Common Terminology |
Case - a person with the particular illness or disease, usually fitting the case definition.
Case Definition - a set of criteria for determining who should be classified as a case. The definition is comprised of clinical information and should include epidemiological information related to time, place, and person. A new case definition will be created for each outbreak. Note: The case definition can be altered as the outbreak progresses and further information becomes available.
Control Measure - any action or activity that can be used to prevent or stop an outbreak. Control measures for gastroenteritis outbreaks are primarily focused on reducing additional exposure.
Exclusion - campers and staff who are ill should be physically separated from other people and should not participate in activities that involve direct person-to-person contact. In some instances, ill campers/staff may be sent home from the camp while infectious. See our Reporting and Exclusion Guidelines.
Incubation period - the interval from the time an individual is infected to the time when symptoms first appear. Incubation periods can range from hours to days, depending on the causative agent.
Infectious period - the time during which infected individuals are able to transmit their infection to others. Infectious periods can range from hours to days, depending on the causative agent. It is possible to have no clinical symptoms and still transmit infection. This is also commonly referred to as the period of communicability.
Line listing - an important tool for effective outbreak management. It is a table that summarizes information about probable or confirmed cases associated with an outbreak. It often includes identifying information, demographics, clinical information, and exposure or risk-factor information. The NBPSDHU Outbreak Manager reviews the new information daily. The daily reporting of data is essential for decision-making throughout the course of the outbreak, including when to declare the outbreak over. The information provided on the line listing contains confidential client information and attention must be given to the transmission of information. Information related to the outbreak is also reported to the Ministry of Health and Long-Term Care, Public Health Division. Updated line listings should be faxed to the Health Unit daily at 11:00 am. The confidential fax line is 705-482-0670. Note: line listings may also be sent via email, by using password protection or encryption. Options can be discussed with the Outbreak Manager.
Outbreak - an unexpected increase of disease occurring within a specific population at a given time and place.
Screening - a process of checking for active symptoms in campers and staff.
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Role of the Health Unit in an Outbreak |
Public Health Inspectors and Public Health Nurses at the NBPSDHU work with the owner/operator of the recreational camp to assist in controlling the spread of illness, which will benefit the health and enjoyment of campers and staff. Services that may be provided as soon as possible after the outbreak has been reported to the Health Unit include:
- Onsite visit to conduct inspection of food preparation and handling
- Onsite visit to speak to the camp director, camp nurse/healthcare providers, custodial staff, or counselors to reinforce basic infection and prevention control measures
- Daily communication via phone/fax/email to support documentation and answer questions related to outbreak management
- Statistical analysis of data collected about ill campers and/or staff to monitor the effectiveness of outbreak control measures and to identify sources of infection
- Arrangement for the pickup and testing of environmental samples (food, water) and clinical specimens (stool specimens)
The NBPSDHU staff are available to answer any questions or concerns that you may have about infection prevention and control, whether or not you are in outbreak.
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Enteric Outbreak |
Definition |
An enteric outbreak is suspected whenever there are a greater than expected number of cases with similar signs and symptoms in the same location, for example, two or more cases experiencing diarrhea and/or vomiting within a 48-hour period. Enteric refers to an illness that affects the gastrointestinal tract (stomach and intestines) and results in symptoms such as nausea, vomiting, and/or diarrhea. Many bacteria and some viruses and parasites can produce enteric illness in people. |
Steps to take when you have a suspected outbreak |
- Notify the NBPSDHU CDC Program of a known or suspected outbreak. It is the responsibility of the NBPSDHU, in consultation with the camp, to decide if an outbreak is going to be declared.
- Start separate line listings, one for staff and one for campers, who have presented with symptoms that may be associated with the outbreak.
- Exclude ill campers and staff to stop the spread of infection to others.
- Implement outbreak control measures to stop the spread of infection, as recommended by the NBPSDHU.
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Managing an enteric outbreak |
Staff at the recreational camp will:
- With the NBPSDHU, develop a case definition for the outbreak. This may change, depending on presenting symptoms, throughout the outbreak.
- Review outbreak control measures, including exclusion recommendations, with the NBPSDHU (faxed or emailed when the outbreak is declared).
- Review cleaning and disinfection recommendations during an outbreak. Discuss cleaning and sanitizing of food preparation/handling areas with a Public Health Inspector from the Environmental Health Program at the NBPSDHU.
- Continue to monitor and exclude all staff and campers who meet the case definition, for the appropriate exclusion period, as determined by the NBPSDHU and the camp. In some instances, staff and/or campers may be sent home to recover. The return of staff and/or campers is based on the specific exclusion guidelines for the outbreak.
