Prevention of Nosocomial Transmission of Norovirus by Strategic Infection Control Measures

• Published in: Infection control and hospital epidemiology 2011-03, Vol.32 (3), p.229-237
• Main Authors: Cheng, Vincent C. C., Wong, Lisa M. W., Tai, Josepha W. M., Chan, Jasper F. W., To, Kelvin K. W., Li, Iris W. S., Hung, Ivan F. N., Chan, K. H., Ho, P. L., Yuen, K. Y.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Caliciviridae Infections - epidemiology; Caliciviridae Infections - prevention & control; Caliciviridae Infections - transmission; Child; Child, Preschool; Cross Infection - epidemiology; Cross Infection - prevention & control; Cross Infection - transmission; Disease Outbreaks - prevention & control; Disease Outbreaks - statistics & numerical data; Disease transmission; DNA, Viral - analysis; Female; General aspects; Hand Disinfection; Health care industry; Hong Kong; Hospital admissions; Hospital units; Hospitals, University; Human infectious diseases. Experimental studies and models; Humans; Incidence; Infant; Infection control; Infection Control - methods; Infections; Infectious diseases; Male; Medical sciences; Microbiology; Middle Aged; Miscellaneous; Norovirus; Norovirus - genetics; Norovirus - isolation & purification; Nursing; Original Article; Pediatrics; Phylogeny; Psychiatric hospitals; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reverse Transcriptase Polymerase Chain Reaction; Young Adult
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/658330

Background. Nosocomial outbreaks of norovirus infection pose a great challenge to the infection control team. Methods. Between November 1, 2009, and February 28, 2010, strategic infection control measures were implemented in a hospital network. In addition to timely staff education and promotion of directly observed hand hygiene, reverse-transcription polymerase chain reaction for norovirus was performed as an added test by the microbiology laboratory for all fecal specimens irrespective of the request for testing. Laboratory-confirmed cases were followed up by the infection control team for timely intervention. The incidence of hospital-acquired norovirus infection per 1,000 potentially infectious patient-days was compared with the corresponding period in the preceding 12 months, and the incidence in the other 6 hospital networks in Hong Kong was chosen as the concurrent control. Phylogenetic analysis of norovirus isolates was performed. Results. Of the 988 patients who were tested, 242 (25%) were positive for norovirus; 114 (47%) of those 242 patients had norovirus detected by our added test. Compared with the corresponding period in the preceding 12 months, the incidence of hospital-acquired norovirus infection decreased from 131 to 16 cases per 1,000 potentially infectious patient-days ( ), although the number of hospital-acquired infections was low in both the study period ( ) and the historical control periods ( ). The incidence of hospital-acquired norovirus infection in our hospital network (0.03 cases per 1,000 patient-days) was significantly lower than that of the concurrent control (0.06 cases per 1,000 patient-days) ( ). Forty-three (93%) of 46 norovirus isolates sequenced belonged to the genogroup II.4 variant. Conclusions. Strategic infection control measures with an added test may be useful in controlling nosocomial transmission of norovirus.