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An Outbreak of Acute Nonbacterial Gastroenteritis in a Nursing Home

Published online by Cambridge University Press:  21 June 2016

David A. Pegues  and
Charles H. Woernle
David A. Pegues
Affiliation:
Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia, Alabama Department of Public Health, Atlanta, Georgia
Charles H. Woernle*
Affiliation:
Division of Epidemiology, Alabama Department of Public Health, Montgomery Alabama, Atlanta, Georgia
*
Alabama Dept. of Public Health, Div. of Epidemiology, 434 Monroe St., Montgomery Alabama 36130-l 701
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Abstract

Objective:

To determine risk factors for and modes of transmission of an outbreak of acute nonbacterial gastroenteritis among residents and staff in a nursing home.

Design:

Cohort study of residents and questionnaire survey of employees.

Setting:

One hundred twenty-bed nursing home in Alabama.

Patients:

From July 11,1991, through July 25,1991,77 of 120 residents (attack rate = 64%) and at least 14 of 49 employees (minimum attack rate = 29%) developed acute gastroenteritis characterized by vomiting and diarrhea; few residents developed fever > 100°F. Nine residents required intravenous rehydration, and 2 residents died.

Results:

The risk of developing illness was greater for female residents (64/92 versus 13/28; relative risk [RR] = 1.5; 95% confidence interval [CI95 ]=1.0-2.3) and for employees who reported handling residents' soiled linen, stools, or vomitus more frequently (>5 times a shift versus = 5 times a shift: 7/13 versus 7/31; RR=2.4; CI95 = 1.1-5.4). Direct transmission of infection, probably via person-to-person spread, sustained the outbreak. Temporal clustering analysis demonstrated that the risk of becoming ill 1 or 2 days after a roommate became ill was significantly greater than that of becoming ill at other times during the outbreak (RR= 2.2; CI95 = 1.3-3.8). No Salmonella or Shigella species, ova, or parasites were identified from 12 fecal specimens obtained from ill residents.

Conclusions:

Although stool and serum specimens were not available for viral studies, the clinical symptoms and incubation period were consistent with illness due to Norwalk-like viral agents. This outbreak emphasizes the severity of acute nonbacterial gastroenteritis among elderly and debilitated residents of nursing homes and the need for prompt use of enteric precautions in controlling outbreaks of gastroenteritis in these facilities.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 2 , February 1993 , pp. 87 - 94
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

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