A trigger is a point at which the incidence of a particular infectious organism is higher than would be normally expected. A trigger is not necessarily an outbreak. Some triggers may be outbreaks but some will be natural variation in the incidence of an organism.
Triggers are signals to alert the infection control team that further infection prevention strategies may be necessary to ensure patient safety.
A typical example of a trigger would be an increase in Clostridium difficile infection (CDI) or a multi-resistant organism (MRO) detected in surveillance data or transmitted between patients
Smaller facilities with a lower incidence of infections should consider one case significant and should review each new MRO or CDI case carefully.
Trigger response implementation
If you do detect an increase in MROs or CDI, and enter a trigger phase, the first thing to do is heighten awareness of infection control strategies across the facility.
Communication pathways and escalation is integral in managing the situation and these need to be clearly defined for individual facilities and HHSs.
When implementing a trigger response you should:
- investigate all cases for evidence of transmission.
- carry out a risk assessment-in line with the Hospital and Health Services (HHS) risk management strategy - to guide the appropriate infection control response.
- monitor the situation and the affected ward/units to facilitate early identification of situation changes. Then you can implement and evaluate strategies to minimise risk to patients in a timely manner.
Your response may also include:
- implementation of transmission based precautions
- appropriate cleaning of the environment and equipment
- hand hygiene strategies
- staff education
- management of patients and visitors
- managing admissions, transfers, discharges, and possibly ward closures
- ongoing monitoring and evaluation of the situation.
Read more about trigger response strategies, including links to supporting resources for each strategy.
Trigger response tools and guidelines
The following trigger response tools have been designed to assist and guide your decisions:
- Trigger response tool (CDI) (PDF, 123KB)
- Trigger response flow chart (PDF, 222KB)
- Case investigation tool (PDF, 202KB)
- Daily trigger response situation report (PDF, 57KB)
- Discharge clean process (PDF, 192KB)
The following Department of Health guideline documents are also to be used to guide the implementation of MRO and CDI trigger response:
- Health Facilities Communicable Disease Outbreak Preparedness, Readiness, Response and Recovery (PDF 822 kB)
- Management of Patients with Clostridium difficile infection (CDI) (PDF, 143KB)
- Management of multi-resistant organisms (MRO) (PDF, 192KB)
- Surveillance of Healthcare Associated Infection (PDF, 57KB)
All facilities should also have cleaning services policies, standards and operational guidelines for staff to refer to. Search your intranet or follow up with the appropriate unit in your facility or HHS.