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Norovirus and Clostridium difficile outbreaks: squelching the wildfire

Fisher, Anna,b; Dembry, Louise M.a,b

Current Opinion in Infectious Diseases: August 2017 - Volume 30 - Issue 4 - p 440–447
doi: 10.1097/QCO.0000000000000382

Purpose of review: Gastrointestinal outbreaks in the healthcare setting cause increased morbidity and mortality in an already vulnerable population. Optimization of infection prevention measures can be a challenge in healthcare settings. This review describes new literature that may change the traditional infection prevention approach to such outbreaks.

Recent findings: Asymptomatic carriers of both norovirus and Clostridium difficile can pose risk of transmission to others and the environment. Rapid recognition and diagnosis can decrease the extent of an outbreak. No-touch technologies for environmental disinfection are new and effective tools. Infection prevention consultant services and systems redesign can augment efforts to control baseline infection rates and outbreaks. Antimicrobial stewardship continues to be essential to prevent C. difficile infection.

Summary: New approaches are needed to stem the tide of norovirus and C. difficile clusters and outbreaks in healthcare settings. Accurate recognition, testing, and implementation of infection prevention measures can be supported with rapid testing modalities, access to updated guidelines and no-touch disinfection systems. The work–environment culture should be carefully assessed and restructured using human engineering models to promote effective infection prevention practices. Antimicrobial stewardship initiatives are needed at the bedside and at national levels.

aInternal Medicine Department, Section of Infectious Diseases, Yale University School of Medicine, New Haven

bVA Connecticut Healthcare System, West Haven, Connecticut, USA

Correspondence to Ann Fisher, MD, VA Connecticut Healthcare System, 950 Campbell Avenue, 111-I, West Haven, CT 06516, USA. Tel: +1 203 932 5711x3743; fax: +1 203 937 3476; e-mail:

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