Organisational outbreak management

Key points

An outbreak is defined as:

• an incident in which two or more people experience a similar illness linked in time or place
• a greater than expected rate of infection compared with the usual background rate for the place and time when the outbreak has occurred

This quick guide is primarily concerned with the investigation, management, and control of outbreaks of infection within the trust. Outbreaks in the wider community will normally be managed by the consultant in communicable disease control (CDDC) for the relevant locality.

Inpatient services outbreak

If colleagues suspect two or more, linked cases of infection and, or clusters of similar infection in inpatient settings they must:

• isolate patients where possible
• obtain appropriate specimens for laboratory examination
• inform the affected patients responsible clinician
• escalate up through their care group as per usual protocols
• contact the Infection Prevention and Control team (IPC team) at the earliest opportunity for advice.

If urgent specialist advice is required out of hours for the Doncaster and North Lincolnshire localities the consultant microbiologist at Doncaster and Bassetlaw Teaching Hospital Foundation Trust (DBTHFT) can be contacted on 01302 366666.

For the Rotherham locality the consultant microbiologist at the Rotherham Foundation Trust (TRFT) can be contacted on 01709 820000.

An Outbreak Control team (OCT) meeting may be held with appropriate representation from the relevant care group and corporate services utilising the silver (tactical) and bronze (operational) principles of command and control.  This will be chaired by the chief nurse, who is also the director of infection control (DIPC) or the deputy chief nurse.

The core function of the trust’s OCT is to:

• establish case definitions
• provide specific infection prevention and control (IPC) guidance
• meet regularly to review the outbreak
• formulate press releases
• communicate with the following as appropriate:
  • United Kingdom Health Security Agency (UKHSA)
  • environmental health
  • NHS England and NHS Improvement
  • Department of Health and Social Care
  • integrated care systems
  • local authorities

Most inpatient area outbreaks are normally managed locally by the IPC team with any urgent escalations via the daily patient flow meeting and the daily incident meeting. If deemed appropriate at any point, for example multiple wards are affected, the OCT can escalate the situation up to a business continuity incident, a critical incident or a major incident. The chair of the OCT will notify the trust’s accountable emergency officer (AEO) and all care group directors of this decision.

If the trust declares a critical or major incident the trust’s OCT may be absorbed into the trust’s command and control arrangements depending on the rationale decided by the AEO to provide strategic leadership. Full details of which can be found in the trust’s critical and major incident plan.

If a critical or major incident is declared the AEO will be required to conduct an internal trust debrief when the incident is over and will liaise with the IPC team to facilitate a report for presentation to the trust board. The debrief will concentrate on the trust’s response and how it worked internally and its liaison with external agencies.  This is to ensure lessons are learned which may inform future actions.

Learning from outbreaks will be shared at the IPC operational group and escalations made to trust board via the infection prevention and control committee, safety and quality group and quality committee. It will also be shared at the operational management group via the chief operating officer and escalated to clinical leadership executive by exception, as needed.

Community outbreaks

Community outbreaks are managed by UKHSA and local authority departments of public health. Intelligence around surveillance and activity is communicated to the IPC team via a daily alert system.

During IPC team operational hours if the IPC team become aware of a possible outbreak they will inform:

• UKHSA
• Local Authority Department of Public Health
• consultant microbiologist (CM)
• RDaSH chief nurse (DIPC)

On call colleagues may receive notification of clusters of cases or an outbreak in the community direct from UKHSA. In such instances they must inform the IPC team at the earliest opportunity.

It is the responsibility of the consultant in communicable disease control (CCDC) UKHSA to declare a major outbreak in the community.  If a major outbreak is declared, the OCT will be convened by the AEO or chief nurse with a view to escalate to command and control if required. Where appropriate this will be following consultation with a CM or senior environmental health officer (EHO).

The decision on whether to activate the trust critical and major incident plan will be made by the AEO. Where appropriate the OCT will be incorporated into the trust command and control structure and will sit as a specialist cell.

A representative from the OCT may be asked by UKHSA or Local Authority Department of Public Health to attend the Multi-Agency Outbreak Control team as described in the National Communicable disease management, operational guidance.

The Doncaster multi agency outbreak plan contains details of roles and responsibilities for RDaSH in the event of a Multi-Agency Outbreak Control team being convened in Doncaster.

The trust does not have the same responsibilities in Rotherham and North Lincolnshire but may be asked for mutual aid or to take part in a multi-agency response.

Any trust representative at multi-Agency OCT should have authority to be able to commit trust resources if required. Supporting documentation in the form of the Memorandum of Understanding for South Yorkshire Local Health Protection is contained in the on-call folder at “L:\Corporate\Trust OnCall Rotas\Gold and silver on call folder documents”.

If a critical or major incident is declared the AEO will be required to conduct an internal trust debrief when the incident is over and will liaise with the IPC team to facilitate a report for trust board. The debrief will concentrate on the trust response and how it worked internally and its liaison with external agencies.  This is to ensure lessons are learned which may inform future actions.

Linked to

• Ward outbreak quick guide
• Doncaster multi-agency outbreak plan
• Patient placement and assessment of infection risk
• critical and major incident plan
• Pandemic plan
• UK communicable disease outbreak management operational guidance (opens in new window)

Page last reviewed: November 06, 2024
Next review due: November 06, 2025