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  • NHS GGC Outbreak Control Plan version December 2009





    Glasgow City Council East Renfrewshire Council

    East Dunbartonshire Council West Dunbartonshire Council

    Inverclyde Council Renfrewshire Council

    Scottish Water

    (August 2008) Updated December 2009

  • NHS GGC Outbreak Control Plan version December 2009

    TABLE OF CONTENTS PAGESignatories to the Plan 1

    Forward 2

    Acronyms 3

    Definitions 4

    Summary A - Summary of Preliminary Investigation 6

    Summary B - Investigation of Possible Outbreak 7

    Summary C - Outbreak Response 8

    Outbreaks - Simply Classified 10

    1. Introduction . 112. Whats an Outbreak? Whats an Incident? . 123. Recognising an Outbreak . 144. Initial Response if there is suspicion of an Outbreak . 175. Declaration of an Outbreak . 266. The Role of the Outbreak Control Team . 277. Incident Room . 288. Care of Patients . 299. Laboratory Resources and Sampling . 3010. Powers and Legislation . 3311. Following the Outbreak . 3512. Revision of the Plan . 37 Distribution List 38

    APPENDICES Appendix A Model Agenda Appendix B Contact Details Appendix C Additional Guidance Appendix D Roles and Responsibilities Appendix E Testing for Norovirus Infection Appendix F Fax: Notification of Alleged Food Poisoning

  • NHS GGC Outbreak Control Plan version December 2009



    Mr Tom Divers

    Chief Executive

    NHS Greater Glasgow & Clyde


    Mr George Black

    Chief Executive

    Glasgow City Council


    Mrs Lorraine McMillan

    Chief Executive

    East Renfrewshire Council

    04/09/2007 (David Dippie)

    Mr David McMillan

    Chief Executive

    West Dunbartonshire Council


    Mrs Sue Bruce

    Chief Executive

    East Dunbartonshire Council


    Mr Jon Hargreaves

    Chief Executive

    Scottish Water


    Mrs Sheilagh Brown

    Divisional Veterinary Manager

    Animal Health


    Mr David Martin

    Chief Executive

    Renfrewshire Council


    Mr John Mundell

    Chief Executive

    Inverclyde Council


    All signatures are held in PHPU


  • NHS GGC Outbreak Control Plan version December 2009


    This updated version of the NHS Greater Glasgow and Clyde Outbreak Control Plan for Food and Waterborne Gastro-intestinal illness (including GI infection) brings together the two outbreak control plans that operated in the former NHS Greater Glasgow and NHS Argyll and Clyde. It was developed in conjunction with the Public Health-Environmental Health-Med-Vet Working Group. It has been compiled by the Public Health Protection Unit and contributed to, and endorsed by, all six local authority departments of environmental health and by Scottish Water. It also has the approval of the Scottish Parasite Diagnostic Laboratory and our attending medical and food microbiologists. This plan should be read in conjunction with the national guidance on the subject (Guidance on the Investigation and Control of Outbreaks of Foodborne Disease in Scotland published jointly by the FSA(S) and the Scottish Government) and the NHS Greater Glasgow and Clyde Generic Incident Management/Outbreak Control Plan. The Appendix B includes a useful list of officers and agencies that one might need to get in touch with during an outbreak and their contact details. We would welcome feedback on the usefulness of this document at any point in the future in order to help us improve on it for future updated versions. Dr Syed Ahmed Clinical Director Public Health Protection Unit


  • NHS GGC Outbreak Control Plan version December 2009

    ACRONYMS AH - Animal Health (formerly known as the State Veterinary Service) CBRN - Chemical, biological, radiological and nuclear (usually refers to deliberate releases) CMO - Chief Medical Officer CPHM (CD/EH) - Consultant in Public Health Medicine (Communicable Diseases and Environmental Health) DPH - Director of Public Health DWQD - Drinking Water Quality Division (of the Scottish Government) DWQRS -Drinking Water Quality Regulator for Scotland (within the Scottish

    Government) EDC - East Dunbartonshire Council EHO - Environmental Health Officer EPO - Emergency Planning Officer ERC - East Renfrewshire Council FSA(S) - Food Standards Agency (Scotland) GCC - Glasgow City Council GEMS - Glasgow Emergency Medical Services * (similar out of hours services operated in the Clyde area) HACCP - Hazard Analysis Critical Control Point HPS - Health Protection Scotland HSE - Health and Safety Executive IMT - Incident Management Team (defined overleaf) LA/EHS - Local Authority/Environmental Health Service NHSGGC- NHS Greater Glasgow and Clyde OCP - Outbreak Control Plan OCT - The Outbreak Control Team (defined overleaf) OCTSG - Outbreak Control Team Support Group OMST - Outbreak Management Support Team PAG - Problem Assessment Group (defined overleaf) PF - Procurator Fiscal PH EH Med Vet Working Group - The Working Group that holds quarterly meetings

    and consists of public health doctors, health protection nurse specialists, EHOs, medical and non-medical microbiologists, Scottish Water and veterinarians with an interest in public health issues relevant in the NHSGGC area

    PHPU - The Public Health Protection Unit, NHSGGC PRO - Public Relations Officer SAC - Scottish Agricultural College SEPA - Scottish Environment Protection Agency SOP - Standard Operating Procedure STAC - Scientific and Technical Advisory Cell SWHP - Scottish Waterborne Hazard Plan WDC - West Dunbartonshire Council


  • NHS GGC Outbreak Control Plan version December 2009

    DEFINITIONS CBRN - Used to refer to deliberate releases of chemical, biological, radiological and nuclear agents by what is inferred to be subversive and/or criminal forces. Cryptosporidiosis - the diarrhoeal infection caused by the Cryptosporidium parasite. Cryptosporidium - the plasmodium protozoan parasite, some species of which can cause Cryptosporidiosis. EHO - Environmental Health Officer, an officer trained in environmental health usually employed by local authority environmental health services (LA/EHS). The EHO shares statutory responsibility with the NHS Board for protecting and improving the public health within their geographical boundaries. HACCP - Hazard Analysis Critical Control Point, a food safety management system used by food businesses to identify vulnerable points (critical control points) and to document appropriate control measures. Incident Management Team (IMT) An IMT is a team of professionals drawn from multiple agencies with the common goal of investigating and bringing under control a potential threat to the public health. It is convened comprising the relevant representatives from the stakeholder agencies with an interest in a public health incident. A public health incident involves a potential threat to the public health (a scare involving food or water in this context, but that has yet to, and may never, cause illness). NHS24 - The response service provided by highly qualified nursing staff that is accessed by the public out of hours and that is used to perform a telephone-based triage including referral to medical services including A&E, domiciliary visit, etc. All areas across Greater Glasgow and Clyde are now included in NHS 24 and the appropriate GP out of hours service for each area is accessed through this mechanism. NHSGGC - The entire NHS within Greater Glasgow and Clyde including all Divisions and the Board. Covers all or part of the six councils named on the coversheet of this plan. NHS GEMS - Glasgow Emergency Medical Service, the GP-based and district nurse-based primary care service available out of hours in the Greater Glasgow and Clyde area, that is accessible via NHS24 after hours. Norovirus - Norwalk-like virus (a common cause of viral gastroenteritis) traditionally thought to cause illness in the winter months hence the term 'winter vomiting disease' - but now found to be occurring at any time of the year. Outbreak - Two or more associated or linked cases of illness or infection; a greater than expected rate of illness or infection in a population; or a single case of certain serious, possibly contagious infections suggesting that there will be many more in the community (see major and minor outbreak definitions overleaf). Outbreak Control Team (OCT) An OCT is convened when any representative from one of the three participating core agencies (NHS Board, Local Authority Environmental


  • NHS GGC Outbreak Control Plan version December 2009

    Health Department, or hospital microbiologist) feels there has been an outbreak of illness (related to food or water in this context). Problem Assessment Group (PAG) - A PAG is an informal group that can communicate either via the telephone, e-mail, fax or in person consisting of any representative from at least two of the three participating core agencies. Normally, a PAG would involve informal, initial communication about a possible incident or outbreak before it has been established that a formal IMT or OCT should be convened. The key members of a PAG would normally be the Consultant in Public Health Medicine (CPHM), an Environmental Health Officer (EHO) and a water authority scientific officer, if the event is suspected to be waterborne, or alternatively, the CPHM, EH