Norovirus outbreak in pediatric ward highlights challenges of infection control
Click Here to Manage Email Alerts
Researchers reported findings from a norovirus outbreak in a pediatric ward with multiple-bed rooms and emphasized the importance of early detection and prompt implementation of strict infection control measures.
Because norovirus can spread rapidly in a small space, controlling an outbreak in such a setting presents a challenge.
“Since the introduction of the rotavirus vaccine, norovirus is emerging as a common cause for acute gastroenteritis among infants and children,” Mi Seon Han, MD, PhD, from the department of pediatrics at Seoul National University Children’s Hospital in South Korea, and colleagues wrote in the American Journal of Infection Control. “Frequent contact with caregivers, bottle feeding, and wet diapers can facilitate the spread of the virus in pediatric wards.”
According to the researchers, common norovirus infection control strategies include adherence to hand hygiene, patient isolation and cohorting, visitor restrictions and enhanced environmental cleaning and disinfection. Although these efforts have been used extensively, the value of implementing specific measures in reducing the extent or duration of an outbreak has yet to be determined, they wrote.
They retrospectively reviewed medical records from an outbreak of acute diarrhea that occurred in a pediatric cardiology/pulmonology unit between December 2017 and January 2018 and found that among 22 patients, norovirus was detected in the stool specimen of 10. The 10 cases occurred in a population of 114 patients at risk for exposure, an attack rate of 8.77%.
The median patient age was 10 months, symptoms lasted for a median of 7.5 days and norovirus shed in stool for a median of 19.5 days. According to the researchers, among the first five cases, four were clustered in the same multi-bed room with seven beds, and each experienced vomiting and acute diarrhea. The researchers noted that all cases occurred in four multi-bed rooms, with a clustering of cases in two of the rooms, implying nosocomial transmission of the virus.
Following the first four cases, the Center for Infection Control and Prevention requested infection control measures, which included cohort isolation for the remaining patients with norovirus infection, strict adherence to contact precautions and environmental cleaning.
A sixth patient was linked with the clustered cases and had stayed in the ICU, leading to three more infections. After the sixth patient and the three subsequently infected patients were transferred back to the ward, one additional patient was infected.
Following the additional cases, the hospital staff implemented enhanced control measures, which included environmental cleaning with an intensified 5,000-ppm bleach solution and evaluation of the effect of cleaning with the adenosine triphosphate surface test. The ward was temporarily closed but soon reopened once no new cases were identified 6 days after the last confirmed case. The outbreak was successfully contained 24 days after the first case, the researchers wrote.
“Norovirus outbreak in a pediatric ward with multi-bed rooms poses a challenge in controlling the spread, as the virus can be rapidly transmitted via both direct and indirect contact in a confined space, children shed the virus for a prolonged time, and their diapers are handled by their caregivers in a shared bathroom,” they wrote. “Various infection control measures, including strict adherence to contact precautions, implementing cohort isolation, and cleaning the environment, are obvious yet still essential in controlling norovirus outbreaks in hospital settings.” – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.
Read more about
Click Here to Manage Email Alerts