Enteric outbreaks in long-term care facilities and recommendations for prevention: a review

Abstract

Outbreaks of enteric illness in long-term care facilities (LTCFs) were reviewed to identify preventative recommendations. Systematic review methodology identified outbreak reports of gastrointestinal illness in LTCFs either published or that occurred from January 1997 to June 2007. The inclusion criteria captured 75 outbreaks; 23 (31%) associated with bacterial agents and 52 (69%) with viral agents. Transmission was mainly foodborne (52%) for those of bacterial origin and person-to-person (71%) for viral outbreaks. Norovirus infection was associated with 58% of hospitalizations. Sixty deaths were reported, about half from Salmonella infections. Recommendations for foodborne outbreaks emphasized appropriate sourcing and preparation of eggs, staff training, and temperature control during food preparation. Recommendations from outbreaks transmitted person-to-person centred on controlling residents' movements, effective environmental cleaning and disinfection, cancelling social events and restricting visitors, excluding ill staff, encouraging effective hand hygiene, and preventing cross-contamination through gloving and gowning. In none of the 75 published outbreak reports were the suggested recommendations evaluated for effectiveness in controlling the outbreak. Applied research of this type could greatly help in the acceptance of prevention and control strategies.

Emerging norovirus GII.4 2008 variant detected in hospitalised paediatric patients in South Africa

“…4 Initially described after a gastroenteritis outbreak at a school in Norwalk, Ohio in 1968, 7 NoVs are now known to cause large gastroenteritis epidemics worldwide. [8][9][10] Outbreaks often occur due to contaminated food or water and are difficult to control because of the high environmental stability, low infectious dose and high rate of secondary spread characteristic of NoVs. 11 Over the last 3 years a number of studies have investigated the prevalence of NoV infection in hospitalised children.…”

Knowledge, attitudes and self-reported practices of food service staff in nursing homes and long-term care facilities

“…The larger increase will be in Spain (35.6%), in Italy (35.5%) and in Greece (32.5%). The growing segment of persons older than 65 years forms a special population at risk for infections (Gerba, Rose, & Haas, 1996;Greig & Lee, 2009;Kendall, Hillers, & Medeiros, 2006). Particularly, more than 80 year-old subjects are at increased risk for both infections and death from infections, including foodborne illnesses, because of the decrease in immune function, comorbidities and other factors, such as malnutrition and inactivity (Strausbaugh, 2001).…”

“…Particularly, more than 80 year-old subjects are at increased risk for both infections and death from infections, including foodborne illnesses, because of the decrease in immune function, comorbidities and other factors, such as malnutrition and inactivity (Strausbaugh, 2001). Malnutrition and the consequent impairment of cell-mediated immunity are very common in nursing home residents and may be more diffuse within the elderly living in community than is generally thought (Alvarez, Monereo, Ortiz, & Salido, 2004;Greig & Lee, 2009;Levine, Smart, Archer, Bean, & Tauxe, 1991;Smith, 1998). Moreover, geriatric patients may be the preferential victims of new or emerging infections in hospitals and other health-care settings (Zimmerman, Gruber-Baldini, Hebel, Sloane, & Magaziner, 2002).…”

“…Moreover, LTCF residents have multiple chronic comorbidities that complicate recognition of infection. Elderly persons, compared with younger adults, have higher incidence of infections caused by Listeria, Salmonella, Vibrio, Yersinia and E. coli O157, Clostridium perfringens and Campylobacter jejuni, due to the decrease in mobility and gastric acid production (Greig & Lee, 2009).…”

Diagnostic Accuracy and Analytical Sensitivity of IDEIA Norovirus Assay for Routine Screening of Human Norovirus

“…Major factors for the public health impact of NoVs include: (i) great strain diversity (five genogroups [GI to -V] and 32 genotypes) (33,52,53), (ii) low infectious dose (as low as 18 particles) (46), (iii) prolonged asymptomatic shedding (3), (iv) environmental stability (10), and (v) the lack of long-term immunity (38,46). NoV outbreaks often occur in semiclosed environments that favor person-to-person transmission, including long-term care facilities, cruise ships, prisons, hospitals, and recreational facilities (6,9,20,23,24,36,41,45,49).…”