Congregate Living Settings and Outbreak Prevention

Vaccination is the most effective public health measure to prevent severe illness and death due to vaccine preventable diseases (I.e. COVID-19, influenza, measles, mumps etc.)

• Encourage all clients/residents, staff and visitors to get their annual vaccines against influenza, RSV and COVID-19 and to remain up-to-date with their Ontario immunizations.
• Provide immunization campaigns and education, as well as on-site immunization clinics to clients and staff for annual vaccinations.
• Review new admissions immunization status and provide opportunity to maintain Ontario scheduled and annual immunizations.
• For more information, visit TBDHU’s Immunizations web page.

Active and passive screening are important measures that may be utilized to prevent those who may be infectious from entering the facility and/or spreading the infection within the congregate living setting (CLS).

• Active Screening - Should be confirmed and can be achieved in person by utilizing a checklist or an online tool.
• Passive Screening - Relies on those entering the CLS monitor their own health and may review screening questions themselves (e.g. signage at entrances as a visual reminder to not enter if symptomatic).

When implementing screening:

• At minimum, CLSs should utilize passive screening at entrances and throughout the setting, advising individuals of symptoms and provide next step actions if the staff, visitor or client is experiencing symptoms.
• Clients/residents must be assessed at least once daily to identify any new or worsening symptoms of respiratory or enteric illness.
• A copy of a screening poster is available to download. 
• Maintain a mask friendly environment and post signage throughout the CLS to encourage all persons to perform hand hygiene.

Posting Signage

Downloadable posters are available so facilities can post signage to:

• Identify outbreaks
• Inform visitors not to enter facility if ill
• Encourage all persons to perform hand hygiene

Essential visitors:

• Provide support to the ongoing operation of a congregate living setting and/or are considered necessary to maintain the health, wellness and safety, or any applicable legal rights of a congregate living client.

When visiting a CLS, essential visitors:

• Are permitted to enter the facility even when clients are under additional precautions and/or the facility is in an outbreak.
• Must be educated on how to properly don and doff PPE, follow any outbreak measures in place and only visit the one client they are assigned to.
• Are provided outbreak communication in a timely manner.

A well-fitted medical mask can help protect the wearer and others from respiratory infections.

Masks are a tool to be utilized by those who are able to wear one and should be handled with care:

• Ensure the mask covers the nose and the chin and it fits snug.  
  • There are more than one type of mask that may provide a better fit.
• Children younger than 2 years of age should not wear a mask.

For masking direction during suspect and confirmed outbreaks:

• See Recommendations for Outbreak Prevention and Control in Institutions and Congregate Living Settings (February 2025).

PPE is intended to protect the wearer and to minimize their risk of exposure to infectious diseases and other potential hazards.

• The effectiveness of PPE depends on using it correctly and consistently.
• Anyone using PPE on-site must be trained in its use.
• Minimal requirements for PPE may be set out by facility policies and procedures and Occupational Health and Safety
• All staff should complete a Point-of- Care Risk Assessment (PCRA) before every client or client environment interaction.

Hand hygiene continues to be the number one way to stop transmission of infectious diseases.  

• Continue to promote hand hygiene within your CLS with numerous educational materials (i.e. posters, signage, emails, newsletters, huddles etc.)
  • For printable posters on proper hand washing practices, visit our “Posters and Resources” page. 
• Instruct staff, volunteers and clients to wash their hands often, especially:
  • upon entering the facility
  • before and after using shared equipment
  • before  and after eating
  • before and after preparing food
  • before touching clean PPE
  • after removing or touching dirty PPE
  • before and after touching the face (including smoking)
• To promote frequent hand hygiene, ensure  hand washing and/or sanitizing stations are available, well stocked and at multiple, prominent locations throughout the CLS (i.e., entrances, common areas, elevators, stairwells)
• Assist clients/residents with hand hygiene before/after meals or activities. 

• Clean and disinfect frequently touched surfaces at regularly scheduled intervals (e.g., at least once daily) and when visibly dirty.
• During an outbreak, clean and disinfect common areas and high-touch surfaces at more frequent intervals (e.g., at least twice daily).
• Ensure the disinfectant being used during a (suspected) outbreak is efficient for the organism(s). 
  • Follow the disinfectants manufactures' instructions for surfaces, contact time and PPE requirements.

• Encourage all individuals to avoid the 3 C’s when respiratory illnesses is at peak within the community:
  • Avoid crowded places with many people nearby;
  • Avoid close-contact settings; and
  • Avoid confined and enclosed spaces with poor ventilation
• Make use of outdoor or larger well-ventilated spaces where people can maintain a 2 metre (6 feet) distance from each other whenever possible.
• Consider how to increase physical distancing when common spaces are used (e.g. staggering start/end times, decreasing room capacity, placing furnishings further apart).
• Encourage masking by participants when physical distancing can't be maintained during the activity.

Ventilation with fresh air and filtration can improve indoor air quality thus reducing the risk of respiratory disease spread within our CLS's.

• Encourage outdoor activities over indoor activities where possible.
• Ventilate indoor spaces through a combination of strategies:
  • natural ventilation (e.g., by opening windows)
  • local exhaust fans, or
  • centrally by a heating, ventilation, and air conditioning (HVAC) system.
• Regularly inspect and maintain HVAC, air filtration units, humidifiers and de-humidifier systems.

Follow the direction provided by the employer and/or the Recommendations for Outbreak Prevention and Control in Institutions and Congregate Living Settings (February 2025).

Staff and Volunteers

• Those who become ill while at work should:
  • report to their superior
  • mask (if respiratory symptoms)
  • leave as soon as possible.
• If staff or volunteers cannot leave immediately, they must be isolated in a specific designated space away from others, until they are able to leave.
• Follow exclusion and back to work guidance in the Recommendations for Outbreak Prevention and Control in Institutions and Congregate Living Settings (February 2025) document.

Clients/ Residents

• Newly symptomatic clients should be placed on additional precautions.
  • Roommates should also be assessed.
  • If required, testing should occur.
• Positive clients within the setting should follow the most recent guidance Recommendations for Outbreak Prevention and Control in Institutions and Congregate Living Settings (February 2025) 

Outbreaks are declared by the local medical officer of health, or their designate while working with your facility.

• Have an outbreak management plan in place for detecting and managing potential outbreaks in your facility.
• Contact TBDHU as soon as you suspect an outbreak within a facility and guidance will be provided.
• Once an outbreak has been declared, TBDHU will provide direction to help manage the outbreak.
• Visit TBDHU's Outbreak Management web page for more information
• Consider utilizing PHOs checklist when navigating an outbreak.

• Recommendations for Outbreak Prevention and Control in Institutions and Congregate Living Settings (February 2025)  (February 2025)
• Cohorting in Respiratory Virus Outbreaks   - Public Health Ontario
• Planning for Respiratory Virus Outbreaks in Congregate Living Settings 2021 - Public Health Ontario
• Infection Prevention and Control Online Learning – Public Health Ontario
• Outbreak Preparedness, Prevention and Management in Congregate Living Settings Checklist- Public Health Ontario
• Respiratory Season Poster for Shelters