NHS Trust uses clinical measures, computer-based surveillance to reduce norovirus outbreaks by over 90%

An NHS Trust has cut outbreaks of the norovirus winter vomiting bug by more than 90% over a five-year period, according to research published in the journal BMJ Quality and Safety.

Portsmouth Hospitals NHS Trust used a combination of simple clinical measures and computer-based surveillance to identify and manage promptly patients who had been infected with the virus.

The initiative meant that norovirus outbreaks at the Trust dropped by 91% between 2009-10 and 2010-14. The drop was much larger than the reduction in outbreaks reported by other hospitals in the Wessex region and across England.

The paper in BMJ Quality and Safety concluded:

A multi-year quality improvement programme, including use of real-time electronic identification of patients with norovirus-like symptoms, and an early robust response to suspected infection, resulted in virtual elimination of outbreaks.

Norovirus is the most common cause of epidemic gastroenteritis and outbreaks in hospitals are frequent, particularly during winter. The virus causes diarrhoea and vomiting, and can cause fatal complications.

When a norovirus outbreak is identified, affected wards may be closed to admissions resulting in a loss of bed capacity, often during the winter months when bed pressures are at their highest.  Outbreaks also result in a loss of productivity, as many staff may be affected.

Portsmouth Hospitals NHS Trust worked with The Learning Clinic to develop computer software called VitalPAC Infection Prevention Manager. It uses an existing hospital–wide electronic vital signs system (VitalPAC), which uses Apple iPods to record patient observations such as nausea and vomiting, to create a series of alerts that highlight potential cases of norovirus infection. It speeds up notification of the infection prevention and control team, who can then respond faster by instituting simple bedside measures. Where appropriate, patients were moved into isolation, hand hygiene measures were enhanced and bed areas, crockery and utensils were intensively cleaned to prevent infection spread.

The study found that between 2009-10, when the initiative began, and 2013-2014, the number of norovirus outbreaks fell by 91%, from 21 to just one. The number of patients affected by norovirus-like symptoms fell by 92%, the number of affected staff fell by 81% and the days of disruption in the hospital as a result of the virus fell by 88%.

The number of reported outbreaks also fell across the Wessex region and across England as a whole, but by a far lower percentage (15% in Wessex and 28% across England) Public Health England has reported that, nationally, norovirus outbreaks are associated with 13,000 patients and 3,400 staff becoming ill every year, plus 8,900 days of ward closure and the loss of more than 15,500 bed-days.

Dr Caroline Mitchell, Associate Director for  Infection and Patient Safety at Portsmouth Hospitals NHS Trust, and one of the study’s authors, said:

By application of simple measures we have significantly reduced the number of cases of Norovirus and other gastrointestinal viruses which can cause serious and unpleasant symptoms in patients and massively disrupt the operational capacity of the hospital.  .

The combination of new technology and better training and organisation of our staff has contributed hugely to our successful results in this field.

Dr Peter Greengross, Medical Director of The Learning Clinic, which developed the VitalPAC system, said:

We believe norovirus outbreaks cost the NHS £41.5 million a year. If every hospital achieved the same result as Portsmouth the savings could be £38 million a year. That would have a massive impact.