Chapter Summary
Compared with outbreaks affecting a single healthcare facility with responsibility for investigation falling squarely within the jurisdiction of a single local/state/federal agency, outbreaks involving multiple healthcare facilities or multiple jurisdictions are more complex and often more difficult to detect, coordinate, and investigate.
In Chapter 7, Multifacility and Multijurisdictional Outbreaks, we examine the unique aspects of these types of investigations. Compared with single facility outbreaks, those that involve multiple facilities or multiple jurisdictions are more complex and are often more difficult to detect, coordinate, and investigate. As the numbers of involved facilities, agencies, and levels of organizations across jurisdictions increase, the need for special efforts to maintain effective communication and coordination increases as well.
This chapter contains information on:
- Example scenarios investigators may encounter
- Coordination and information sharing needs beginning with initial detection of a potential multifacility/multijurisdictional outbreak
- Designation of a coordinating agency, assembly and management of a multidisciplinary outbreak response team, and regular assessment of the scope of the outbreak and the resources needed
- Considerations for ramping down and concluding an interagency 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
- URLs in this document are valid as of May 31, 2024.
Chapter References
- Assiri A, Abedi GR, Bin Saeed AA, et al. Multifacility outbreak of Middle East Respiratory Syndrome in Taif, Saudi Arabia. Emerg Infect Dis. 2016;22(1):32–40. doi: 10.3201/eid2201.151370
- Centers for Disease Control and Prevention (CDC). Multiple outbreaks of hepatitis b virus infection related to assisted monitoring of blood glucose among residents of assisted living facilities—Virginia, 2009–2011. MMWR Morb Mortal Wkly Rep. 2012;61(19):339–343.
- Hancock-Allen JB, Janelle SJ, Lujan K, Bamberg WM. Outbreak of group A Streptococcus infections in an outpatient wound clinic–Colorado, 2014. Am J Infect Control. 2016;44(10):1133–1138. doi:10.1016/j.ajic.2016.03.058
- Adams E, Quinn M, Tsay S, et al. Candida auris in healthcare facilities, New York, USA, 2013–2017. Emerg Infect Dis. 2018;24(10):1816–1824. doi:10.3201/eid2410.180649
- Holden D, Mitsunaga T, Sanford D, Fryer T, et al. Multifacility outbreak of NDM/OXA-23–producing Acinetobacter baumannii in California, 2020–2021. Antimicrobial Stewardship & Healthcare Epidemiology, 1(Suppl 1). 2021;s79. doi:10.1017/ash.2021.155
- Buser GL, Cassidy PM, Cunningham MC, et al. Failure to communicate: transmission of extensively drug-resistant blaOXA-237-containing acinetobacter baumannii-multiple facilities in Oregon, 2012–2014. Infect Control Hosp Epidemiol. 2017;38(11):1335–1341. doi:10.1017/ice.2017.189
- Perkins KM, Lawsin A, Hasan NA, et al. Notes from the Field. Mycobacterium chimaera contamination of heatercooler
devices used in cardiac surgery—United States. MMWR Morb Mortal Wkly Rep. 2016;65:1117–1118. doi:10.15585/mmwr.mm6540a6 - Centers for Disease Control and Prevention (CDC). CDC Yellow Book 2024: Medical Tourism. https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism