Page 158 - policy and procedure infection control

Policies and Procedures on Infection Control

8. HOSPITAL OUTBREAK MANAGEMENT

8.1 Introduction
All health care facilities especially major hospitals would have an on going surveillance
activities for healthcare associated infection (HCAI). The usual level of occurrence or
incidence of an infection within the facility is usually known and this would be considered
as the mean control limit. However, an upper control limit of the occurrence of the infection
should be identified in order to serve as an alert line for the Infection Control Team (ICT) to
investigate for a probable outbreak.

DEFINITION OF HEALTHCARE ASSOCIATED INFECTION OUTBREAK (EITHER ONE)

1. Two or more associated cases occurs at the same time within same locality/
department

2. Greater than expected rate of infection compared with the usual background case for
the place and time
3. In certain newly emerging disease e.g. Legionnaires infection or anthrax, will only
require 1 single case.

In HCAI outbreak, clinical findings of reported cases should be reviewed closely. It is important to
directly examine the patients, reviewing of the medical records and have a discussion with the
doctor in-charge. A discrepancy between the clinical and laboratory findings may occur if an
outbreak is factitious, for example due to laboratory error. An outbreak maybe judged minor or
major after consideration of its complexity, number of person affected, pathogenicity of the organism
involved, potential transmission and any unusual features.

8.2 Steps in Outbreak Investigation and Management
NO PROCEDURES RESPONSIBILITES

1. A probable diagnosis of an outbreak arises from laboratory based ICN
surveillance or clinical report from a unit/department

2. Investigate and gather information on the probable outbreak, both ICN
from microbiological data, environmental investigation and patient’s
placement and movement. Carry out mapping of cases.

3. Suspect a true outbreak if cases appear to be linked in time, space ICCT
or persons. Produce a preliminary report and hold the discussion.

Ministry of Health Malaysia 147