title: Temporary suspension of visiting during norovirus outbreaks in NHS Boards and the independent care home sector in Scotland: a cross-sectional survey of practice.
abstract: BACKGROUND
  Norovirus outbreaks cause significant patient distress and adversely affect healthcare service delivery. Measures to manage outbreaks include controlling patient/staff movement and advising visitors of the risks of infection; temporary suspension of visiting (TSV) is advocated by some. Factors influencing the use of TSV have not previously been reported.
  
  
  OBJECTIVE
  To describe current practice in Scotland regarding TSV during norovirus outbreaks.
  
  
  METHODS
  Cross-sectional survey of Scottish Health Boards [National Health Service (NHS)] Infection Prevention Leads (N = 22) and independent care home (ICH) managers (N = 107).
  
  
  RESULTS
  TSV practice is inconsistent across care settings. NHS findings: although 86.4% reported a recent norovirus outbreak, only 36.4% reported having criteria in place to guide TSV decisions and only 57.9% of those who had an outbreak implemented TSV. Conversely, 77.6% ICH respondents do have TSV criteria in place; 70.1% who had previously experienced an outbreak all reported that they would normally close to visitors. The majority of both NHS (81.8%) and ICH (84.2%) respondents reported making exceptions to TSV for individual cases. Despite variation in practice, 75% NHS and 81.8% ICH respondents agreed that TSV was helpful in controlling outbreaks. Factors influencing TSV implementation decisions included use of judgement in individual cases, perceived lack of evidence for the role of visitors in transmission, and belief in patients' rights to have visitors.
  
  
  CONCLUSIONS
  Implementation of TSV in Scotland is inconsistent, with variation in the use of criteria, personal beliefs, and professional judgements. Further research on the role of visitors in transmission and service-user acceptability of TSV is required for policy development.
authors.affiliation: Glasgow Caledonian University, Glasgow, UK. Electronic address: k.currie@gcu.ac.uk.
authors.forename: K
authors.initials: K
authors.lastname: Currie
authors.affiliation: Health Protection Scotland, Glasgow, UK.
authors.forename: E
authors.initials: E
authors.lastname: Curran
authors.affiliation: Glasgow Caledonian University, Glasgow, UK.
authors.forename: E
authors.initials: E
authors.lastname: Strachan
authors.affiliation: Health Protection Scotland, Glasgow, UK.
authors.forename: D
authors.initials: D
authors.lastname: Bunyan
authors.affiliation: Glasgow Caledonian University, Glasgow, UK.
authors.forename: L
authors.initials: L
authors.lastname: Price
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D029322:Norovirus / Q000302:isolation & purification*; D016134:Organizational Policy; D012606:Scotland / Q000453:epidemiology; D014789:Visitors to Patients
keywords: Norovirus outbreaks; Outbreak management; Suspended visiting