title: Institutional risk factors for outbreaks of nosocomial gastroenteritis: survival analysis of a cohort of hospital units in South-west England, 2002-2003.
abstract: Nosocomial outbreaks of gastroenteritis are a major burden on hospital inpatient services, costing an estimated pound115 million annually to the English National Health Service. We actively followed-up 171 inpatient units from four major acute hospitals and 11 community hospitals in South-west England for one year. Outbreaks of gastroenteritis were ascertained through an active surveillance network using standard clinical definitions. Survival analysis Cox regression models using an outbreak of gastroenteritis as the endpoint were fitted to identify institutional and operational attributes related to increased outbreak rates at the level of the care unit. Greater number of beds in unit [hazard ratio (HR) 1.22 (per 10 additional beds), 95% confidence intervals (CI) 0.96-1.55] was associated with increased hazard, as were geriatric (HR 2.6, 95%CI 1.6-4.3) and general medical (HR 1.7, 95%CI 1.1-2.6) care units. The average length of stay on a unit was inversely associated with outbreak incidence [HR=0.89 (per additional week of stay), 95%CI 0.80-0.99]. Larger care units and those with higher throughput have increased rates of gastroenteritis outbreaks. These results should guide infection control policy and support the design of hospitals with smaller care units.
authors.affiliation: Gastrointestinal Diseases Department, Communicable Disease Surveillance Centre, Health Protection Agency, London, UK. b.lopman@imperial.ac.uk
authors.forename: B A
authors.initials: BA
authors.lastname: Lopman
authors.forename: N
authors.initials: N
authors.lastname: Andrews
authors.forename: J
authors.initials: J
authors.lastname: Sarangi
authors.forename: I B
authors.initials: IB
authors.lastname: Vipond
authors.forename: D W G
authors.initials: DW
authors.lastname: Brown
authors.forename: M H
authors.initials: MH
authors.lastname: Reacher
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016009:Chi-Square Distribution; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005500:Follow-Up Studies; D005759:Gastroenteritis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006749:Hospital Design and Construction; D006757:Hospital Units; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007902:Length of Stay / Q000706:statistics & numerical data; D016013:Likelihood Functions; D029322:Norovirus; D016012:Poisson Distribution; D011159:Population Surveillance; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors