A member of nursing staff reports to the nurse-in-charge that three residents in the care home have developed symptoms of gastroenteritis during the past 24 hours. An outbreak is suspected. 

Questions

• What are the common symptoms of gastroenteritis?
• What is an outbreak?
• What are the first actions the nurse in charge should take and why?

Common symptoms

• Nausea
• Vomiting
• Cramping
• Diarrhoea (loose stool) – as this can be infectious or non-infectious, all diarrhoea should be considered infectious until fully investigated

An outbreak can be defined as the occurrence of higher than expected levels of illness/disease within a specific area and over a defined period of time. In a health or social care environment, an outbreak may be defined more specifically as two or more residents/patients/staff with similar unexplained/unexpected symptoms.

Recognising the symptoms of gastroenteritis and awareness of the timing/patterns of any spread supports the management of individuals and/or helps in the early detection and investigation of potential outbreaks. 

• Good communication/interdisciplinary working is crucial to the management of suspected outbreaks and outbreak management. The multi-disciplinary team require to work together to investigate and control the spread of infection – in outbreak situations, making early contact with the infection control team is important for help and advice;
• Establishing the cause of the symptoms and whether an outbreak is occurring requires a diagnosis – undertaking a holistic assessment including the collection of samples of vomit, stool and blood for microbiological investigation is important;
• Control measures should be introduced as soon as possible – good infection control practices will reduce the risk of transmission are important, including the use of isolation (or cohorting) and the use of standard infection control precautions.

The nurse in charge is aware that one of the affected residents had a birthday party earlier in the day, with the family bringing in a selection of cakes and pastries to share amongst residents. Food poisoning is suspected as a reason for the residents’ symptoms. Specimens of loose stool and blood are sent to the microbiological laboratory for testing.

• What microorganisms might be responsible for causing food poisoning?
• What foods are these microorganisms known to contaminate?

Specimens returned from the laboratory indicating all three residents positive for Staphylococcus aureus. With the support of the local Environmental Health Officer (EHO), the source is traced to cream within cakes from the birthday celebration, which had been stored in warm conditions for a number of hours before being eaten.

The residents made a full recovery over the days which followed, and no other resident of staff member developed symptoms. The care home was advised to review its policy on the food hygiene, the aim being to emphasise and promote the arrangements required to support high quality food hygiene practices. In addition, a leaflet for relatives and visitors was developed to raise awareness of the importance of food safety and to identify those foods which could/could not be brought into the care home.

• Can you identify foods which might be considered high risk and which are not suitable for bringing into care home environments where vulnerable and immunocompromised persons may reside?
• What foods might be safe to bring into the care home?

Foods which are not prepared, cooked and/or stored correctly may present a risk to the health of residents within a care home. These may include:

• Cooked meat/meat products
• Fish/fish products
• Cream (fresh or synthetic)/cream products
• Eggs
• Take away meals (particularly those requiring reheating)

Food and drink which may be considered safer (lower risk) include:

• Individual pre-packed cakes and biscuits (without cream)
• Crisps and nuts
• Canned and bottled juice
• Fresh and dried fruit
• Chocolate