Published: Thursday, 2nd July, 2009 8:30am

The health chiefs waging war on virus

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IT"S known as the winter vomiting disease and, like its name, causes severe, dramatic throwing up, with some sufferers developing diarrhoea.

But don"t be fooled – although there is an increase of norovirus in winter, cases occur in all seasons.

Dunfermline"s Queen Margaret Hospital saw 10 outbreaks between January and March this year. In 2007, the hospital had 20 outbreaks of norovirus, but only seven in 2008.

This caused several ward closures, prompting public concern about cleanliness and infection control at the Queen Margaret.

However, NHS Fife has insisted it had rigorous infection control measures in place and also shed light on the figures.

Dr Gordon Birnie, medical director of NHS Fife"s operational division, said, 'The thing to take about norovirus is that we are no different to any other healthcare system.

'If you look at these figures, they are roughly proportional to the percentage of the healthcare that we deliver compared to the rest of Scotland. So we"re not in any way out of line on norovirus.'

National figures for norovirus outbreaks in 2009 are not yet available but in 2008 there were 324 cases Scotland-wide. In 2007, there were 235.

NHS Fife consultant microbiologist Dr Keith Morris explained that there was also data to suggest that different serotypes of norovirus can cause worse disease.

He said, 'It has to do with the virus type and the way in which it is transmitted. An example would be if it"s causing more vomiting, then it can be generated as an aerosol and get spread more easily.

'Whereas if it"s causing more diarrhoea – people tend not to have diarrhoea in the middle of the street. It"s just simple things like that that can make it worse one year compared to the next.'

NHS Fife infection control manager David Livingstone added, 'We see variations from season to season – some years are very bad, some years are a lot better. We believe that"s actually due to the differences in the specific organism that"s around any one year.'

And it may also have appeared that outbreaks were frequent this year because of NHS policy.

Mr Livingstone explained, 'We made a decision during this winter to be as open as we could.

'From that point of view, when we had a ward closed with norovirus, we tended to make sure that information was put out about it.

'Traditionally it tends to start when the schools go back in the autumn. If you think about it, if there"s a bit of norovirus around the community, children all go back to school, they mix around, they take it home, it spreads through the community.

'This year it"s actually been late in Scotland. You expect it to be starting around September, peaking in January. This year it started in November and didn"t really peak until the end of February, beginning of March.

'We don"t really know why – there"s no obvious national explanation – but from that point of view all the Scottish hospitals are in the same boat.

'Another thing to bear in mind is that there are as many norovirus outbreaks everywhere else in the community as there are here.

'Care homes, schools, cruise ships – anywhere where you have groups of people in a confined environment, it spreads.'

To help control the spread, enhanced infection control measures are put in place whenever there is an outbreak but the health board stresses that visitors have a part to play, particularly as two of the outbreaks were caused by visitors.

Dr Morris said, 'Visitors can transmit infections into hospitals and we know this has occurred for norovirus.

'There were actually two outbreaks – we can confirm that a relative visited a patient and then the relative vomited in the hospital. We know they were ill when they were in hospital.

'That"s one example of visitors transmitting infections into hospital.

'The other way we can use visitors is to get them to help us fight infections so if they notice something is not being done well on a ward or there"s something dirty, they could raise that with the nursing staff or medical team.'

The health board is also considering trying out a 'meet and greet' service at ward waiting areas, where just before visiting time, staff explain infection control measures and the use of alcohol gel.

Mr Livingstone said, 'Our objective really is visitor education particularly in terms of the dos and don"ts. It"s not for norovirus but it"s specific advice for visitors.

'It"s obvious stuff – if you"re feeling ill, don"t come in, if somebody in the house is ill, don"t come in, clean your hands.

'For norovirus particularly it"s trying to suggest to people that bringing food from outside, particularly when it"s unwrapped and not washed, is not a good idea in hospitals because that"s a common route for norovirus to pass.

'The other thing we do stress is we really discourage visitors from sitting on patients" beds. In that situation you are not just contacting with your hands but most of your body.

'We are trying as much as possible to prevent it coming in but obviously we don"t want to make too many rules for visitors – they are very important for a patient"s well-being, so we try to strike as good a balance as we can.'

And the health board stressed the importance of hand hygiene – the primary way in which organisms are transferred.

Dr Birnie said, 'These are public buildings and obviously the public have to have access to them. We expect the public to recognise the risks around infection.

'We try and publicise the risks – we expect them to act responsibly and not come in in dirty clothing and to decontaminate their hands.

'The usage of hand gel is certainly improving but we can never emphasise enough how important it is that people do this.'

The health board also tries to ensure that staff follow these measures.

Dr Birnie explained, 'We are driving that very hard. Nobody can guarantee that every single member of staff washes their hands on every single occasion.

'But we have systems in place to audit compliance – staff who are not washing their hands, we are pointing it out to them.

'What we are trying to do is to encourage every staff member to take responsibility for themselves but also the staff around them, so that everybody is reminding everybody of the need to wash their hands properly all the time.'

The health board also carries out continuous surveillance to help prevent outbreaks.

Dr Morris said, 'Surveillance is an ongoing, continuous process, and staff at the ward level are very helpful – we ask them to tell us when they think something is wrong or when there is a specific problem identified.

'So we"re getting this feedback on a continuous basis, every day, and we analyse it and feed it back to the wards.'

He added, 'Infection control in Fife and in Scotland generally has changed in the last three years. Certainly in Fife the infection control team has moved from being reactive to proactive – we now perform much more surveillance and we"re actually looking for outbreaks.

'We get background levels and put in interventions to try and reduce the outbreaks. This surveillance is ongoing and we are noticing a reduction.'

Mr Livingstone explained that there were also systems in place now which alert infection control.

He said, 'For example, when a patient who previously had MRSA colonisation comes back into hospital, the patient management systems triggers the infection control IT system and an alert comes up.

'The lab results also feed into that and that"s monitored three times a day by the infection control team. If something unusual comes up, we know within hours.

'The infection control nurse can go into the ward and make sure any precautions are in place and give any advice that needs to be given.'

Dr Birnie also underlined the importance of strengthening infection control education.

He said, 'Consultant staff each year have mandatory training sessions which includes infection control, infection control training is integrated into all our induction packages for new staff and we"re constantly raising the profile around infection control.'

However, to the Queen Margaret"s credit, the outbreaks did not affect the hospital in terms of resources.

Dr Birnie said, 'In terms of service delivery, we have continued to deliver the service. Because of norovirus and ward closures, we haven"t had to stop any particular service or transferred any patients out of Fife. I think there were a small number of people who were due to have elective operations who had short delays and they were postponed for a few weeks because we had some of the capacity shut.

'But despite that we"ve met all our Government targets and access times. The staff worked very hard to minimise the impact of these events on patients.'