Public Health Agency

Outbreak Management


An outbreak of infection is defined as:

An incident in which two / more people experiencing a similar illness are linked in time or place

  • A greater than expected incidence of infection compared to the usual background rate for the particular location
  • A single case for certain rare diseases
  • A suspected, anticipated or actual event involving microbial or chemical contamination of food / water

Common outbreaks include:

  • Gastroenteritis (usually viral caused by Norovirus)
  • Clostridium difficile infection (CDI)
  • Meticillin resistant Staphylococcus aureus (MRSA)
  • Multi-resistant gram negative bacilli
  • Influenza / other respiratory illnesses   

Immediate Outbreak Control Measures

Periods of increased incidence of infections / confirmed outbreaks should be risk assessed immediately. Staff who recognize problems should inform:

  • Senior managers
  • The Infection Prevention Control Nurse / Team
  • The patient’s GP (community settings) / Clinical Consultant (acute settings)
  • RQIA (for Independent Sector Care Home settings)

The Trust’s Infection Prevention Control Team should also inform The Public Health Agency Health Protection Duty-Room so that potential regional implications can be considered. Verbal information provided to The Health Protection Duty Room should be confirmed with written details via e-mail.

Action to be taken by the Ward / Unit Manager

  • Immediately initiate relevant infection prevention control measures to prevent further transmission and ensure minimum disruption to services.

  • Immediately notify the doctor on duty or G.P. and request a review of the affected patients and, if appropriate, their antimicrobial treatment.

  • Review of antimicrobials in the unit in the event of a Clostridium difficile outbreak.

  • Inform the Infection Prevention Control Team (Trust setting) or Public Health Agency Health Protection Team via the Duty Room (Independent Sector).

  • Inform all relevant senior managers.

  • Following the advice of a Microbiologist/IPCN/PHA, obtain appropriate specimens for laboratory investigation providing relevant clinical information on the laboratory request form, inform laboratory staff to ensure that they are aware of a possible outbreak and potential increase in the number of samples and ensure that samples are transported to the laboratory without delay.

  • Record a timeline of events that includes admission dates of cases, clinical symptoms, date of onset, laboratory specimen results that are pending and those that have already been reported. Movement of patients to different locations in the healthcare facility should also be summarised.

  • Where appropriate, refer staff to Occupational Health for advice and support. It may be necessary for the IPCN/Nurse Manager to provide occupational health with a staff contact list.

General Outbreak Control Measures

The Infection Prevention Control Team (IPCT) or Health Protection Duty-Room staff (Public Health Agency) will provide specific advice.

  • Staff and patient movement will need to be restricted during an outbreak. If an outbreak has been declared, the rotation of staff or the discharge/ transfer of patients should be discussed with the IPCT/ Health Protection Duty Room.
  • In outbreak situations it may be necessary to close a ward /unit / care home. This recommendation will be guided by a risk assessment carried out by the Infection Prevention Control Team in The Trust or the Health Protection Duty-room officer in the independent sector.  In an acute Trust setting the IPC Team may immediately advise on the closure of a ward. If an outbreak control team is established it will decide on closures to admissions / transfers and staff movement restrictions.
  • It is essential that communication with patients / residents, the public and staff are clear and that messages are consistent.
  • Extra cleaning and domestic staff may be required during and immediately following the outbreak. Guidance on the decontamination of affected area/s will be determined by the IPCT (Trust location) / Health Protection Duty-room Officer (Independent Sector).
  • It may be necessary to order / purchase additional personal protective equipment. If specialist respiratory equipment is required, then access to fit-testing and training will also be necessary.
  • It may also be necessary to purchase additional supplies of cleaning equipment to facilitate enhanced / terminal cleaning of the environment.
  • Visiting may need to be restricted and visitors should receive information regarding any risks to them of being exposed to potentially pathogenic micro-organisms.
  • It may be necessary to record the details of contacts of cases if advised to do so by the Infection Prevention & Control Team (Trust location) / Health Protection Duty-room officer (Independent Sector).
  • Additional work is created during an outbreak and increased staff numbers will probably be necessary to cope with additional pressures.

Outbreak Control Management

Whenever an outbreak has been confirmed, the decision of whether or not to convene an OCT should be made by the IPC team (Acute Trust) or the PHA staff (Independent Sector) and the rationale should be documented. Depending on the setting, the OCT may be convened by the Director responsible for Infection Prevention & Control or the Unit / care home manager in consultation with Public Health Agency Health Protection Team. Outbreak control management remains the responsibility of The Trust / manager in The Independent Sector and regardless of whether or not a committee is established, clear lines of communication between the clinical area, the microbiology department, environmental health (if required) and the Health Protection Team (Public Health Agency), should be established.

Role of the Outbreak Control Team

The OCT is responsible for the management, investigation and control of the outbreak and this includes:

  • Reviewing all of the evidence including microbiology reports and epidemiological information collected to date and confirm that an outbreak is taking place.
  • Agreeing a case definition.
  • Describing the outbreak in terms of time, persons and place and providing details of onset dates and incubation periods and outcome of case(s).
  • Communicating with the Health Protection Team (PHA), who will then decide whether or not details of the outbreak should be shared with PHE (Public Health England).
  • Determine whether or not the outbreak should be reported as an adverse incident.
  • Co-coordinating arrangements for investigating the cause of the outbreak.
  • Completing regular risk assessments throughout the duration and for an agreed period following the outbreak.
  • Confirming that appropriate infection prevention & control precautions are in place to prevent primary and secondary cases and make recommendations for action when they are not.
  • Agreeing the need for patient, staff and environmental microbiological screening.
  • Establishing that patients and their relatives have been involved in decisions relating to their care and that the rationale for infection prevention and control precautions has been communicated effectively.
  • Establishing adequate lines of communication including developing and agreeing communication with the media.
  • Obtaining adequate resources to manage the outbreak.
  • Meeting regularly to review the progress of the outbreak and agreeing minutes of the meetings. Accurate records should be kept of all meetings and be shared with the Health Protection Duty Room.
  • Ensuring that effective communication with other services has been established e.g. Central Decontamination Services, Central Stores, Laundry, Pharmacy, RQIA, General Medical Practices, community staff and Estates etc.
  • Declaring when the outbreak is over and making sure that all relevant parties have been informed (including Health Protection Duty-Room).
  • Evaluating the outbreak and making recommendations for the prevention of future outbreaks.
  • Preparing a written report at the end of the outbreak.

Members of the Outbreak Control Team should consist of the following:

  • Infection Control Doctor/ Microbiologist

  • Infection Prevention & Control Nurse

  • PHA representative

  • Consultant in charge of patients / representative of medical staff / G.P.

  • Ward / Unit / Home Manager

  • Domestic / Hotel Services Manager

  • The Chief executive (or their representative) OR the relevant Service Director

  • Director of Nursing or their representative

  • Medical Director or their representative

  • Director of infection prevention & control (if applicable)

  • Occupational Health Service Physician or representative

  • Press Officer

  • Others to be invited dependent on outbreak circumstances:

Roles of OCT member


  • Chief Environmental Health Officer
  • Catering Manager
  • Pharmaceutical Manager
  • Laundry Manager
  • Estates Manager
    1. FRAISE, A. and BRADLEY, C. (2009) Ayliffe’s Control of Healthcare-Associated Infection: A Practical Handbook Fifth Ed. CRC Press, Croydon
    1. PHA (2013) Northern Ireland Infectious Disease Incident / Outbreak Plan Version 1
    1. PHE (2014) Communicable Disease Outbreak management: Operational Guidance London