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Mandatory Outbreak Reporting
Acute care hospitals and long-term care facilities (LTCFs) are required to report to the local health authority under OAR 333-018-0000 any healthcare-associated infections (HAI), including by multidrug-resistant organisms (MDRO), that meet the following threshold: “any known or suspected common-source outbreaks; any uncommon illness of potential public health significance” (OAR 333-018-0015; ORS 433.004). Local health authorities are empowered to investigate such outbreaks under OAR 333-019-0000, ORS 433.006.
Carbapenem-resistant Enterobacteriaceae is a reportable disease (OAR 333-018-0015; ORS 433.004).
Local health authorities need to report HAI outbreaks, including MDRO outbreaks, to the state communicable disease epidemiology program at 971-673-1111 within 24 hours of receiving an outbreak report. Download Outbreak Investigation Guidelines pdf).
Healthcare-associated infections (HAIs) are caused by a wide variety of bacteria, viruses, and fungi, and are often associated with medical devices. Some of the bacteria are multidrug-resistant organisms (MDRO).
Download MDRO Definitions (pdf)
Healthcare-associated MDROs of public health significance include:
Infection: Isolation of an organism, including a MDRO, from a patient specimen with symptoms of infection.
Colonization: Isolation of an organism, including a MDRO, from a patient specimen without symptoms of infection.
Acute care hospitals: Short- and long-term acute care hospitals (LTACHs).
Long-term care facilities: skilled nursing homes (SNFs), nursing homes (NH), assisted living (AL),residential care (RC).
Outbreaks in healthcare facilities:
- General definitions: an “unusual” number of patients or residents with the same infection, including MDROs, clustered by time and place.
- Working definition: two or more patients or residents in the same hospital unit or same LTCF with matching organism (genus, species), including MDROs, and onset dates within 6 months of each other.
Data Collection and Basic Descriptive Epidemiology
- Track cases using the Healthcare Associated Infection Case Log (pdf). The log can be completed by hospital or LTCF infection control staff; establishing a single point of contact is recommended.
- Use tools to get basic descriptive epidemiology, including an epidemic curve (i.e., cases by onset day).
- Review facility’s microbiology laboratory for other cases of the same organism or MDRO within the last 12 months. If found, perform a limited chart review and note name, date of birth, source, room number, admission source, healthcare facility exposures.
- Consider performing a patient prevalence survey to assess burden of the organism or MDRO in healthcare facility. Refer to the Specimen Collection Protocol (pdf).
- Monitor the outbreak for new cases for 6 months.
- If ongoing transmission is identified, discuss performing further investigations (e.g., environmental prevalence survey)
- Review case medical records for risk factors
- Environmental cleaning
- Interfacility transfer forms: Find forms and resources at Interfacility Communication
- Patient prevalence survey
- Staff Education: Person Protective Equipment (PPE) Protocol (pdf)
- Patient Education: