Chapter Summary
Collaboration between public health and healthcare is essential for an effective outbreak response. While healthcare settings are responsible for disease prevention and infection control practices on their premises, public health officials are generally responsible for ensuring the health and safety of the entire population within their jurisdiction, including patients, visitors, and employees in healthcare settings.
In Chapter 5, Investigation & Control, we review the key elements and steps involved in the investigation and control of outbreaks involving HAIs and AR pathogens. During an outbreak investigation, a systematic approach is necessary to determine the nature and scope of the problem, identify the etiologic agent, establish the existence of an outbreak, define the population at risk, determine risk factors and routes of transmission, implement appropriate control measures, and develop strategies to prevent future occurrences.
The chapter is arranged to follow steps typically followed in an outbreak investigation, recognizing that such steps may indeed not occur in linear order and will depend on the precise nature and needs of the response. The chapter also reviews the goals of a healthcare outbreak investigation and includes collections of resources to support and improve HAI/AR outbreak response.
Change Log
As advances occur in outbreak protocols, this guidance document will be updated. Previous changes can be tracked below:
- 2nd Edition – Published June 2024
- 1st Edition – Published October 2022
- URLs in this document are valid as of May 1, 2024.
Chapter References
- Franklin SM, Crist MB, Perkins KM, Perz JF. Outbreak Response Capacity Assessments and Improvements Among Public Health Department Health Care–Associated Infection Programs— United States, 2015-2017. J Public Health Manag Pract. 2022;28(2):116-125. doi: 10.1097/PHH.0000000000001148
- Christensen BE, Fagan RP. Healthcare Settings. In: Rasmussen SA, Goodman RA, eds. The CDC Field Epidemiology Manual. US Department of Health and Human Services Centers for Disease Control and Prevention (CDC); 2018: chap 18. https://www.cdc.gov/eis/field-epimanual/chapters/Healthcare-Settings.html
- Lyman MM, Grigg C, Bicking Kinsey C, et al. Invasive nontuberculous mycobacterial infections among cardiothoracic surgical patients exposed to heater–cooler devices. Emerg Infect Dis. 2017;23(5):796-805. doi: 10.3201/eid2305.161899
- Centers for Disease Control and Prevention (CDC). Healthcare-associated Infections (HAIs): Contaminated heater-cooler devices. http://www.cdc.gov/hai/outbreaks/heater-cooler.html
- Banach DB, Johnston BL, Al-Zubeidi D, et. al. Outbreak response and incident management: SHEA guidance and resources for healthcare epidemiologists in United States acute-care hospitals. Infect Control Hosp Epidemiol. 2017;38(12):1393-1419. doi: 10.1017/ice.2017.212
- Centers for Disease Control and Prevention (CDC). Epidemic Intelligence Service: Urgent Assistance (Epi-Aids). Available at: http:/www.cdc.gov/eis/request-services/epiaids.html
- Ostrowsky BE, Weil LM, Olaisen RH et al. Real-time virtual infection prevention and control assessments in skilled nursing homes, New York, March 2020-A pilot project. Infect Control Hosp Epidemiol. 2022;43(3):351-357. doi: 10.1017/ice.2021.100
- Centers for Disease Control and Prevention (CDC). Tap Water Quality and Infrastructure Discussion Guide for Investigation of Potential Water-Associated Infections in Healthcare Facilities. https://www.cdc.gov/HAI/pdfs/Water-Quality-Discussion-Guide-P.pdf
- Centers for Disease Control and Prevention (CDC). Targeted Environmental Investigation Checklist for Outbreaks of Invasive Infections Caused by Environmental Fungi (i.e., Aspergillus, Mucormycetes). https://www.cdc.gov/fungal/pdf/targeted-environmental-investigationchecklist-508.pdf