title: Impact of an outbreak of norovirus infection on hospital resources.
abstract: OBJECTIVE
  To describe a nosocomial norovirus outbreak, its management, and its financial impact on hospital resources.
  
  
  METHODS
  A matched case-control study and microbiological investigation.
  
  
  METHODS
  We compared 16 patients with norovirus infection with control-patients matched by age, gender, disease category, and length of stay. Bed occupancy-days during the peak incidence period of the outbreak were compared with the corresponding periods in 2001 and 2002. Expenses due to increased workload were calculated based on a measuring system that records time spent for nursing care per patient per day.
  
  
  RESULTS
  The attack rates were 13.9% among patients and 29.5% among healthcare workers. The median number of occupied beds was significantly lower due to bed closure during the peak incidence in 2003 (29) compared with the median number of occupied beds in 2001 and 2002 combined (42.5). Based on this difference and a daily charge of 562.50 dollars per patient, we calculated a revenue loss of 37,968 dollars. Additional expenses totaled 10,300 dollars for increased nursing care. Extra costs for microbiological diagnosis totaled 2707 dollars. Lost productivity costs due to healthcare workers on sick leave totaled 12,807 dollars. The expenses for work by the infection control team totaled 1408 dollars. The financial impact of this outbreak on hospital resources comprising loss of revenue and extra costs for microbiological diagnosis but without lost productivity costs, increased nursing care, and expenses for the infection control team totaled 40,675 dollars.
  
  
  CONCLUSIONS
  Nosocomial norovirus outbreaks result in significant loss of revenue and increased use of resources. Bed closures had a greater impact on hospital resources than increased need for nursing care
authors.affiliation: Hospital Epidemiology Unit, Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Walter.Zingg@kispi.unizh.ch
authors.forename: Walter
authors.initials: W
authors.lastname: Zingg
authors.forename: Carlo
authors.initials: C
authors.lastname: Colombo
authors.forename: Thomas
authors.initials: T
authors.lastname: Jucker
authors.forename: Walter
authors.initials: W
authors.lastname: Bossart
authors.forename: Christian
authors.initials: C
authors.lastname: Ruef
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology / Q000635:transmission*; D016022:Case-Control Studies; D003428:Cross Infection / Q000517:prevention & control / Q000821:virology*; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis / Q000628:therapy; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000191:economics / Q000517:prevention & control; D008297:Male; D029322:Norovirus / Q000235:genetics / Q000302:isolation & purification*; D015995:Prevalence; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013557:Switzerland / Q000453:epidemiology