3.10 Nv Poster Draft

Retrospective Study 2008 Norovirus Outbreak in LTC Gillian Jones MBA MPH; Tae Joon Lee, MD, CMD UMC-IRB # 09-0250 Conflict of Interest: The investigators affiliated with both the university and the subject long term care facility, however retained full independence in the conduct of this study. AMDA Poster abstract # 513 References Abstract Setting: This 16 day acute gastroenteritis outbreak began December 29, 2008 in a 152-bed Medicaid/Medicare certified detached for-profit nursing home facility in eastern North Carolina. The midsized free standing for-profit facility has two nursing stations with six halls. See floor plan below. Retrospective epidemiologic investigation: Facility approval and East Carolina University Internal Review Board approval for exempt study status was granted on March 18, 2009. Discharged and current patient data from medical charts and supporting related documents were reviewed. Also interviewed were local health department (LHD), state health department (SHD), and D), key NH staff, and a sampling of infected staff. Key facility personnel were interviewed to gather pertinent patient care costs and facility revenue and outbreak related expenditures and costs. AGE Case definition: A case was defined as a patient or employee with onset of vomitus and/or diarrheal symptoms with vomiting or diarrhea, two or more loose stools in a minimum two gastro-intestinal episodes in a twenty four hour period with onset during December 29, 2008-January 15, 2009 in a resident or employee of the nursing home during the outbreak period. To prevent possible misclassification, exclusions included a history of recent loose stool or gastrointestinal diagnosis in the last 30 days, and/or use of antibiotics during the outbreak. Analysis: A variety of analyses were performed on 125 patients with complete records including. Analyses included simple descriptive, t-tests, non-parametric tests for medians, chi-square tests, and multivariate logistic regression using a combination of using JMP 9 and PASW v17 (REFS ) software. Epidemiologic curves were generated with GOATv2.1/EpiInfo software. Costs summarized on Excel software. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Methods OBJECTIVES: 1. Perform retrospective descriptive epidemiologic study of lab confirmed Noro-virus (NV) outbreak in a midsized North Carolina detached nursing home (NH) 2. Examine and compare acute gastroenteritis (AGE) outbreak characteristics and patient risk factors in NV transmission 3. Describe the infection control measures implemented by the NH and the local health department 4. Examine NV outbreak cost to NH. METHODS: Epidemiological data were collected retrospectively and results compared to other individual long term care facility NV outbreaks as well as compared to 1982 Kaplan criteria for NV diagnosis. Outbreak control methods and costs were assessed and compared. RESULTS: A NV outbreak duration of 16 days with 2.5 median symptomatic days affected 71 patient cases (56.8 %) and 24 staff cases (19.8%) with symptoms of acute gastroenteritis. NV strain geno group type II confirmed. 11 patients required in-house oral and IV rehydration, 6 patients required hospital evaluation and care, and 1 patient with multiple co-morbidities died. Risk factors (as measured by adjusted odds ratios) for NV infection include females (OR 3.39; p=0.006), diabetes mellitus (OR 2.76; p=0.031), and Activities of Daily Living (ADL) Dependency index score of less than 5 (OR 7.18; p = 0.04). Outbreak cost incurred to NH estimated to be $34,000. CONCLUSIONS: Group II NV outbreak likely spread via person-to-person contact. Multi-disciplinary enhanced hygiene measures, staff self-quarantine, and admissions/visitors ban may have lessened duration and severity. Implementation of control measures should not wait for reference lab viral identification of specimens. Table 3: CDC Reporting and NV Identification Figure 1. Onset Curve by Date Table 1: Outbreak Characteristics Table 2: NV Risk Factors (unadjusted odds ratio) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],UNIT II Station UNIT I Station Symptom No symptom OR (95% interval) p-value n=71 (%) n=54 (%) Female* 61 (85.9) 36 (66.7) 3.39 (1.38-8.33) 0.006 Caucasian 28 (39.4) 24 (44.4) 1.23 (0.59-2.52) 0.57 Sick Roommate 39 (54.9) 24 (44.4) 1.52 (0.75-3.1) 0.25 Private Room 11 (15.5) 4 (7.4) 2.29 (0.69-7.64) 0.17 Unit I 47 (66.2) 27 (50.0) 1.95 (0.94-4.05) 0.068 Unit II 25 (35.2) 27 (50.0) 0.54 (0.26-1.12) 0.097 Diabetes* 29 (40.9) 7 (13.0) 2.76 (1.07-7.1) 0.031 ALZ/Dementia 27 (38.0) 13 (24.1) 1.89 (0.86-4.15) 0.11 Renal Failure/ 7 (9.9) 6 (11.1) 0.84 (0.26-2.66) 0.76 Kidney Disease CVD/CVA 13 (18.3) 12 (22.2) 0.77 (0.32-1.85) 0.55 HTN 19 (26.8) 14 (25.9) 1.02 (0.45-2.28) 0.97 HD/CHF 13 (18.3) 13 (24.1) 0.69 (0.29-1.64) 0.40 Other DX 31 (43.7) 19 (35.2) 1.39 (0.67-2.88) 0.38 ADL Score < 5 8 (11.3) 1 (1.9) 7.18 (1.01-59.38) 0.042 * Statistically significant findings Jan 2, 2009 Day 5 Clinical outbreak protocol begins Jan 5, 2009 Day 8 Ban on ad-missions & transfers begins NV lab confirmed Enhanced hygiene measures begun Jan 11, 2009 Day 14 Last new case reported. Discussion 2008 NV LTC OUTBREAK – animated infection transmission video: To view the internet video of an animated room by room time lapsed infection sequence showing rate and pattern of spread please enter the following hyperlink. The sequence repeats several times. and will play automatically on Windows media player. http://personal.ecu.edu/brinkleyjresearch/outbreak.avi Table 4: Infection Control & Prevention Measures Dec 29, 2008 Day 1 Index case reported NURSING HOMES 30% of 1996-2000 Reported GE Outbreaks Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Figure 2. Facility Floor plan NV infected cases State reference lab confirmed NV cases Asymptomatic residents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Clinical Measures Administrative Measures Local Health Department ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

3.10 Nv Poster Draft

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