Outbreak Reporting in Health Care Facilities

October, 1998

Dear Nursing Home Administrator:

Please Distribute to Director of Nursing, Employee Health, and Infection Control Personnel

Re: Outbreak Reporting in Health Care Facilities

On the recommendation of the New York State Department of Health (NYSDOH) Infection Control Advisory Committee, we are providing further clarification to long term care facilities regarding the reporting of nosocomial outbreaks and infections. This letter includes background information, examples of what should be reported, reporting procedures, and legal requirements. Please incorporate this information into your facility's written policy on reporting.

Background

In February 1996, Commissioner DeBuono advised all health care facilities to report nosocomial outbreaks to the Infection Control Program instead of the Health Systems Management area offices.

This shift in responsibility has been well received by facilities and has enhanced our ability to offer epidemiologic assistance, laboratory support when needed, and consultation. Some health care facilities however, have expressed uncertainty concerning what, when, and how to report. The information below should help answer these questions.

Why Report?

There are a number of reasons why reporting of outbreaks or select infections is important:

• The NYSDOH is charged with the responsibility of protecting public health and ensuring the safety of health care facilities.
• Reporting is necessary to detect interfacility outbreaks, geographic trends, and identify emerging infectious diseases.
• The collection of outbreak data enables the NYSDOH to inform health care facilities of potential risks and preventive actions (e.g. influenza strains and chemoprophylaxis, emergence of Staphylococcus aureus with intermediate resistance to vancomycin, vancomycin-resistant enterococci).
• Reporting facilities can obtain consultation, laboratory support and on-site assistance in outbreak investigations, as needed.
• If the public or press becomes aware of the situation, facilities can offer assurance that the matter is being addressed in conjunction with public health authorities.
• Reporting is legally required under Sections 2.1 and 2.2 of the New York State Codes, Rules and Regulations.

What Should be Reported?

Any outbreak or significant increase in nosocomial infections above the norm or baseline in nursing home residents or employees should be reported. Health care facilities are expected to conduct surveillance that is adequate to identify background rates and detect significant increases above those rates. Categories and examples of nosocomial infections that should be reported to the NYSDOH include:

• An outbreak or increased incidence of disease due to any infectious agent (e.g. staphylococci, vancomycin resistant enterococci, Pseudomonas, Clostridium difficile, Klebsiella, Acinetobacter) occurring in residents or persons working in the facility.
• Intrafacility outbreaks of influenza, gastroenteritis, pneumonia, or respiratory syncytial virus.
• Foodborne outbreaks.
• Infections associated with transfusions, biologics, contaminated medications, replacement fluids or commercial products.
• Single cases of nosocomial infection due to any of the diseases on the Communicable Disease Reporting list. For example, single cases of nosocomially acquired Legionella, measles virus, invasive group A beta hemolytic Streptococcus.
• A single case involving Staphylococcus aureus showing reduced susceptibility to vancomycin.
• Clusters of tuberculin skin test conversions.
• A single case of active pulmonary or laryngeal tuberculosis in a nursing home resident or employee.
• Increased or unexpected morbidity or mortality associated with medical devices, practices or procedures resulting in significant infections and/or hospital admissions.
• Closure of a unit or service due to infections.

When Should Nosocomial Outbreaks or Select Infections be Reported?

Outbreaks or select nosocomial infections must be reported within 24 hours of recognition. Timely reporting is important. It is preferred that clusters or significant increases be reported as soon as they are recognized so that control measures, laboratory testing or need for assistance can be discussed.

To Whom and How Should Outbreaks or Select Infections be Reported?

Legal requirements call for both the NYSDOH and local health department to be notified of outbreaks.

• Nosocomial outbreaks and infections are to be reported to the NYSDOH Infection Control Program by phone (518) 474-1142 or FAX (518) 402-5165 using the Health Care Facility Infection Control (Nosocomial) Report form. The night/weekend phone is 1-866-881-2809.
• Nosocomial outbreaks and infections are to be reported to the local health department by phone.
• A single community acquired case of a disease on the Reportable Disease list should be reported by phone or mailed to the local health department.

What is the NYSDOH Response to an Outbreak Report?

Of the several hundred reported nosocomial outbreaks in 1997, most were handled by providing telephone consultation. Laboratory support by NYSDOH was provided to more than half of the facilities. On-site visits for epidemiologic follow-up were provided in less than 10% of the reported outbreaks.

Thank you for your cooperation. If you have further questions regarding reporting, please feel free to call us at (518) 474-1142. We look forward to working cooperatively with you in the control of nosocomial infections.

cc: Infection Control Professional

Enclosures