- Update the line listing(s) daily with all new campers and staff that present with symptoms throughout the outbreak. Fax the line listing(s) daily (including weekends and holidays) to the NBPSDHU at 705-482-0670 by 11:00 am. Line listing(s) may also be emailed to the NBPSDHU via password protection or encryption; discuss options with the Outbreak Manager.
- Obtain an order from the camp physician/nurse practitioner to collect stool samples (NBPSDHU to provide kits upon request) from campers and/or staff with the most recent onset of enteric symptoms. (Helpful Hint: A pre-existing medical directive from the camp physician/nurse practitioner, for the purposes of an outbreak, would ensure timely collection of samples). Usually, the maximum number of specimens collected during an enteric outbreak is 15. Ensure that each specimen is appropriately labeled. All specimens must be placed in the bag provided with the kit.
- Once specimens are collected and bagged, place on ice or refrigerate, but do not freeze. Contact the NBPSDHU to arrange pick-up and delivery to the Public Health Laboratory.
- Any food or environmental specimens will be coordinated by an Environmental Health Public Health Inspector.
- Inform all staff of the outbreak status and provide education on how to stop the spread of infection.
- Educate all campers on stopping the spread of infection.
- Inform parent(s)/guardian(s) of campers that an outbreak has been declared at camp.
- Post appropriate signage at entrances and exits of camp to inform visitors than an outbreak has been declared and what precautions they should take to stop the spread of infection.
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Respiratory Outbreak |
Definition |
A respiratory outbreak is suspected whenever there is a greater than expected number of cases with similar respiratory illness signs and symptoms in the same location. Respiratory refers to an illness that affects the respiratory tract and results in symptoms such as couch, runny nose, sneezing, sore throat, abnormal lung sounds, hoarseness, difficulty swallowing, headache, chills, loss of appetite, and/or fever. Many viruses and bacteria can produce respiratory illness in people. Public Health presently has a minimal role in the management of respiratory outbreaks in recreational camps, unless there is an outbreak of a Disease of Public Health Significance, or the illness experienced by campers and/or staff is severe, unusual, or there are hospitalizations. In these situations, please contact the NBPSDHU's CDC Program for further directions. We are always available to answer questions and provide information/support regarding infection control practices. |
Managing a respiratory outbreak |
Staff at the recreational camp will:
- Exclude ill campers and staff to stop the spread of infection to others. See our Exclusion Guidelines.
- Implement Infection Prevention and Control recommendations for stopping the spread of infection. Contact the NBPSDHU with any questions or concerns.
- Inform all staff, campers, and parent(s)/guardian(s) of the outbreak and provide education on how to stop the spread of infection.
- Inform visitors to the camp facility of the increase in respiratory symptoms, so they may take appropriate precautions upon entering and leaving camp. See Appropriate Signage.
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Cleaning and Disinfection Recommendations During an Outbreak |
NOTE: Please discuss the cleaning and sanitizing of food preparation/handling areas with an Environmental Health Public Health Inspector. The recommendations below do not apply to food handling/preparation areas.
A contaminated environment can play a role in the transmission of infections during outbreaks. There is an increased potential for environmental contamination during an outbreak. Emphasize these practices (MOHLTC2, 2018):
- Increase routine cleaning/disinfection of commonly touched items such as door handles, railings, light switches, toilets, sinks and handles, dining tables, and counters.
- Increase the cleaning and disinfection of all surfaces in the ill campers' and/or staffs' immediate environment.
- If possible, dedicate specific equipment to each ill camper and/or staff. Alternatively, properly clean and disinfect equipment shared between persons.
- Remove exposed food, such as fruit and cookies, from common areas, including staff lounges and activity lounges.
- Promptly clean and disinfect surfaces contaminated by stool and vomit. Immediately cover spillage with dry disposable paper towels (see below for further information).
- Clean soiled carpets and soft furnishings with hot water and detergent, or steam clean. Note: vacuum cleaning is not recommended.
- Contaminated clothing, bedding, plush toys, and non-disposable mop heads should be laundered on hot cycle with detergent and hot air dried.
- Toys and sports/activity equipment, in an outbreak affected area, should be cleaned, and disinfected at least daily. Remove from use where possible.
- Toys and sports/activity equipment, handled by a camper who becomes ill, should be removed from use until they have been cleaned and disinfected.
*Ensure surfaces contaminated by feces or vomit are immediately cleaned with soap and water to remove organic material and then disinfected with a suitable disinfectant (i.e., accelerated hydrogen peroxide - follow manufacturer's guidelines for contact times; sodium hypochlorite solution [1part bleach to 9 parts water] - allow 10 minutes contact time, followed by a rinse of the area/object). Mix fresh bleach solutions daily and verify concentration with appropriate testing agents (i.e., test strips).
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Gastroenteritis |
Gastroenteritis
What is it?
- Inflammation of the stomach and intestines that often results in diarrhea and/or vomiting.
