Epidemiology and costs associated with norovirus outbreaks in NHS Lothian, Scotland 2007-2009

Healthcare-associated gastroenteritis outbreaks are becoming more common and are recognized challenges in hospital and community settings. In Edinburgh [NHS (National Health Service) Lothian], all the hospitals and the community were actively monitored for outbreaks of gastroenteritis from September 2007 to June 2009. In total, 1732 patients and 599 healthcare staff were affected in 192 unit outbreaks. In the acute sector, 1368 patients (0.99 cases/1000 inpatient bed-days) and 406 healthcare staff (0.29 cases/1000 inpatient bed-days) were affected in 155 unit outbreaks (0.23 unit outbreaks/day). Noroviruses were detected in 142 outbreaks (74%); 50 were not laboratory confirmed but were presumed to be noroviruses on epidemiological grounds. The closure of affected units to new admissions resulted in the loss of 3678 bed-days. By extrapolation, lost bed-days and staff absence due to gastroenteritis outbreaks cost NHS Lothian £1.2 million for the two norovirus seasons. Outbreaks in which the affected unit was closed within the first three days of recognizing the index case were contained in a mean of six days, and outbreaks in units that were closed later persisted for a mean of seven days; this difference was not statistically significant. Rapid implementation of control measures was effective in the control of outbreaks.