Attempting to Find Clarity in Chaos: A Collaborative Development of the Enteric Outbreak Binder


      Gastroenteritis can be caused by a wide variety of bacteria and viruses. Outbreaks can impose considerable disruptions to activities and often result in ward closures. Gastroenteritis typically requires a low infectious dose and for this reason often affects both patients and staff. This causes staffing shortages on units thus incurring higher workload volumes due to outbreak measures put in place. The management of outbreaks can change daily often-leaving overburden staff confused and frustrated.


      Infection Prevention and Control, Public Health, Environmental Services, Volunteer Services, Risk Management, and Nursing staff collaborated to develop an Enteric Outbreak Binder to clarify interventions for suspected and confirmed outbreaks in the hospital setting.


      The Enteric Outbreak Binder includes nine sections that outline steps to follow during suspected and confirmed outbreaks. The first section provides information on organisms that cause enteric outbreaks such as incubation periods, periods of communicability, transmission and symptom duration. Section two describes the use of routine and additional precautions pertaining to enteric outbreaks. Section three gives case definitions for both suspected and confirmed outbreaks and includes outbreak control measures to be taken under each situation. Specific checklists are incorporated should an outbreak occur over the weekend or if Infection Control cannot be reached. Section four and five deal with communication to staff and patients, families and visitors. Sample signage and memos are included in these sections. Members of an outbreak management team are specified to facilitate clear communication and expectations to various departments during an outbreak. Environmental cleaning requirements are covered in section six, which also includes checklists and information tables for environmental service staff. Educational information provided by Public Health on various organisms that cause enteric outbreaks is covered in section seven. Sections eight and nine include criteria for outbreak resolution and references for the binder.

      Lessons Learned

      The development of Enteric Outbreak Binder required involvement of multiple services, which resulted in the creation of comprehensive outbreak initiatives. The project strengthened relationships between various leadership teams and fostered a united front among the stakeholders.