181783 Two norovirus outbreaks: Same nurse manager, different outcomes

Wednesday, October 29, 2008

Stephen G. Long, MD , Bureau of Epidemiology, Houston Department of Health and Human Services, Houston, TX
Yufang Zhang, MD MPH , Bureau of Epidemiology, Houston Department of Health and Human Services, Houston, TX
Brenda J. Thorne, MS, DTM , Bureau of Epidemiology, Houston Department of Health and Human Services, Houston, TX
Adebowale Awosika-Olumo, MD, MS, MPH , Bureau of Epidemiology, Houston Department of Health and Human Services, Houston, TX
Background: Houston Department of Health and Human Services (HDHHS) investigated two norovirus outbreaks at two assisted living facilities in Houston. The director of nursing at the prior nursing home, later became the director of nursing in another nursing home with a similar outbreak. Methods: In March 2007, the first outbreak was reported to HDHHS on day 16 of onset. At reporting, 36 of 127 residents were ill and the illness had spread to all units of the facility. Recommended control measures included room isolation of ill residents and work exclusion of ill staff for four days post-symptoms; however, management delayed enforcement of these recommendations. In December 2007, the same nurse manager employed by the new facility of 350 residents reported the second outbreak to HDHHS on day 9 of onset. She immediately adopted recommended control measures. Recommendations were similar for both facilities. Results: The first outbreak was contained by day 32. In all, 71 residents became sick (attack rate 56%), and two residents died. The second outbreak was contained by day 16. The spread of disease in the second outbreak was limited to two floors (out of 17 floors); 28 residents became sick (attack rate 8%), and none died. Conclusion: The control of norovirus outbreaks at assisted living facilities is dependent on the early reporting of the outbreak to the local health department and the cooperation of management in enforcing recommendations. The swift adoption of the control measures enabled the second facility to lessen the severity of the second outbreak.

Learning Objectives:
1. Develop a protocol for successfully responding to a potential norovirus outbreak in an assisted living facility 2.Recognize the importance of early reporting to a local health department of an outbreak of gastrointestinal illness in an assisted living facility 3. Identify strategies that would lead to early cooperation between a health department and an assisted living facility in the event of an outbreak 4.Assess the strengths and weaknesses of a response to a gastrointestinal outbreak

Keywords: Outbreaks, Nursing Homes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I work as an epidemiologist at Houston Department of Health and Human Services, where I am assigned the task of investigating outbreaks of gastrointestinal illness. I participated in the two investigations described in this abstract
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.