Control and Containment of a Norovirus Outbreak in a Skilled Nursing Facility Unit

Control and Containment of a Norovirus Outbreak in a Skilled Nursing Facility Unit

Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145 Outbreak Investigation and Emerging/ Reemerging Infectious Diseases/ Effic...

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Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145

Outbreak Investigation and Emerging/ Reemerging Infectious Diseases/ Efficacy and Impact Presentation Number 10-445 Control and Containment of a Norovirus Outbreak in a Skilled Nursing Facility Unit Pamela Iwamoto MSN, RN, CIC, Sr. RN Case Manager, University of New Mexico College of Nursing, Albuquerque, New Mexico; David Selvage NMS, PA-C, Infectious Disease Epidemiologist/ Pertussis Surveillance Coordinator, New Mexico Department of Health ISSUE: Identification of an outbreak and description of the investigation and follow-up of a suspected norovirus cluster in a skilled nursing facility unit. If present in a health care facility, Norovirus has become a pathogen present that presents challenges of basic infection prevention principles. The infection prevention guidelines needed to contain and control the transmission of infection is critical in the containment and transmission of this pathogen. Information on action plans and lessons learned following this outbreak and summary of measures taken including the collaboration needed to contain this event will be presented. PROJECT: In February 2012, the Infection Control department was notified of a potential outbreak of norovirus in the skilled nursing facility unit. The hospital is a large community hospital with two other community hospitals that are affiliated in a urban community. Initial efforts included confirmation/identification of an outbreak and follow-up measures needed to contain an outbreak. RESULTS: This outbreak included the following population: patients, medical providers and healthcare workers. There were two waves identified in this outbreak cluster. Attention to food services and environmental cleaning were the focus of this outbreak. Measures implemented included specific food handling practices (use of disposable flatware and dishes for patient use), terminal cleaning of environmental surfaces, including use of Bioquell technology for cleaning and specific hospital approved disinfectants to be used for cleaning. Enforcement of restrictions to deter ill individuals from work schedules, education for staff and visitors, and clear communication of practices to ensure a clean environment. During this same time period,a community wide outbreak was ongoing. LESSON LEARNED: Communication and support with the state health department was done to faciliate laboratory testing and confirmation; this was a key to confirm and identify the outbreak cluster. Basic infection prevention principles were re-emphasized to contain the infectious pathogen.. Staff compliance with cleaning procedures was also critical in containmnent of outbreak. Many staff were reluctant to recognize signs and symptoms of illness and continued to report to work; this made it difficult to control the initial outbreak. Working collaboratively with the state health department was one of the measures for successful containment of the outbreak.

Presentation Number 10-446 When an Outbreak Isn’t Really an Outbreak: Use of an Electronic Surveillance System to Quickly Evaluate and Manage Infection Clusters Kimberly Simon RN, BSN, CIC, Infection Prevention Nurse Manager, Riverview Medical Center; Sarah A. Jadin MPH, CIC, Sr. Clinical Consultant-Infection Prevention, Premier healthcare alliance


ISSUE: Identification and investigation of potential healthcare associated infection clusters is time-consuming but essential to infection prevention programs. Incidents of infection clusters have been well documented but there is less data available on those cases where after investigation, it is determined that there is actually no cluster of infection. We describe an incident of a potential cluster where an electronic surveillance system (ESS) quickly made data available to complete the research to show that an issue requiring intervention did not exist. PROJECT: In a 491-bed acute care community hospital, an ESS is used for daily surveillance notifying the IPs of new laboratory results in the form of alerts. When an alert is received for a VRE result, the patient is investigated by infection preventionists (IPs) to determine if the infection is hospital or community acquired. The patient is then tagged in the ESS with that information. The Infectious Disease doctor identified 3 recent VRE cases on a 34 bed unit, suspected a cluster and notified the infection prevention department. Using the ESS, a report was generated of all VRE on the unit during the time period and the available data was reviewed. Prior to having an ESS, researching this issue would have involved a number of manual steps including: locating and verifying the patients suspected of having VRE, investigating if VRE was present on admission and determining patient placement at the time of VRE acquisition. RESULTS: The three patients identified by the doctor were the only patients on the unit that had VRE. The profile of the patients in the ESS included tags which showed that each of the patients had community acquired VRE identified on a previous admission. It was therefore determined that there was not a cluster of healthcare associated VRE. This entire investigation was completed within five minutes while the doctor was still on the telephone. The approximate time this activity would have taken without an ESS could have been a half hour to several hours, depending upon the initial findings and level of detail. LESSON LEARNED: Identification of infection clusters is necessary and laborious. Suspected clusters can occur multiple times per year with each requiring immediate investigation. If an ESS is used, patients are managed as they have positive results and when a cluster is suspected, data is readily available reducing the time spent by IPs. This time can instead be used to develop and implement prevention initiatives and staff education.

Presentation Number 10-447 Probiotics for the Reduction of Colonization with MRSA Simone R. Warrack BS, Research Specialist, University of Wisconsin School of Medicine and Public Health; Prerna Panjikar BS, Research Specialist, University of Wisconsin; Megan Duster BS, MT (ASCP), Research Specialist, University of Wisconsin; Nasia Safdar MD, PhD, Associate Professor of Medicine, University of Wisconsin School of Medicine and Public Health BACKGROUND/OBJECTIVES: Seventy percent of healthcare-associated infections (HAI) are caused by antimicrobial resistant bacteria. Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of HAI and limited options exist for decolonization. Probiotics may offer promise for MRSA decolonization. We undertook a pilot study to examine the feasibility of undertaking a randomized controlled trial on probiotics for reducing carriage of MRSA and to examine the safety and effectiveness of using a probiotic, Lactobacillus rhamnosus HN001, to eradicate nasal colonization and intestinal colonization by MRSA.

APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013