title: To close or not to close? Analysis of 4 year's data from national surveillance of norovirus outbreaks in hospitals in England.
abstract: OBJECTIVE
  To assess the impact of ward or bay closures, specifically, whether prompt closure of an affected ward shortens the duration of norovirus outbreaks and the resulting disruption in hospitals.
  
  
  METHODS
  Analysis of summary data from hospitals on outbreaks of norovirus from 2009 to 2012.
  
  
  METHODS
  Using a large outbreak surveillance dataset, we examined the duration of outbreaks, duration of disruption, ward closures, the number of patients and staff affected and the number of lost bed-days, as functions of the timing of closure. We conducted Quasi-Poisson regression analyses to assess the effect of ward closure (timing of closure) on outcome measures, controlling for time of year (winter or summer), ward size and ward type (elderly care wards).
  
  
  RESULTS
  Regression analysis indicates that after controlling for season ward size and type, the duration of outbreak and duration of disruption were shorter, fewer patients were affected by the time of closure and fewer patients were affected overall, when closure occurred promptly (within 3 days of the first case becoming ill) compared with non-prompt closure groups. However, in outbreaks where wards were not closed, the length of outbreaks were similar to the prompt closure group and also had fewer patients and staff affected and fewer cases per day of outbreak compared with prompt closure.
  
  
  CONCLUSIONS
  Closing a bay or ward promptly in an outbreak of norovirus leads to a shorter duration of outbreaks, a shorter duration of disruption and fewer patients being affected compared with outbreaks where wards were not promptly closed. However, the interpretation of these results is not straightforward. The outbreaks where the ward was not closed at all have similar characteristics in terms of the duration of outbreak and fewer people were affected compared with the baseline prompt closure group.
authors.affiliation: Gastrointestinal Emerging and Zoonotic Diseases Department, Public Health England, London, UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Harris
authors.forename: Goutam K
authors.initials: GK
authors.lastname: Adak
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: O'Brien
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D004196:Disease Outbreaks; D004739:England / Q000453:epidemiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000517:prevention & control* / Q000821:virology; D006271:Health Facility Closure; D006761:Hospitals; D006801:Humans; D029322:Norovirus; D011159:Population Surveillance; D013997:Time Factors
keywords: Infectious Diseases