A Qualitative Evaluation of the ICTs' Experiences of Norovirus Season 2009/10 in NHS Boards in Scotland

Background: Since 2008 Health Protection Scotland (HPS) has produced real-time prevalence data (each Monday) of all wards closed in Scotland due to presumed or confirmed norovirus¹. The peak ward closure prevalence for season 2009/10 was 53 wards. This peak came when all resources were stretched. HPS was asked to undertake an evaluation of the Infection Control Teams’ (ICTs) norovirus experience.

Objective: To describe the ICTs’ experiences of the norovirus season 2009/10 and identify good management practices. To identify if there were any specific events that occurred prior to sudden peaks in ward closures. To identify the most important points of norovirus control in NHS boards in Scotland.

Methods: Ten telephone surveys and 1 face-to-face interview with ICTs were undertaken. This represents all but 2 NHS boards in Scotland that experienced norovirus ward closures. A semi-structured questionnaire was used. Three points of control were examined: not placing a symptomatic patient in isolation, not reporting an outbreak promptly, not being able to continuously apply norovirus control measures once an outbreak commences.

Results: The experiences of the ICTs varied: 5 ICTs described the season in neutral terms, e.g. ‘not that bad’, and a second group (6 ICTs) who described the season as the ‘worst ever’. There were no recallable events that preceded sudden rises in ward closures.

Those who described the system in more neutral terms also described more extensive preparedness including, visits to Emergency departments pre season, review of assets and education programmes for staff who were new to the area.

ICTs (8) considered the poor placement of symptomatic patients as the point of control which most often triggered norovirus outbreaks.

Conclusions:  A programme of norovirus outbreak preparedness at a national and local level may help to reduce impact of norovirus season. This programme needs to include actions to improve community care as well as in-hospital infection control.

ICTs can improve their in-house epidemiology and understanding of the causes of norovirus outbreaks. This data could be used to identify and reduce systems’ weaknesses.

The use of norovirus diaries may help ICTs better evaluate their actions and inactions at the end of the season.

An annual evaluation of norovirus experiences and management will help ongoing system improvements at a national and local level.

1 http://www.hps.scot.nhs.uk/haiic/ic/noroviruspointprev.aspx