Khanna N, Goldenberger D, Graber P, Battegay M, Widmer A F
Division of Infectious Disease, University Hospital Basel, Basel CH-4031, Switzerland.
J Hosp Infect. 2003 Oct;55(2):131-6. doi: 10.1016/s0195-6701(03)00257-3.
We report an outbreak of norovirus-associated gastroenteritis in patients and healthcare workers (HCWs) at a university hospital in Switzerland during the period from 28 February to 31 March 2001. Faecal and vomitus specimens and bottled and drinking water were investigated for norovirus by reverse transcriptase-polymerase chain reaction (RT-PCR) Sixty-three patients and HCWs were affected. 37% of the investigated stool specimens were positive for norovirus. Sequencing showed a new phylogenetic strain, "Basel". There was no evidence for a water-borne, foodborne or environmental source. The source of the outbreak was most likely a patient admitted to the hospital. Once an outbreak was suspected, measures were instituted based on published guidelines, such as isolation of patients and excluding sick HCWs from work. However, the application of the guidelines proved difficult. A first realistic goal in such situations is to limit spread of the disease to other areas, specifically to high-risk areas such as intensive care and haemato-oncology units. Optimal management includes a rapid diagnosis of norovirus, written recommendations for management of affected patients and HCWs, and cleaning of surfaces with an effective disinfectant. These recommendations should be available in written form well before such an outbreak is in progress. Such preparations may limit the extent of the outbreak, but norovirus infection in a hospital will probably spread despite infection control interventions.
我们报告了2001年2月28日至3月31日期间，瑞士一家大学医院的患者及医护人员中发生的一起与诺如病毒相关的肠胃炎暴发事件。通过逆转录聚合酶链反应（RT-PCR）对粪便和呕吐物标本以及瓶装水和饮用水进行了诺如病毒检测。63名患者和医护人员受到影响。37%的受检粪便标本诺如病毒呈阳性。测序显示为一种新的系统发育菌株，“巴塞尔”株。没有证据表明存在水源性、食源性或环境源。此次暴发的源头很可能是一名入院患者。一旦怀疑发生暴发，便根据已发布的指南采取措施，如隔离患者并禁止患病医护人员工作。然而，事实证明实施这些指南存在困难。在这种情况下，第一个现实目标是将疾病传播限制在其他区域，特别是重症监护和血液肿瘤病房等高风险区域。最佳管理措施包括快速诊断诺如病毒、为受影响的患者和医护人员提供书面管理建议，以及用有效的消毒剂清洁表面。这些建议应在暴发发生之前就以书面形式提供。此类准备工作可能会限制暴发的程度，但尽管采取了感染控制干预措施，医院内的诺如病毒感染仍可能传播。
