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Health Protection Scotland monitors and publishes ward closures due to presumed or confirmed norovirus outbreaks via a point prevalence surveillance. This is Management Information data and not Official Statistics. Norovirus point prevalence reporting commenced on 7 January 2008.

This weekly point prevalence data relates to the number of wards closed at any time on a Monday. This provides an indicator (in as close to real-time as is possible) of the impact norovirus is having on NHSScotland but is not incidence data and can therefore miss some outbreaks, i.e. if an outbreak started on a Tuesday and was over by the Sunday it would not be recorded on the prevalence data.

Ward closures occurring on a Monday that are still ongoing the following Monday will be counted twice even though they relate to a single outbreak.

Since this is point prevalence data it is not possible to aggregate this to get an annual total of ward closures. Weekly point prevalence data by NHS board for 2008 to 2011 is available from the Scottish Parliament Information Centre (Bib. number 53503).

Future weekly data for 2011 will be available at:

http://www.hps.scot.nhs.uk/haiic/ic/noroviruspointprev.aspx.

The relevant details are in the following table.

Nhs Lanarkshire: Hospital Ward Closures/Partial Ward Closures: 2007–2010

Source: NHS Lanarkshire

Information on the total number of patients who have contracted norovirus is not available.

The number of laboratory confirmed cases of norovirus infection that are reported to Health Protection Scotland (HPS) are provided for each NHS board and calendar years 2007 to 2011 grouped into four-week periods. The tables are available from the Scottish Parliament Information Centre (Bib. number 53504).

These data are based on voluntary reporting by clinical laboratories in Scotland to HPS on a weekly basis and include cases originating in both healthcare and community settings.

Laboratory confirmed cases are only a subset of the absolute number of patients infected with norovirus. These figures will not include those infected with norovirus, who did not seek medical attention or have a stool sample submitted. Only a small proportion of cases are likely to seek medical advice and of those who do only a small sample will have a stool sample submitted. Therefore, the figures shown should be treated with caution.

Health Protection Scotland monitors and publishes ward closures due to presumed or confirmed norovirus outbreaks via a point prevalence surveillance. Weekly point prevalence data by NHS board for 2008 to 2011 is available in the answer to question S4W-04427 on 20 December 2011. This provides an indicator (in as close to real-time as is possible) of the impact norovirus is having on NHSScotland.

All answers to written parliamentary questions are available on the parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.

Information on the total number of patients who have contracted norovirus in NHS Lanarkshire is not available.

The number of laboratory confirmed cases of norovirus infection that are reported to Health Protection Scotland by NHS board is provided in the answer to question S4W-04429 on 20 December 2011. This information is not available at hospital level.

Health Protection Scotland monitors and publishes ward closures due to presumed or confirmed norovirus outbreaks via a point prevalence surveillance. Weekly point prevalence data by NHS board for 2008 to 2011 is available in the answer to question S4W-04427 on 20 December 2011. This provides an indicator (in as close to real-time as is possible) of the impact norovirus is having on NHSScotland.

All answers to written parliamentary questions are available on the parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.

The Health Protection document “Norovirus Outbreak Preparedness, Control Measures & Practical Considerations for Optimal Patient Safety and Service Continuation in Hospitals” was first issued in 2007 and then revised and reissued on 30 September 2011. Section 3 - “Why noroviruses cause outbreaks in hospitals settings” - provides the relevant information.

http://www.documents.hps.scot.nhs.uk/hai/infection-control/toolkits/norovirus-control-measures-2011-09.pdf.

NHS Lanarkshire have confirmed that, including the most recent outbreak of norovirus at Monklands Hospital (at certain points since 29 November wards 6,14 and 16 to 22 have been closed), the main reason for ward closures in 2011 to date has been appropriate infection control measures as a result of patients with Diarrhoea and Vomiting (D&V). The incidence up to the most recent outbreak is detailed in the following table. The NHS board has confirmed that some wards at the hospital have also been closed for a limited period in 2011 as a result of routine redecoration and maintenance.

Monklands Hospital: Ward Closures due to D&V up to November 2011

Source: NHS Lanarkshire.

The Health Protection Scotland document Norovirus Outbreak Preparedness, Control Measures & Practical Considerations for Optimal Patient Safety and Service Continuation in Hospitals was first issued in 2007 and revised and reissued on 30 September 2011. Section 4. The Norovirus Year – focussing on preparedness in particular advised boards on activity required to help prevent norovirus outbreaks.

http://www.documents.hps.scot.nhs.uk/hai/infection-control/toolkits/norovirus-control-measures-2011-09.pdf.

Individual boards have their own procedures in place to contain norovirus. These will be based on the national guidance from Health Protection Scotland Norovirus Outbreak Preparedness, Control Measures & Practical Considerations for Optimal Patient Safety and Service Continuation in Hospitals which was first issued in 2007 and revised and reissued on 30 September 2011.

http://www.documents.hps.scot.nhs.uk/hai/infection-control/toolkits/norovirus-control-measures-2011-09.pdf.

The information which is available is given in the following table. National Records of Scotland (NRS) statistics on winter mortality are based on the numbers of deaths which were registered between 1 December and 31 March, inclusive. The following figures are for deaths which occurred in hospitals. NRS produces its statistics from what is recorded on the medical certificate of the cause of death (MCCD), which should mention only medical conditions that caused or contributed to the death. As the MCCD should not mention medical conditions which did not cause or contribute to the death, NRS cannot know exactly how many patients had underlying health conditions. However, on the basis of what was recorded on the MCCDs, it would appear that very few (if any) of these people did not have other medical conditions.

Winter deaths in hospitals in Scotland for which “norovirus” or an equivalent term* was mentioned on the death certificate:

Winter in which the Death was Registered (1 December to 31 March)

Note: *This table counts all deaths for which any one of the following words or terms was mentioned in the death certificate: “norovirus”, “noroviral”, “Norwalk” (as this is what “norovirus” was originally called when it was identified in 1968), “small round structured virus” or “SRSV” (a term which was used later) and “winter vomiting” (as such illnesses are usually caused by norovirus). It also includes the deaths for which the underlying cause or any contributory cause was coded, in terms of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD10) as “A08.1 Acute gastroenteropathy due to Norwalk agent”.

**Deaths are counted against the area in which the hospital is located (rather than against the person’s area of usual residence, if in Scotland, which is the usual basis of NRS statistics).

These figures may underestimate slightly the true number of deaths to which norovirus has contributed, because they do not include deaths which were certified as due to (e.g.) gastroenteritis without any mention of norovirus (or one of the other terms referred above), perhaps because the presence of the virus had not been identified.

Symptoms from Norovirus usually last for 24 to 48 hours. In line with infection control guidance, staff are required to be symptom free for more than 48 hours before returning to work.

NHS Lanarkshire have confirmed that they are covering any staffing shortfalls as a result of the recent outbreak through the use of the local nurse bank, overtime, and additional hours; alongside a small reduction in planned activity - the staff from which are redeployed as appropriate in line with infection control guidance. The NHS board has provided assurances that they are ensuring that safe minimum staffing levels are being maintained based on the clinical assessment of patient condition and numbers, and general workload.