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State-level adoption of national guidelines for norovirus outbreaks in health care settings

      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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      References

        • Mac Kenzie W.R.
        • Davidson A.J.
        • Wiesenthal A.
        • Engel J.P.
        • Turner K.
        • Conn L.
        • et al.
        The promise of electronic case reporting.
        Public Health Rep. 2016; 131: 742-746
        • Office of the Assistant Secretary for Health
        Public health 3.0: a call to action to create a 21st century public health infrastructure.
        U.S. Department of Health and Human Services, Washington (DC)2016
        • Li Y.
        • Fang L.
        • Gao S.
        • Wang Z.
        • Gao H.
        • Liu P.
        • et al.
        Decision support system for the response to infectious disease emergencies based on webgis and mobile services in China.
        PLoS ONE. 2013; 8 (e54842)
        • MacCannel T.
        • Umscheid C.A.
        • Agarwal R.K.
        • Lee I.
        • Kuntz G.
        • Stevenson K.B.
        Guideline for the prevention and control of norovirus gastroenteritis outbreaks in healthcare settings.
        Infect Control Hosp Epidemiol. 2011; 32: 939-969
        • Hall A.J.
        • Lopman B.A.
        • Payne D.C.
        • Patel M.M.
        • Gastanaduy P.A.
        • Vinje J.
        • et al.
        Norovirus disease in the United States.
        Emerg Infect Dis. 2013; 19: 1198-1205
        • Hall A.J.
        • Wikswo M.E.
        • Manikonda K.
        • Roberts V.A.
        • Yoder J.S.
        • Gould L.H.
        Acute gastroenteritis surveillance through the national outbreak reporting system, United States.
        Emerg Infect Dis. 2013; 19: 1305-1306
        • Healthcare-Associated Infection Program
        Norovirus outbreak detection and management: guidance for long-term care facilities.
        Arizona Department of Health Services, Phoenix (AZ)2012
        • Division of Communicable Disease Control
        Recommendations for the prevention and control of viral gastroenteritis outbreaks in California long-term care facilities.
        California Department of Health Services, Richmond (CA)2006
        • Colorado Department of Public Health & Environment
        Investigation and management of outbreaks of known or suspected norovirus in health care and residential facilities.
        Colorado Department of Public Health & Environment, Denver (CO)2015
        • Applewhite C.
        • Weeks T.
        Foodborne disease outbreak investigations: a practical guide for local health departments.
        Version 3. Connecticut Department of Public Health, Hartford (CT)2015
        • Division of Public Health
        Guidelines for norovirus prevention and control in long term care facilities.
        Delaware Health and Social Services, Dover (DE)2011
      1. Georgia Department of Public Health. Recommendations for the control of viral gastroenteritis outbreaks in long-term care facilities. Atlanta (GA): Georgia Department of Public Health.

