Infection preventionists need to be able to identify any increase in disease frequency and unusual infectious disease occurrences, report the incident to their local health department (LHD) and CDPH Licensing & Certification District office, and implement appropriate infection control measures to protect residents and healthcare workers.
An outbreak is defined by the occurrence of cases of a disease above the expected or baseline level, over a given period of time, in a geographic area or facility. The number of cases indicating the presence of an outbreak will vary according to the disease agent, size and type of population exposed, previous exposure to the agent, and the time and place of occurrence. For example, a single case of a communicable disease long absent from a population or the first invasion by a disease not previously recognized may warrant additional investigation as a possible outbreak.
Outbreaks can result from lapses in infection control practices such as hand hygiene (HH), use of personal protective equipment (PPE), and environmental cleaning and disinfection. Occasionally, outbreaks occur as a result of a contaminated medical product or device.
SNF should ensure consistent implementation and adherence monitoring of evidence-based infection prevention strategies to help prevent outbreaks. See the Establishing an Effective IP Program webpage for additional information on infection prevention strategies in SNF.
SNF infection preventionists should have policies and procedures in place for what to do as soon as an outbreak is suspected. SNF must report suspected or confirmed outbreaks and unusual infectious disease occurrences to their LHD and CDPH Licensing & Certification District office; see AFL 19-18 (PDF). In consultation with the LHD, SNF infection prevention staff should gather pertinent information, identify gaps in infection prevention, and implement control measures as recommended by the LHD.
Influenza - See AFL 18-08 and Recommendations for the Prevention and Control of Influenza California Long-Term Care Facilities (PDF) - reviewed and updated October 2019
Legionnaires’ Disease - See AFL 18-39 (coming soon)
Carbapenem-resistant Enterobacteriaceae (CRE) - See the CRE for Public Health and Healthcare Providers guidance
Norovirus - See Recommendations for the Prevention and Control of Viral Gastroenteritis Outbreaks in California Long-Term Care Facilities guidance (PDF)
C. difficile infection - See CDI Prevention for Public Health and Healthcare Providers guidance
Scabies - See Management of Scabies Outbreaks in California Health Care Facilities guidance (PDF)
See the COVID-19: Guidance for Skilled Nursing Facilities slidset (PDF) and webinar recording (opens in YouTube) for detailed guidance (as of 3/13/20).