Patient Safety Topics

​​​​​​​Recurring, annual attacks of norovirus affect resident/patient and staff safety, disrupt healthcare facility operations, and may result in financial and operational burden to facilities. Key components of an outbreak prevention/containment program include addressing risk factors that increase the potential for norovirus infection and applying best practices to identify and control an acute gastroenteritis outbreak.

Key Data and Statistics

Pennsylvania long-term care (LTC) facilities report gastrointestinal (GI) infections, including norovirus, to the Pennsylvania Patient Safety Authority through its Pennsylvania Patient Safety Reporting System. In April 2014, in accord with changes to national standards, the Authority revised the LTC criteria for identifying and reporting gastroenteritis. The revision included a new gastroenteritis subcategory that allows detailed surveillance and reporting of norovirus cases separate from other causes of gastroenteritis within PA-PSRS.

Norovirus events comprised the majority of GI infections for 12 of 36 months in three clusters of consecutive months concurrent with what is commonly considered the norovirus season (Figure 2). These three clusters accounted for 87.5% of all norovirus reports over the three-year period.


Also of note are the seasonal spikes of monthly norovirus rates as compared to relatively stable monthly rates of other GI infections (Figure 3).  

The timing and magnitude of event clusters varied among facilities, as shown when grouped by Pennsylvania region (Figure 4). Each region had different monthly peaks, demonstrating that although events are seasonal, variability exists by region. Table 1 shows peak norovirus periods and rates for the Authority's six state regions.



Table 1. Regional Peak Outbreak Rates, by Region, Academic Years 2015 through 2017 ​ ​ ​
RegionPeak Month and AYPeak Rate*Average Rate, AY15–AY17*
NorthcentralJanuary 20140.370.03
NortheastApril 20150.440.07
NorthwestMarch 20160.510.07
SouthcentralJanuary 20160.670.08
SoutheastFebruary 20160.250.06
SouthwestMarch 20140.180.04

Note: Academic years are for the 12 months ended June 30 of each year.
AY, Academic year.

* Rate calculated by number of norovirus reports per 1,000 resident days.


Excerpted from: Bradley S, Finley E. Combat norovirus infections in long-term care facilities. Pa Patient Saf Advis 2018 Jun;15(2).  

Educational Tools

Norovirus Prevention and Control Training
This PowerPoint presentation comes complete with instructor notes and tools to train your staff to understand the factors that increase the potential for a norovirus outbreak, and to translate evidence-based interventions into actionable facility practices that impact norovirus.

Norovirus Preparedness Checklist
This sample checklist is designed to assist facilities with assessment of facility-specific preparedness plan activities, basic precautions, enhanced precautions, and outcome and process measures.

Acute Gastroenteritis Outbreaks Case Log
Facilities can use this sample log to determine common factors about any acute gastroenteritis outbreaks and collect information in a timely, reliable, and organized method.

Norovirus Preparedness: Outcome and Process Measures Worksheet
This sample worksheet may be used for documenting facility-specific process and outcome measures associated with norovirus.

Stop the Spread of Norovirus Poster (Clinicians)
Norovirus is a highly contagious virus and the principal cause of worldwide acute gastroenteritis epidemics in all age groups. This poster can help ensure healthcare facilities and their staff are better equipped to respond to norovirus.

Stop the Spread of Norovirus Poster (Patients)
Norovirus is a highly contagious gastrointestinal illness, also referred to as the “stomach flu.” This poster can help patients protect themselves from norovirus.


The Authority makes available its past webinars and other presentations about a variety of patient safety topics, including healthcare-associated infections, through its YouTube channel.

 Norovirus Prevention: Tips from the Toolkit


 Designing a Norovirus Prevention and Rapid Response Program: An Evidence-Based Approach



Safety Tips for Patients