test results. Staff interacting with the
resident should wear appropriate
PPE, including gown, gloves, mask
and/or face shield, depending on
the suspected pathogen. 3 Many
residents have underlying developmental
or medical conditions
that make it difficult to implement
standard isolation precautions, such
as masking or quarantining. The
resident should not leave their room
until the risk of infecting others has
passed. They should not participate
in shared dining or group activities.
Those who have had close contact
with, or may have been potentially
exposed to, an infected resident
should likewise be isolated. If two
or more people develop the same
infection from the same organism
in the same place, this is concerning
for an outbreak within the facility.
1 Those with known diagnosis
of pathogen may be cohorted
(grouping like persons together). In
this case, if two patients have the
same influenza on PCR and there
are no isolation rooms available,
those two patients can be roomed
together. Ideally, staff treating
infected patients should not also
treat patients who are not exhibiting
symptoms. PPE should be worn in
accordance with CDC recommendations.
1 CDC’s website provides guidance
on selecting appropriate PPE.
If an outbreak is suspected,
immediately notify the Arkansas
Department of Health who will assist
the facility to help manage it early
and if necessary ADH will contact
the CDC, etc. When notifying regulatory
agencies, have the demographics
and diagnostic testing of infected
residents available, a timeline of
events, contact tracing (if available),
and infection control policies and
practices. Regulatory agencies can
AFMC: A CLOSER LOOK AT QUALITY
assist facilities in management of an
outbreak, provide recommendations
on staffing, modification of programming
and use of PPE.
Clinical staff must be critically
evaluated, as they can be very
vulnerable to infection. All staff
should be assessed to determine
availability and qualifications that
may allow them to float outside their
traditional role during an outbreak.
For example, education or recreation
staff can help serve meals.
Disaster preparedness plans
should include how to secure
qualified personnel to fill essential
positions. Include staff responsible
for supplies in disaster preparedness
discussions to allow for critical purchases,
including PPE, emergency
funding for possible staff shortages
and assessment of financial risks
associated with an outbreak. If legal
representation is available, it can
be helpful when planning to avoid
unintentional oversights. Frequent
reassessments of plans should occur
to adjust areas that are not functioning
well.
Communication with staff,
residents and families is essential.
If public relations personnel are
available, they should share information
in a clear and accessible manner,
including regular emails, video
messages or in-service sessions. An
outbreak can be frightening for staff
and information should be provided
about risks and ways to mitigate
them. The disaster preparedness
plan should include protocol for
notifying residents’ families about
steps being taken to protect their
loved ones.
Depending on the scope and
severity of the outbreak, it can be
helpful to contact local hospitals to
alert them to potential admissions
so they can prepare their staff and
obtain additional resources. Hospitals
may also be able to provide
guidance on outbreak management.
An outbreak within a vulnerable
population can be extremely
challenging to manage and keep
residents and staff safe. Listening
to internal and external input can
be invaluable in calculating a
response that minimizes morbidity
and mortality. �
Dr. Hobart-Porter is the medical
director of Easter Seals Children’s
Rehabilitation Center in Little Rock.
REFERENCES
1. Centers for Disease Control and Prevention.
(2020). Retrieved 2020, from www.
cdc.gov
2. Curran, E. (2017). Infection Outbreaks in
Care Homes: Prevention and Management.
Nursing Times [online], 113 (9), 18-21.
3. Harris, J.A. (2006). Infection Control in Pediatric
Extended Care Facilities. Infection
Control and Hospital Epidemiology, 27 (6),
598-603.
4. Azofeifa, A., & et. al. (2013). Infection
Control Assessment after an Influenza
Outbreak in a Residential Care Facility for
Children and Young Adults with Neurologic
and Neurodevelopmental Conditions.
Infection Control and Hospital Epidemiology,
34 (7), 717-722.
5. Neu, N., & et al. (2012). Epidemiology of
Human Metapneumovirus in a Pediatric
Long-Term Care Facility. Infection Control
and Hospital Epidemiology, 33 (6), 545-
550.
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ABOUT AFMC QUALITY IMPROVEMENT PROJECTS,
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SEPTEMBER 2020
Volume 117 • Number 3 SEPTEMBER 2020 • 61