title: Using a PDSA cycle of improvement to increase preparedness for, and management of, norovirus in NHS Scotland.
abstract: BACKGROUND
  The 2009-2010 norovirus season was reported anecdotally by infection prevention and control teams (IPCTs) to be one of the worst seasons in Scotland. At its peak, Health Protection Scotland's (HPS) weekly point prevalence identified that 53 wards were closed.
  
  
  OBJECTIVE
  To develop an annual cycle of learning lessons and improving systems to reduce the impact and incidence of norovirus outbreaks in Scotland.
  
  
  METHODS
  An analysis of two end-of-year norovirus season evaluations (2009-2010 and 2010-2011) by IPCTs in Scotland using a national Plan, Do, Study, Act (PDSA) model.
  
  
  RESULTS
  The first evaluation (2009-2010) identified that IPCTs responded well when outbreaks were reported, but were not optimally prepared for the season. In addition, IPCTs had little data to describe their particular problems in detail. HPS planned for the 2010-2011 season with tools to optimize preparedness and norovirus management. The second evaluation (2010-2011) identified much more proactive responses to both preparedness and norovirus management.
  
  
  CONCLUSIONS
  This national PDSA cycle has led to system improvements designed to reduce the incidence and impact of norovirus in NHS Scotland. The incidence of norovirus was reduced in the 2011-2012 season; however, confounding from the variation in circulating viruses makes it difficult to measure any effect of the system improvements. As noroviruses challenge the health service every year, mainly in winter months, the end-of-season evaluations can be used to improve planning for subsequent seasons to share and demonstrate good practice. As more years of data become available for analysis, the impact of system improvements will become measurable.
authors.affiliation: Health Protection Scotland, Glasgow, UK. evonne.curran@nhs.net
authors.forename: E T
authors.initials: ET
authors.lastname: Curran
authors.forename: D
authors.initials: D
authors.lastname: Bunyan
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000517:prevention & control*; D003140:Communicable Disease Control / Q000379:methods*; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D029322:Norovirus / Q000302:isolation & purification*; D011787:Quality of Health Care; D012606:Scotland / Q000453:epidemiology