Background
Clinical decision support (CDS) systems can help investigators use best practices
when responding to outbreaks, but variation in guidelines between jurisdictions can
make such systems hard to develop and implement. This study aimed to identify (1)
the extent to which state-level guidelines adhere to national recommendations for
norovirus outbreak response in health care settings and (2) the impact of variation
between states on outbreak outcomes.
Methods
State guidelines were obtained from Internet searches and direct contact with state
public health officials in early 2016. Outcomes from norovirus outbreaks that occurred
in 2015 were compared using data from the National Outbreak Reporting System.
Results
Guidelines were obtained from 41 of 45 (91%) state health departments that responded
to queries or had guidelines available on their Web sites. Most state guidelines addressed
each of the national recommendations, but specific guidance varied considerably. For
example, among 36 states with guidance on numbers of stool specimens to collect, there
were 21 different recommendations. Furthermore, having guidelines consistent with
national recommendations was associated with fewer outbreaks reported and more outbreaks
with confirmed etiology.
Conclusions
This study identified substantial variation in state health care–associated norovirus
outbreak response guidelines, which must be considered when developing related CDS
systems. More research is needed to understand why this variation exists, how it impacts
outbreak outcomes, and where improvements in evidence-based recommendations and communication
of national guidance are needed.
Key Words
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Article Info
Publication History
Published online: May 17, 2018
Footnotes
Conflicts of interest: None declared.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
