State-level adoption of national guidelines for norovirus outbreaks in health care settings

Clinical decision support (CDS) systems can help investigators use best practices when responding to outbreaks, but variation in guidelines between jurisdictions can make such systems hard to develop and implement. This study aimed to identify (1) the extent to which state-level guidelines adhere to national recommendations for norovirus outbreak response in health care settings and (2) the impact of variation between states on outbreak outcomes.

State guidelines were obtained from Internet searches and direct contact with state public health officials in early 2016. Outcomes from norovirus outbreaks that occurred in 2015 were compared using data from the National Outbreak Reporting System.

Guidelines were obtained from 41 of 45 (91%) state health departments that responded to queries or had guidelines available on their Web sites. Most state guidelines addressed each of the national recommendations, but specific guidance varied considerably. For example, among 36 states with guidance on numbers of stool specimens to collect, there were 21 different recommendations. Furthermore, having guidelines consistent with national recommendations was associated with fewer outbreaks reported and more outbreaks with confirmed etiology.

This study identified substantial variation in state health care-associated norovirus outbreak response guidelines, which must be considered when developing related CDS systems. More research is needed to understand why this variation exists, how it impacts outbreak outcomes, and where improvements in evidence-based recommendations and communication of national guidance are needed.