Communicable Disease: Respiratory

Policy number:  IC - 26

Effective date:  September 2002

Last revision date:  January 2024

On this page

1. Background
2. Purpose
3. Policy
4. Procedure
5. References

1. Background

Registered staff will identify Residents with signs and symptoms of respiratory infections and document infections on the “Monthly Resident Infection Control Surveillance Report”, as per policy. 

Case definition of Upper Respiratory Track Infection (includes the common cold, pharyngitis)

Resident must have at least two of the following symptoms:

• Runny nose or sneezing
• Stuffy nose
• Sore throat or hoarseness or difficulty swallowing
• Dry cough
• Swollen or tender glands in the neck
• Fever or abnormal temperature may or may not be present.

Identification of Symptoms of Influenza-like illness in Residents

Residents with at least two of the following symptoms;

• Abnormal temperature >38 degrees Celsius or <35.5 degrees Celsius
• Cough
• Myalgia
• Malaise
• Sore throat or runny nose
• Loss of appetite
• Headache
• Chills

Identification of COVID-19

An infectious disease caused by the SARS-CoV-2 virus which can affect the upper and lower respiratory tracts. Typical symptoms may include one or more of the following:

• Fever and/or chills
• Sore throat or difficulty swallowing
• Cough or barking cough (croup)
• Decreased loss of smell or taste
• Shortness of breath
• Fatigue
• Headache (not related to the vaccine)Nausea, vomiting and/or diarrhea
• Muscle aches/joint pain

Identification of Bronchitis and Tracheobronchitis (other LRTI)

• New or increased cough
• New or increased sputum production
• Abnormal temperature >38 or 35.5 degrees Celsius
• Pleuritic chest pain
•  New physical findings (rales, rhonchi, wheezes)
• New or increased SOB, respiratory rate > 25/min, worsening functional ability to perform ADL or change in consciousness

Identification of Pneumonia (LRTI)

• Confirmed by chest X-ray
• or physician-confirmed assessment
• Infiltration

(rule out other non-infectious causes such as CHF or underlying disease process)

Severe Respiratory Syndrome (SARS)

• Fever over 38 Celsius or abnormal temperature
• Cough or breathing difficulty not otherwise explained
• Severe pneumonia determined by chest x-ray (likely admitted to hospital for treatment)

2. Purpose

Residents in a long-term care home are susceptible hosts for respiratory outbreaks for a number of reasons associated with ageing; e.g., declines in natural barriers, immune system changes, debilitated status, organ deficits, multiple chronic diseases, nutritional factors and delays in recognizing infections.

All respiratory outbreaks shall be reported to the Local Health Home area by the IPAC coordinator or Designate.

3. Policy

It is the policy of the home to provide information on respiratory illness to manage infections within the Lodge.

To provide direction for staff to ensure rapid response to respiratory disease outbreaks and to minimize the impact on residents, families, visitors, volunteers and staff.

To provide information to key personnel to assist with prompt infection control activities to reduce the spread of infection, assist with determining the source (s) of infection and determine the specific pathogen related to an outbreak. To decrease the duration of the outbreak

4. Procedure

Nursing Department

1. The Registered Nurse in the affected area will follow the Outbreak Checklist (IC-27 )
2. Implement isolation precautions, gowns, masks, eye protection, gloves (isolate linen)
3. Post signage outside the home area and on the main entrance indicating presence of respiratory outbreak and area (s) affected. Post signage on affected Residents’ rooms. Encourage room isolation of ill Residents (refer to communicable illnesses-isolation barriers).
4. Maintain cohorting of Residents and staff in the affected area (s).
5. Requisition extra fluids from dietary for sick trays and for nourishment carts. Refer to III-60
6. Registered staff in the affected areas will assess Residents for symptoms and document any new case every shift on the outbreak surveillance line listing and in the Resident’s multidisciplinary notes. Assessments should include assessment of temperature & Vitals, any medical treatment received notification of family/SDM and an assessment of vital signs prn. It is recommended that a chest assessment be done on any Resident suspected of developing a lower respiratory infection.
7. Monitor Residents in other areas of the Home for onset of similar symptoms, and possible outbreak spread. Implement contingency plan to include other areas if cases identified.
8. Ensure staff and Residents utilize hand-washing techniques.
9. Acquire extra supplies (hand sanitizing gel, masks, gowns, gloves). Isolation carts should be located outside all isolated residents' doors unless the home area requires reverse isolation. If so, the supplies will be located outside the home area. 
10. Place pharmacy on standby that a respiratory outbreak has occurred and Amantadine/Tamiflu may be required for home area (s).
11. Collect Nasopharyngeal swabs as per policy.
12. The Infection Control Officer or designate is to notify staff of confirmed virus detection.
13. The DON/designate is to inform the LHIN of the outbreak area.
14. Transfer to hospital of ill Residents: Registered staff are to notify the hospital of the respiratory outbreak and pathogen if known and alert the hospital whether he Resident is symptomatic or asymptomatic. All transfers are required to have a PTAC completed and FRI/SRI.
15. All respiratory precautions are to remain in place until the outbreak is declared over.
16. Ambulance staff are to be notified if an outbreak occurs, the area(s) affected, precautions taken and whenever called if a Resident is symptomatic or not.
17. Resident appointments that are non-urgent are to be rescheduled. (affected home area(s) only)

Activation Department

1. Outings, special events and programs may need to be cancelled. (Decision to be made by the Program Supervisor and Infection Control Officer/designate)
2. Residents in isolation may need to receive visits or receive room activities once they begin to improve but are still communicable.

Dietary Department

1. Explicit instruction and specific training in personal hygiene and sanitary food handling will be given to staff (see Nutritional Department Manual).
2. Disposable dishes will only be initiated upon the request of the Dietary supervisor/delegate.
3. Ensure adequate supply of ginger ale and other clear fluids are on hand.
4. Ensure to follow routine and additional precautions when completing daily tasks.(i.e., hand hygiene, donning and doffing etc.)

Housekeeping, Laundry & Maintenance Departments

See PIDAC’s Best Practices for Environmental Cleaning for Prevention and Control of Infections

1. Ensure that specific responsibilities are understood (department manual)
2. Additional cleaning on the affected home area will need to be implemented
3. Increase cleaning of high-touch surfaces such as but not limited to; keypads, doorknobs, handrails, tables, bathroom faucets and grab bars in the bathroom.
4. Isolation of linen will occur where deemed necessary by nursing staff, follow policy regarding handling of isolation linen and garbage in ill Resident rooms.
5. If reverse isolation is necessary the isolation cart outside of the home area will contain necessary isolation supplies, gowns, gloves, eye protection and masks.
6. Keep home areas supplied with disinfecting products, and other supplies.
7. Laundry should mask when sorting contaminated linens and donning of protective eyewear is recommended.

Infection Control Committee Members

1. Attend meeting at the first reporting of a suspected outbreak as well as any meetings that are further requested by the IPAC Coordinator. 
   1. Refer to the IC-60 policy for more details

Infection Control Officer/designate

1. Monitor outbreak, assist in identifying new cases, identify any further spread of infections, assess effectiveness of precautions and implement ongoing management of outbreak.
2. Review the results of specimens tested.
3. Determine when the outbreak can be declared over.
4. Report concerns
5. Conduct audits more frequently during outbreaks. COVID-19 Self-Assessment Audit Tool Kit to be completed weekly during outbreak.

Administrator/Designate

1. Reviews progress reports from the committee/designate and report to the General Manager and Council.
2. Acts as spokesperson to the media, visitors, family, Auxiliary, volunteers.

Director of Nursing/Designate

1. Receives information from the nursing staff regarding outbreak
2. Communicates progress and decisions to the Administrator, Committee, Nursing team, Residents and other departments.
3. Notifies the Ministry of Health and completes outbreak notification (or designate).
4. Notifies LHIN & Hospital of Outbreak
5. Update Infection Control message on voicemail system. (Residents Service Clerk)
6. Liaises PHD during outbreak period in absence of Infection Control Officer.

IPAC Measures

1. Receives information from Nursing Staff regarding outbreak
2. Reinforce implementation of Droplet, Contact, or Droplet/Contact Precautions as soon as possible for all residents at onset of respiratory symptoms.
3. Dedicate equipment to residents with Respiratory Symptoms
4. Routine cleaning. Clean resident care equipment, high-touch items at nursing stations, carts (medication, isolation) and other areas touched by health care providers daily and before discontinuing precautions of a client/patient/resident with a confirmed viral respiratory infection.
5. Remove and launder all curtains (privacy, shower) when visibly soiled and on discharge/transfer cleaning
6. Audit compliance with IPAC Self-Assessment Tool on a weekly basis, and regularly with hand hygiene, routine practices, additional precautions and environmental cleaning.

Public Health Inspector

1. Visits the Home as required during an outbreak and participates in the Infection control meetings.
2. Collects and analyses data.
3. Collects Public Health specimens
4. Notifies the Infection control committee if deemed necessary to close the facility to visitors.
5. Supplies specimen collection containers.
6. Provides information to the facility regarding specimen results.
7. Monitors the effectiveness of the antiviral if given in an Influenza Outbreak.
8. Assist with monitoring for resurgence

Visitors

1. Visitors may visit if they are free of infection symptoms.
2. Visitors will be discouraged from visiting other Residents while visiting their loved ones.
3. No restrictions on compassionate visiting.
4. Visitation should be encouraged in Resident rooms instead of common areas. Visitors are encouraged to apply protective barriers when entering an isolation Resident room.
5. Visitors who provide significant aid in the nursing care of their loved ones will not have visitation restricted.
6. Visiting may be prohibited on the order of the Medical Officer of Health or Administrator, DON.

Patient Transfer

1. Limit transport unless required for diagnostic or therapeutic procedures 
2. Recommend resident to wear a mask during transport. Transport staff wear gloves and gowns for direct contact with the client/patient/resident during transport. Clean and disinfect equipment used for transport after use.
3. Prior to transport, Transportation Services, the receiving home area/ department or facility and Infection Prevention and Control must be notified that a patient/ resident with respiratory infection is being transferred.

New Admissions

Take into consideration the burden of the respiratory outbreak on the home area and the ability to cohort residents

5. References

PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November 2012

PIDAC: Best Practices for Environmental Cleaning for Prevention and Control of Infections | April 2018

PIDAC: Best Practices for Prevention, Surveillance and Infection Control Management of Novel Respiratory Infections in All Health Care Settings| February 2020

PIDAC: Annex B: Best Practices for Prevention of Transmission of Acute Respiratory Infection | March 2013

PIDAC: Guide to IPAC Management of Suspected or Confirmed VHF in Acute Care | July 2019