Associations of infection control measures and norovirus outbreak outcomes in healthcare settings: a systematic review and meta-analysis

ABSTRACT

Background

Although most norovirus outbreaks in high-income countries occur in healthcare facilities, information on associations between control measures and outbreak outcomes in these settings is lacking.

Methods

We conducted a systematic review/meta-analysis to assess associations between norovirus outbreak control measures and outcomes in hospitals and long-term care facilities (LTCFs), globally. Using regression analyses stratified by setting (hospital/LTCF), we compared durations, attack rates, and case counts for outbreaks in which control measures were reportedly implemented to those in which they were not.

Results

We identified 102 papers describing 162 norovirus outbreaks. Control measures were reportedly implemented in 118 (73%) outbreaks and were associated with 0.6 (95% CI: 0.3–1.1) times smaller patient case counts and 0.7 (95% CI: 0.4, 1.0) times shorter durations in hospitals but 1.5 (95% CI: 1.1-2.2), 1.5 (95% CI: 1.0–2.1) and 1.6 (95% CI: 1.0–2.6) times larger overall, resident and staff case counts, respectively, and 1.4 (95% CI: 1.0–2.0) times longer durations in LTCFs.

Conclusions

Reported implementation of control measures was associated with smaller/shorter outbreaks in hospitals but larger/longer outbreaks in LTCFs. Control measures were likely implemented in response to larger/longer outbreaks in LTCFs, rather than causing them. Prospective observational or intervention studies are needed to determine effectiveness.

KEYWORDS:

• Control measures
• gastrointestinal infection
• healthcare
• hospitals
• infection control
• long-term care facilities
• meta-analysis
• norovirus
• outbreaks
• systematic review

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Declaration of interest

Dr. Lopman reports grants and personal fees from Takeda Pharmaceuticals and personal fees from World Health Organization, outside the submitted work.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

Funding for this study was provided by NIH/AHRQ (R01 HS025987) and NIH/NIGMS (R01 GM124280).