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   Accountability Indicators
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Initial Report on Public Health
Respiratory Infection Outbreaks in Long-Term Care Homes
Narrative

The respiratory infection outbreak indicator estimates the number of confirmed respiratory infection outbreaks in long-term care homes between September 1, 2006 and August 31, 2007.

Respiratory tract infections such as the common cold (Rhinovirus), adenovirus, and influenza, along with other respiratory pathogens, are spread through contact with an infected person via droplets from coughs, sneezes, and tissues or surfaces contaminated with the virus. Although symptoms vary depending on the causative agent, they generally include nasal congestion, cough, running nose, sore throat, fever, sneezing, and fatigue.

A confirmed respiratory infection outbreak in a long-term care home is defined as:

  • Two cases of acute respiratory tract illness, at least one of which must be laboratory confirmed; or
  • Three cases of acute respiratory tract illness occurring within 48 hours in a geographic area (e.g. unit, floor); or
  • More than two units having a case of acute respiratory tract illness within 48 hours. 105

Respiratory tract infections are one of the most commonly diagnosed infections of long-term care home residents. Long term care residents are predisposed to such infections in part because they may:

  • be elderly
  • have chronic illnesses which weaken their immune system
  • have chronic lung or neurological disease which impairs their ability to clear secretions from their lungs and airways

Residents are also at risk because they are often already medically compromised and many viral and bacterial respiratory pathogens are easily transmitted in an institutional environment. Thus, respiratory infections can result in substantial morbidity and mortality in residents of long-term care homes. 106, 107

Public health units provide support to long-term care homes to prevent and reduce the spread of infectious diseases. This includes:

  • promoting influenza immunization to staff and residents
  • providing education to staff on infectious disease prevention
  • working in partnership with staff to:
    • develop infection prevention and control policies and procedures
    • develop an outbreak contingency plan surveillance system
    • assist in the prevention, investigation, confirmation and management of cases and outbreaks

The number of outbreaks provides an indication of the workload and resources required of public health units to carry out appropriate response and investigations, to prevent the further spread of illness, and to prevent death. A high number of outbreaks should not be considered a sign of poor performance by a health unit, but may indicate an effective surveillance strategy and strong working relationships between long term care homes and a local public health unit staff. The data presented reflect the number of outbreaks and not closures due to outbreaks.

Through long-term care home reporting of respiratory infection outbreaks to public health units, early detection and investigation of outbreaks and implementation of appropriate infection control measures can be put in place to limit further transmission, illness and death.

Between September 1, 2006 and August 31, 2007 there were a total of 602 respiratory infection outbreaks in Ontario long-term care homes. Based on 36 public health units, the highest number of respiratory infection outbreaks in long-term care homes was 113 and the lowest number was zero.

Indicator Definition

Definition:

The respiratory infection outbreak indicator estimates the number of confirmed respiratory infection outbreaks in long-term care homes between September 1, 2006 and August 31, 2007.

Data Source(s):

Integrated Public Health Information System, Ministry of Health and Long-Term Care

Formula:

Number of confirmed respiratory infection outbreaks in Long-Term Care homes for the 2006/2007 respiratory virus surveillance season.

Notes:

  • Data was extracted on February 2, 2009 from the Integrated Public Health Information System.
  • Indicated by selecting Long-Term Care Home option in the Exposure Setting Type Field for outbreaks in iPHIS
  • Outbreaks that do not meet the case definition for a confirmed respiratory infection outbreak in a long-term care home were removed
  • The report is called: List of created Outbreaks - Child Care Facilities Highlighted - for HU use
  • Cognos ReportNet path: Public Folders > CRN 1.0 > Shared Communicable Diseases Reports > Management Reports > QA Reports

105 Ministry of Health and Long-Term Care, Public Health Division and Long-Term Care Homes Branch. A guide to the control of respiratory infection outbreaks in long-term care homes. Toronto, ON: Queen’s Printer for Ontario; 2004. p.19. Retrieved April 23, 2009 from: http://www.health.gov.on.ca/english/providers/pub/pubhealth/ltc_respoutbreak/
ltc_respoutbreak.pdf
.
106 Chong CP, Street PR. Pneumonia in the elderly: a review of the epidemiology, pathogenesis, microbiology, and clinical features. South Med J. 2008;101(11):1141-5.
107 Chan Carusone SB, Walter SD, Brazil K, Loeb MB. Pneumonia and lower respiratory infections in nursing home residents: predictors of hospitalization and mortality. J Am Geriatr Soc. 2007 ;55(3):414-9.

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