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Frequency of outbreak investigations in US hospitals: Results of a national survey of infection preventionists

      Background

      A survey of infection preventionists was conducted to determine the frequency of outbreak investigations in US hospitals.

      Methods

      A 2-part electronic survey was sent to Association for Professionals in Infection Control and Epidemiology, Inc, members in US hospitals in January 2010. Part 1 of the survey tool involved hospital demographics and the infection prevention/control program. Part 2 explored specific outbreak investigations allowing responses for up to 8 investigations within the previous 24 months.

      Results

      A final sample of 822 responses was analyzed representing 386 outbreak investigations in 289 US hospitals. Nearly 60% of the outbreaks were caused by 4 organisms: norovirus (18%), Staphylococcus aureus (17%), Acinetobactor spp (14%), and Clostridium difficile (10%). Norovirus occurred most often in behavioral health and rehabilitation/long-term acute care units, whereas the other organisms occurred in medical/surgical units. Unit/department closure was reported in 22.6% of investigations and most often associated with norovirus. Outbreak investigations are triggered by unusual organisms, rate above baseline for specific site of infection, and rate above baseline for specific unit. Investigations were most frequently conducted in community/nonteaching hospitals and facilities with 201 to 300 beds. Mean number of confirmed cases was 10; mean duration was 58 days.

      Conclusion

      Norovirus is emerging as an increasingly common hospital-associated organism causing outbreaks in nonacute settings and may lead to unit/department closures.

      Key Words

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      References

        • Horan T.C.
        • Andrus M.
        • Dudeck M.A.
        CDC/NHSN surveillance definitions of healthcare-associated infections and criteria for specific types of infections in the acute care setting.
        Am J Infect Control. 2008; 35: 309-332
        • NNIS System Report
        National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004.
        Am J Infect Control. 2004; 32: 470-485
        • Edwards J.R.
        • Peterson K.P.
        • Mu Y.
        • Banerjee S.
        • Allen-Bridson K.
        • Morrell G.
        • et al.
        National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009.
        Am J Infect Control. 2009; 37: 783-805
        • Gastmeier P.
        • Stamm-Balderjahn S.
        • Hansen S.
        • Nitzschke-Tiemann F.
        • Zuschneid I.
        • Groneberg K.
        • et al.
        How outbreaks can contribute to prevention of nosocomial infection: analysis of 1022 outbreaks.
        Infect Control Hosp Epidemiol. 2005; 26: 357-361
        • CDC
        Norovirus activity: United States, 2006-2007.
        Morb Mortal Wkly Rep. 2007; 56: 842-846
        • Said M.A.
        • Perl T.M.
        • Sears C.L.
        Healthcare epidemiology: gastrointestinal flu: norovirus in healthcare and long term care facilities.
        Clin Infect Dis. 2008; 47: 1202-1208
        • Jarvis W.R.
        • Schlosser J.
        • Jarvis A.A.
        • Chinn R.Y.
        National point prevalence of Clostridium difficile in US healthcare facility inpatients, 2008.
        Am J Infect Control. 2009; 37: 263-270
        • Kuijper E.F.
        • Coignard B.
        • Tull P.
        • et al.
        Emergence of Clostridium difficile-associated disease in North America and Europe.
        Clin Microbiol Infect. 2006; 12: 2-18
        • Siegel J.
        • Rhinehart E.
        • Jackson M.
        • Chiarello L.
        The Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-resistant organisms in healthcare settings: 2006.
        Am J Infect Control. 2007; 35: S165-S193
        • Hansen S.
        • Stamm-Balderjahn S.
        • Zuschneid I.
        • Behnke M.
        • Ruden H.
        • Vonberg R.
        • et al.
        Closure of medical departments during nosocomial outbreaks: data from a systematic analysis of the literature.
        J Hosp Infect. 2007; 65: 348-353
      1. McCannell T, Umscheid CA, Agarwal RK, Lee I, Kuntz G, Stevenson KB, et al. Guideline for the prevention and control of norovirus gastroenteritis outbreaks in healthcare settings. Available from: http://www.cdc.gov/hicpac/norovirus/002_norovirus-toc.html. Accessed November 30, 2011.

        • Lopman B.A.
        • Adak G.K.
        • Reacher M.H.
        • Brown D.W.G.
        Two epidemiologic patterns of norovirus outbreaks: surveillance in England and Wales, 1992-2000.
        Emerg Infect Dis. 2003; 9: 71-77
        • Srinivasan A.
        Outbreak investigation. APIC text of infection control and epidemiology.
        3rd ed. Association for Professionals in Infection Control and Epidemiology, Inc, Washington [DC]2009 (p. 4-1-10)
      2. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Available from: http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html. Accessed November 30, 2011.

        • Johnston C.P.
        • Qiu H.
        • Ticehurst J.R.
        • et al.
        Outbreak management and implications of a nosocomial norovirus outbreak.
        Clin Infect Dis. 2007; 45: 534-540
        • Piednoir E.
        • Bureau-Chalot F.
        • Merle C.
        • et al.
        Direct costs associated with a nosocomial outbreak of adenoviral conjunctivitis infection in a long-term care institution.
        Am J Infect Control. 2002; 30: 407-410