Poor Behaviors are Wall Breakers – Lessons Learned from a Rotavirus Outbreak in a Children's Hospital

Poor Behaviors are Wall Breakers – Lessons Learned from a Rotavirus Outbreak in a Children's Hospital

Background:   Rotavirus is a leading cause of severe diarrhea in young children.  The virus can survive for long periods of time on ordinary surfaces and is easily spread through contaminated hands or objects.  In addition to hand washing and wearing gown and gloves, placing patients (pts) in private rooms is one of the measures for preventing rotavirus transmission in healthcare settings.

Objective:   To describe behavior factors that contributed to a rotavirus outbreak in a children's hospital.

Methods:   The outbreak occurred in an inpatient unit providing pre-surgery evaluation and post-surgery care for children with heart and kidney diseases at Children's National Medical Center in Washington, D.C.  Pts in the unit between 2/09 and 3/09 were eligible for the study. Cases were pts who developed gastroenteritis during the study period and had ≥1 stool samples tested positive for rotavirus. Case pts' medical charts were reviewed to extract information on demographic, underlying diseases, and clinical courses for the hospitalization. The presence of a rotavirus outbreak was confirmed by constructing an EpiCurve, and by results of genomic analysis of stool samples collected from case pts.

Results:   In the study period, 7 case pts were confirmed by clinical symptoms and stool testing results. Of the two index pts, one was 2 years old and had a history of Fontan procedure. The pt was deceased after a prolonged hospitalization. Following the admission of the two index patients, five pts acquired rotavirus infections within 3 weeks (Figure). Genome sequencing showed that G9P [8] rotavirus were isolated from 6 of the 7 stool specimens. The average age of case pts was 173 days (range 20 days to 1.9 years) at the infection onset and 57% were boys.  All case pts had undergone surgeries for congenital heart defects. During the outbreak period, these 7 pts were all in private rooms, but neighbored to each other at a given time. Parents of two pts visited each other's room after one pt developed diarrhea. Further observation revealed that radiology technicians put the same sheet underneath a pt when taking chest X-ray and performed inadequate disinfection of the sheet between pts. The outbreak was disrupted after instituting two infection control measures: 1) prohibiting parents from visiting other pt's room, and 2) re-enforcing proper disinfection of medical equipment between pt uses among radiology technicians.

Conclusions:   Despite great engineering control by providing private rooms to hospitalized pts, risks of transmitting infectious agents in hospitalized pts remain. In the course of preventing healthcare associated infections, attentions ought to be given to vigilant adherence to basic infection control tactics among both healthcare providers as well as family visitors.