Norovirus Outbreak at a Small Acute Care Hospital

Abstract

BACKGROUND Our 35-bed acute care pediatric hospital with a specialization in therapy and rehabilitation services experienced an outbreak of norovirus. We describe the measures implemented to prevent secondary transmission. METHODS Once laboratory testing confirmed that norovirus was responsible for the outbreak, additional cases were identified using clinical criteria of either abrupt onset of vomiting followed by diarrhea, or acute diarrhea without vomiting. RESULTS In total 38 staff members, 14 patients, and 5 family members were affected over a period of 17?days. All patients, whether symptomatic or not, were placed on contact precautions. New admissions were postponed and visitor restrictions were implemented. Only soap and water was used for hand hygiene. The environmental disinfectants were confirmed to have Environmental Protection Agency kill claims for norovirus. Cleaning was done three times daily on high-touch surfaces, patient rooms, hallways, bathrooms, and staff work stations. Supplemental ultraviolet light disinfection (UVD) was deployed. Congregating in the cafeteria was discouraged by providing meals to patients and families in their rooms. We eliminated group activities in common spaces. Staff were instructed not to share food and to utilize disposable lunch containers. Symptomatic staff were furloughed for 48 hours; food handlers were furloughed for seven days. Auditing by infection prevention was initiated to assess personal protective equipment (PPE) use and hand hygiene. Measured compliance with PPE use was 96% and with hand hygiene was 95%. CONCLUSIONS While the route by which infection was introduced was not identified, factors that may have contributed to the spread of disease include: sharing of food among staff, close contact during therapy, hardiness of norovirus in the environment, and low infectious dose. Lessons learned include: importance of frequent environmental cleaning, ensuring disinfectants have norovirus kill claims, staff understanding precautions and having one staff member dedicated to UVD. Our 35-bed acute care pediatric hospital with a specialization in therapy and rehabilitation services experienced an outbreak of norovirus. We describe the measures implemented to prevent secondary transmission. Once laboratory testing confirmed that norovirus was responsible for the outbreak, additional cases were identified using clinical criteria of either abrupt onset of vomiting followed by diarrhea, or acute diarrhea without vomiting. In total 38 staff members, 14 patients, and 5 family members were affected over a period of 17?days. All patients, whether symptomatic or not, were placed on contact precautions. New admissions were postponed and visitor restrictions were implemented. Only soap and water was used for hand hygiene. The environmental disinfectants were confirmed to have Environmental Protection Agency kill claims for norovirus. Cleaning was done three times daily on high-touch surfaces, patient rooms, hallways, bathrooms, and staff work stations. Supplemental ultraviolet light disinfection (UVD) was deployed. Congregating in the cafeteria was discouraged by providing meals to patients and families in their rooms. We eliminated group activities in common spaces. Staff were instructed not to share food and to utilize disposable lunch containers. Symptomatic staff were furloughed for 48 hours; food handlers were furloughed for seven days. Auditing by infection prevention was initiated to assess personal protective equipment (PPE) use and hand hygiene. Measured compliance with PPE use was 96% and with hand hygiene was 95%. While the route by which infection was introduced was not identified, factors that may have contributed to the spread of disease include: sharing of food among staff, close contact during therapy, hardiness of norovirus in the environment, and low infectious dose. Lessons learned include: importance of frequent environmental cleaning, ensuring disinfectants have norovirus kill claims, staff understanding precautions and having one staff member dedicated to UVD.