Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada

•Almost three quarters (70%) of sites reported having at least one outbreak in 2013, and ward closure was utilized in 44% of the sites.•Overcapacity was perceived to be the main limitation on the implementation of ward closure. Over three quarters of sites had an Overcapacity/Full Capacity Protocol (OCP/FCP), and 63% of those respondents reported that this protocol was used “frequently” or “continuously”.•Ward closure was considered as an appropriate strategy either in general by 50% or sometimes, under some circumstances by 45%.•Respondents who said that ward closure was “sometimes” appropriate indicated that it would be so only if other measures fail, after a risk assessment, or depending on the nature and extent of the outbreak.•Responses indicated that ward closure was generally used for acute and virulent enteric and respiratory outbreaks, but not outbreaks involving antibiotic resistant organisms (AROs). BackgroundWard closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain.PurposeTo understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.MethodsA Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis.ResultsA total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an “appropriate,” “sometimes appropriate,” or “not appropriate” strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak.DiscussionResults suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration. Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain. To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis. A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an “appropriate,” “sometimes appropriate,” or “not appropriate” strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak. Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration. There have been more than 2,322 infectious disease nosocomial outbreaks filed in the Worldwide Outbreak Database based on articles published since 1966, which indicates the frequent and continuous occurrence of outbreaks across the globe.1Vonberg R.P. Weitzel-Kage D. Behnke M. Gastmeier P. Worldwide Outbreak Database: the largest collection of nosocomial outbreaks.Infection. 2011; 39: 29-34Crossref PubMed Scopus (49) Google Scholar An infectious disease outbreak is defined as the occurrence of more cases than expected of an infectious disease in a given area or among a particular group of people over a particular duration of time.2Alberta Health Services Guidelines for outbreak prevention, control and management in acute care and facility living sites. Alberta Health Services, Edmonton (AB)2015http://www.albertahealthservices.ca/assets/healthinfo/Diseases/hi-dis-flu-prov-hlsl.pdfGoogle Scholar Outbreaks occur frequently in hospitals and health care centers and pose a serious risk of colonization or illness to susceptible patients and health care staff.3Greig J.D. Lee M.B. A review of nosocomial norovirus outbreaks: infection control interventions found effective.Epidemiol Infect. 2012; 140: 1151-1160Crossref PubMed Scopus (43) Google Scholar, 4Harris J.P. Adak G.K. O'Brien S.J. To close or not to close? Analysis of 4 year's data from national surveillance of norovirus outbreaks in hospitals in England.BMJ Open. 2014; 4: e003919Crossref PubMed Scopus (17) Google Scholar In an effort to control hospital-acquired infectious disease outbreaks, many measures may be used, sometimes in combination, and include enhanced hygiene, isolation of infected patients, cohorting of cases and staff, visitor restrictions, and ward closures.3Greig J.D. Lee M.B. A review of nosocomial norovirus outbreaks: infection control interventions found effective.Epidemiol Infect. 2012; 140: 1151-1160Crossref PubMed Scopus (43) Google Scholar, 4Harris J.P. Adak G.K. O'Brien S.J. To close or not to close? Analysis of 4 year's data from national surveillance of norovirus outbreaks in hospitals in England.BMJ Open. 2014; 4: e003919Crossref PubMed Scopus (17) Google Scholar Hospitals providing acute care began publishing reports on the use of ward closure in an effort to control infections and communicable diseases more than 4 decades ago.5Noone P. Griffiths R.J. The effect on sepsis rates of closing and cleaning hospital wards.J Clin Pathol. 