Reportable Disease Follow-Up/Outbreak Control During Office Hours and On-Call

Policy

Category: Control of Infectious Diseases
Subject: Reportable Disease Follow-Up/Outbreak Control During Office Hours and On-Call
Division: Health Protection
Policy Number: CA.82.01.104
Effective Date: August 10, 2016

POLICY STATEMENT

It is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) to investigate all reports of sporadic cases, clusters and outbreaks of infectious diseases of public health importance or any clusters of unusual/unexpected illness within WDGPH boundaries during regular business hours and after hours, on weekends and holidays.  Cases/clusters/outbreaks (excluding those diseases followed by clinical services) will be prioritized for investigation based on severity of disease and public health importance according to the corresponding procedure CA.82.02.104 Reportable Disease Follow-up/Outbreak Control and Appendix A: Reportable Disease Coded List.

SCOPE

This policy applies to employees working in the Control of Infectious Diseases program including Public Health Nurses, Public Health Inspectors, Program Assistants, Supervisor and Manager 

DEFINITIONS

Outbreak:  A greater than expected number of cases that are spatially and temporally linked.

Infectious diseases of public health importance: Infectious diseases of public health importance include, but are not limited to, those specified reportable diseases as set out by Regulation 559/91 (as amended) under the Health Protection and Promotion Act and include zoonotic diseases and emerging infectious diseases.

Cluster: Two or more epi-linked cases beyond a household/exposure site

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.82.02.104 Reportable Disease Follow-up/Outbreak Control
Health Protection and Promotion Act (as current)
http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h07_e…
Ontario Public Health Standards (as current) http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_stan…
Infectious Diseases Protocol (as current) http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_stan…
Institutional/Facility Outbreak Prevention and Control Protocol (as current)
A Guide to the Control of Respiratory Outbreaks in Long-Term Care Homes (MOHLTC, as current)
Control of Gastroenteritis Outbreaks in Long-Term Care Homes (MOHLTC, as current)

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases

APPROVED BY

Director, Health Protection  


Procedure

Category: Control of Infectious Diseases
Subject: Reportable Disease Follow-Up/Outbreak Control During Office Hours and On-Call
Division: Health Protection
Procedure Number: CA.82.02.104
Effective Date: October 1, 2015

PROCEDURE

1. When notification of a sporadic case or outbreak of infectious disease of public health importance is received, Control of Infectious Diseases (CID) employees will begin the investigation by completing a risk assessment and documenting all details in Excelicare. A disease-specific standardized questionnaire should be completed for all diseases where a questionnaire has been developed by PHO/MOHLTC; otherwise, a Disease-Specific Work Sheet (DSW) should guide the data collection.

2. CID employees will refer to the current disease/outbreak specific guidance documents for disease-specific information, case/outbreak definitions, specimen collection requirements, infection prevention and control measures and case/outbreak management guidelines:

  • Infectious Diseases Protocol (Appendix A and B);
  • WDGPH Guidance Documents;
  • Provincial Infectious Disease Advisory Committee (PIDAC) Best Practice Manuals;
  • Control of Communicable Diseases Manual, David L. Heymann, MD (Editor);
  • Red Book, Committee on Infectious Diseases, American Academy of Pediatrics;
  • Disease-specific best practice and clinical guidance documents (e.g. Canada Communicable Disease Report (CCDR), Ontario Agency for Health Protection and Promotion (OAHPP), and Ministry of Health and Long-Term Care (MOHLTC) memos);
  • Specimen Collection Guide and Labstracts;
  • MOHLTC, Public Health Branch – Enhanced Surveillance Directives; and
  • Appendix 5:  Outbreak Management Plan (WDGPH Emergency Plan).

3. CID employees will contact the physician or source of the report (e.g. the Infection Control Practitioner (ICP), school, reporting laboratory, parent) to obtain additional case/outbreak details.

4. CID employees will interview clients, as per policy CA.82.01.124 Confidential Interviewing of Clients (or legal guardian/parent/primary caregiver where applicable) in order to obtain all relevant case information, as required under Ontario Regulation 569 – Reports, and additional information as per MOHLTC Disease Specific User Guides, Infectious Disease Protocols, standardized questionnaires, and Enhanced Surveillance Directives, as applicable. Prior to obtaining any information from the client or proxy (with client consent), CID employees will give information to the client or proxy on how the collected information will be used by CID employees and that the collected information will be treated confidentially by WDGPH.

5. Where PHO standardized questionnaires (SQ) or DWS are used to guide the client interview, CID employees may add additional charting (chart by exception), which includes any information learned from the client that is not covered by the disease-specific work sheet. Charting by exception can be completed in an episode note in Excelicare. The work sheets will be transcribed into an electronic chart and electronically attached to the file.

6. CID employees will notify the CID Supervisor/Program Manager and/or on-call Manager (after hours, on weekends or holidays) regarding sporadic cases and outbreaks that require further direction from the Medical Officer of Health (MOH).

