Gastrointestinal flu: Norovirus in health care and long-term care facilities
ABSTRACT Noroviruses, recognized as the leading global cause of viral gastroenteritis and a major contributor to food-borne illness, present a growing challenge in health care and long-term care facilities. The virus spreads easily and by multiple routes. A visitor to a ward might initiate an outbreak by person-to-person contact, vomiting staff members or patients can disseminate the virus by airborne means, and contaminated surfaces, such as doorknobs and computer keyboards, can sustain an epidemic. In addition, although self-limited in healthy hosts, the virus can cause increased morbidity in more-vulnerable people. The GII.4 strain of the virus now dominates in multiple recent worldwide epidemics as well as in health care and long-term care facilities. Much like the influenza virus, norovirus appears to evolve by antigenic drift and evading the immune system, causing waves of global epidemics. Previous attempts at controlling outbreaks, both in the community and in closed facilities, provide guidance about the vigilance and action required by the health care community to diminish the clinical impact of norovirus infection.
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ABSTRACT: The objective of this study was to compare the aetiologic yield of standard-of-care microbiologic testing ordered by physicians with that of a multiplex PCR platform. Stool specimens obtained from children and young adults with gastrointestinal illness were evaluated by standard laboratory methods and a developmental version of the FilmArray Gastrointestinal (GI) Diagnostic System (FilmArray GI Panel), a rapid multiplex PCR platform that detects 23 bacterial, viral and protozoal agents. Results were classified according to the microbiologic tests requested by the treating physician. A median of three (range 1-10) microbiologic tests were performed by the clinical laboratory during 378 unique diarrhoeal episodes. A potential aetiologic agent was identified in 46% of stool specimens by standard laboratory methods and in 65% of specimens tested using the FilmArray GI Panel (p < 0.001). For those patients who only had Clostridium difficile testing requested, an alternative pathogen was identified in 29% of cases with the FilmArray GI Panel. Notably, 11 (12%) cases of norovirus were identified among children who only had testing for Clostridium difficile ordered. Among those who had C. difficile testing ordered in combination with other tests, an additional pathogen was identified in 57% of stool specimens with the FilmArray GI Panel. For patients who had no C. difficile testing performed, the FilmArray GI Panel identified a pathogen in 63% of cases, including C. difficile in 8%. Physician-specified laboratory testing may miss important diarrhoeal pathogens. Additionally, standard laboratory testing is likely to underestimate co-infections with multiple infectious diarrhoeagenic agents. Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Article: Isolation Precautions for Visitors[Show abstract] [Hide abstract]
ABSTRACT: Transmission of organisms within the hospital setting has become a topic of major concern not only for patients and healthcare facilities but also for government agencies and the general public. This increased awareness has occurred in part due to the spread of organisms that have limited treatment options, such as carbapenem-resistant Enterobacteriaceae (CRE), as well as the heightened recognition that many hospital-associated infections (HAIs) are preventable. A large body of literature shows that horizontal transmission of multidrug-resistant organisms involves the hands, and potentially the attire, of healthcare workers (HCWs). This evidence provides the rationale for the use of standard and contact isolation precautions among HCWs. However, the health risks to visitors and the role of visitors in the horizontal transmission of pathogens within acute care hospitals is not as clearly defined. Consequently, uncertainty remains regarding which precautions visitors should take when interacting with patients placed on isolation precautions. Frequent arguments against the use of isolation precautions among visitors include lack of visitor movement between patient rooms, the difficulty of educating visitors, and the difficulty of enforcing compliance with isolation practices. This manuscript was created to provide general recommendations for isolation precautions among visitors based on the literature and a survey of the Society for Healthcare Epidemiology of America (SHEA) membership and SHEA Research Network (SRN). For endemic situations with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), we recommend not using contact isolation precautions, although visitors interacting with multiple patients should use isolation practices similar to those of HCWs. Utilization of contact precautions should be considered for visitors to patients with extensively drug-resistant Gram-negative organisms (eg, Klebsiella pneumoniae carbapenemase (KPC) or enteric pathogens with diarrhea, such as Clostridium difficile and norovirus). Visitors with extensive documented exposure to the symptomatic patient prior to hospitalization such as parents/guardians/ family members may be excluded from isolation precautions. These recommendations should be adapted to patient populations and individual hospital needs.Infection Control and Hospital Epidemiology 04/2015; DOI:10.1017/ice.2015.67 · 3.94 Impact Factor
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ABSTRACT: A nosocomial outbreak in a 740-bed hospital in Athens, Greece, was investigated in January-February 2012. Recommendations on infection control measures were given and two case-control studies were conducted among patients (study A) and health care workers (HCWs) (study B). Compliance to control measures was evaluated. The absence of a routine recording system of nosocomial-acquired gastroenteritis cases led to a 10 days delay in outbreak identification. In total, 63 gastroenteritis cases were identified; 30 HCWs and 33 patients. In the multivariable analysis of study A the disease incidence among patients was statistical significantly associated with a prior incident of vomitus in their room (OR=7.96, 95% CI=1.29-49.2). In study B, the incidence was associated with the history of direct contact with a symptomatic patient (OR=3.03, 95%CI 1.01-9.12). Twenty one (75%) of the symptomatic HCWs reported absence from work for a median of 2 days (range: 1-4). Seven (25.0%) continued to work despite being symptomatic. Only, 11.1% of patients were isolated or cohorted after developing symptoms. In-hospital virological testing was not feasible and one specimen sent to a university laboratory was positive for norovirus. An appropriately designed protocol regarding the detection, the management and the laboratory investigation of nosocomial gastroenteritis outbreaks should be followed in order effective containment to be reassured. Hippokratia 2014; 18 (3): 204-208.Hippokratia 07/2014; 18(3):204-8. · 0.36 Impact Factor