Guidelines for Outbreak Prevention, Management and Control ...

Guidelines for Outbreak Prevention, Management and Control in Work Camps January 2018

Population, Public and Indigenous Health

Table of Contents

Acknowledgments .........................................................................................................................4

Glossary of Terms ........................................................................................................... 5

Introduction ...................................................................................................................... 6 Purpose......................................................................................................................................... 6 What is the Goal of Outbreak Management Guidelines? ............................................................... 6 Who do you contact in Alberta Health Services with questions about communicable disease outbreaks? .................................................................................................................................... 7 Table 1: AHS Zone Medical Officer of Health/Designate Contacts ................................................ 9 Roles and Responsibilities .......................................................................................................... 10 What are Zone Medical Officer of Health/designates roles? ........................................................ 10 What are the Work Camps' roles?............................................................................................... 10

SECTION 1: GENERAL GUIDELINES FOR OUTBREAK MANAGEMENT IN WORK CAMPS ........................................................................................................................... 11 How are gastrointestinal, influenza like illnesses and rash illnesses spread? .............................. 11 What are some general strategies that can help manage and prevent spread of common communicable diseases? ............................................................................................................ 11

( i) Monitor, Identify and Report............................................................................................. 11 ( ii) How does the Zone MOH or representative help? ........................................................... 11 (iii) Implement Initial Infection Prevention and Control Measures........................................... 12 (iv) Consider Cancelling Group Activities ............................................................................... 14 On-going Monitoring.................................................................................................................... 14 Communication ........................................................................................................................... 14 Declaring Outbreak Over.................................................................................................... ........14

SECTION 2: INFLUENZA-LIKE ILLNESS (ILI) OUTBREAK MANAGEMENT IN WORK CAMPS ........................................................................................................................... 15 What is ILI? ................................................................................................................................. 15 How is ILI spread? ...................................................................................................................... 15 When is a person with ILI infectious? .......................................................................................... 15 How can you prevent the spread of ILI in your facility? ................................................................ 16

(i) Immunize your staff and staff. .......................................................................................... 16 (ii) Monitor staff/clients and visitors to ensure recognition of outbreaks as early as possible. 17 (iii) Identify potential ILI using the case definition................................................................... 17 (iv) Recognize when there may be an outbreak ..................................................................... 17 (v) Report ILI outbreaks to the Zone MOH/Designate ........................................................... 17 (vi) Implement the Initial Infection Prevention and Control Measures..................................... 17 What should you communicate during an ILI outbreak? .............................................................. 18 When should you seek medical care for a client/client with ILI? .................................................. 18 When is the ILI outbreak declared over? ..................................................................................... 19 Watching for ILI after the outbreak .............................................................................................. 19

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SECTION 3: GASTROINTESTINAL ILLNESS OUTBREAK MANAGEMENT IN WORK CAMPS 20 What is GI illness? ......................................................................................................... 20 How is Gastrointestinal (GI) Illness spread? ................................................................... 20 When is a person with GI illness infectious?................................................................... 20 How can you prevent the spread of GI Illness in your facility? ........................................ 21

(i) Monitor clients and staff to ensure recognition of outbreaks as early as possible21 (ii) Identify potential GI illness in clients and staff using the GI illness case definition21 (iii) Recognize when there may be an outbreak of GI illness..................................... 21 (iv) Report GI Illness outbreaks to the Zone MOH/Designate.................................... 21 (v) Implement the Initial Infection Prevention and Control Measures........................ 22 What should you communicate during a GI Illness outbreak? ........................................ 22 When should you seek medical care for a client/staff with GI illness? ........................... 22 When is the GI illness outbreak declared over?.............................................................. 23 Watching for GI illness after the outbreak....................................................................... 23 SECTION 4: RASH OUTBREAK MANAGEMENT IN WORK CAMPS............... 24 What is a rash? ............................................................................................................... 24 Recognize when there may be a rash outbreak ..................................................24 Report rash outbreaks to the Zone MOH/Designate ..........................................24 APPENDICES...................................................................................................... 25 Appendix A ? Isolation Strategies ? Influenza-like Illness ............................................... 25

