This article describes a major outbreak of Norovirus that occurred in February 2010 in an acute hospi-T tal in London, including a summary of the epidemiology, control measures, and impact on the organisation. Due to the scale of this outbreak, the design of the site, and multiple patient safety priorities, outbreak management strictly in accordance with national guidelines proved to be difficult. Large-scale cohorting measures were implemented and appeared to be helpful in terminating the outbreak, supporting the delivery of safe patient care for emergency admissions, and minimising impact on the trust’s achievement of performance targets. With current demands on NHS resources, adoption of more flexible approaches to the isolation and cohorting of patients with diarrhoea and vomiting due to Norovirus may be required.
Adak GK, Barker M. ( 2003) Outbreak of norovirus infection on a cruise liner in the Mediterranean. Eurosurveillance7(45): 2321. http:// www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2321 (accessed 29 December 2010).
2.
Barker J., Vipond IB, Bloomfield SF ( 2004) Effects of cleaning and disinfection in reducing the spread of Norovirus contamination via environmental surfaces. Journal of Hospital Infection58: 42-9.
3.
Chadwick PR, Beards G., Brown D., Caul EO, Cheesbrough J., Clarke I., Curry A., O’Brien S., Quigley K., Sellwood J., Westmoreland D. ( 2000) Management of hospital outbreaks of gastro-enteritis due to small round structured viruses. Report of the public health laboratory service viral gastroenteritis working group. Journal of Hospital Infection45: 1-10.
4.
Chadwick PR, McCann R. ( 1994) Transmission of a small round structured virus by vomiting during a hospital outbreak of gastroenteritis. Journal of Hospital Infection26: 251-9.
5.
Cooke RPD, Goddard SV and Golland J. ( 2003) Costing a major hospital outbreak of gastroenteritis due to Norovirus (Norwalk-like virus). British Journal of Infection Control4(2): 18-21.
6.
Cramer EH, Blanton CJ, Blanton LH, Vaughan GH, Bopp CA, Forney DL ( 2006) Epidemiology of gastroenteritis on cruise ships, 2001-2004 . American Journal of Preventive Medicine30(3): 252-7.
7.
Dalling J. ( 2004) A review of environmental contamination during outbreaks of Norwalk-like virus. British Journal of Infection Control5(2): 9-13.
8.
Glass RI, Noel J., Ando T., Fankhauser R., Belliot G., Mounts A., Parashar UD, Bresee JS, Monroe SS ( 2000) The epidemiology of enteric caliciviruses from humans: a reassessment using new diagnostics. Journal of Infectious Diseases181(Suppl 2): S254-61.
9.
Harris JP, Allen DJ, Iturriza-Gomara M. ( 2010a) Norovirus: changing epidemiology, changing virology. The challenges for infection control. Journal of Infection Preventionhttp://bji.sagepub.com/content/early/2010/12/08/1757177410392094 (accessed 29 December 2010). Harris JP, Lopman BA, O’Brien SJ (2010b) Infection control measures for norovirus: a systematic review of outbreaks in semi-enclosed settings. Journal of Hospital Infection74: 1-9.
10.
Health Protection Agency. (2010a) Comparison of laboratory data on hospital norovirus reports in 2009 and 2010 . http://www.hpa.org.uk/hpr/infections/enteric.htm#noro (accessed 29 December 2010).
11.
Health Protection Agency. (2010b) Norovirus outbreaks surge in London. http://www.hpa.org.uk/ProductsServices/LocalServices/London/LondonPressReleases/lond100113NorovirusoutbreakssurgeinLondon/ (aessed 29th December 2010).
12.
Heijne JCM, Teunis P., Morroy G., Wijkmans C., Oostveen S., Duizer E., Kretzschmar M., Wallinga J. ( 2009) Enhanced hygiene measures and norovirus transmission during an outbreak. Emerging Infectious Diseaseshttp://www.cdc.gov/EID/content/15/1/24.htm (accessed 29 December 2010).
13.
Lopman BA, Andrews N., Sarangi J., Vipond IB, Brown DWG, Reacher MH ( 2005) Institutional risk factors for outbreaks of nosocomial gastroenteritis: survival analysis of a cohort of hospital units in South-west England, 2002-2003. Journal of Hospital Infection60: 135-43.
14.
Lopman BA, Reacher M., van Duijnhoven Y., Hanon F., Brown D., Koopmans M. ( 2003) Viral gastroenteritis outbreaks in Europe, 1995- 2000 . Emerging Infectious Diseases9(1): 90-6.
15.
Orr D., Illingworth E., Taborn E., Fielding D., Cheesbrough J. ( 2010) Is closure of entire wards necessary to control norovirus outbreaks in hospital? Comparing the effectiveness of two infection control strategies: Abstract, 7th International Conference of the Hospital Infection Society, 10-13 October 2010, Liverpool, UK. Journal of Hospital Infection 76(Supplement): S56.
16.
Perry C. ( 2003) Evidence and common sense. British Journal of Infection Control4(2): 5.
17.
Siegel JD, Rhinehart E., Jackson M., Chiarello L., the Healthcare Infection Control Practices Advisory Committee. (2007) Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf (accessed 9 January 2011).
18.
Vidal R., Solari V., Mamani N., Jiang X., Vollaire J., Roessler P., Prado V., Matson DO, O’Ryan ML ( 2005) Caliciviruses and foodborne gastroenteritis, Chile . Emerging Infectious Diseases11: 1134-7.
19.
Wyeth J., Virgincar N., Stacey A., Chrisopoulos S., Honor C. ( 2010) Norovirus outbreaks versus operational activity: a balancing act: Abstract, 7th International Conference of the Hospital Infection Society, 10-13 October 2010, Liverpool, UK. Journal of Hospital Infection 76(Supplement): S44.
20.
Zintz C., Bok K., Parada E., Barnes-Eley M., Berkre T., Staat M., Azimi P., Jiang X., Matson DO ( 2005) Prevalence and genetic characterization of caliciviruses among children hospitalized for acute gastroenteritis in the United States . Infection, Genetics and Evolution5: 281-90.
