Epidemiology and Infection

Review Article

Enteric outbreaks in long-term care facilities and recommendations for prevention: a review

J. D. GREIGa1 and M. B. LEEa2 c1

a1 Microbial Food Safety Risk Assessment Unit, the Laboratory for Foodborne Zoonoses Public Health Agency of Canada, Guelph, Ontario, Canada

a2 School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada


Outbreaks of enteric illness in long-term care facilities (LTCFs) were reviewed to identify preventative recommendations. Systematic review methodology identified outbreak reports of gastrointestinal illness in LTCFs either published or that occurred from January 1997 to June 2007. The inclusion criteria captured 75 outbreaks; 23 (31%) associated with bacterial agents and 52 (69%) with viral agents. Transmission was mainly foodborne (52%) for those of bacterial origin and person-to-person (71%) for viral outbreaks. Norovirus infection was associated with 58% of hospitalizations. Sixty deaths were reported, about half from Salmonella infections. Recommendations for foodborne outbreaks emphasized appropriate sourcing and preparation of eggs, staff training, and temperature control during food preparation. Recommendations from outbreaks transmitted person-to-person centred on controlling residents' movements, effective environmental cleaning and disinfection, cancelling social events and restricting visitors, excluding ill staff, encouraging effective hand hygiene, and preventing cross-contamination through gloving and gowning. In none of the 75 published outbreak reports were the suggested recommendations evaluated for effectiveness in controlling the outbreak. Applied research of this type could greatly help in the acceptance of prevention and control strategies.

(Accepted April 09 2008)

(Online publication May 12 2008)


c1 Author for correspondence: Professor M. B. Lee, School of Occupational and Public Health, Ryerson University, 350 Victoria St, Toronto, Ontario, Canada M5B 2K3. (Email: mblee@ryerson.ca)