title: Use of alcohol-based hand sanitizers as a risk factor for norovirus outbreaks in long-term care facilities in northern New England: December 2006 to March 2007.
abstract: BACKGROUND
  During December 2006 to March 2007, a substantial increase in norovirus illnesses was noted in northern New England. We sought to identify institutional risk factors for norovirus outbreaks in northern New England long-term care facilities (LTCFs).
  
  
  METHODS
  State health departments in Maine, New Hampshire, and Vermont distributed surveys to infection preventionists at all LTCFs in their respective states. We collected information regarding facility attributes, routine staff use of alcohol-based hand sanitizer (ABHS) versus soap and water, facility cleaning practices, and occurrence of any acute gastroenteritis outbreaks during December 2006 to March 2007. Norovirus confirmation was conducted in public health laboratories. Data were analyzed with univariate and logistic regression methods.
  
  
  RESULTS
  Of 160 facilities, 91 (60%) provided survey responses, with 61 facilities reporting 73 outbreaks; 29 were confirmed norovirus. Facilities reporting that staff were equally or more likely to use ABHS than soap and water for routine hand hygiene had higher odds of an outbreak than facilities with staff less likely to use ABHS (adjusted odds ratio, 6.06; 95% confidence interval: 1.44-33.99).
  
  
  CONCLUSIONS
  This study suggests that preferential use of ABHS over soap and water for routine hand hygiene might be associated with increased risk of norovirus outbreaks in LTCFs.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. dblaney@cdc.gov
authors.forename: David D
authors.initials: DD
authors.lastname: Blaney
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Daly
authors.forename: Kathryn B
authors.initials: KB
authors.lastname: Kirkland
authors.forename: Jon Eric
authors.initials: JE
authors.lastname: Tongren
authors.forename: Patsy Tassler
authors.initials: PT
authors.lastname: Kelso
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Talbot
mesh_terms: D000438:Alcohols / Q000008:administration & dosage*; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000821:virology; D003428:Cross Infection / Q000453:epidemiology* / Q000821:virology; D004196:Disease Outbreaks; D004202:Disinfectants / Q000008:administration & dosage*; D006235:Hand Disinfection / Q000379:methods*; D006268:Health Facilities; D006801:Humans; D017053:Infection Control / Q000379:methods; D008134:Long-Term Care; D009511:New England / Q000453:epidemiology; D029322:Norovirus / Q000302:isolation & purification*; D012307:Risk Factors
chemical_list: D000438:Alcohols; D004202:Disinfectants