Mitchell Caroline, Meredith Paul, Richardson Matthew, Greengross Peter, Smith Gary B
Department of Infection Prevention, Portsmouth Hospitals NHS Trust, Portsmouth, UK Department of Infection & Immunity, University College, London, UK.
Research & Development Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
BMJ Qual Saf. 2016 Jun;25(6):466-74. doi: 10.1136/bmjqs-2015-004134. Epub 2015 Sep 8.
Nosocomial norovirus infections and their control measures disrupt patient care, increase staff workload and raise healthcare costs.
To determine the impact on outbreaks of nosocomial viral gastroenteritis, staff and patients affected, and bed closures of a multidimensional quality improvement (QI) initiative focused on education; improved patient surveillance; early automated recognition and notification of infection of index patients; and proactive care and control measures.
In a pragmatic, retrospective, observational study, we compared numbers of suspected/confirmed norovirus outbreaks at Portsmouth Hospitals National Health Service Trust (PHT) with regional and national data, before and after a multidimensional QI initiative. We also compared mean daily bed closures due to norovirus-like symptoms. At PHT only we recorded patient and staff numbers with norovirus-like symptoms, and days of disruption due to outbreaks.
Annual outbreak numbers fell between 2009-2010 and 2010-2014 by 91% at PHT compared with 15% and 28% for Wessex and England, respectively. After April 2010, recorded outbreaks were 8 (PHT), 383 (Wessex) and 5063 (England). For the winter periods from 2010/2011 to 2013/2014, total bed closures due to norovirus were 38 (PHT; mean 0.5 per week), 3565 (Wessex hospitals; mean 48.8 per hospital per week) and 2730 (England; mean 37.4 per hospital per week). At PHT, patients affected by norovirus-like symptoms fell by 92%, affected staff by 81% and days of disruption by 88%.
A multiyear QI programme, including use of real-time electronic identification of patients with norovirus-like symptoms, and an early robust response to suspected infection, resulted in virtual elimination of outbreaks. The ability to identify index cases of infection early facilitates prompt action to prevent ongoing transmission and appears to be a crucial intervention.
医院内诺如病毒感染及其控制措施会干扰患者护理、增加工作人员工作量并提高医疗成本。
确定一项侧重于教育的多维度质量改进（QI）举措对医院病毒性肠胃炎暴发、受影响的工作人员和患者以及病床关闭情况的影响；改进患者监测；对索引患者感染进行早期自动识别和通报；以及采取积极的护理和控制措施。
在一项实用的回顾性观察研究中，我们比较了朴茨茅斯医院国民保健服务信托基金（PHT）在多维度QI举措前后与地区及全国数据中疑似/确诊诺如病毒暴发的数量。我们还比较了因诺如病毒样症状导致的平均每日病床关闭情况。仅在PHT，我们记录了出现诺如病毒样症状的患者和工作人员数量以及暴发造成的干扰天数。
与韦塞克斯和英格兰分别下降15%和28%相比，PHT在2009 - 2010年至2010 - 2014年期间年度暴发数量下降了91%。2010年4月之后，记录的暴发数量分别为8起（PHT）、383起（韦塞克斯）和5063起（英格兰）。在2010/2011年至2013/2014年的冬季期间，因诺如病毒导致的病床关闭总数分别为38起（PHT；平均每周0.5起）、3565起（韦塞克斯医院；平均每家医院每周48.8起）和2730起（英格兰；平均每家医院每周37.4起）。在PHT，出现诺如病毒样症状的患者减少了92%，受影响的工作人员减少了81%，干扰天数减少了88%。
一项为期多年的QI计划，包括使用实时电子识别出现诺如病毒样症状的患者，并对疑似感染做出早期有力反应，几乎消除了暴发情况。早期识别感染索引病例的能力有助于迅速采取行动防止持续传播，似乎是一项关键干预措施。
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