The Enteric Outbreak Kit is the primary collection kit for the initial specimens from symptomatic patients in an outbreak.

The Enteric Outbreak Kit and components are described below.

The outbreak kit is designed primarily for the use of health units and institutions for the investigation of enteric outbreaks.  It is very useful when examinations have to be carried out simultaneously for bacteria, viruses and parasites, as is the case at the beginning of an outbreak when the etiology is yet to be determined.  Its use should be limited;  e.g., to the first 6-10 specimens collected from symptomatic persons.  The laboratory should be consulted before using these kits before this number in order to keep the investigations cost-efficient.  The kits are available in all Public Health Laboratories in Ontario and should be ordered from the Laboratory Manager or alternate.

The Enteric Outbreak Kit consists of a clear plastic bag (zip-loc or whirlpak) containing three screw-capped, spoon-fitted vials and a sheet of instructions.  The vials are colour-coded:

• the green capped vial for bacteriological tests (contains a red-coloured transport medium);
• the yellow-capped vial for parasites (contains a clear liquid preservative; handle with care as it contains formalin), and
• the white-capped vial for viruses and bacterial toxins (empty).

€  Source:  Control Measures for Gastroenteritis Outbreaks in Institutions, 1992.  Peterborough County-City Health Unit, Outbreak Control Program.

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Submission of Specimens from Patients and Contacts:  Use of the Outbreak Kit

N.B.  The kits should be store at room temperature until used.

Begin specimen collection immediately on being informed of an outbreak since delays will significantly reduce the chance of finding the etiological agent.  Collect at least 25 grams (ml) of faeces from each of 6-10 symptomatic cases so that the specimens can be subdivided to do all the tests.

• Remove vials from plastic bag.
• Fill in particulars about the patient on the main label on the bag with a ball point pen (press firmly). The labels must be left on the bag.  Include a Multiple Specimen Submission Form (MSSF), with only the top portion completed, with each batch of specimens sent to the laboratory.
• Using the spoon from each vial, select different sites of the faeces specimen, preferably blood, mucus or pus, transfer to vials as follows:
• green-capped vial:
• Add 2-3 spoonfuls of faeces, up to the line indicated.
• Mix into transport medium.
• Replace and tighten cap.
•   white-capped vial:
• Add faeces up to the line indicated.
• Replace and tighten cap.
•    yellow-capped vial:
• Add faeces up to the line indicated.
• Replace and tighten cap.
• Place all vials into the plastic bag.  Refrigerate immediately and return to the health unit or laboratory as soon as possible, but within 48 hours.  DO NOT FREEZE SPECIMENS.  Call the Health Unit at (705) 743-1000, Control of Infectious Diseases Program for pick up if you cannot deliver the specimens yourself.

Appropriate components of the kit should be used for follow-up specimens.

Handling, Labelling and Sorting Specimens

The contact person at the facility (Health Unit or Institution) should ensure that specimens are collected in proper containers and correctly labelled as specified on the label of each bag and on the top portion of the Multiple Sample Submission Forms.  The dates of onset and specimen collection should be indicated on the label, as they are essential for appropriate handling of the specimens in the laboratory and for the interpretation of results.  Also include the outbreak number on respiratory outbreak specimens.

During specimen sorting, special attention should be paid to eliminate duplications and to adherence to the protocol for specimen submission.  When more than one outbreak is occurring, care should be taken not to mix specimens from the concurrent investigations;  in such situations, specimens should be sorted by outbreak and submitted to the laboratory in separate, clearly labelled parcels.  Specimens from acutely ill patients require more rigorous investigation, especially in the early stages of an outbreak;  therefore, they have first priority and must be flagged accordingly.  They should be separated from specimens from asymptomatic persons (foodhandlers, contacts, etc.) before being sent to the laboratory.  It is recommended that specimens belonging to different categories be packaged separately.

Delivery of Specimens to the Provincial Public Health Laboratory

The Health Unit or the Institution should ensure that the specimens are delivered promptly to the nearest Provincial Public Health Laboratory.  The importance of consultation with and advance notice to the laboratory cannot be overemphasized.

When the specimens are delivered to the laboratory, the person making the delivery should ensure that the Laboratory Manager of LCEO is informed of their arrival.  The laboratory should advise the contact person at the facility immediately, if any specimen is unsatisfactory or if there are problems related to the collection or delivery of specimens.

Nasopharyngeal Specimens

Refer to institution policy/procedure on collection of nasopharyngeal specimens.  Contact the Peterborough County-City Health Unit or Regional Public Health Laboratory for questions on the method of collection.

Store nasopharyngeal swabs in a refrigeration unit prior to and after collection of specimen (Appendix 10).

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