Accimap diagram:
Norovirus gastroeneteritis outbreak single resort Dominican Republic
1. External
2. Government
3. Organizational/workplace
4. Physical/ individual events,
processes and conditions
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Caribbean region
Winter seasonality
Media difficulties
Department of health
Department of tourism
Environmental health advisor
Epidemiology division
Government water supply
department
Private water treatment company
Resort management
Tour operator warning
Airline hygiene procedure
Medical/lab resources
Delated prevention measures
Multi-disciplinary investigation team
Communication and information
flow deficiencies
Difficulties to stop person-to-person
transmission
Food/potable water
Wastewater and mangles
Mangle/sea water
waterborne spread
Hotel guest(s) with foodborne
illness
Passenger infections
Cross contamination
Aeroplane returning flight
Poor sanitary conditions
Contaminated surfaces
Airborne environmental
transmission
Risk food: salad/sea food
Epidemiological data
Susceptible population
Lack of analysis test
Staff hygiene practices
Cleaning and disinfections standards
Inefficient water treatment
Explosive vomiting common areas
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5. Conditions
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Cleanears/housekeepers
Semiclose populations (e.g. hotels,
hospitals)
The hotel maintained no logs or
procedural guidelines water
treatment
Reduce laboratory testing
Inactive surveillance system
Irregular inspection and monitor
drinking water supplies and waste
water systems
Insufficient treatment conditions
Unimplemented food safety
systems
Norovirus gastroenteritis outbreaks
Acute gastroenteritis
Cross contamination
800 illness