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Norovirus Outbreaks in Nursing Homes
10/19/2012
Norovirus outbreaks are common in nursing homes in the US and affect vulnerable, elderly populations.
Hospitalizations and deaths have been reported during norovirus outbreak investigations but a causal association remains unclear. We compared all-cause mortality and hospitalization rates in nursing homes during norovirus outbreak periods to rates during non-outbreak periods.

Norovirus outbreaks were associated with a significant increase in all-cause hospitalization and mortality in nursing homes. Homes with older resident populations and lower RN hours-to-bed ratios may be the most at risk for increased mortality during norovirus outbreaks.

Results of the study:
We constructed a retrospective cohort of Medicare-certified nursing homes in Oregon, Wisconsin, and Pennsylvania that reported at least one norovirus outbreak to the National Outbreak Reporting System (NORS) during January 2009 to December 2010. All deaths and hospitalizations occurring among residents of these nursing homes were identified through the Medicare Minimum Data Set (MDS). Using a random-effect Poisson regression model, we compared rates of all-cause hospitalization and mortality during outbreak time periods with rates during non-outbreak time periods, controlling for background seasonality in both outcomes. The cohort consisted of 308 nursing homes that reported 407 norovirus outbreaks to NORS. Per MDS, there were 67,730 hospitalizations and 26,055 deaths in these homes during the 2-year study period. Hospitalization rates were 124.0 and 109.5 hospitalizations/home-year during outbreak and non-outbreak periods respectively, yielding a seasonally-adjusted rate ratio (aRR) of 1.09 (95% CI: 1.05–1.14, p<0.001). Similarly, mortality rates were 53.7 versus 41.9 deaths/home-year in outbreak versus non-outbreak periods; an aRR of 1.11 [95% CI: 1.04–1.18, p=0.001]. The increases in hospitalizations and mortality were concentrated in the first two weeks and the first week of the outbreak, respectively. The increase in mortality during outbreak periods was limited to nursing homes with < 0.75 daily registered nurse (RN) hours per bed. Residents over the age of 90 experienced the greatest increase in hospitalization and mortality rates during outbreaks.

To read the original article and study CLICK HERE.
Pedagogy Inc. addresses these issues in a recent online continuing education course Norovirus in Long-Term Care Facilities

This online continuing education course has been designed primarily for nurses and infection prevention and control practitioners working and caring for residents in long-term care facilities. However, other care providers such as epidemiologists, facility administrators, environmental services, and other long-term care staff members will find the course information useful. The course is designed to be applicable to various types of long-term care settings and follows the recommendations of the Centers for Disease Control and Prevention’s latest 2011 HICPAC Guideline for the Prevention of Norovirus.

Norovirus is the predominant cause of acute gastroenteritis, causing both sporadic cases and outbreaks. It is estimated to be the causative agent for over 23 million gastroenteritis cases occurring every year in the U.S. Norovirus gastroenteritis infections commonly occur in healthcare settings. In fact, healthcare institutions, such as hospitals and nursing homes, are the most frequently reported settings for norovirus outbreaks in the United States and other industrialized countries.

Norovirus gastrointestinal infections can be particularly problematic in long-term care facilities. Due to the close proximity of living quarters, communal spaces, the reduced levels of personal hygiene and mobility of residents, along with the extreme contagious nature of the virus, norovirus can spread quickly in these types of facilities. Most long-term care facilities are populated by elderly residents and/or individuals who have significant underlying medical conditions. This makes them a susceptible and vulnerable group for norovirus infections. Due to these challenges, it is vitally important for long-term care facilities to implement measures and policies to prevent norovirus infections and take swift infection control actions if an outbreak is suspected.
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