ASSESSMENT OF CDC HICPAC GUIDELINES FOR PREVENTION AND CONTROL OF NOROVIRUS OUTBREAKS IN HEALTHCARE INSTITUTIONS 公开

Abstract

Norovirus is the leading cause of acute gastroenteritis outbreaks. Although illness is usually self-limiting, norovirus can cause severe illness and potentially death in immune compromised individuals and the elderly. Several attributes of norovirus impede prevention and control: multiple transmission routes (person-to-person, food, environment, and water), large genetic diversity, limited immunity, environmental stability, and resistance to common disinfectants. No vaccine is currently available.

Norovirus outbreaks disproportionately affect healthcare institutions more than non-healthcare institutions. Recently, the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Centers for Disease Control and Prevention (CDC) published guidelines (CDC HICPAC guidelines), which included 61 recommendations, specifically for healthcare institutions, to prevent and control norovirus outbreaks. However, challenges and limitations can affect consistent implementation in every institution.

The purpose of this study was to gain a better understanding of commonly implemented recommendations and challenges involved in implementing infection control measures. The study analyzed data from a survey distributed to members of the Association for Professionals in Infection Control and Epidemiology (APIC). The survey focused on three areas: knowledge of norovirus and the CDC HICPAC guidelines, implementation of the CDC HICPAC guidelines, and barriers encountered during the implementation process.

The study found that most (93%) participants were aware of the CDC HICPAC guidelines, but only 50% were aware of the norovirus prevention toolkit. Of those that used the toolkit, 78% found it useful in implementing recommendations. Participants most frequently implemented active hand hygiene promotion (88%) and increased cleaning frequency (74%). The most challenging recommendations to implement were reportedly exclusion of ill staff (22%) and closure of units (19%). Poor compliance (28%) and personnel limitations (21%) were selected as the most significant barriers to implementation. Participants that recently experienced a norovirus outbreak were significantly (P<0.01) more likely to implement recommendations.

Implementation of the CDC HICPAC guidelines is widespread, particularly among facilities with recent outbreak experience. However, gaps in norovirus knowledge exist. Recommendations include educational training opportunities focusing on norovirus and infection control practices, in particular norovirus outbreak prevention, and promotion of the norovirus toolkit. Future studies should address reducing barriers that inhibit implementation of the CDC HICPAC guidelines.

Table of Contents

CHAPTER 1: INTRODUCTION (1)

Background (1)

Problem Statement (3)

Theoretical Framework (3)

Purpose Statement (4)

Significance (4)

Definition of Terms (5)

CHAPTER 2: LITERATURE REVIEW (7)

Introduction (7)

Literature Review (7)

Norovirus Characteristics (7)

Norovirus Epidemiology (9)

Norovirus Infection Control Practices (11)

Summary (20)

CHAPTER 3: METHODOLOGY (22)

Introduction (22)

Population and Sample (22)

Research Design and Procedure (23)

Data Analysis Plan (24)

CHAPTER 4: RESULTS (26)

Introduction (26)

Findings (26)

Summary (47)

CHAPTER 5: DISCUSSION (49)

Introduction (49)

Summary of Study (49)

Limitations and Delimitations (52)

Conclusion (54)

Recommendations (55)

REFERENCES (56)

APPENDICES

Appendix A: Survey Instrument (63)

Appendix B: Emory IRB Determination Letter (68)

Appendix C: R Programming Code (69)

LIST OF TABLES

Table 1. Characteristics of survey participants (27)

Table 2. Participants' beliefs and understanding of norovirus, the CDC norovirus prevention toolkit, and the CDC HICPAC guidelines (29)

Table 3. Participants' beliefs in the value of prevention and control of norovirus outbreaks (30)

Table 4. Associations between experiencing at least 1 norovirus outbreak within the past 5 years and participants' facility type or belief of where the most norovirus outbreaks occur (31)

Table 5. Associations between norovirus being a serious problem in healthcare facilities and participants' facility type, occupation, and experiencing at least one norovirus outbreak within the past 5 years (32)

Table 6. Associations between belief that infection control practices having a major impact on norovirus outbreak prevention and participants' facility type, occupation, and experiencing at least one norovirus outbreak within the past 5 years (33)

Table 7. Associations between belief that infection control practices having a major impact on norovirus outbreak control and participants' facility type, occupation, and experiencing at least one norovirus outbreak within the past 5 years (34)

Table 8. Associations between consulting the CDC HICPAC guidelines and participants' facility type, occupation, and experiencing at least one norovirus outbreak within the past 5 years (35)

Table 9. Associations between the CDC HICPAC guidelines effectiveness on norovirus outbreak prevention and participants' facility type, occupation, and experiencing at least one norovirus outbreaks within the past 5 years (36)

Table 10. Associations between the CDC HICPAC guidelines effectiveness on norovirus outbreak control and participants' facility type, occupation, and experiencing at least one norovirus outbreak within the past 5 years (37)

Table 11. Association between implementing selected recommendations and participants' facility type (39)

Table 12. Association between implementing selected recommendations and participants' occupation (41)

Table 13. Association between implementing selected recommendations and experiencing at least one norovirus outbreak within the past 5 years (43)

LIST OF FIGURES

Figure 1. Number of participants reporting the most recent year a norovirus outbreak occurred (n=342) (28)

Figure 2. Proportion of participants reporting the extent that the norovirus toolkit assisted with the implementation of the CDC HICPAC guidelines (n=284) (29)

Figure 3. Proportion of participants that reported implementing only 1 through all 12 selected recommendations (n=764) (38)

Figure 4. Proportion of participants that reported implementing selected recommendations from the CDC HICPAC guidelines (n=764) (38)

Figure 5. Proportion of participants reporting the most significant barrier to the implementation of selected recommendations (n=683) (45)

Figure 6. Proportion of participants reporting the most challendign recommendation to implement (n=726) (45)

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, General Health Sciences, Health Care Management
关键词	norovirus infection control nosocomial healthcare
Committee Chair / Thesis Advisor	Lopman, Benjamin Alan, Emory University
Committee Members	Hall, Aron Jacob, Emory University Miner, Kathleen R, Emory University
Partnering Agencies	National or regional non-profit organization (e.g., American Cancer Society) CDC

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