Skip to main content Accessibility help
×
×
Home

Impact of an Outbreak of Norovirus Infection on Hospital Resources

  • Walter Zingg (a1), Carlo Colombo (a1), Thomas Jucker (a2), Walter Bossart (a3) and Christian Ruef (a1)...

Abstract

Objective:

To describe a nosocomial norovirus outbreak, its management, and its financial impact on hospital resources.

Design:

A matched case-control study and microbiological investigation.

Methods:

We compared 16 patients with norovirus infection with control-patients matched by age, gender, disease category, and length of stay. Bed occupancy-days during the peak incidence period of the outbreak were compared with the corresponding periods in 2001 and 2002. Expenses due to increased workload were calculated based on a measuring system that records time spent for nursing care per patient per day.

Results:

The attack rates were 13.9% among patients and 29.5% among healthcare workers. The median number of occupied beds was significantly lower due to bed closure during the peak incidence in 2003 (29) compared with the median number of occupied beds in 2001 and 2002 combined (42.5). Based on this difference and a daily charge of $562.50 per patient, we calculated a revenue loss of S37.968. Additional expenses totaled $10,300 for increased nursing care. Extra costs for microbiological diagnosis totaled $2,707. Lost productivity costs due to healthcare workers on sick leave totaled $12,807. The expenses for work by the infection control team totaled $1,408. The financial impact of this outbreak on hospital resources comprising loss of revenue and extra costs for microbiological diagnosis but without lost productivity costs, increased nursing care, and expenses for the infection control team totaled $40,675.

Conclusions:

Nosocomial norovirus outbreaks result in significant loss of revenue and increased use of resources. Bed closures had a greater impact on hospital resources than increased need for nursing care.

Copyright

Corresponding author

Hospital Epidemiology Unit, Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, SwitzerlandWalter.Zingg@kispi.unizh.ch

References

Hide All
1.Kapikian, AZ, Wyatt, RG, Dolin, R, Thornhill, TS, Kalica, AR, Chanock, RM. Visualization by immune electron microscopy of a 27-nm particle associated with acute infectious nonbacterial gastroenteritis. J Virol 1972;10:10751081.
2.Appleton, H, Buckley, M, Thorn, BT, Cotton, JL, Henderson, S. Virus-like particles in winter vomiting disease. Lancet 1977;1:409411.
3.Dolin, R, Blacklow, NR, DuPont, H, et al.Biological properties of Norwalk agent of acute infectious nonbacterial gastroenteritis. Proceedings of the Society for Experimental Biology and Medicine 1972; 140:578583.
4.Berg, DE, Kohn, MA, Farley, TA, McFarland, LM. Multi-state outbreaks of acute gastroenteritis traced to fecal-contaminated oysters harvested in Louisiana. J Infect Dis 2000;181(suppl 2):S381S386.
5.Kaplan, JE, Gary, GW, Baron, RC, et al.Epidemiology of Norwalk gastroenteritis and the role of Norwalk virus in outbreaks of acute nonbacterial gastroenteritis. Ann Intern Med 1982;96:756761.
6.Kaplan, JE, Schönberger, LB, Varano, G, Jackman, N, Bied, J, Gary, GW. An outbreak of acute nonbacterial gastroenteritis in a nursing home: demonstration of person-to-person transmission by temporal clustering of cases. Am J Epidemiol 1982;116:940948.
7.Geliert, GA, Waterman, SH, Ewert, D, et al.An outbreak of acute gastroenteritis caused by a small round structured virus in a geriatric convalescent facility. Infect Control Hosp Epidemiol 1990;11:459464.
8.Chadwick, PR, McCann, R. Transmission of a small round structured virus by vomiting during a hospital outbreak of gastroenteritis. J Hosp Infect 1994;26:251259.
9.Stevenson, P, McCann, R, Duthie, R, Glew, E, Ganguli, L. A hospital outbreak due to Norwalk virus. J Hosp Infect 1994;26:261272.
10.Billgren, M, Christenson, B, Hedlund, KO, Vinje, J. Epidemiology of Norwalk-like human caliciviruses in hospital outbreaks of acute gastroenteritis in the Stockholm area in 1996. J Infect 2002;44:2632.
11.Gunn, RA, Terranova, WA, Greenberg, HB, et al.Norwalk virus gastroenteritis aboard a cruise ship: an outbreak on five consecutive cruises. Am J Epidemiol 1980;112:820827.
12.Ho, MS, Glass, RI, Monroe, SS, et al.Viral gastroenteritis aboard a cruise ship. Lancet 1989;2:961965.
13.Khan, AS, Moe, CL, Glass, RI, et al.Norwalk virus-associated gastroenteritis traced to ice consumption aboard a cruise ship in Hawaii: comparison and application of molecular method-based assays. J Clin Microbiol 1994;32:318322.
14.Arness, MK, Feighner, BH, Canham, ML, et al.Norwalk-like viral gastroenteritis outbreak in U.S. Army trainees. Emerg Infect Dis 2000;6:204207.
15.Girish, R, Broor, S, Dar, L, Ghosh, D. Foodborne outbreak caused by a Norwalk-like virus in India. J Med Virol 2002;67:603607.
16.Caceres, VM, Kim, DK, Bresee, JS, et al.A viral gastroenteritis outbreak associated with person-to-person spread among hospital staff. Infect Control Hosp Epidemiol 1998;19:162167.
17.Lo, SV, Connolly, AM, Palmer, SR, Wright, D, Thomas, PD, Joynson, D. The role of the pre-symptomatic food handler in a common source outbreak of food-borne SRSV gastroenteritis in a group of hospitals. Epidemiol Infect 1994;113:513521.
18.Sawyer, LA, Murphy, JJ, Kaplan, JE, et al.25- to 30-nm virus particle associated with a hospital outbreak of acute gastroenteritis with evidence for airborne transmission. Am J Epidemiol 1988;127:12611271.
19.Caul, EO. Hyperemesis hiemis: a sick hazard. J Hosp Infect 1995;30(suppl): 498502.
20.Colombo, C, Giger, H, Grote, J, et al.Impact of teaching interventions on nurse compliance with hand disinfection. J Hosp Infect 2002;51:6972.
21.Turgeon, DK, Novicki, TJ, Quick, J, et al.Six rapid tests for direct detection of Clostridium difficile and its toxins in fecal samples compared with the fibroblast cytotoxicity assay. J Clin Microbiol 2003;41:667670.
22.Beuret, C. A simple method for isolation of enteric viruses (norovirus-es and enteroviruses) in water. J Virol Methods 2003;107:18.
23.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:15981601.
24.Whitehouse, JD, Friedman, ND, Kirkland, KB, Richardson, WJ, Sexton, DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183189.
25.Spearing, NM, Jensen, A, McCall, BJ, Neill, AS, McCormack, JG. Direct costs associated with a nosocomial outbreak of Salmonella infection: an ounce of prevention is worth a pound of cure. Am J Infect Control 2000;28:5457.
26.Sartor, C, Zandotti, C, Romain, F, et al.Disruption of services in an internal medicine unit due to a nosocomial influenza outbreak. Infect Control Hosp Epidemiol 2002;23:615619.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed