Compartmentalization of wards to cohort symptomatic patients at the beginning and end of norovirus outbreaks

Haill, Claire F.; Newell, Paul; Ford, Carolyn E.; Whitley, M.; Cox, Janneke; Wallis, M. Chad; Best, R. Russell; Jenks, Peter J.

doi:10.1016/j.jhin.2012.05.015

Cited by 14 publications

(9 citation statements)

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“…The finding that larger ward size is associated with increased duration of outbreaks fits in with other studies which suggested that enclosing bays and putting doors on bays were beneficial and shortened the duration of outbreaks 7 8…”

Section: Discussionsupporting

confidence: 88%

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To close or not to close? Analysis of 4 year's data from national surveillance of norovirus outbreaks in hospitals in England

2014

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ObjectiveTo assess the impact of ward or bay closures, specifically, whether prompt closure of an affected ward shortens the duration of norovirus outbreaks and the resulting disruption in hospitals.DesignAnalysis of summary data from hospitals on outbreaks of norovirus from 2009 to 2012.MethodsUsing a large outbreak surveillance dataset, we examined the duration of outbreaks, duration of disruption, ward closures, the number of patients and staff affected and the number of lost bed-days, as functions of the timing of closure. We conducted Quasi-Poisson regression analyses to assess the effect of ward closure (timing of closure) on outcome measures, controlling for time of year (winter or summer), ward size and ward type (elderly care wards).ResultsRegression analysis indicates that after controlling for season ward size and type, the duration of outbreak and duration of disruption were shorter, fewer patients were affected by the time of closure and fewer patients were affected overall, when closure occurred promptly (within 3 days of the first case becoming ill) compared with non-prompt closure groups. However, in outbreaks where wards were not closed, the length of outbreaks were similar to the prompt closure group and also had fewer patients and staff affected and fewer cases per day of outbreak compared with prompt closure.ConclusionsClosing a bay or ward promptly in an outbreak of norovirus leads to a shorter duration of outbreaks, a shorter duration of disruption and fewer patients being affected compared with outbreaks where wards were not promptly closed. However, the interpretation of these results is not straightforward. The outbreaks where the ward was not closed at all have similar characteristics in terms of the duration of outbreak and fewer people were affected compared with the baseline prompt closure group.

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Section: Discussionsupporting

confidence: 88%

“…Recent cost effectiveness and simulation studies7 8 question the need for a complete ward closure. In addition, new multiagency guidelines in the UK on the control of norovirus outbreaks in hospitals and care homes move away from a strategy of whole-ward closure to one of the managing strategies within bays 9.…”

Section: Introductionmentioning

confidence: 99%

To close or not to close? Analysis of 4 year's data from national surveillance of norovirus outbreaks in hospitals in England

2014

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“…Beginning in 2007 to 2008, several investigators evaluated partial ward closure as a means of restricting nosocomial spread and limiting service disruptions. Cohorting by bay, as opposed to total-ward closure, resulted in decreased total closure time and improved the outbreak management efficiency in one study (246). Additionally, in a before-and-after-program implementation study conducted by the Lancashire Teaching Hospitals, the modified bay closure strategy resulted in a significant decrease in the ratio of hospital to community outbreaks, with the number of confirmed outbreaks in hospitals decreasing from 42 to 25 during the 2 study points, while the number of community outbreaks increased from 46 to 81 (r ϭ 0.317; P ϭ 0.025).…”

Section: Staff and Patient Policiesmentioning

confidence: 99%

Norovirus

2015

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SUMMARY Norovirus, an RNA virus of the family Caliciviridae , is a human enteric pathogen that causes substantial morbidity across both health care and community settings. Several factors enhance the transmissibility of norovirus, including the small inoculum required to produce infection (<100 viral particles), prolonged viral shedding, and its ability to survive in the environment. In this review, we describe the basic virology and immunology of noroviruses, the clinical disease resulting from infection and its diagnosis and management, as well as host and pathogen factors that complicate vaccine development. Additionally, we discuss overall epidemiology, infection control strategies, and global reporting efforts aimed at controlling this worldwide cause of acute gastroenteritis. Prompt implementation of infection control measures remains the mainstay of norovirus outbreak management.

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“…We identified six studies that focused on the impact of specific infection prevention and control policies or a control intervention [12,13,[111][112][113][114]. The mode of transmission for the microbes described within this category is via contact [20].…”

Section: Studies On Infection Prevention and Control Policies Or Specmentioning

confidence: 99%

“…The literature generally suggests that ward closure is a necessary control intervention as part of a bundle [9][10][11] versus a bundle that does not include ward closure [12,13]. However, an analysis of a large standardized data set from 2009-2012 from the Hospital Norovirus Outbreak Reporting Scheme in the UK found that in instances where no ward closure was used, the length of outbreaks was similar to those where wards were closed but with fewer patients and healthcare workers (HCW) affected (in total and per day of outbreak) [14].…”

Section: Introductionmentioning

confidence: 99%

Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review

Wong

Eso

et al. 2015

Syst Rev

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BackgroundThough often used to control outbreaks, the efficacy of ward closure is unclear. This systematic review sought to identify studies defining and describing ward closure in outbreak control and to determine impact of ward closure as an intervention on outbreak containment.MethodsWe searched these databases with no language restrictions: MEDLINE, 1946 to 7 July 2014; EMBASE, 1974 to 7 July 2014; CINAHL, 1937 to 8 July 2014; and Cochrane Database of Systematic Reviews, 2005 to May 2014. We also searched the following: IndMED; LILACS; reference lists from retrieved articles; conference proceedings; and websites of the CDCP, the ICID, and the WHO. We included studies of patients hospitalized in acute care facilities; used ward closure as a control measure; used other control measures; and discussed control of the outbreak(s) under investigation. A component approach was used to assess study quality.ResultsWe included 97 English and non-English observational studies. None included a controlled comparison between ward closure and other interventions. We found that ward closure was often used as part of a bundle of interventions but could not determine its direct impact separate from all the other interventions whether used in parallel or in sequence with other interventions. We also found no universal definition of ward closure which was widely accepted.ConclusionsWith no published controlled studies identified, ward closure for control of outbreaks remains an intervention that is not evidence based and healthcare personnel will need to continue to balance the competing risks associated with its use, taking into consideration the nature of the outbreak, the type of pathogen and its virulence, mode of transmission, and the setting in which it occurs. Our review has identified a major research gap in this area.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0131-2) contains supplementary material, which is available to authorized users.

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Compartmentalization of wards to cohort symptomatic patients at the beginning and end of norovirus outbreaks

Cited by 14 publications

References 14 publications

To close or not to close? Analysis of 4 year's data from national surveillance of norovirus outbreaks in hospitals in England

To close or not to close? Analysis of 4 year's data from national surveillance of norovirus outbreaks in hospitals in England

Norovirus

Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review

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