Evaluation of West Virginia's Surveillance System for Respiratory Outbreaks in Long-Term Care Facilities

BACKGROUND:   West Virginia has 125 long-term care facilities which are required to report outbreaks to their local health departments.  Respiratory outbreaks in long-term care facilities can be widespread and severe.  The purpose of this study is to determine the usefulness and acceptability of the surveillance system from the perspective of long-term care facilities and local health departments, determine how accurately long-term care facility staff are able to ascertain cases, and make recommendations for more effective training on prevention and control measures.

METHODS:   The Centers for Disease Control and Prevention Updated Guidelines for Evaluating Public Health Surveillance Systems(MMWR 2001), review of the literature and outbreak data from 2007-2011, informal interviews, and standardized questionnaires were used to assess the understanding and use of the system by long-term care facility staff, local health department staff, regional epidemiologists, state epidemiologists, and state laboratorians.  Data from long-term care and local health are currently being collected and analyzed using Epi Info 7.

RESULTS:   Respiratory outbreaks are immediately reportable by long-term care facilities to their local health department, which in turn report to regional epidemiologists and the state; laboratory samples are sent to the state laboratory.  Using this surveillance system, the number of confirmed outbreaks in West Virginia has increased from 64 in 2007 to 169 in 2011; the number of respiratory outbreaks identified in long-term care facilities has increased from 5 to 34 (8 to 20% of total outbreaks, respectively).  The system is fairly simple and flexible, as data collection and management is easy to understand and can be adapted to any outbreak.  Outbreak notification is timely with a mean notification time of 7 hours (median 45 minutes) between local and state health departments.  The system is not representative, as 91% of respiratory outbreaks were reported from 50% of the regions in the state.  Laboratory or rapid testing was completed for 85% of outbreaks, though the etiologic agent was determined for only 54% of outbreaks.  Stakeholder interviews suggested that data quality is affected by workforce turnover in long-term care facilities and inconsistent use of case definitions.

CONCLUSIONS:   Efforts should be made to address data quality by evaluating inconsistent reporting, case ascertainment, and laboratory sampling methods.  Training of stakeholders is needed on an annual basis to reinforce prevention and control measures; training materials should be accessible year-round for incoming staff.  Additional analysis from long-term care facilities and local health departments is under way to further assess system usefulness and acceptability.