Isolation Strategies ? Gastrointestinal Illness ..................................26 Appendix B ? Personal Protective Equipment (PPE) ...................................................... 27

(i) Putting on (Donning) Personal Protective Equipment (PPE) ............................... 29 (ii) Taking off (Doffing) Personal Protective Equipment (PPE) ................................. 30 Appendix C ? Hand Hygiene - Clean your hands properly.............................................. 32 (i) How to wash hands with soap and water ............................................................ 32 (ii) How to clean hands with hand sanitizer (gels, liquids and foams)....................... 32 (iii) When to wash your hands .................................................................................. 33 (iv) Promoting Hand Hygiene .....................................................................33 Appendix D - Respiratory etiquette................................................................................. 34 Appendix E ? Increased Cleaning and Disinfection during an Outbreak ......................... 36 Appendix F ? Sample Outbreak Sign ............................................................................. 36

Additional Resources ........................................................................................ 39

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Acknowledgments

The AHS Work Camps Facilities Outbreak Guideline Working Group would like to thank and acknowledge individuals, program managers and leads as well as the Medical Officers of Health who have contributed their comments and suggestions to provide outbreak management guidelines for Work Camp facilities in Alberta

Some of the material contained in this updated provincial document has been taken from various zone guidelines across the province as well as previous provincial guidelines developed by the AHS Outbreak Management team.

AHS Work Camps Outbreak Guidelines Working Group Members:

Karen De Wet, Supervisor, Environmental Public Health, North Zone, Central Area Jeff Hammer, Public Health Inspector, AHS, North Zone Carolyn Hayes, Notifiable Disease-Clinical Lead, Communicable Disease Control, AHS Lance Honish, Environmental Public Health-Edmonton Zone, AHS Angela Jacobs, Associate Manager-Notifiable Disease North, Communicable Disease Control, AHS Joy Jaipaul, Manager Notifiable Disease, Education & Practice Development, AHS Dr. Kathryn Koliaska, Medical Officer of Health, Environmental Public Health, AHS Dr. Judy MacDonald, Medical Officer of Health, Communicable Disease Control, AHS Olusegun (Olu) Motajo, Public Health Inspector, AHS, North Zone Theresa Saunders, Communicable Disease Control Nurse, Communicable Disease Control, AHS Dr. Mayank Singal, Medical Officer of Health, AHS

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Glossary of Terms

AHS: Alberta Health Services.

Client: A person that stays at, visits or uses the services of a work camp, and does not have an operational or administrative role at the work camp.

Close Contact: Any person suspected to have been exposed to an infected person or environment and had the opportunity to become infected or colonized with the germs.

Gastrointestinal (GI) Illness - For GI case and outbreak definitions refer to Section 2: Gastrointestinal (GI) Illness.

ILI: influenza-like-illness. For ILI case and outbreak definitions, refer to Section 2 - Influenzalike-illness.

Medical Officer of Health (MOH): a physician with specific training and expertise in public health given authority under the Alberta Public Health Act to protect the health of the community, including control of communicable disease.

Medical Officer of Health (MOH) Designate: A member of the Public Health staff designated by the Zone Medical Officer of Health to assist with outbreak management in the Zone.

Outbreak: The occurrence of more cases of a communicable disease than expected in a given area or among a specific group of people over a defined period of time.

Person-in-charge: The most accountable staff member at a work camp. There are many different situations with work camps: some companies contract out these facilities (whole or part) for their workers, and there can be multiple companies with workers staying at one work camp. Therefore it is critical to establish who is the "Person in Charge" in a work camp, who must be assigned the responsibility to maintain internal communications with all service providers (including OHS) at that work camp, and communications with Public Health.

