Outbreaks of viral gastroenteritis occur commonly in ACFs. Australian health departments have existing protocols and practices for managing these. There are variations in the level of direct involvement by different PHUs and also by the same Unit at a given time, as guided by availability of resources and other competing workload demands.

The purpose of these Guidelines is not to suggest a standardised, one-size-fits-all type of an approach. Rather, they are offered to assist PHUs in further developing and refining their operational protocols. The remaining components of this Appendix are included more for the purpose of aiding staff in ACFs through provision of concise protocols and key tools for outbreak management. Again, individual PHUs will have their own tools which would replace the suggested templates here as appropriate.

Table 2 on the next page depicts three tiers of PHU-response levels for managing outbreaks of norovirus or suspected viral gastroenteritis in institutions. Such classification may be useful in making explicit decisions about the level and type of response that will be offered for these outbreaks. This may be as a general ‘standard’ approach or may be varied, depending on the requirements of a specific outbreak or during a particular time period. For example, while the standard level of response of a particular PHU might be Level III, during a busy season it may only be feasible to carry out a Level II response on a routine basis unless there are particular concerns.

Table 2: PHU-response levels for managing norovirus or suspected viral gastroenteritis outbreaks in institutions

IssueLevel I
Information dissemination
Level II
Passive supervision
Level III
Active supervision
1Initial response
1.1Initial telephone discussionPublic Health Officer (PHO)PHOPHO
1.2Information pack distributionYesYesYes
1.3Initial checklist Prepared & submitted by facilityPrepared & submitted by facilityPHU by telephone
2Pathology
2.1Specimen testingArranged by ACF - usualarrangementsArranged by ACF - usualarrangementsArranged by PHU at Reference Laboratory
2.2Tests to be requestedMCS, OCP, NoVMCS, OCP, NoVMCS, OCP, NoV
2.3Specimen pick-up arrangementsArranged by ACF - usualarrangementsArranged by ACF -usualarrangementsACF delivers to Reference Laboratory, or
Taxi, or
EHO pick-up
2.4ResultsFacility informs PHUFacility informs PHUPHU receives & informs facility
3Site visits
3.1Carrying out site visits
to affected institutions
If specific concernsIf specific concerns
Consider Council EHO
PHO & EHO visit if possible (modified depending on risk assessment)
4Follow-up
4.1Daily line-listingFacility keeps for internal recordsFacility submits to PHUFacility submits to PHU
4.2Follow-up contactOnly by ACF if have issuesBy PHO if no feedback received in 2 daysDaily by PHO
4.3Follow-up durationOnly if required by ACFUntil end of outbreakUntil end of outbreak
5Data management
5.1Data collationACF for own recordsPHU keeps hard copies & updates summary dataPHU on electronic daily
follow-up templates
5.2OzFoodNet summaryPHU based on initial checklistPHU based on all available dataPHU based on all available data

Note: PHO – Public Health Officer; ACF – Aged-care Facility; PHU – Public Health Unit;
MCS – Microscopy, Culture, Sensitivity; OCP – Ova, Cysts & Parasites; NoV – Norovirus
EHO – Environmental Health Officer

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Table 3 assists in flagging specific outbreaks that may require a higher level response. It is based on the subjective assessment of a number of key factors during an initial interview by PHU staff. For each factor (category), a ‘level’ is indicated (1–3), which are then added up to give a total score. The total score then gives an indication of the overall alert level for the outbreak at the time of initial reporting. Thus, an outbreak with a high alert level might warrant more direct involvement from the PHU than would otherwise be the case.

Table 3: PHU-response risk assessment matrix for managing norovirus or suspected gastroenteritis outbreaks in institutions

CATEGORYALERT LEVELScore
1 (Low)2 (Medium)3 (High)
1Facility has previously managed similar outbreaks in liaison with PHUIn past year, without major concernsIn past couple of years, without major concernsNone or major concerns about way outbreak managed
2Promptness of outbreak reportingImmediate (within 1 day)Intermediate (within 2–3 days)Delayed (longer than 3 days)
3Receptivity to/ease of communicating public health advice (impression over telephone)Easily understoodSome difficulty communicatingMajor issues in communicating
4Proportion of staff affected at
time of reporting
Nil
(or <10%)
Low
(or 10–19%)
Moderate to high
(or >20%)
5Food handling staff affectedNil After other casesAround onset of outbreak
6Facility has Infection Control Practitioner supportEasily accessibleNot easily accessibleNone
7Promptness of implementing public health advice generallyVery promptIntermediateDelayed
8Ease of implementing cohorting (staff, residents, areas of facility)Readily achievedAchieved with some difficultyDifficult/impossible to implement adequately
9Ease of implementing appropriate cleaning measuresReadily achievedAchieved with some difficultyDifficult/impossible to implement adequately
10Separation of food handling and
cleaning duties
Normal practicePromptly institutedDifficulty or delay in instituting
Total score
Instructions
a) Scoring:Assign alert level score (1–3) for each category (row)
Add the alert level numbers for a total score
Possible score range: 10 (lowest) to 30 (highest)
b) Overall alert score:LowIntermediateHigh
10–1617–2324–30
c) Additional considerations:Consider assigning a ‘High’ score regardless if:
Number of High alerts (3’s) = 3 or more
Category 5 (food handling staff) score = 3

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