As norovirus season gets into full swing, spare a thought for those hospital that still have open plan ‘Nightingale’ style wards. These worked for Florence in a Victorian era, but narrow bed spacing and a lack of single rooms makes the containment of infectious diseases very challenging in these wards.   A study just published in the Journal of Infectious Diseases puts some numbers to this risk, finding that the frequency of norovirus outbreaks varied hugely across 6 hospitals in the London area. With 2 or fewer outbreaks reported in 5/6 and a whopping 16 separate outbreaks in one of the hospitals. This hospital had the lowest proportion of single rooms (a miserly 7%) and the tightest bed spacing (2.3m between bed centres), and the authors attribute these structural challenges to the frequent outbreaks in these hospitals.   Managing norovirus in these challenging ward environments may require some additional measures. Whilst effective hand and environmental hygiene are the key to controlling the spread of noro, this needs to be complemented with effective isolation of patients. Perhaps more segregated cohorting of patients would be a way to tackle segregation of patients with diarrhoea and vomiting in Nightingale wards? But the real solution to address this issue is to increase the number of single rooms in new hospitals!