1676. Impact of the environment in the development of nosocomial norovirus infection in a bone marrow transplant unit
Session: Poster Abstract Session: Role of the Healthcare Environment in HAIs
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_2013_pdf.pdf (175.3 kB)
  • Background: Norovirus infection has been increasingly recognized as an important cause of diarrhea in hematopoietic stem cell transplant (HSCT) patients. In 2012, a cluster of nosocomial norovirus infections was detected in our 28 bed Bone Marrow Transplant (BMT) unit that houses patients with all types of hematological malignancies. We sought to identify potentially modifiable patient and institutional risk factors in order to prevent future infections.

    Methods: A retrospective case-cohort study was performed among all patients admitted to our BMT unit from Jan – May 2012. Cases were defined as patients who developed ≥ 3 loose stools per day with or without vomiting for ≥48 hours duration with a positive norovirus stool EIA.  Patients with other gastrointestinal infections were excluded. Demographic, clinical, pharmacy, laboratory and radiographic data were abstracted from the medical records. Univariate analyses were performed using Fisher’s exact test; all analyses were performed using STATA v.12.0.

    Results: Among the cohort of 149 patients, 7 cases were identified.  5 cases occurred during the 3 week period from 1/24 - 2/11/12 followed by single cases in March and May. 57.5% (4/7) of cases were male with an average age of 60.1 years. All cases had a hematologic malignancy including: lymphoma (3), leukemia (2), multiple myeloma (MM) (1) and myelodysplastic syndrome (MDS) (1); 2 had undergone BMT. There was no significant difference in the type of malignancy, transplant status or presence of graft versus host disease. Cases were more likely to have received steroids than the rest of the cohort (100% vs. 73.9%, p=0.12). 2 cases were admitted to the ICU for complications of norovirus and 1 expired (case fatality rate of 14.3%).  Of the cases, 3 (42.9%) resided in a room previously used by the index patient compared with 11.3% (16/142) of the rest of the cohort (p=0.04). 

    Conclusion: We describe a cluster of nosocomial norovirus infections in a BMT unit with significant morbidity and mortality.  In our single center study, steroid use was associated with nosocomial norovirus infection but did not reach statistical significance. One patient room was significantly associated with infection in subsequent patients suggesting the importance of environmental cleaning in prevention efforts.

    Roger Araujo-Castillo, M.D.1, Carolyn D. Alonso, M.D.1, Bernadette Sullivan, RN MBA2, James D. Levine, MD3 and Sharon B. Wright, MD MPH1,4, (1)Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, (2)Silverman Health Care Quality Institute, Beth Israel Deaconess Medical Center, Boston, MA, (3)Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA, (4)Silverman Health Care Quality Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

    Disclosures:

    R. Araujo-Castillo, None

    C. D. Alonso, None

    B. Sullivan, None

    J. D. Levine, None

    S. B. Wright, None

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