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Acute Care Hospital's Experience with Norovirus Outbreak
E128
Vol. 35 No. 5
Publication Number 10-136
Acute Care Hospital’s Experience with Norovirus Outbreak SK Vyhlidal, RN, MSN, CIC RG Penn, MD, FACP, FSHEA ME Kirby, RN, BSN, CIC TA Micheels, RN, MSN SG Miller, RN, BSN, CIC, et al. Epidemiology, Nebraska Methodist Hospital, Omaha, NE, USA ISSUE: In November 2006, our #350-bed hospital experienced norvirus outbreak among staff and patients. Upon recognition, rapid interventions including assistance from health department were required. Norvirus is highly contagious gastroenteritis with high attach rate. Transmission is by person-to-person fecal-oral and aersolization during vomiting/clean-up. PROJECT: An outbreak of norovirus-like illness was noted among patients and staff. Multiple units and staff disciples were invovlved. Interventions included: (1) epidemiological investigation, (2) developing working case definition, (3) involvement of health department for recommendations, interviews/surveys and collection/testing of stool/vomitus specimens, (4) housewide surveillance of patients/employees, and (5) rapid identification of cases and implementation of control measures. Control measures included: education, communication, contact/droplet precautions, hand hygiene, prompt clean-up of ‘‘accidents’’ with full PPE, hospital-wide disinfection including steam disinfection of carpets, 33/day surface disinfection on involved clinical units, staff work restrictions, safeguards with laundry, and Food Service alternations. RESULTS: November 02, 2006, identified norovirus-like outbreak (patients & staff); epicurve denoted reduction in illness 24 hours after interventions implemented; outbreak ended November 17, 2006. No source found. Working Definition: any person with epideiological link to facilty with acute diarrhea and/or vomiting since October 16 (first documented illness) and no other explanation for illness. Health Department’s (HD) Interviews/survey: Of 236 respondents, 84% (199) met case definition; 80% (159) staff, 12% (24) patients, 7% (14) nursing students, 1% (2) visitors. HD’s Lab findings: All specimens, including community sampling, positive for norovirus, genotype II, RNA Inverventions: control measures successful in controlling outbreak; no repeat of outbreak occurred. LESSONS LEARNED: 1. Health department involvement provided critical recommendations and epidemiological tools/resources. 2. Implementing Contact with Droplet Precautions for vomiting patients limited spread of illness. 3. Enviromental Services wearing full PPE attire when cleaning up ‘‘accidents’’ (mask, eyewear, gown, gloves, headcover, feet-cover and surgical scrubs) limited spread of illness. 3. Incident command system was instrumental in managing staffing, education and communication needs/activities. 3. Continuous use of same chemicals (disinfectants) resulted in adverse effects to staff. 4. Housewide illness call-in system needs to be developed that includes an identified person(s) analyzing data on regular frequency for trending issues. 5. Planned recovery phase activities prevented reoccurrance of another housewide norovirus outbreak.
Publication Number 10-137
A Complex Outbreak of Multi-Drug Resistant Acinetobacter (MDRA) in Multiple Adult ICUs at a Tertiary Care Center: The Importance of Teamwork W Jean, MPH1 V Fisher, CIC1 L Ostrosky, MD1 D Johantges, RN1 G Douglas1, et al.
Vol. 35 No. 5
Publication Number 10-136
Acute Care Hospital’s Experience with Norovirus Outbreak SK Vyhlidal, RN, MSN, CIC RG Penn, MD, FACP, FSHEA ME Kirby, RN, BSN, CIC TA Micheels, RN, MSN SG Miller, RN, BSN, CIC, et al. Epidemiology, Nebraska Methodist Hospital, Omaha, NE, USA ISSUE: In November 2006, our #350-bed hospital experienced norvirus outbreak among staff and patients. Upon recognition, rapid interventions including assistance from health department were required. Norvirus is highly contagious gastroenteritis with high attach rate. Transmission is by person-to-person fecal-oral and aersolization during vomiting/clean-up. PROJECT: An outbreak of norovirus-like illness was noted among patients and staff. Multiple units and staff disciples were invovlved. Interventions included: (1) epidemiological investigation, (2) developing working case definition, (3) involvement of health department for recommendations, interviews/surveys and collection/testing of stool/vomitus specimens, (4) housewide surveillance of patients/employees, and (5) rapid identification of cases and implementation of control measures. Control measures included: education, communication, contact/droplet precautions, hand hygiene, prompt clean-up of ‘‘accidents’’ with full PPE, hospital-wide disinfection including steam disinfection of carpets, 33/day surface disinfection on involved clinical units, staff work restrictions, safeguards with laundry, and Food Service alternations. RESULTS: November 02, 2006, identified norovirus-like outbreak (patients & staff); epicurve denoted reduction in illness 24 hours after interventions implemented; outbreak ended November 17, 2006. No source found. Working Definition: any person with epideiological link to facilty with acute diarrhea and/or vomiting since October 16 (first documented illness) and no other explanation for illness. Health Department’s (HD) Interviews/survey: Of 236 respondents, 84% (199) met case definition; 80% (159) staff, 12% (24) patients, 7% (14) nursing students, 1% (2) visitors. HD’s Lab findings: All specimens, including community sampling, positive for norovirus, genotype II, RNA Inverventions: control measures successful in controlling outbreak; no repeat of outbreak occurred. LESSONS LEARNED: 1. Health department involvement provided critical recommendations and epidemiological tools/resources. 2. Implementing Contact with Droplet Precautions for vomiting patients limited spread of illness. 3. Enviromental Services wearing full PPE attire when cleaning up ‘‘accidents’’ (mask, eyewear, gown, gloves, headcover, feet-cover and surgical scrubs) limited spread of illness. 3. Incident command system was instrumental in managing staffing, education and communication needs/activities. 3. Continuous use of same chemicals (disinfectants) resulted in adverse effects to staff. 4. Housewide illness call-in system needs to be developed that includes an identified person(s) analyzing data on regular frequency for trending issues. 5. Planned recovery phase activities prevented reoccurrance of another housewide norovirus outbreak.
Publication Number 10-137
A Complex Outbreak of Multi-Drug Resistant Acinetobacter (MDRA) in Multiple Adult ICUs at a Tertiary Care Center: The Importance of Teamwork W Jean, MPH1 V Fisher, CIC1 L Ostrosky, MD1 D Johantges, RN1 G Douglas1, et al.