Annual Threat of Norovirus Approaches for Nursing Homes and Hospitals

In early 2010, Pennsylvania nursing homes and hospitals reported an increased number of cases of gastrointestinal illness which are consistent with recurring outbreaks of the highly contagious norovirus and norovirus-like illnesses nationwide. With a new norovirus season approaching, the Pennsylvania Patient Safety Authority issues its 2010 December Pennsylvania Patient Safety Advisory with data analysis, guidance and success stories provided by Pennsylvania nursing homes for preventing and controlling the illness.

Norovirus is a highly contagious severe gastrointestinal illness commonly referred to as the "stomach flu." The virus spreads quickly because it is transmitted easily from person to person through vomit and feces of people who are sick with the illness. Contact with only a few particles can make you sick. In nursing home settings outbreaks happen quickly due to shared bathroom facilities, dining facilities and incontinence hygiene issues. Norovirus outbreaks usually peak in cold weather when people are more likely to gather indoors. Spread of the virus may also increase because of environmental factors in winter (e.g., lower temperatures, less sunlight).

Norovirus and norovirus-like cases in Pennsylvania nursing homes increased from 634 cases in the third quarter of 2009 (July-September) to 813 cases in the fourth quarter of 2009 (October-December) and then surged to 4,090 cases in the first quarter of 2010 (January-March). Pennsylvania hospitals also reported an increase in norovirus and norovirus-like cases in the first quarter of 2010 (January-March).

"Our analysis shows on average twenty-five cases of norovirus occurred per nursing home outbreak and an average of six norovirus cases occurred per hospital outbreak," says Sharon Bradley, infection control analyst for the Pennsylvania Patient Safety Authority. "When you add the cases up, there were a significant number of sick residents and patients in the first part of this year in Pennsylvania. But hopefully with the strategies provided in this Advisory and other preventive resources nursing homes will take the necessary steps to avoid the outbreaks as the winter season approaches."

According to Authority analysis of nursing homes, 42 of the 67 counties in Pennsylvania reported norovirus or norovirus-like cases. The most outbreaks occurred in Philadelphia and Montgomery counties. Thirty-seven percent (25) of the counties reported no nursing home outbreaks, 25 percent (17) of the counties had a lower than average percentage of their facilities reporting outbreaks, and 37 percent (25) had a higher than average percentage of their facilities reporting outbreaks.

Bradley says early detection of the virus is important for controlling the outbreaks, as well as preparation for the norovirus season.

"In this Advisory, we've provided nursing homes and hospitals the background information they need to prevent the virus as well as the next steps to ensure that everything that can be done is being done to avoid an outbreak of the virus," Bradley says. "The Authority has also provided a toolkit for healthcare providers to prepare for norovirus season, monitor compliance of control measures to contain the virus and consumer tips for patients."

Bradley says five Pennsylvania nursing homes are featured in the Advisory for having reported the most effective practices contributing to a quick, successful resolution of a gastrointestinal (norovirus) outbreak.The nursing homes include: Vincentian Regency, Allison Park; Nottingham Village, Northumberland; Somerton Center, Philadelphia; Twin Oaks, Campbelltown; and Golden Living Center-East Mountain, Wilkes-Barre.

For more information on the success strategies for preventing the norovirus and norovirus-like cases go to the 2010 December Pennsylvania Patient Safety Advisory and click on "Controlling the Annual Threat of Norovirus Gastroenteritis Outbreaks" at www.patientsafetyauthority.org.