Reducing the number and impact of outbreaks of nosocomial XXXX : time-series analysis of a multidimensional quality improvement initiative.

@entity1 @entity281 @entity1800 @entity120
BACKGROUND: Nosocomial norovirus infections and their control measures disrupt @entity1 care, increase staff workload and raise healthcare costs. OBJECTIVE: To determine the impact on outbreaks of nosocomial @entity1800 , staff and @entity1 affected, and bed closures of a multidimensional quality improvement (QI) initiative focused on education; improved @entity1 surveillance; early automated recognition and notification of @entity281 of index @entity1 ; and proactive care and control measures. METHODS: In a pragmatic, retrospective, observational study, we compared numbers of suspected/confirmed norovirus outbreaks at Portsmouth Hospitals National Health Service Trust ( @entity120 ) with regional and national data, before and after a multidimensional QI initiative. We also compared mean daily bed closures due to norovirus-like symptoms. At @entity120 only we recorded @entity1 and staff numbers with norovirus-like symptoms, and days of disruption due to outbreaks. RESULTS: Annual outbreak numbers fell between 2009-2010 and 2010-2014 by 91% at @entity120 compared with 15% and 28% for Wessex and England, respectively. After April 2010, recorded outbreaks were 8 ( @entity120 ), 383 (Wessex) and 5063 (England). For the winter periods from 2010/2011 to 2013/2014, total bed closures due to norovirus were 38 ( @entity120 ; mean 0.5 per week), 3565 (Wessex hospitals; mean 48.8 per hospital per week) and 2730 (England; mean 37.4 per hospital per week). At @entity120 , @entity1 affected by norovirus-like symptoms fell by 92%, affected staff by 81% and days of disruption by 88%. CONCLUSIONS: A multiyear QI programme, including use of real-time electronic identification of @entity1 with norovirus-like symptoms, and an early robust response to suspected @entity281 , resulted in virtual elimination of outbreaks. The ability to identify index cases of @entity281 early facilitates prompt action to prevent ongoing transmission and appears to be a crucial intervention.
