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Table 2 Control measures introduced during the outbreak of S. Saintpaul at a childcare facility in Ayrshire, December 2017

From: An outbreak of Salmonella Saintpaul in a Scottish childcare facility: the influence of parental under-reporting

Phase of Risk Assessment

Control Measure

Actioned By:

Phase 1

Immediate: Day 0

Exclusion of affected children/staff until 48 h symptom free

Facility

Removal of sand and water play

Facility

Deep clean of facility ahead of weekly schedule

Facility

High temperature washing of fabric toys

Facility

Disposal of toys unable to be washed

Facility

Phase 2

Initial IMT risk assessment: Day 3

Food safety inspection of facility kitchen

Environmental Health

Letter to parents and staff re 48-h exclusion for GI symptoms

HPT & Facility

Site visit to inspect infection control procedures

HPT & HPS

Phase 3

1st reassessment of risk (emergence of mild clinical profile): Day 5

Confirmed cases excluded until negative clearance sample

HPT & Facility

Interview with external cleaning company to discuss practices

HPS

Facility social events cancelled

Facility

Second letter to parents reiterating mildness of symptoms

HPT & Facility

Text reminder to parents re 48-h exclusion for GI symptoms

Facility

Parents to sign disclaimer stating children well on attendance

Facility

Additional deep clean of affected rooms

Facility

Phase 4

2nd reassessment of risk (cases in second room): Day 14

Newly symptomatic children excluded until confirmed negative

HPT & Facility

Voluntary 2-week closure of facility

Facility

Further deep clean of whole facility during period of closure

Facility

Public health exclusion of confirmed cases when facility re-opens

HPT & Facility

Further testing of negative cases for viral gastroenteritis

Microbiology

Testing of facility water tank

Scottish Water

Asymptomatic facility staff to submit stool samples

Facility

Consider possibility of screening asymptomatic children

IMT

No mixing of age groups from 7.30 am–8.30 am on re-opening

Facility

Minimise staff cross-cover between rooms on re-opening

Facility

Phase 5

Final reassessment of risk (facility re-opened): Day 38

Confirmed cases to be excluded until outbreak declared over

HPT & Facility

Continue without mixing age groups until outbreak declared over

Facility

Continue increased environmental cleaning until outbreak over

Facility

On return, confirmed cases to be supervised when handwashing

Facility