Care Home Outbreaks Research Articles

How timely closure can reduce outbreak duration: gastroenteritis in care homes in North West England, 2012\u20132016

BackgroundData on outbreaks of infectious gastroenteritis in care homes have been collected using an internet-based surveillance system in North West England since 2012. We analysed the burden and characteristics of care home outbreaks to inform future public health decision-making.MethodsWe described characteristics of care homes and summary measures of the outbreaks such as attack rate, duration and pathogen identified. The primary analysis outcome was duration of closure following an outbreak. We used negative binomial regression to estimate Incidence Rate Ratios (IRR) and confidence intervals (CI) for each explanatory variable.ResultsWe recorded 795 outbreaks from 379 care homes (37.1 outbreaks per 100 care homes per year). In total 11,568 cases, 75 hospitalisations and 29 deaths were reported. Closure within three days of the first case (IRR = 0.442, 95%CI 0.366–0.534) was significantly associated with reduced duration of closure. The total size of the home (IRR = 1.426, 95%CI = 1.275–1.595) and the total attack rate (IRR = 1.434, 95%CI = 1.257–1.595) were significantly associated with increased duration of closure.ConclusionsCare homes that closed promptly had outbreaks of shorter duration. Care home providers, and those advising them on infection control, should aim to close homes quickly to prevent lengthy disruption to services.

End-of-season influenza vaccine effectiveness in adults and children, United Kingdom, 2016/17.

IntroductionThe United Kingdom is in the fourth season of introducing a universal childhood influenza vaccine programme. The 2016/17 season saw early influenza A(H3N2) virus circulation with care home outbreaks and increased excess mortality particularly in those 65 years or older. Virus characterisation data indicated emergence of genetic clusters within the A(H3N2) 3C.2a group which the 2016/17 vaccine strain belonged to. Methods: The test-negative case–control (TNCC) design was used to estimate vaccine effectiveness (VE) against laboratory confirmed influenza in primary care. Results: Adjusted end-of-season vaccine effectiveness (aVE) estimates were 39.8% (95% confidence interval (CI): 23.1 to 52.8) against all influenza and 40.6% (95% CI: 19.0 to 56.3) in 18–64-year-olds, but no significant aVE in ≥ 65-year-olds. aVE was 65.8% (95% CI: 30.3 to 83.2) for 2–17-year-olds receiving quadrivalent live attenuated influenza vaccine. Discussion: The findings continue to provide support for the ongoing roll-out of the paediatric vaccine programme, with a need for ongoing evaluation. The importance of effective interventions to protect the ≥ 65-year-olds remains.

Characteristics of respiratory outbreaks in care homes during four influenza seasons, 2011–2015

Influenza and other respiratory infections can spread rapidly and cause severe morbidity and mortality in care home settings. This study describes the characteristics of respiratory outbreaks in care homes in Northern Ireland during a four-year period, and aims to identify factors that predict which respiratory outbreaks are more likely to be positively identified as influenza. Epidemiological, virological, and clinical characteristics of outbreaks during the study period were described. Variables collected at notification were compared to identify predictors for an outbreak testing positive for influenza. t-Tests and χ2-tests were used to compare means and proportions respectively; significance level was set at 95%. During the four seasons, 95 respiratory outbreaks were reported in care homes, 70 of which were confirmed as influenza. More than 1000 cases were reported, with 135 associated hospitalizations and 22 deaths. Vaccination uptake in residents was consistently high (mean: 86%); however, in staff it was poorly reported, and, when reported, consistently low (mean: 14%). Time to notification and number of cases at notification were both higher than expected according to national recommendations for reporting outbreaks. No clinically significant predictors of a positive influenza outbreak were identified. Respiratory outbreaks in care homes were associated with significant morbidity and mortality, despite high vaccination uptake. The absence of indicators at notification of an outbreak to accurately predict influenza infection highlights the need for prompt reporting and laboratory testing. Raising staff awareness, training in the management of respiratory outbreaks in accordance with national guidance, and improvement of staff vaccination uptake are recommended.

Oseltamivir in influenza outbreaks in care homes: challenges and benefits of use in the real world

Respiratory virus infections, including influenza, are an important cause of potentially avoidable hospital admissions in the elderly. Although recent reviews have questioned the efficacy of oseltamivir in the prevention of transmission, it has been a central part of the authors' strategy to manage outbreaks in residential homes. To evaluate the management of respiratory virus infection outbreaks in residential homes, with particular emphasis on the logistics and effectiveness of antiviral prophylaxis with oseltamivir. A descriptive analysis was undertaken from a retrospective survey of records held on a local database for three northern hemisphere influenza seasons from 2010 to 2013. In total, 75 respiratory outbreaks were reported from 590 care homes during the study period; of these, the aetiological agent was confirmed as influenza in 35 outbreaks. Overall attack, hospital admission and death rates for influenza were 29.7%, 5.3% and 3.3%, respectively. A further 10 outbreaks were caused by parainfluenza, human metapneumovirus or respiratory syncytial virus in combination with each other or rhinovirus, and six outbreaks were caused by rhinovirus alone. No agent was identified for the remaining 24 outbreaks. Early public health involvement can lead to rapid termination of outbreaks of respiratory virus infections in residential homes. Although the use of oseltamivir is expensive, the data suggest that it does have some benefits as prophylaxis in this setting. Trials are needed to determine the most clinically and cost-effective interventions to control outbreaks in residential homes and avoid hospital admissions.

Factors affecting prevention and control of viral gastroenteritis outbreaks in care homes

We assess the effect of key care quality indicators on viral gastroenteritis outbreaks and control in care homes using mandatory inspection data collected by a non-departmental public body. Outbreak occurrence was associated with care home size but not with overall quality or individual environmental standards. Care home size, hygiene and infection control standard scores were inversely associated with attack rate in residents, whereas delayed reporting to the local public health agency was associated with higher attack rates.

Control measures for invasive group A streptococci (iGAS) outbreaks in care homes

The incidence of invasive group A streptococcal infections (iGAS) is increasing in Europe, with a particularly high morbidity and mortality in the elderly. Control of outbreaks in care homes is therefore important; but is unclear how best to manage these incidents. We attempted to identify which control measures are most likely to be effective. We undertook literature searches using PubMed and Google Scholar and contacted colleagues in Health Protection Units in England for unpublished outbreaks. We identified 31 outbreaks; of which 20 had sufficient detail for further analysis. Overall carriage rates of GAS in care home residents identified in outbreak investigations were 4.7%, and in staff 3.2%. In 8 outbreaks mass antibiotic prophylaxis was offered, in 9 selective prophylaxis only and in 3 none at all. Surveillance swabbing had limited influence on decisions regarding prophylaxis. A few papers mentioned the role of environmental contamination and the risk from an affected roommate. Pooling of results from these outbreaks failed to suggest any clear advantage to either a selective or mass antibiotic prophylaxis strategy in controlling spread. Systematic investigation and data collection from future outbreaks could be of benefit in informing future policy.

P20.06 Factors affecting prevention and control of viral gastroenteritis outbreaks in care homes

P20.06 Factors affecting prevention and control of viral gastroenteritis outbreaks in care homes

Five hepatitis B outbreaks in care homes in the UK associated with deficiencies in infection control practice in blood glucose monitoring

Healthcare-associated hepatitis B virus (HBV) outbreaks have been reported in the USA and from several countries in Europe. Patient-to-patient transmission of HBV in these settings has been linked to several different types of exposure but one of the most common exposures implicated is the use of 'finger-stick' lancet devices for blood glucose testing. This article is an account of the investigations into a series of HBV outbreaks linked to the use of lancing devices in community healthcare settings in the UK. Between February 2004 and December 2006, nine individuals with acute HBV infection were reported to five local units of the Health Protection Agency. Investigations identified a further 12 individuals with HBV infection in residents in these settings. The epidemiological and environmental evidence suggests that HBV transmission occurred mostly from a significant breakdown in infection control measures in blood glucose testing. The occurrence of these outbreaks has highlighted the confusion that exists and the need for clear recommendations regarding the use of such devices in the UK.

Effect of exclusion policy on the control of outbreaks of suspected viral gastroenteritis: Analysis of outbreak investigations in care homes

Norovirus is an important cause of gastroenteritis outbreaks in care homes. Differences exist in the recommended duration of exclusion for affected staff during an outbreak. We conducted a retrospective analysis of outbreak reports in 2006 and 2007 managed by health protection staff in 2 counties with differing exclusion policies, one advising exclusion of affected staff and isolation of residents for 72 hours and the other for 48 hours after the resolution of symptoms. We compared attack rates and average numbers of cases in residents and staff, adjusting for type of care home and staffing rate. A total of 96 outbreaks were managed, 63 with a 72-hour exclusion policy and 33 with a 48-hour exclusion policy. The longer exclusion policy resulted in lower mean number of cases among staff (6.5 vs 9.6; P=.044) and a lower overall attack rate (32.6% vs 35.1%; P=.05). No differences in the mean number of cases or the attack rate among residents were seen. This brief study suggests that a longer exclusion policy reduces the number of cases among staff affected with viral gastroenteritis, possibly resulting in less staff absences. This could have potential benefits, particularly when resources are limited.

Public health responses to influenza in care homes: a questionnaire-based study of local Health Protection Units

Influenza virus infection poses a major threat to the elderly people in residential care. We sought to describe the extent to which local public health services in England were positioned to detect and respond effectively to influenza-like illness (ILI) in nursing homes. A questionnaire-based survey was conducted in all 34 Health Protection Units (HPUs) regarding the 2004-05 influenza season. Of the 20 responses, half reported 24 outbreaks of ILI in care homes. The mean resident population attack rate was 41% (range 15-79) with 31 deaths. Staff ILI occurred in 23 of 24 outbreaks. Seven of 20 HPUs stated that a local policy for the management of ILI in nursing homes was in place, with only four specifying the use of neuraminidase inhibitors (NI) for treatment of cases and prophylaxis of residents. In the outbreaks reported, NIs were used for treatment and prophylaxis, respectively, in only 46 and 54% of instances. Given the availability of effective interventions for treatment and prophylaxis, there is potential to prevent substantial morbidity and mortality from influenza in at-risk populations. This study suggests that challenges remain in the effective response to influenza outbreaks in care homes and that there are wide variations in practice at local level.