PHE West Midlands Health Protection Nurses Summer 2015 Outbreaks- what to do…. What’s an outbreak What to do When/ who to call

Objectives of This Session PHE local arrangements PHE contact details Update on advice in event of any outbreak Specific advice on: Diarrhoea & vomiting Influenza Scabies 2SSOTP IPC Teaching Summer ‘15

Health Protection - PHE’s Role Who are we? Executive Agency of the Department of Health (established April 2013) What do we do? Health Promotion/ Teaching. Prevention of incidents of infection/ outbreaks Management of outbreaks- protecting the community from communicable diseases and other health protection threats. Working in partnership with others (e.g. NHS, LAs, Environment Agency, Emergency Services) Local Surveillance Specialist Microbiology Services 3SSOTP IPC Teaching Summer ‘15

Health Protection functions in Public Health England Health Protection Centres and Local Teams Field Epidemiology Services Laboratories (Colindale and Regional Labs) Centre for Chemicals Radiation and Environmental Hazards Emergency planning SSOTP IPC Teaching Summer ‘144

West Midlands North Health Protection Team (HPT) Covers Staffordshire, Shropshire and Telford & Wrekin Consultants in Communicable Disease Control (CCDCs) Health Protection Nurses Surveillance Officers Admin Support SSOTP IPC Teaching Summer ‘145

Contact details Nurses: Liz Knapper, Sharron Duffin, Linda Morgan, Sarah Dowle & Andrea Normington West Midlands North HPT, Stonefield House, St Georges Hospital Corporation Street, Stafford, ST16 3SR Phone: option 2, option option 2, option 2 6SSOTP IPC Teaching Summer ‘14

What is an Outbreak? In this context: Two or more residents of a care home reporting similar symptoms during a specific time period Eg D&V over a 24-36hr period. SSOTP IPC Teaching Summer ‘14 7

Can anything be done to prevent outbreaks? Maintaining high standard of Infection Control: Standard precautions (including hand washing & use of PPE) & cleaning. Staff illness: good reporting/ communication, consistent & accurate advice about staff exclusion from work (eg for Diarrhoea & Vomiting). Relative/ Visitor Illness: good reporting/ communication. Signage/ asking people not to visit if the have colds/flu/ D&V. Resident Admissions & Transfers: asking the right questions: symptoms, date of symptom onset, date & time of last episode of illness, lab results. Skin Friendly: Scabies or Dermatitis? Emollients. Early Advice / Reporting: call PHE Health Protection for early advice. 8SSOTP IPC Teaching Summer ‘15

What to do if you suspect an outbreak- any type: Prompt recognition- inform to PHE & any visiting GP’s. Prompt isolation & exclusion of those ill. PHE staff will then advise you on communicate with visitors, staff, other Health Professionals inc. ambulance And any other actions needed to manage the outbreak. SSOTP IPC Teaching Summer ‘14 9

Diarrhoea & Vomiting Usually viral Sudden onset of illness. Usual incubation is hours Mild gastroenteritis; diarrhoea, vomiting (often projectile), abdominal pain, headache, fever, chills, muscle aches Illness usually resolves in hours but may last longer 10SSOTP IPC Teaching Summer ‘15

Why is Norovirus so common? Small infectious dose (secondary attack rate >30%) Environmentally stable Large human reservoir High numbers of susceptible persons Asymptomatic infection may occur Limited immunity (genetic variability in strains) Multiple routes of transmission (persons-to-person, food, water, aerosol) NB Norovirus is common but there are other viruses which can cause gastroenteritis & outbreaks (e.g. rotavirus) so symptoms & time scales can vary. 11SSOTP IPC Teaching Summer ‘15

Management In Residential Care Settings- D&V advice 1.You will be asked to provide detailed information on staff & resident onset of illness & symptoms. 2.You will be asked to close to admissions and commence a thorough cleaning schedule 3.You may be asked to test a number of residents 12SSOTP IPC Teaching Summer ‘15

Staff Advice Difficulties- advice on exclusion from work place Rapid onset symptoms Pay Issues STAFF- Stay away from work until 48hrs AFTER your last symptom. SSOTP IPC Teaching Summer ‘14 13

What went well for you? Take a few minutes to think about your last outbreak What went well? What did you struggle with? Resources, instructions, visitor compliance, communication. 14SSOTP IPC Teaching Summer ‘15

Scabies- What is it? Why do we see it in care homes? A mite Transmitted by prolonged skin to skin contact Symptoms develop after 2-4 weeks of exposure May be just 12 mites on an infested person, more in hyperkeratotic scabies 15SSOTP IPC Teaching Summer ‘15

Typical Rash associated with scabies infestations 16SSOTP IPC Teaching Summer ‘15

What are the keys to success in managing scabies outbreaks? Diagnosis Communication Call PHE & inform any visiting GP’s. PHE staff will then advise you on communicate with visitors, staff, other Health Professionals And any other actions needed to manage the outbreak. A common issue: for managers seems to be in managing staff reactions. Sometimes staff panic & seek premature treatment. This is NOT advised. Success requires a plan/co-ordination. 17SSOTP IPC Teaching Summer ‘15

Who else might catch scabies? Higher risk: Staff with intimate resident contact Staff moving between wings or wards Physios, OTs, chiropodists, etc. Relatives of patients with suspected/confirmed scabies Medium risk: Staff relatives Low risk: Cooks, gardeners, etc Other relatives 18SSOTP IPC Teaching Summer ‘15

Mass Treatment of a Scabies O/B Needs to be planned carefully Principles: All cases & contacts treated on the same day All cases = Treatment on day 1 & day 7 Contacts = Treatment on day 1 only Symptomatic Staff need to ensure their household & sexual contacts are also treated If any area is washed during treatment period- reapply Interim actions: take contact precautions 19SSOTP IPC Teaching Summer ‘15

What went well for you? Have you recently had a problem or outbreak of scabies? What went well? What did you struggle with? Resources, instructions, visitor compliance, communication. 20SSOTP IPC Teaching Summer ‘15

Outbreaks of Respiratory Illness (Flu) in Care Homes Outbreaks in care homes can be a problem due to vulnerability of the residents Vulnerable groups are eligible for vaccination & many receive it. It is sometimes very difficult to spot a flu outbreak- symptoms are not typical. 21SSOTP IPC Teaching Summer ‘15

Symptoms Two or more residents or staff having the following symptoms: Fever of 37.8C or above OR Sudden decline in physical or mental ability PLUS New onset or acute worsening of one or more of these symptoms: Cough (with or without sputum Runny nose or nasal congestion Sore throat Sneezing Hoarseness Shortness of breath Wheezing Chest pain 22SSOTP IPC Teaching Summer ‘14

Management Of Flu Outbreaks Contact PHE, we will need to know: How many residents recently ill, recently hospitalised, recently RIP & dates. Residents who have received flu vaccination in the current season Numbers of any staff ill This helps our risk assessment and the decision on whether we can/ should recommend use anti- viral medication. We may also need to arrange for some viral throat swabs to be done on a small number of residents. we will help & advise you on all outbreak measures 23SSOTP IPC Teaching Summer ‘15

What went well for you? Have you recently had a problem with chest infections or a ‘Flu outbreak ? What went well? What did you struggle with? Resources, instructions, visitor compliance, communication. 24SSOTP IPC Teaching Summer ‘15

Any Questions? SSOTP IPC Teaching Summer ‘14 25