Closure of medical departments during nosocomial outbreaks: data from a systematic analysis of the literature.

A total closure of an affected medical department is one of the most expensive infection control measures during investigation of a nosocomial outbreak. However, until now there has been no systematic analysis of typical characteristics of outbreaks, for which closure was considered necessary. This article presents data on features of such nosocomial epidemics published during the past 40 years in the medical literature. A search of the Outbreak Database (1561 nosocomial outbreaks in file) revealed a total of 194 outbreaks that ended up with some kind of closure of the unit (median closure time: 14 days). Closure rates (CRs) were calculated and stratified for medical departments, for causative pathogens, for outbreak sources, and for the assumed mode of transmission. Data were then compared to the overall average CR of 12.4% in the entire database. Wards in geriatric patient care were closed significantly more frequently (CR: 30.3%; P<0.001) whereas paediatric wards showed a significantly lower CR (6.1%; P=0.03). Pathogen species with the highest CR were norovirus (44.1%; P<0.001) and influenza/parainfluenza virus (38.5%; P<0.001). If patients were the source of the outbreak, the CR was significantly increased (16.7%; P=0.03). Infections of the central nervous system were most often associated with closure of the ward (24.2%; P=001). A systematic evaluation of nosocomial outbreaks can be a valuable tool for education of staff in the absence of an outbreak, but may be even more helpful for potentially cost-intensive decisions in the acute outbreak setting on the ward.

[Use of information on nosocomial outbreaks for infection control]. / Der Beitrag von Ausbruchanalysen zur Prävention nosokomialer Infektionen.

Outbreaks of nosocomial infections can be associated with significant morbidity in the patients involved and require time, effort, and resources. In addition, they may lead to panic reactions among health care workers and patients as well as the community. However, their systematic analysis can contribute to knowledge about the sources and transmission of nosocomial infections and the best methods for prevention. Furthermore, the results of outbreak investigations may serve as a valuable tool for education. That is why a systematic register of nosocomial outbreaks would be a very useful instrument for people working in the field of nosocomial infection control. This article describes the need for a systematic collection of outbreaks published in the literature and an available possibility for filling this gap.