Norovirus outbreaks in nursing homes: the evaluation of infection control measures

Friesema, Ingrid; Vennema, Harry; Heijne, Janneke C. M.; Jager, C M de; Morroy, G.; Kerkhof, J H C T van den; Coster, E. J. M. de; Wolters, Bert; Waarbeek, Henriëtte L G Ter; Fanoy, Ewout; Teunis, Peter; Linde, R. van der; Duynhoven, Y. T. H. P. Van

doi:10.1017/s095026880900274x

Cited by 69 publications

(81 citation statements)

References 25 publications

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“…In five clusters, the index was found to be a missed patient, which suggests that diagnosing these missed patients could effectively improve the timely institution of infection-preventive measures. Friesema et al recently reported a beneficial effect of the early institution of preventive measures for NoV (7). Second, we found that missed NoV patients underwent significantly more abdominal imaging than recognized patients, including colonoscopy, computed tomography, and abdominal X-ray examination.…”

Section: Discussionmentioning

confidence: 47%

Unrecognized Norovirus Infections in Health Care Institutions and Their Clinical Impact

Beersma

Sukhrie²,

Bogerman³

et al. 2012

J Clin Microbiol

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e Noroviruses (NoVs) have emerged as the leading cause of acute viral gastroenteritis (GE) in humans. Although diagnostic facilities have greatly improved, significant underdiagnosis of NoV in hospitals may still occur, thereby increasing clinical burden and nosocomial spread. We evaluated the underdiagnosis of sporadic NoV infections in a tertiary care hospital and estimated its clinical impact. From December 2008 until July 2009, fecal samples specifically referred for bacterial but not viral examination were retrospectively tested for NoV by real-time PCR. The clinical and virological data from patients with undiagnosed NoV infection (missed patients) were evaluated and compared with those from patients with recognized NoV. During the study period, 45 patients with undiagnosed NoV were detected, whereas 50 patients were regularly diagnosed. The missed NoV cases were more frequently adults than children (80% versus 46%; P < 0.001). The viral load levels did not differ between the diagnosed and missed patients, but missed patients more frequently presented without diarrhea (20% versus 4%; P < 0.07). The newly admitted missed NoV cases with GE underwent more diagnostic imaging (24% versus 4%; P < 0.01) and tended to be hospitalized longer. When missed-NoV patients were included, the number of nosocomial clusters doubled and missed patients were index cases in 5 of the 6 clusters. These data indicate that NoV infections are frequently missed despite routine laboratory testing and demonstrate that underdiagnosis of NoV patients is associated with costly abdominal imaging and nosocomial clustering. Awareness of NoV infection in adult patients and education about the importance of viral GE should be increased. N oroviruses (NoVs) have emerged as the one of the most important pathogens causing acute gastroenteritis (GE) in children and adults (8,12). Nursing homes and hospitals are widely confronted with NoV outbreaks. Additionally, isolated (sporadic) cases of NoV frequently occur, but their incidence and clinical impact in hospitals have not been studied systematically (2, 17). Sporadic cases of NoV may result both from community-acquired infections in newly admitted patients and from nosocomial transmissions between patients, personnel, or visitors (9). Although sensitive commercial and homemade diagnostic assays for NoV have become widely available, sporadic NoV infections in hospitalized patients remain underdiagnosed, increasing the clinical burden and potential for nosocomial spread (1, 3, 21). Underrecognition of NoV may result in the individual patient undergoing more diagnostic procedures and may increase the influx of infectious patients into hospital wards, where they may trigger outbreaks (5, 14). Underdiagnosis of NoV may result from a referral bias, as well as from suboptimal laboratory facilities and inadequate specimen collection. This bias may occur when physicians selectively refer GE patients for bacteriological or parasitological testing but not virological testing. In the present study, we prosp...

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Section: Discussionmentioning

confidence: 47%

Unrecognized Norovirus Infections in Health Care Institutions and Their Clinical Impact

Beersma

Sukhrie²,

Bogerman³

et al. 2012

J Clin Microbiol

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“…Additionally, some institutions may offer delayed admission to prospective long-term-care residents during ongoing outbreaks (252). In a prospective study of 49 Dutch nursing homes, investigators demonstrated that infection control measures were most effective when initiated within 3 days of the identification of an index case (253). Visitor restrictions have also been utilized in a number of reports of outbreaks in long-term-care or other extended-care settings.…”

Section: Long-term-care and Other Facilitiesmentioning

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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“…Key factors in successful transmission are the quantity of infectious virus particles shed, the minimal infectious dose, the stability in the environment, and the resistance to disinfection (2). Consequently, cleaning and disinfection are means to control outbreaks and transmission of viruses; however, proper cleaning and disinfection can be laborious, and for nonenveloped enteric viruses such as noroviruses, the effectivity of currently practiced cleaning and disinfection procedures is not clear (5,7). Therefore, self-decontaminating surfaces may be helpful in preventing transmission in health care settings, in food production areas, and in general from frequently touched and contaminated fomites.…”

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confidence: 99%

Different Virucidal Activities of Hyperbranched Quaternary Ammonium Coatings on Poliovirus and Influenza Virus

Tuladhar

Koning²,

Fundeanu³

et al. 2012

Appl Environ Microbiol

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Norovirus outbreaks in nursing homes: the evaluation of infection control measures

Cited by 69 publications

References 25 publications

Unrecognized Norovirus Infections in Health Care Institutions and Their Clinical Impact

Unrecognized Norovirus Infections in Health Care Institutions and Their Clinical Impact

Norovirus

Different Virucidal Activities of Hyperbranched Quaternary Ammonium Coatings on Poliovirus and Influenza Virus

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