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Norovirus in the hospital setting: virus introduction and spread within the hospital environment
Journal of Hospital Infection
Volume 77, Issue 2, February 2011, Pages 106-112
S. Mortera, G. Benneta, J. Fisha, J. Richardsa, D.J. Allenb, S. Nawazb, M. Iturriza-Gómarab, S. Brollyc and J. Grayc, ,
a Infection Prevention and Control Team, Norfolk and Norwich University Hospital, Norwich, UK
b Enteric Virus Unit, Virus Reference Department, Centre for Infections, Health Protection Agency, London, UK
c Specialist Virology Centre, Microbiology Laboratory, Norfolk and Norwich University Hospital, Norwich, UK
Received 20 September 2010; accepted 24 September 2010. Available online 16 December 2010.
Summary
Norovirus (NoV) strains were collected over a four-month period during 2009–2010 from hospitalised patients with symptoms of gastroenteritis. These were characterised in order to estimate how many strains were introduced into the hospital from the community. In addition, environmental swabbing was performed after clinical cleaning of bays or wards accommodating infected patients. This was performed in order to assess the efficiency of cleaning and identify any NoV contamination in the environment. A total of eight distinct genetic clusters of NoV GII-4 genotype were identified during the four-month period, with some wards experiencing multiple outbreaks with different GII-4 strains during the season. NoV was detected from 31.4% of environmental swabs post cleaning. Notes trolleys, computer keyboards, soap and alcohol dispensers, blood pressure equipment, pulse oximeters and tympanic thermometers were identified as NoV reservoirs but contamination was also found on surfaces around the bedside environment, and furniture, fixtures and fittings associated with toilets and shower rooms. The combination of detailed virus characterisation and environmental swabbing is a powerful tool for infection control audits to determine the size and scope of an outbreak and to monitor the efficiency of clinical cleaning.
Keywords: Environmental contamination; Genetic variants; Norovirus; Virus introduction |