles of strict hand hygiene and the '5 Moments For Hand Hygiene' can help prevent further cases and reduce environmental contamination

PPE stations will be required outside rooms and within areas where affected residents are accommodated

Adequate supplies of PPE will need to be available for initial set-up, as well as ongoing use during the outbreak

PPE should be included in the outbreak kit 

Details of suppliers should be included in the outbreak management plan

All staff should be educated about PPE and how to use it, such as donning and doffing processes

 

Environmental cleaning

During an outbreak, the cleaning frequency will need to be increased, and the efficacy of cleaning will need to be monitored on an ongoing basis

Only approved chemicals should be used in accordance with facility cleaning protocols. Neutral detergent and TGA-approved disinfectant should be readily available. Sodium hypochlorite may also need to be used according to the guidelines

Detergent and disinfectant wipes are made available

Isolation rooms should be cleaned with yellow colour-coded cleaning equipment

Cleaning schedules should incorporate the frequent cleaning of frequently touched environmental surfaces such as door handles, taps, handrails, technical aids, buzzers, and other switches and devices

Cleaning equipment, such as cloths, should preferably be disposable. Reusable equipment to be cleaned and laundered according to required laundry standards

Limited essential equipment and furniture should be placed within the affected room/s or area/s during an outbreak

Special consideration should be made for the cleaning of soft furnishings and carpets

Ideally, separate cleaning staff should be allocated to cleaning affected rooms/areas. If this is impracticable, then rooms of non-affected residents should be cleaned first, and then isolation rooms 

Once the outbreak has been deemed to be cleared, terminal cleaning should be completed for all affected areas

Employees assigned to cleaning duties should not have access to the kitchen during an outbreak

 

Resident isolation and cohorting

Isolation of affected residents is vital to outbreak management. Single rooms with ensuite bathrooms are the preferred choice for managing infectious residents

When isolation is unable to be accommodated, then residents with the same organism may need to be cohorted together in a shared room

Depending on the number of residents affected or the type of identified infectious disease, isolating a section or even the entire facility may need to be considered

Isolated rooms and zones or areas should be clearly identified and signposted to alert anyone in the facility

 

Exclusion during an outbreak

Examples of exclusions that may be implemented during an outbreak to prevent the transmission of infection include

Cancelling or excluding residents from therapies and or recreational activities

Restriction or exclusion of visitors to residents

Restricting residential aged care facility access to essential personnel only

Restriction or cancellation of volunteer programmes

Exclusion of employees who are unwell.  Depending on the infectious disease, this may also involve the exclusion and isolation of their close contacts

Employees who are deemed at risk, e.g., unvaccinated, may need to be deployed to other areas or be excluded

 

Restricting movement within and outside the facility 

Restricted movement of residents within the facility will assist with the reduction of transmission

Appropriate management will need to be considered if a hospital transfer is required

Essential external appointments will need to be reviewed and discussed with facility management

Non-essential appointments may need to be cancelled and postponed until the outbreak is over

 

Employee considerations 

Employee movement should be restricted within the facility during an outbreak

Separate healthcare workers should be allocated to affected or non-affected residents where possible

If healthcare workers must care for affected and non-affected residents, then those who are not affected should be attended to first

Separate staff rooms may need to be provided in each section or wing of the residential aged care facility, which includes the number of employees allowed in each staff room at each time

Encourage employees to have their breaks isolated outside to reduce the risk of transmission 

Only kitchen employees can enter the kitchen area and should not be accessing outbreak rooms/areas

Meals are to be delivered to residents by healthcare workers 

During an outbreak, there is the risk that employees may also be affected by the infection and be unable to attend work, an employee contingency plan is recommended to be included in the outbreak management plan

Infected employees should remain off duty until it is deemed appropriate for them to return to work. Clearance requirements to return to work may be required depending on the infectious disease

 

Laundry 

Alginate bags are to be used for all soiled, wet, and contaminated laundry

All laundry should always be handled with the use of appropriate PPE

 

Waste management

Clinical waste is to be identified and managed in accordance with individual national, state, and territory clinical waste management guidelines

All waste types should always be handled with the use of appropriate PPE

 

Food Handling

Only kitchen employees should have access to the kitchen during an outbreak.

All appliances, work benches, and equipment are to be effectively cleaned and disinfected

Communal dining areas should be closed

All utensils, including cutlery, crockery, and glassware, must be washed in the dishwasher with detergent and an appropriate hot temperature.

Food taken out of the kitchen and not consumed is to be discarded

Kitchen employees to deliver food outside the affected area for healthcare workers to distribute to residents