1971; 24: 721-725Crossref PubMed Scopus (7) Google Scholar Although there is no standard definition of “ward closure” and its use varies considerably, it usually involves some restriction of new patient admissions in some manner and is usually coupled with a bundle of other infection control measures, such as enhanced environmental services, rigorous hand hygiene, and enhanced surveillance to control transmission.6Centers for Disease Control and Prevention Key infection control recommendations for the control of norovirus outbreaks in healthcare settings.https://www.cdc.gov/hai/pdfs/norovirus/229110A-NorovirusControlRecomm508A.pdfGoogle Scholar During recent years, the value and efficacy of using ward closure to control hospital-acquired infection (HAI) outbreaks has been questioned because it is among the most expensive and disruptive infection prevention and control (IPC) measures that can be used.4Harris J.P. Adak G.K. O'Brien S.J. To close or not to close? Analysis of 4 year's data from national surveillance of norovirus outbreaks in hospitals in England.BMJ Open. 2014; 4: e003919Crossref PubMed Scopus (17) Google Scholar, 7Haill C.F. Newell P. Ford C. Whitley M. Cox J. Wallis M. et al.Compartmentalization of wards to cohort symptomatic patients at the beginning and end of norovirus outbreaks.J Hosp Infect. 2012; 82: 30-35Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 8Hansen S. Stamm-Balderjahn S. Zuschneid I. Behnke M. Rüden H. Vonberg R.P. et al.Closure of medical departments during nosocomial outbreaks: data from a systematic analysis of the literature.J Hosp Infect. 2007; 65: 348-353Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar, 9Illingworth E. Taborn E. Fielding D. Cheesbrough J. Diggle P.J. Orr D. Is closure of entire wards necessary to control norovirus outbreaks in hospital? Comparing the effectiveness of two infection control strategies.J Hosp Infect. 2011; 79: 32-37Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Total closures of a ward, assuming 25 patients or more housed on the ward, can have a major influence on bed-days lost, cancellation of elective admissions, loss of capacity for emergency admissions with its attendant impacts on morbidity and mortality, and may be difficult to implement in health care facilities where lack of capacity is a problem, or in wards providing unique clinical services.9Illingworth E. Taborn E. Fielding D. Cheesbrough J. Diggle P.J. Orr D. Is closure of entire wards necessary to control norovirus outbreaks in hospital? Comparing the effectiveness of two infection control strategies.J Hosp Infect. 2011; 79: 32-37Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Ward closures have historically been employed to curtail spread (by restricting admission of new, susceptible hosts) and thereby shorten the overall duration of an outbreak. In addition, ethical concerns when new patients are knowingly admitted into an area known to be experiencing ongoing spread of an infectious agent may factor into decision making regarding ward closure. Recent studies comparing the efficiency of ward closures to other, less expensive and less disruptive outbreak methods suggest that ward closures may not be necessary, depending on the setting and the type of microbe associated with the outbreak.9Illingworth E. Taborn E. Fielding D. Cheesbrough J. Diggle P.J. Orr D. Is closure of entire wards necessary to control norovirus outbreaks in hospital? Comparing the effectiveness of two infection control strategies.J Hosp Infect. 2011; 79: 32-37Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar This study was part of an effort to understand current evidence in the literature as well as practices on the use of ward closure across Canada in the event of an HAI outbreak, with the ultimate goal of informing the provincial policy on ward closure in Alberta. The first part of this work has been published as a systematic review.10Wong H. Eso K. Jones J. Kwon Y. Powelson S. de Grood J. et al.Use of ward closure to control outbreaks among patients in acute care a systematic 4: PubMed Scopus (7) Google Scholar The work is a environmental scan that was to a of the current practices regarding the use of ward closure to control HAI outbreaks in acute care settings in Canada. The of the environmental scan was to the of use of ward closure in acute care hospital settings to control HAI the and for the use of ward and on the and used by hospital IPC and other infection regarding and under circumstances ward closure is an appropriate of or in the control of HAI The team IPC experts who in a and manner to the and of the survey that would be most appropriate in the of this were from the Canadian for for Hospitals for of Health of Canada Canadian Scholar A of the survey was and and by of the study team to of the The survey was by the PDF to a of in of the survey a of to the the survey was to a more using The survey was a among experts to and issues The survey can be found in were an on of the to the survey an or by The survey was distributed to from IPC in acute care hospitals across Canada. were from from the Canadian and in the study by the for the for Health and During the Canadian of Health a total of hospitals in Canada. 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