Control of a Hospital Norovirus Outbreak Using Hydrogen Peroxide and Peroxyacetic Acid (H2O2-PAA) Disinfectant Cleaner. (4th October 2017)

• Record Type: Journal Article
• Authors: Nolt, Dawn; Williamson, Keenan; Burnett, Nancy; Cortes-Ramos, Carmen
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S172
• Page End: S173
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.309
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Protracted outbreaks of norovirus result from the low infectious doses, as well as the lack of anti-norovirus activity within routine hospital disinfectants. We describe a June 2015 norovirus outbreak in a pediatric intensive care unit (PICU) controlled with hydrogen peroxide and peroxyacetic acid (H2O2-PAA) as an environmental cleaner. This is the first report of using H2 O2 -PAA during an outbreak setting in an acute care hospital. Methods: A retrospective cohort study of PICU healthcare workers (HCW) was conducted to determine the source of the norovirus outbreak and potential modes of transmission. A case was identified as a PICU HCW without prior community exposure to norovirus-like illness who, following admission of the suspect patient index case, either (1) was lab-confirmed for Norovirus G.II or (2) had acute onset of vomiting or diarrhea. During the outbreak, control measures included the use of H2 O2 -PAA disinfectant, restriction of ill HCWs from work, elimination of shared food, and screening of staff and visitors for gastroenteritis symptoms prior to unit entry. Notification of PICU staff regarding the ongoing outbreak occurred via work email. Prospective surveillance was conducted for 4 weeks afterwards to detect recrudescence. Results: Within a 17-day period, 32 PICU HCW developed gastroenteritis. The epidemic curve suggested a point-source outbreak and continuous person-to-person transmission. Email notification without receipt verification failed to exclude symptomatic HCW from work. Following implementation of control measures, the outbreak resolved in 6 days, with no transmission to patients. Conclusion: Patient-to-HCW transmission of norovirus led to an outbreak among PICU HCWs. Elimination of shared food in patient care areas, early reporting of HCW illnesses with work exclusion, and standard use of virucidal disinfectant may limit the spread of norovirus in acute care settings. Lessons learned include the need for closed-loop communication in HCW notification of possible exposure, and for anonymous HCW syndromic surveillance. This is the first report of H2 O2 -PAA disinfectant used in control of a hospital-associated norovirus outbreak, which limited the outbreak's scope, duration, and transmission. Disclosures: All authors: No reported disclosures.