Personal Protective Equipment (PPE): Refers to protective clothing or equipment used by staff, service providers and/or volunteers who work directly in areas with staff/clients. PPE protects from disabling injury or illness, including exposure to an infectious agent.

Staff: A person that has an operational or administrative role at a work camp.

Work Camp: one or more buildings established to accommodate persons who are employed in mining, lumbering, construction, drilling, resource exploration or any other similar industry, and facilities associated with their operation

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Introduction

Work Camps often have one or more common dining, sleeping or bathroom facilities. Under these circumstances, transmission of common communicable diseases from an infected person is more likely to occur, either by person-to-person spread or contaminated object-to-person spread.

AHS recognizes that limited staffing, physical lay-out, shared accommodation, and communal areas at facilities can pose challenges for implementing the recommendations outlined in this document. In recognizing these challenges, many of the recommendations suggest different options that could be used. It is also anticipated that facilities may develop their own custom options to meet the recommendations of the Medical Officer of Health/designate when developing their contingency plans for outbreaks of communicable diseases.

The notification of outbreaks and other infectious disease threats to public health in Alberta is required under Section 26 of the provincial Public Health Act. The Medical Officer of Health (MOH) is responsible for appropriate outbreak response (Section 29).

Note: This is not a complete infection prevention and control document. Only the minimum infection control strategies necessary for managing outbreaks of influenza-like illness, gastrointestinal illness and rash illness outbreaks are outlined here. For more detailed information about infection prevention and control or information about other types of disease outbreaks, please contact your Zone MOH/designate (see Table 1).

In order to best serve the clients of Alberta, Alberta Health Services (AHS) has divided the province into five zones (see Figure 1, page 8). Under the leadership of the Senior Medical Officer of Health for Alberta Health Services, each zone is supported by zone-specific Medical Officers of Health. The Zone Medical Officers of Health have designated Public Health staff to assist with outbreak management in each Zone (Table 1). In this guideline, they are referred to as the Medical Officer of Health (MOH)/ designate.

Purpose

The purpose of this document is to provide guidelines for outbreak prevention, control and management in Work Camp facilities across Alberta.

What is the Goal of Outbreak Management Guidelines?

The goal of this document is to provide current best-practice/evidence-based outbreak management guidelines that help reduce the spread of communicable disease outbreaks in Work Camps. Early recognition of unusual activity and swift response are essential for effective management of outbreaks.

Alberta Health Services will work collaboratively with Work Camp Operators to facilitate prompt response to help minimize the impact and manage the spread of common communicable disease outbreaks, including influenza-like illnesses, gastrointestinal illnesses and rash illnesses for the benefit of clients, the health system and work camp operations.

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There are several important activities in outbreak management that the MOH/designate will recommend to be carried out in order to achieve these goals. These activities are described in the following sections of this guideline:

Section 1: General Guidelines for Outbreak Management Section 2: Influenza-like Illness (ILI) Outbreak Management Section 3: Gastrointestinal (GI) Illness Outbreak Management Section 4: Rash Outbreak Management

Who do you contact in Alberta Health Services to report a possible communicable disease outbreak?

To report an outbreak or ask a question about communicable diseases or outbreaks, please contact the Zone MOH/designate in your area (see Table 1). There are five geographic areas (zones) in Alberta Health Services as shown on the map on the next page.

Table 1 provides contact information for notification of outbreaks or for questions about communicable diseases. During regular business hours (typically 8:30 a.m. ? 4:30 p.m.) two sets of contact numbers appear:

? Environmental Public Health (EPH) ? designated by the Zone MOH to assist with the outbreak management of gastrointestinal illnesses.

? Communicable Disease Control (CDC) ? designated by the Zone MOH to assist with all other outbreaks.

If you are unsure which contact number to call, contact the Zone Communicable Disease Control Lead and they will be able to assist you. After regular hours and on weekends/holidays there is one on-call number for each Zone.

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Figure 1. Alberta Health Services Zone Map

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