Gastro in Aged Care

Aug 14 / Lyndon Forrest
Gastroenteritis outbreaks pose a significant challenge in aged care facilities across Australia and New Zealand, with a survey finding that 30% of Australian residential aged care services experienced an outbreak affecting both residents and staff in a 12-month period. These outbreaks, often caused by highly infectious pathogens like norovirus, can lead to substantial illness, distress, and adverse impacts on staff, resources, and residents' activities in these vulnerable populations.

Role of Public Health Units in Outbreak Management

Local public health units (LPHUs) play a crucial role in enhancing outbreak response in residential aged care facilities (RACFs) by offering a place-based approach to disease threats. These units collaborate with local stakeholders, particularly health services, to protect vulnerable populations during outbreaks.

In southeast metropolitan Victoria, Australia, a newly formed LPHU demonstrated flexible and collaborative approaches to COVID-19 outbreak management in RACFs throughout different phases of the pandemic. These approaches included developing prioritization and risk matrices, refining outbreak management team membership, and redefining the LPHU's role as stakeholder capacity evolved.

The LPHU's adaptability ensured that public health actions met the changing demands and needs of stakeholders, strengthening the overall outbreak response in aged care facilities.

Challenges of Norovirus Control in Aged Care

Norovirus control in aged care facilities presents unique challenges due to the vulnerability of residents and the nature of the living environment. Long-term care facilities account for over 60% of norovirus outbreaks, with residents four times more likely to succumb to the virus compared to the general population. The close living quarters, shared spaces, and frequent personal contact in these settings facilitate rapid person-to-person transmission, which accounts for over 90% of norovirus infections.
Additionally, residents often have multiple comorbidities and reduced mental function, complicating outbreak control efforts. The small concentration of virus particles needed to cause infection, and the virus's resilience on surfaces further exacerbate the difficulty of containment.
These factors, combined with potential staff shortages and the need to balance infection control measures with resident quality of life, make norovirus outbreaks particularly challenging to manage in aged care settings.
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Impact of Prompt Notification on Outbreak Duration

Prompt notification of gastroenteritis outbreaks to public health services (PHS) is associated with reduced outbreak duration and size in institutional settings. A study of 175 gastroenteritis outbreaks in New Zealand found that shorter notification times were linked to shorter outbreak durations and smaller outbreak sizes.

Specifically, outbreaks where notification was delayed by 7 or more days lasted 3.4 days longer on average compared to those notified within 0-1 days.

Similarly, research in Queensland, Australia, showed that outbreaks notified within 1 day were significantly shorter than those notified after 2-3 days or 4+ days. The average time to notification was 4 days, with outbreaks lasting an average of 12 days. These findings highlight the importance of rapid communication between aged care facilities and public health authorities in minimizing the impact of gastroenteritis outbreaks.

References

The Role of Local Public Health Units in Enhancing Outbreak Response in Residential Aged Care Facilities

https://pubmed.ncbi.nlm.nih.gov/38407114/

The Role of Local Public Health Units in Enhancing Outbreak Response in Residential Aged Care Facilities

https://journals.sagepub.com/doi/abs/10.1177/10105395241233635

Strategies For Norovirus Prevention In Senior Care Facilities

https://facilityexecutive.com/strategies-for-norovirus-prevention-in-senior-care-facilities/

GuidelinesForManagementOfNorovirus_ExecutiveSummary

https://www.rph.org.nz/health-professionals/arc-facilities/executivesummaryguidelinesformanagementofnorovirus.pdf

Institutional gastroenteritis outbreaks and time to notify public health services

https://nzmj.org.nz/media/pages/journal/vol-131-no-1478/institutional-gastroenteritis-outbreaks-and-time-to-notify-public-health-services/2558756c3e-1696478963/institutional-gastroenteritis-outbreaks-and-time-to-notify-public-health-services.pdf

Norovirus in residential care facilities: Does prompt notification of outbreaks help?

https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3502e.htm

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