        • Center for Acute Disease Epidemiology
        Guide to surveillance, investigations, and reporting.
        Iowa Department of Public Health, Des Moines (IA)2014
        • Division of Public Health
        Idaho investigative guidelines: norovirus.
        Idaho Department of Health and Welfare, Boise (ID)2015
        • Conway J.A.
        Guideline for the prevention and control of viral acute gastroenteritis outbreaks in illinois long-term care facilities, 2012.
        Illinois Department of Public Health, Springfield (IL)2012
        • Stauffer J.
        Indiana epidemiology newsletter: norovirus outbreak prevention and control in long-term care settings.
        Indiana State Department of Health, Indianapolis (IN)2014
        • Indiana State Department of Health
        Gastrointestinal virus infection control measures: healthcare facilities.
        Indiana State Department of Health, Indianapolis (IN)2014
        • Kentucky Department for Public Health
        Norovirus outbreak response guide.
        (Revision 3) Kentucky Department for Public Health, Frankfort (KY)2014
        • Infectious Disease Epidemiology Section
        Norovirus infections.
        Louisiana Department of Health & Hospitals, Baton Rouge (LA)2013
        • Infectious Disease Epidemiology Section
        Guidelines for the control of a suspected or confirmed outbreak of viral gastroenteritis in a long term care facility.
        Louisiana Department of Health & Hospitals, Baton Rouge (LA)2010
        • Division of Epidemiology and Immunization
        Gastrointestinal disease: infection control guidelines for long-term care facilities.
        Massachusetts Department of Public Health, Boston (MA)2009
        • Bureau of Communicable Disease Control
        Norovirus & other caliciviruses.
        Massachusetts Department of Public Health, Boston (MA)2006
        • Maryland Department of Health and Mental Hygiene
        Guidelines for the epidemiological investigation of gastroenteritis outbreaks in long term care facilities.
        Maryland Department of Health and Mental Hygiene, Baltimore (MD)2001
        • Maine Center for Disease Control and Prevention
        Norovirus outbreak guidance for long term care.
        Maine Center for Disease Control and Prevention, Augusta (ME)2015
        • Communicable Disease Division
        Guidelines for the control of a suspected or confirmed outbreak of viral gastroenteritis in a nursing home.
        Michigan Department of Community Health, Lansing (MI)2015
        • Communicable Disease Division
        Norovirus investigations in long term care facilities: things to consider.
        Michigan Department of Community Health, Lansing (MI)2015
      2. Minnesota Department of Health. Checklist for nursing homes/long term care facilities when outbreaks of gastroenteritis are suspected. St. Paul (MN): Minnesota Department of Health.

        • Division of Community and Public Health
        Communicable disease investigation reference manual: outbreak investigation: acute gastroenteritis.
        Missouri Department of Health and Senior Services, Jefferson City (MO)2012
        • Office of Communicable Diseases
        Epidemiology manual: guidelines for surveillance reporting and control.
        Mississippi State Department of Health, Jackson (MS)2016
        • Montana Department of Public Health and Human Services
        Norovirus outbreak management and disease prevention guidelines: health care settings.
        Montana Department of Public Health and Human Services, Helena (MT)2016
        • North Carolina Statewide Program for Infection Control and Epidemiology
        Control of suspected norovirus outbreaks in long term care facilities.
        (N.C. Public Health Recommendations) North Carolina Division of Public Health, Raleigh (NC)2015
        • Division of Disease Control
        What do I need to know? Norovirus in health-care facilities.
        North Dakota Department of Health, Bismarck (ND)2006
        • Schaefer J.
        • Safranek T.J.
        Health alert network update: preventing and containing norovirus outbreaks.
        Nebraska Department of Health and Human Services, Lincoln (NE)2013
        • NH Division of Public Health Services
        NH DHHS health alert: increase in norovirus activity in New Hampshire.
        New Hampshire Department of Health and Human Services, Concord (NH)2016
        • Communicable Disease Service
        Guidelines for the control of gastroenteritis outbreaks in long-term care and other institutional settings.
        New Jersey Department of Health and Senior Services, Trenton (NJ)2011
      3. New Mexico Department of Health. Norovirus in long term care facilities: outbreak checklist. Santa Fe (NM): New Mexico Department of Health.