7. CID employees or CID Program Assistant (PA) will enter relevant case/outbreak details on the Integrated Public Health Information System (iPHIS) if this has not already been entered by the iPHIS Data Entry Clerk. For outbreaks, CID employees will obtain an outbreak investigation number. For sporadic cases and outbreaks received after-hours, on weekends or on holidays, case/outbreak information will be entered into iPHIS on the next business day.

8. For institutional outbreaks, CID employees will notify the CID PA to ensure that an updated outbreak bulletin is issued to community stakeholders and surrounding health units. During on-call hours, the on-call CID employees may be required to issue an outbreak bulletin according to policy CA.82.01.105 Distribution of Outbreak Bulletin.

9. If contact tracing is required, the CID employees will complete the Excelicare contact tracing log and follow up as outlined in the Infectious Disease Protocols and WDGPH guidance documents. If contact tracing involves a school, daycare, sports team, or organized group, CID employees will discuss issuing an Advisory letter (disease-specific templates are located on CID SharePoint) with the CID Supervisor/Program Manager and/or on-call Manager.

10. Sporadic cases/outbreaks that require follow up after hours or on weekends or holidays are to be transferred to the on-call CID employees for follow-up outside of normal business hours. The on-call Manager should also be notified.

11. CID employees will regularly update iPHIS with required information. Sporadic diseases of public health importance will be entered into iPHIS within one business day. CID staff will regularly update the Excelicare file on the case/outbreak with new actions, test results, email communications, etc.

12. CID employees or the CID PA will complete iPHIS entry as soon as possible after the investigating CID employees has completed the case/outbreak investigation. Once the case/outbreak has been closed on iPHIS, the chart (if any) will be filed in the Guelph office.

13. Chickenpox cases reported by schools or daycares on the Chickenpox Monthly Case Report (CID(F)2) will be entered by  the CID PA or iPHIS Data Entry Clerk on CID SharePoint. Any cases reported through the intake line (ext. 4752) will be entered in the Excelicare chickenpox aggregate log. These aggregate case counts will be entered into iPHIS on a monthly basis by the iPHIS Data Entry Clerk.

Note: Lab confirmed cases of chickenpox need to be entered into iPHIS as a sporadic case, and will be investigated as per Infectious Disease protocols and iPHIS entry completed accordingly. 

RESPONSIBILITIES

Responsibilities for investigation of sporadic cases, outbreaks and/or clusters of infectious diseases of public health importance will be assigned to applicable CID employees and/or scheduled on-call employees. The CID Supervisor, Program Manager and or scheduled On-Call Manager/Directors will consult with the MOH on recommendations for follow-up as needed. PAs and/or Data Entry Clerks (Health Analytics) are responsible for the initial entry of sporadic cases and outbreaks in iPHIS and notifying the appropriate office for follow-up.

Manager will:

  • Ensure all employees have been sufficiently trained in reportable disease follow-up and outbreak management, documentation, Excelicare, and privacy; and
  • Ensure employees have the equipment and resources necessary to safely and competently investigate disease/outbreaks.

Employees will:

  • Review policies, procedures, and best practice documents on:
  • Sporadic disease follow-up;
  • Outbreak management;
  • Documentation; and
  • Privacy.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy CA.82.01.104 Reportable Disease Follow-up/Outbreak Control
CA.59.01.100 and CA.59.02.100 Documentation Practices
CA.82.01.105 and CA 82.02.105 Distribution of Outbreak Bulletin
CA.82.01.124 Confidential Interviewing of Clients
CA.86.01/02.105 Documentation
CID(F)2 Chickenpox Monthly Case Report
WDGPH Guidance Documents

  • Applicable disease-specific work sheets
  • Reportable disease work sheet cover sheet
  • Institutional/Facility Outbreak Prevention and Control Protocol (as current)
  • A Guide to the Control of Respiratory Outbreaks in Long-Term Care Homes (MOHLTC, as current)
  • Control of Gastroenteritis Outbreaks in Long-Term Care Homes (MOHLTC, as current)
  • Disease-specific Guidance Documents
  • O. Reg. 559/91 Specification of Reportable Diseases
  • Health Protection and Promotion Act, 1990, Available online at: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h07_e…
  • Infectious Diseases Protocol, 2009, Available online at: http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_stan…
  • Provincial Infectious Disease Advisory Committee (PIDAC) Best Practice Manuals
  • Control of Communicable Diseases Manual, David. L. Heymann, MD, Editor
  • Red Book, Committee on Infectious Diseases, American Academy of Pediatrics
  • Disease-specific best practice and clinical guidance documents (e.g. Canada Communicable Disease Report (CCDR), Ontario Agency for Health Protection and Promotion (OAHPP), and Ministry of Health and Long-Term Care (MOHLTC) memos)
  • Specimen Collection Guide and Labstracts
  • Public Health Ontario – Enhanced Surveillance Directives
  • Appendix 5: Outbreak Management Plan (WDGPH Emergency Plan)
  • Public Health Ontario Disease-specific Standardized Questionnaires 

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases and Tuberculosis 

APPROVED BY

Director, Health Protection