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Norovirus Most Common Culprit in Hospital Outbreaks

February 13, 2012 — Nearly one fifth of all infectious outbreaks in hospitals have been linked to norovirus, and according to results from a nationwide survey that covered outbreaks in 289 US hospitals, those organisms were to blame for 65% of ward closings.

The results of the survey appear in the February issue of the American Journal of Infection Control.

"Norovirus is emerging as an increasingly common hospital-associated organism, causing outbreaks in nonacute settings, and may lead to unit/department closures," write Emily Rhinehart, RN, MPH, CIC, from the Department of Global Loss Prevention, Chartis Insurance, Atlanta, Georgia, and colleagues.

The authors point out that even though hospital-associated infections have been studied for decades, there are few published reports zeroing in on how often they occur, how long they last, and how often they lead to closures of hospital wards.

To address that lack of data, these researchers analyzed survey results from 822 hospitals in 7 states: California, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas. The hospitals varied in size and structure and included rural hospitals, university-affiliated teaching hospitals, and specialty healthcare facilities such as pediatric hospitals.

The survey was conducted in early 2010; all of the outbreaks occurred from 2008 to 2009.

A total of 386 outbreak investigations were reported in 289 hospitals, the authors report. Of the responding hospitals, 533 reported no outbreak investigations.

Four organisms accounted for nearly 60% of the outbreaks. The most common were norovirus (18.2%), Staphylococcus aureus (17.5%), Acinetobactor spp (13.7%), and Clostridium difficile (10.3%).

Norovirus was most often seen in behavioral and rehabilitation/long-term healthcare facilities. In medical and surgical units, other pathogens were more often seen.

About a quarter (25.7%) of outbreak investigations took place in medical/surgical units. The next most common location was surgical units, accounting for 15.9% of investigations.

Nearly one third (29.2%) of outbreaks that were investigated occurred in rehabilitation units, long-term acute care facilities, emergency departments, psychiatric facilities, and skilled nursing facilities, the authors report.

Nearly a quarter of reported outbreaks resulted in units/departments being closed. Of those, norovirus accounted for the most closings (65%).

Outbreaks lasted from fewer than 7 to more than 60 days, with a mean duration of 58.4 days, the authors write. The number of confirmed cases ranged from less than 2 to more than 50, with a mean number of 10.1 confirmed cases per outbreak investigation.

Most state regulations require that infectious outbreaks in healthcare facilities be reported to state authorities. Even so, of the outbreaks reported in the survey, only about half (52.2%) were reported to state authorities.

The authors emphasize that state health departments can and should play a pivotal role in managing outbreaks.

"Although some individual hospital epidemiologists and [infection preventionists (IPs)] are resistant to including the state health department in an outbreak investigation, state agencies often bring investigative expertise that many IPs may not have, resulting in not only an expedited and more thorough investigation but a great learning experience for the IP, physicians, and staff," they write.

诺瓦克病毒是院感中最常见的病原体

2012年2月13日

艾米丽Rhinehart（注册护士，公共卫生事业管理专业，哥伦比亚国际学院， Chartis保险公司（亚特兰大和格鲁吉亚地区）全球损失预防部）等人在《美国感染控制杂志》第2月刊上发表了关于全美289所医院发生院感的调查报告。调查结果中发现：“诺瓦克病毒引起了近五分之一的医院感染，并造成了65％的病房被封锁的不良后果”。报告如下：

医院感染病原体中诺瓦克病毒逐步增多，传播到未感染的设备表面，最终可能会导致病房或科室被封锁。尽管对于院感的研究已经有几十年的时间，但是关于院感发生的频率、持续的时间以及导致医院病房被封锁的频率尚未见报道。因此，本研究分析了在2010年年初进行的来自7个州822所医院在2008年到2009年期间发生院感情况的调查结果。其中七个州是指：加利福尼亚州，伊利诺斯州，密歇根州，纽约州，俄亥俄州，宾夕法尼亚州和得克萨斯州。所调查的医院的规模和结构是不同的，涵盖了农村医院、大学附属教学医院，以及像儿科医院等具备专业医疗设施的医院。在 822所医院中，共对289所医院进行了386次院感调查，其余533所医院未进行调查。调查中发现近60%的院感是由以下最常见的四种病原体所引起的：诺瓦克病毒(占18.2%)、金黄色葡萄球菌(占17.5%)、阴沟肠杆菌(占13.7%)、艰难梭状芽胞杆菌(占10.3%)。诺瓦克病毒多见于行为和康复或长期使用的医疗设施表面，其他病原体多见于内、外科病房。调查中大约四分之一(25.7%)的院感发生在内、外科病房，外科病房占15.9%，近三分之一（29.2％）发生在康复科，长期急性护理设施，急诊科，精神科设备和特殊护理设备。近四分之一的院感导致病房或科室被封锁，其中，大多数是由诺瓦克病毒引发的 (占65%)。院感的持续时间是从7天以内到60天以上，平均时间是58.4天。确诊病例的数量从2例以下到50例以上，平均每次院感调查中确诊的病例数为10.1例。大多数州规定：如果医疗保健设施爆发传染病，应向州卫生部门汇报。即便如此，在院感报告的调查中发现，只有约一半（52.2％）的医院是按要求做的。但是我们应该深刻认识到州卫生部门是能够并且应该在院感管理中发挥重要作用的。尽管有个别医院的流行病学家和感染控制人员反对州卫生部门干预院感调查，但是我们不得不认同这样的事实：州卫生部门人员往往具备很多医院感染控制人员所不具备的专业调查知识，他们进行的调查不仅仅是一次更快速、更彻底的调查，而是为感染控制人员、医生和工作人员提供了一次很好的学习机会。