Impact of Hand Hygiene (HH) Compliance on a Norovirus Outbreak in a Long Term Care home (LTCH)

 

Background:

Norovirus outbreaks are common in LTCHs. Norovirus is highly infectious and is transmitted via the fecal-oral route, including by contaminated hands. In January 2009, a Norovirus outbreak was observed in our hospital's 535-bed LTCH.

 

Objective:

We examined the impact of HH compliance on a Norovirus outbreak in our LTCH.

 

Methods:

Staff HH compliance was collected using standardized, validated audit tool prior to the outbreak. During the outbreak, resident and staff cases were followed. Attack rates (AR) of residents and staff for all outbreak-affected units were calculated. Linear regression analysis was used to examine the relationships between unit HH compliance and (a) overall unit AR, (b) unit staff AR and (c) unit resident AR for all affected units.

Results:

The outbreak involved all 9 units within one building and lasted 34 days. 111 people were affected, 72 residents and 39 staff. The mean unit AR was 18 % (range 1-51%): mean resident AR was 27% (range 0-80%) and mean staff AR was 12% (range 0 - 47%) Mean unit HH compliance rate was 51% (range 12-81%). Individual unit HH compliance rate was inversely related to overall unit AR, unit staff AR and unit resident AR: the higher the unit HH compliance rate, the lower the AR. The relationships are statistically significant (p=0.001).

 

Conclusions:

Staff HH compliance rate may be used as an indicator to predict the impact of a Norovirus outbreak. Improving HH compliance in LTCHs may decrease the impact of Norovirus outbreaks.