Pennsylvania Patient Safety Advisory for 2010 December focusses on tackling norovirus outbreaks

Pennsylvania Patient Safety Authority data shows a significant increase in cases of norovirus and norovirus-like gastrointestinal illness particularly in nursing homes in early 2010; but the virus can be controlled as shown by Pennsylvania nursing homes who share their success stories

In early 2010, Pennsylvania nursing homes and hospitals reported an increased number of cases of gastrointestinal illness which are consistent with recurring outbreaks of the highly contagious norovirus and norovirus-like illnesses nationwide. With a new norovirus season approaching, the Pennsylvania Patient Safety Authority issues its 2010 December Pennsylvania Patient Safety Advisory with data analysis, guidance and success stories provided by Pennsylvania nursing homes for preventing and controlling the illness.

Norovirus is a highly contagious severe gastrointestinal illness commonly referred to as the "stomach flu." The virus spreads quickly because it is transmitted easily from person to person through vomit and feces of people who are sick with the illness. Contact with only a few particles can make you sick. In nursing home settings outbreaks happen quickly due to shared bathroom facilities, dining facilities and incontinence hygiene issues. Norovirus outbreaks usually peak in cold weather when people are more likely to gather indoors. Spread of the virus may also increase because of environmental factors in winter (e.g., lower temperatures, less sunlight).

Norovirus and norovirus-like cases in Pennsylvania nursing homes increased from 634 cases in the third quarter of 2009 (July-September) to 813 cases in the fourth quarter of 2009 (October-December) and then surged to 4,090 cases in the first quarter of 2010 (January-March). Pennsylvania hospitals also reported an increase in norovirus and norovirus-like cases in the first quarter of 2010 (January-March).

"Our analysis shows on average twenty-five cases of norovirus occurred per nursing home outbreak and an average of six norovirus cases occurred per hospital outbreak," Sharon Bradley, infection control analyst for the Pennsylvania Patient Safety Authority said. "When you add the cases up, there were a significant number of sick residents and patients in the first part of this year in Pennsylvania. But hopefully with the strategies provided in this Advisory and other preventive resources nursing homes will take the necessary steps to avoid the outbreaks as the winter season approaches."

According to Authority analysis of nursing homes, 42 of the 67 counties in Pennsylvania reported norovirus or norovirus-like cases. The most outbreaks occurred in Philadelphia and Montgomery counties. Thirty-seven percent (25) of the counties reported no nursing home outbreaks, 25 percent (17) of the counties had a lower than average percentage of their facilities reporting outbreaks, and 37 percent (25) had a higher than average percentage of their facilities reporting outbreaks.

Bradley said early detection of the virus is important for controlling the outbreaks, as well as preparation for the norovirus season.

"In this Advisory, we've provided nursing homes and hospitals the background information they need to prevent the virus as well as the next steps to ensure that everything that can be done is being done to avoid an outbreak of the virus," Bradley said. "The Authority has also provided a toolkit for healthcare providers to prepare for norovirus season, monitor compliance of control measures to contain the virus and consumer tips for patients."

Bradley said five Pennsylvania nursing homes are featured in the Advisory for having reported the most effective practices contributing to a quick, successful resolution of a gastrointestinal (norovirus) outbreak.

The nursing homes include: Vincentian Regency, Allison Park; Nottingham Village, Northumberland; Somerton Center, Philadelphia; Twin Oaks, Campbelltown; and Golden Living Center-East Mountain, Wilkes-Barre.

For more information on the success strategies for preventing the norovirus and norovirus-like cases go to the 2010 December Pennsylvania Patient Safety Advisory and click on "Controlling the Annual Threat of Norovirus Gastroenteritis Outbreaks" at www.patientsafetyauthority.org.

The Authority's 2010 December Advisory contains other articles with toolkits for the healthcare provider to improve patient safety. Highlights include:

Management of Unanticipated Difficult Intubation: Airway management, ensuring the patient is receiving uninterrupted oxygen and proper ventilation, is a fundamental part of the practice of anesthesia and of emergency and critical care medicine. In 2009, the Authority received 448 event reports involving complications related to anesthesia. Of these reports, 36 involved a difficult intubation. In 23 of those reports, difficult intubation was described as unanticipated. Even the most thorough assessment of the airway may not detect the possibility of a difficult intubation, and every anesthetist should have a predetermined strategy for dealing with this situation. This article discusses assessment of the airway, identification of patients at risk for a difficult intubation, and risk reduction strategies. A toolkit containing a form for facilities to better determine whether or not a patient could be at risk for a difficult intubation is also available on the Authority's website.

Managing Patient Access and Flow in the Emergency Department: In 2009, Pennsylvania healthcare facilities reported 1,930 events of complications of procedures, treatments or tests from the emergency department (ED). National figures show the number of ED visits continues to increase. This article focuses on strategies to increase patient safety and improve quality during the ED visit from the point of patient arrival to the diagnostic evaluation. The article also breaks down in a graphic the Serious Events and Incidents by patient treatment phase for a better view of how treatment may have gone wrong. A toolkit is also available for facilities that contains a census tracking tool, a front-end process measures threshold tool and an operational measures tool.

Reusing Endoscopes: Are They Clean?: Between 2004 and 2009, the Authority received 107 reports describing potential patient contamination because the endoscope was not cleaned properly before using it again. Of the 107 reports, 62 made reference to potentially contaminated endoscopes being used on patients, while the rest described potentially contaminated endoscopes getting to the patient (e.g., the sterile surgical field), but not used, or lacked information to determine patient involvement. This article discusses what healthcare facilities can do to reduce the likelihood of cross contamination. Comprehensive, model specific reprocessing protocols are provided.

Falls in Behavioral Health Facilities Are More Likely to Involve Patient Harm:

After a request from a healthcare facility through its Patient Safety Liaison, the Authority researched falls in behavioral health facilities and their relationship to medications. The Authority looked specifically at falls reported from behavioral health hospitals. The Authority found that reports of falls in behavioral health hospitals were more likely to involve patient harm; 9.6 percent of behavioral health falls were Serious Events, compared to 3.7 percent of those submitted by other hospitals. Roughly 70 percent of falls reports from behavioral health hospitals and 58 percent from nonbehavioral health hospitals indicate medications were possibly involved in the fall. This shows that facilities should consider the medications that are being administered and how they may increase their patients' risk of falls. This article provides facilities with a data snapshot of falls in behavioral health and nonbehavioral health facilities.

Wrong-Site Surgery Update: Wrong-site surgery continues in Pennsylvania, at the rate of approximately one report per week, despite the availability of evidence-based best practices. This article summarizes and updates the evidence base for the 18 best practices for preventing wrong-site surgery that are associated with the Joint Commission's Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery™. A toolkit is also available on the Authority's website for healthcare facilities to prevent wrong-site surgery.

For the complete 2010 December Pennsylvania Patient Safety Advisory, go to www.patientsafetyauthority.org.