Patient Safety Topics
:
Norovirus
Overview

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 facilities report gastrointestinal infections, including norovirus, to the Pennsylvania Patient Safety Authority through its Pennsylvania Patient Safety Reporting System.

Table. Gastrointestinal Infections, Pooled Mean Rates, by Subcategory and Care Unit, 2016 ​ ​ ​
Unit Name (N) Number of Infections Resident Days Pooled Infection
Rate (95% CI)*
Clostridium difficile—The resident has diarrhea and a stool sample is positive for C. difficile toxin A or B, or a
toxin-producing C. difficile organism is identified from stool culture or by molecular testing, or Pseudomembranous colitis identified through endoscopic examination, surgery, or biopsy ​ ​ ​
Dementia unit (32)532,293,5380.02 (0.02 - 0.03)
Mixed unit (160)5487,739,4180.07 (0.06 - 0.08)
Nursing unit (150)4478,426,4150.05 (0.05 - 0.06)
SN/STR unit (250)1,0749,109,7750.12 (0.11 - 0.12)
Vent unit (11)43173,4050.25 (0.17 - 0.32)
Total (480) 2,165 27,742,551 0.08 (0.07 - 0.08)
Norovirus—The resident has diarrhea and/or vomiting and laboratory results are positive for Norovirus ​ ​ ​
Dementia unit (1)12,293,5380 (0 - 0)
Mixed unit (7)157,739,4180 (0 - 0)
Nursing unit (4)48,426,4150 (0 - 0)
SN/STR unit (13)219,109,7750 (0 - 0)
Vent unit (0)0173,4050 (0 - 0)
Total (22) 41 27,742,551 0 (0 - 0)
Bacterial gastroenteritis—The resident has diarrhea and/or vomiting and laboratory results are positive for a bacteriologic pathogen ​ ​ ​
Dementia unit (1)12,293,5380 (0 - 0)
Mixed unit (6)77,739,4180 (0 - 0)
Nursing unit (5)58,426,4150 (0 - 0)
SN/STR unit (7)89,109,7750 (0 - 0)
Vent unit (0)0173,4050 (0 - 0)
Total (19) 21 27,742,551 0 (0 - 0)
Kaplan—Norovirus is suspected based on Kaplan criteria; the resident has diarrhea and/or vomiting and C. difficile results are negative ​ ​ ​
Dementia unit (17)1372,293,5380.06 (0.05 - 0.07)
Mixed unit (20)2947,739,4180.04 (0.03 - 0.04)
Nursing unit (25)3258,426,4150.04 (0.03 - 0.04)
SN/STR unit (30)4179,109,7750.05 (0.04 - 0.05)
Vent unit (0)0173,4050 (0 - 0)
Total (67) 1,173 27,742,551 0.04 (0.04 - 0.04)
Total Gastrointestinal Infections Reported ​ ​ ​
Dementia unit (32)1922,293,5380.08 (0.07 - 0.1)
Mixed unit (160)8647,739,4180.11 (0.1 - 0.12)
Nursing unit (150)7818,426,4150.09 (0.09 - 0.1)
SN/STR unit (250)1,5209,109,7750.17 (0.16 - 0.18)
Vent unit (11)43173,4050.25 (0.17 - 0.32)
Total (504) 3,400 27,742,551 0.12 (0.12 - 0.13)

Notes: As reported through the Pennsylvania Patient Safety Reporting System (PA-PSRS) in 2016. Table rows indicating totals show the number of nursing homes reporting for the given type of infection with each unit name. This is not to be confused with the sum of the unit types for that infection. There may be overlap of unit types reporting at any given facility.

CI, Confidence interval; SN/STR, skilled nursing/short-term rehabilitation; vent, ventilator dependent. 

 

To aid Pennsylvania nursing homes, the Figure provides seasonal trends to help nursing homes prepare for norovirus in the coming year associated with timing and expected duration of external pressure. A norovirus outbreak is defined as three or more cases of norovirus defined within a three-day period. Further, the Figure shows the number of reports from nursing homes that did or did not meet the norovirus outbreak definition.

Figure. Norovirus Outbreaks by Month, 2016

Figure 9. Norovirus Outbreaks by Month, 2016

Excerpted from: Pennsylvania Patient Safety Authority. 2016 Annual Report. 2016 Apr 28 [cited 2017 Jun 7]. http://patientsafety.pa.gov/PatientSafetyAuthority/Pages/annual_report_2016.aspx 

Educational Tools

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.

Multimedia

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.

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

 
 
Advisory Articles

 

Safety Tips for Patients

©2017 Pennsylvania Patient Safety Authority