LTCF Outbreak Reporting

De Pere LTCF Reporting Outbreak:*

Rennes Health & RehabRenaissance Assisted LivingResidence by RennesSt. Norbert AbbeyInnovative Services- BURGOYNE CTHomes For Independent Living- FOX RUNHomes For Independent Living- JUNIPERJasmer Adult Foster HomeOther

Type of Outbreak:*

Type of Report:*

This outbreak has NOT previously been reported - I am reporting for the first time (no prior cases in the last 28 days)This outbreak HAS previously been reported- I am providing additional information/casesThis outbreak had ENDED - I am providing final detailsOther

General Guidelines and Resources

PRECAUTIONS: Patients and residents who are experiencing symptoms should promptly be placed on transmission-based precautions while the infection is identified or ruled out.
- Recommended precautions vary depending on the type of suspected or confirmed infectious agent. However, facilities should use the most protective level of precautions (this includes gown, gloves, fit-tested N95, and eye protection for ARI outbreaks, for example) when the cause of the outbreak is unknown.
- When the cause(s) of an outbreak is determined, precautions taken may be adjusted based on confirmed diagnosis. The DHS Transmission-Based Precautions Reference Guide may be referenced to help determine appropriate precautions.
- LTCF residents in transmission-based precautions should be restricted to their room and be excluded from participation in group activities.
CLEANING: Ensure adequate cleaning and disinfection. High-touch surfaces and items should be cleaned and disinfected frequently and well as after each patient and resident use.
- Use Environmental Protection Agency (EPA) registered products and follow the manufacturer’s instructions for use, including contact time.
- Consider implementing a tool such as the DHS Non-Critical Items Cleaning and Disinfection Product List that defines which disinfection products are being used, which items are being cleaned and disinfected and how often, and which staff members are responsible for such tasks.
CONTACT INFORMATION: If you have immediate needs or questions, please call us at one of the below numbers. If you have additional non-urgent questions, please email deperehealth@deperewi.gov
- M-Th 7:30am-5:00pm and F 7:30am-11:30am: 920-339-4054
- Afterhours: 1-877-619-9221

Facility Address *

Street Address (within City of De Pere, WI 54115)

PERTAINING UNIT(S)

Facility/Outbreak Contact Person:*

First NameLast Name

Contact Phone:*

Area CodePhone Number

Contact Email

example@example.com

Initial Outbreak Details*

Additional Details Regarding Outbreak (testing/treatment plan, assistance needs, etc.):

RESPIRATORY ILLNESS RESOURCES:

Noro/Gastrointestinal Illness Resources:

ARI Line Lists (Staff and Residents)

Respiratory Outbreak Checklist Items Completed:

Review DHS "Recommendations for Prevention and Control of Respiratory Illness"*Initiate line list of ill residents AND staff (submit via Jotform below)Assess need for testing/prophylaxis interventionsReview and implement contact and droplet precautions as neededEvaluate need to restrict visitors, new admissions, and optional activities in affected unitsPost signage as appropriateExclude ill staff: Staff with ARI who are tested and do not have COVID-19 should be excluded from work until at least 24 hours after they no longer have a fever. If symptoms, such as cough and sneezing, are still present, staff should wear a surgical mask during resident care activities. Work exclusion and return to work recommendations for staff exposed or infected with COVID-19 can be found in the CDC's Interim COVID Guidelines listed in the respiratory illness resources

Recommendations for Prevention and Control of Viral Gastroenteritis Outbreaks in Wisconsin LTCFs

GI Line Lists (Staff and Residents)

Gastrointestinal Outbreak Checklist Items Completed:

Review "Recommendations for Prevention and Control of Viral Gastroenteritis Outbreaks in Wisconsin LTCFs"Initiate line list of ill residents AND staff (submit via Jotform below)Review proper cleaning, disinfecting, and handwashing proceduresReview and implement contact precautions as neededEvaluate need to restrict visitors, new admissions, and optional activities in affected unitsPost signage as appropriateAssess need for testing- if FIVE or more residents are ill with GI symptoms, begin collecting stool specimens for submittal to the WI State Lab of Hygiene with LHD approvalExclude ill staff: Staff with symptoms of gastrointestinal illness should be excluded from work until they are asymptomatic and free of diarrhea and vomiting for 48 hours. See DHS Recommendations for Prevention and Control of Acute Gastroenteritis Outbreaks in Wisconsin Long-Term Care Facilities for additional guidance and recommendations.

Outbreak Closure Details*

Outbreak Closure Checklist:

Complete all internal documentation and submit all relevant lab results via WEDSS if not already completed by outside laboratorySubmit final line list of ill residents AND staff (via Jotform below)Remove restrictions for visitors, new admissions, and optional activities as appropriate

Please Select:

I have a line list of staff or residents related to the outbreak I would like to UPLOADI have a list of staff or residents related to the outbreak I would like to ENTEROther

LINE LIST UPLOAD*

Upload a File

CASE ENTER*

Additional Comments:

De Pere Long Term Care Facility Outbreak Reporting

Outbreak Information

INITIAL OUTBREAK REPORTING

OUTBREAK CLOSURE

Outbreak Cases/Line List