Use of alcohol-based hand sanitizers as a risk factor for norovirus outbreaks in long-term care facilities in northern New England: December 2006 to March 2007

• Published in: American journal of infection control Vol. 39; no. 4; pp. 296 - 301
• Main Authors: Blaney, David D., MD, MPH, Daly, Elizabeth R., MPH, Kirkland, Kathryn B., MD, Tongren, Jon Eric, PhD, MSPH, Kelso, Patsy Tassler, PhD, Talbot, Elizabeth A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-05-2011; Elsevier; Mosby-Year Book, Inc
• Subjects: alcohol-based hand sanitizer; Alcohols - administration & dosage; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiseptics; Biological and medical sciences; Caliciviridae Infections - epidemiology; Caliciviridae Infections - virology; Cross Infection - epidemiology; Cross Infection - virology; Disease Outbreaks; Disease prevention; Disinfectants - administration & dosage; Epidemics; Epidemiology. Vaccinations; General aspects; Hand Disinfection - methods; hand hygiene; Health Facilities; Humans; Hygiene; Infection Control; Infection Control - methods; Infectious Disease; Infectious diseases; Long term health care; Long-Term Care; long-term care facility; Medical sciences; New England - epidemiology; Norovirus; Norovirus - isolation & purification; outbreak; Pharmacology. Drug treatments; Public health; Risk Factors; England; Italy; United Kingdom; Great Britain; Marches; Europe; New England; United Kingdom > UK; outbreak; hand hygiene; infection control; Norovirus; long-term care facility; alcohol-based hand sanitizer; Epidemic; Check; Hand; Prevention; Virus; Infection; Caliciviridae; Risk factor; Alcoholic solution; Disinfecting agent; Homes for the aged; Hygiene
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2010.10.010

Background During December 2006 to March 2007, a substantial increase in norovirus illnesses was noted in northern New England. We sought to identify institutional risk factors for norovirus outbreaks in northern New England long-term care facilities (LTCFs). Methods State health departments in Maine, New Hampshire, and Vermont distributed surveys to infection preventionists at all LTCFs in their respective states. We collected information regarding facility attributes, routine staff use of alcohol-based hand sanitizer (ABHS) versus soap and water, facility cleaning practices, and occurrence of any acute gastroenteritis outbreaks during December 2006 to March 2007. Norovirus confirmation was conducted in public health laboratories. Data were analyzed with univariate and logistic regression methods. Results Of 160 facilities, 91 (60%) provided survey responses, with 61 facilities reporting 73 outbreaks; 29 were confirmed norovirus. Facilities reporting that staff were equally or more likely to use ABHS than soap and water for routine hand hygiene had higher odds of an outbreak than facilities with staff less likely to use ABHS (adjusted odds ratio, 6.06; 95% confidence interval: 1.44-33.99). Conclusion This study suggests that preferential use of ABHS over soap and water for routine hand hygiene might be associated with increased risk of norovirus outbreaks in LTCFs.