Public Health assists childcare centres in the management of outbreaks by:
- Providing best practice recommendations on infection control measures to minimize the spread of diseases when outbreaks occur
- Issuing advisories for distribution to parents and staff
- Providing exclusion guidelines for reportable and non-reportable diseases
What is an outbreak?
An outbreak is an increase in the number of children or staff absent due to illness, above what you would expect. Stress to parents that it is important for them to report their child’s illness to you so that you can recognize an outbreak as early as possible. An enteric (gastrointestinal) outbreak is defined as three or more cases within a four-day period.
How to report an outbreak
Under the Health Protection and Promotion Act, R.S.O. 1990, C.H. 7 you must report an outbreak to Public Health. Call 1-800-265-7293 ext. 4752 (after hours 1-877-884-8653) as soon as you have three or more cases of enteric illness in a four-day period or an increase in absent/ill children.
You will be asked to provide the following information:
- Number of ill children and/or staff
- Affected age group/room details
- Number of children and staff in the facility (including volunteers or students)
- Symptoms and dates of symptom onset
Managing an outbreak
Start a line list
When there are more than two cases in your centre start a line list (PDF, 1 page, 556 KB). Complete separate line lists for ill staff and children. Fax the line list EVERY DAY to Public Health at 1-855-934-5463 and call 1-800-265-7293, ext. 4752 to report the outbreak. We will help you identify common symptoms and give you a quick assessment of the nature and extent of the outbreak. Public Health will review line listings daily and provide direction on any additional control measures recommended during the outbreak.
Collect stool samples
It is important to collect stool samples from ill children and/or staff during an outbreak in order to identify what is causing the illness. Stool samples can either be collected at the childcare centre or by parents. A childcare centre must have permission from parents to collect samples from ill children. Inform parents when a stool sample has been collected. Public Health will follow up with parents directly regarding the results. Public Health will not disclose results to the childcare centre without parental consent as this is personal health information. Parents can also be encouraged to collect a stool sample from their ill child. All stool samples must be labelled with two unique identifiers (e.g., name and date of birth) and be refrigerated until pick-up.
Call Public Health at 1-800-265-7293 ext. 4752 for pick-up of stool samples.
Notify family and visitors of the outbreak
Inform all family members as well as visitors/external organizations when an outbreak is declared at your centre. Outbreak Declared (PDF, 1 page, 613 KB) signage must be posted during the outbreak at the entrance of the building to inform families and visitors of the outbreak.
Fact sheets or Advisories regarding any suspected cause of illness can also be posted for families and visitors. During the outbreak it is also important to notify family and visitors of the progress of the outbreak (rooms affected, spread, number of cases, etc.). When speaking with external organizations, you must decide if the service is essential and if the benefits outweigh the health risks. Post the Outbreak Over (PDF, 1 page, 591 KB) sign once Public Health has declared the outbreak over.
Cleaning and disinfection
Increase cleaning and disinfection of environmental surfaces and toys during an outbreak as some viruses can live on surfaces for several days. Make sure the disinfectant you have on site is effective against norovirus (e.g. “Virox 5”, “Percept”, “Accel TB”, 1:10 bleach and water solution). For more information on cleaning and disinfection, refer to the Gastrointestinal Outbreak Decontamination Protocol (PDF, 2 pages, 396 KB).
Outbreak control measures
- Increase handwashing before and after tasks. Help children wash their hands.
- Provide alcohol-based hand sanitizer for staff and visitors to use.
- Wear disposable gloves and mask when you are likely to touch contaminated materials.
- Handle soiled clothing and linens as little as possible.
- Use disposable paper towels to remove all vomit and discard into a plastic-lined garbage can.
- Enforce exclusions of ill children or staff until 48 hours after symptoms have stopped.
- Stop group and communal activities (discuss scheduled activities with Public Health).
- Stop sensory play (discard items in sensory bins that are not able to be cleaned and disinfected).
- Increase cleaning and disinfection of environmental surfaces and toys.
- Public Health may review food temperature logs and take food samples if food is suspected as a possible cause of enteric illness.
Exclusions in an enteric outbreak
During an enteric outbreak at the childcare centre, children and staff should stay home until they are free of vomiting and/or diarrhea for:
- 24 hours when there is no outbreak (outbreak definition not met)
- 48 hours after symptoms have stopped (during an outbreak)
Exclusions during a non-enteric outbreak (e.g., respiratory, vaccine-preventable disease) are determined by Public Health and communicated to the childcare centre.