- Diarrhea is usually mild and brief and occurs when bowel movements are less formed and more watery.
- When diarrhea or vomiting is caused by an infection it is often called "acute gastroenteritis", or "stomach flu".
- Infection is usually caused by viruses (e.g., rotavirus or Norovirus). It can also be caused by bacteria (e.g., Shigella, E. coli, Salmonella, Campylobacter, and Yersinia) or parasites (e.g., Giardia).
- Diarrhea or vomiting may also be caused by dietary changes, medications, or other causes.
How is it spread?
- Germs can be found in the stool or vomit of infected people and spread easily to others:
- by eating food or drinking liquid that is contaminated
- if they touch their mouth after touching contaminated surfaces or objects
- when in direct contact with an infected person who has symptoms
- Contact with animals (e.g., pets, farm animals, reptiles) can also spread germs.
What are the symptoms?
- More bowel movements than usual and stools that are less formed and more watery.
- Other symptoms may include fever, chills, loss of appetite, nausea, vomiting, stomach cramps, muscle aches, fatigue, and blood and/or mucous in the stool.
When do symptoms start and how long is it contagious?
- It varies, depending on the cause.
How is it treated?
- Drink plenty of fluids to avoid dehydration.
- SEEK MEDICAL ATTENTION IF ANY CONCERNS.
How is it prevented?
- Those with diarrhea and/or vomiting should not prepare meals or feed others. If absolutely necessary, do proper hand washing prior to preparing food and before feeding someone.
- Clean and disinfect washrooms and commonly touched surfaces (e.g., doorknobs, taps, counter and table tops, light switches, etc.) more frequently.
Hand washing is the most important way to stop the spread of infectious gastroenteritis. Wash hands often with warm water and soap for at least 15 seconds or use alcohol-based hand sanitizer, especially:
- after diaper changes, toileting, or using the bathroom
- after handling pets, animals, or their waste
- for children who have diarrhea, especially if they are still in diapers
Safe Food Handling
- Wash fruits and vegetables, especially if eating raw.
- Separate raw food from cooked food.
- Wash hands, utensils, chopping boards and surfaces carefully after handling raw meat to prevent cross-contamination.
- Cook meat, poultry, and eggs thoroughly.
- Eat foods soon after they are cooked.
- Keep hot foods hot and cold foods cold.
- Reheat cooked foods adequately.
- Store cooked foods appropriately and store foods in closed containers in a safe place.
- Always use water that has been treated or tested.
You may need to stay home from childcare, school, work, or group activities.
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Hand Hygiene |
Hand Hygiene
Why is hand washing important?
- Hand washing, when done correctly, is the single most effective way to prevent the spread of illness.
When should I wash my hands?
- When they are visibly dirty.
- Before preparing and immediately after handling food.
- After using the toilet or changing a diaper.
- After contact with contaminated surfaces (e.g., garbage bins).
- After handling pets, animals, animal waste, pet food, or treats.
- After wiping or blowing your nose.
- After coughing or sneezing into your hand.
- After contact with blood, bodily fluids, or wounds.
- Before and after giving care or visiting someone who is ill or less able to fight infections.
Five simple steps to hand washing
- Wet your hands with warm running water and apply soap.
- Rub your hands vigorously for at least 15-20 seconds. Remember to wash the front and back of your hands, as well as in between fingers, around thumbs, and under fingernails and jewelry.
- Rinse hands well under warm running water.
- Pat hands dry with paper towel.
- Turn off water using a paper towel and discard.
When can you use alcohol based hand rub?
- Washing hands with soap and water is the best way to reduce the number of germs on them in most situations. If soap and water are not available, use an alcohol based hand rub that contains at least 70% alcohol.
How do I use alcohol based hand rub?
- Ensure hands are visibly clean and dry.
- Apply enough hand rub into a cupped palm to completely wet both your hands.
- Rub your hands together to cover all areas of your hands, including under your nails.
- Use a rubbing motion to evenly distribute the product over ALL surfaces of your hands until your hands feel dry. This should take at least 15 seconds.
Is it safe to use alcohol based hand rub on the hands of children?
- Yes it is safe in children over the age of 24 months; however, young children should be closely supervised when using it. After application of the hand rub to hands, the alcohol content evaporates.
Take care of your hands
- Use a protective hand cream or lotion frequently to reduce irritation.
- Keep nails clean and short.
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Outbreak Line Listing Forms: Campers/Staff |
Outbreak Line Listing Form for printing only |
How to Collect a Stool Sample |
How to Collect a Stool Sample |
Template Letter for Parents/Staff |
Template Letter for Parents/Staff |
Appropriate Signage |
Post appropriate signage at entrances and exits of the camp to inform visitors that an outbreak has been declared. |
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