        • Bureau of Health Statistics, Planning, Epidemiology & Response
        Norovirus management toolkit: outbreak preparedness & response.
        Version 1.1. Nevada State Health Division, Carson City (NV)2012
        • Enos L.
        • Peek J.
        • Graber P.
        • Gomez M.
        • Sowadsky R.
        • Urrutia M.
        Norovirus in skilled nursing facilities in Nevada.
        Nevada State Health Division, Carson City (NV)2012
        • Bureau of Health Care Quality and Compliance
        Recommendations for preventing and controlling viral gastroenteritis outbreaks in medical and residential care facilities.
        Nevada State Health Division, Carson City (NV)2009
        • Bureau of Communicable Disease Control
        Health advisory: prevention and control of nosocomial gastrointestinal illness outbreaks.
        New York State Department of Health, Albany (NY)2006
        • Ohio Department of Health
        General infection prevention and control recommendations: residential and long-term care facilities.
        Ohio Department of Health, Columbus (OH)2012
        • Acute Disease Service
        Public health fact sheet: norovirus infection control recommendations for healthcare, long-term care, and residential care settings.
        Oklahoma State Department of Health, Oklahoma City (OK)2011
        • Oregon State Public Health Division
        Norovirus outbreak detection and management: instruction for long-term care facilities.
        Oregon Health Authority, Portland (OR)2014
        • Center for Acute Infectious Disease Epidemiology
        Gastrointestinal illness cluster/outbreak investigation in a long-term care facility.
        Version 1. Rhode Island Department of Health, Providence (RI)2016
        • South Carolina Department of Health and Environmental Control
        Guidance: suspected norovirus outbreaks in institutional settings.
        South Carolina Department of Health and Environmental Control, Columbia (SC)2014
        • Communicable and Environmental Diseases and Emergency Preparedness
        Recommendations for the prevention and control of viral gastroenteritis outbreaks in long-term care facilities.
        Tennessee Department of Health, Nashville (TN)2013
        • Infectious Disease Control Unit
        The emerging and acute infectious disease guidelines: norovirus outbreaks.
        Texas Department of State Health Services, Austin (TX)2015
        • Utah Department of Health
        Utah Public Health—disease investigation plans: norovirus (Norwalk-like virus).
        Utah Deparment of Health, Salt Lake City (UT)2010
        • Virginia Department of Health
        Norovirus prevention guidance for institutions/facilities.
        Virginia Department of Health, Richmond (VA)2013
        • Virginia Department of Health
        Office of epidemiology. Norovirus outbreaks.
        Virginia Department of Health, Richmond (VA)2014
        • Kelso P.
        Health advisory: norovirus update.
        Vermont Department of Health, Burlington (VT)2012
        • Bureau of Communicable Diseases and Emergency Response
        Recommendations for the prevention and control of viral gastroenteritis outbreaks in Wisconsin long-term care facilities.
        Wisconsin Division of Public Health, Madison (WI)2009
      4. West Virginia Bureau for Public Health. Guidelines for suspected norovirus outbreaks in healthcare facilities. Charleston (WV): Department of Health and Human Services.

      5. Epidemiology Unit. Guidelines for the control of a suspected or confirmed outbreak of viral gastroenteritis in a nursing home or institution. Cheyenne (WY): Wyoming Department of Health.

        • Centers for Disease Control and Prevention
        Prevention strategies for seasonal influenza in healthcare settings.
        (Available from:)
        • Hall A.J.
        • Vinjé J.
        • Lopman B.A.
        • Park G.W.
        • Yen C.
        • Gregoricus N.
        • et al.
        Updated norovirus outbreak management and disease prevention guidelines.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1-15
        • NORS Team
        National Outbreak Reporting System (NORS) guidance.
        Centers for Disease Control and Prevention, Atlanta (GA)2017
        • Faulkner A.
        • Skoff T.
        • Cassiday P.
        • Tondella M.L.
        • Liang J.
        Measles.
        in: Rousch S.W. Baldy L.M. Manual for the surveillance of vaccine-preventable diseases. Centers for Disease Control and Prevention, Atlanta (GA)2008: 7-11
        • Population Division, U.S. Census Bureau
        American community survey. Annual estimates of the resident population: April 1, 2010 to July 1, 2016.
        (Available from:)
        https://factfinder.census.gov/
        Date: 2016
        Date accessed: July 1, 2017
        • Kaplan J.E.
        • Gary G.W.
        • Baron R.C.
        • Singh N.
        • Schonberger L.B.
        • Feldman R.
        • et al.
        Epidemiology of Norwalk gastroenteritis and the role of Norwalk virus in outbreaks of acute nonbacterial gastroenteritis.
        Ann Intern Med. 1982; 96: 756-761