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Norovirus Oakwood Health &
Rehabilitation Adriane Biggio RN, BS, IP
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Background Noroviruses are a group of related,
single-stranded RNA, non-enveloped viruses that cause acute gastroenteritits in humans.
A.K.A. Norwalk Virus, stomach flu Norovirus is highly contagious and
very hardy (can survive freezing and heating to 140˚F).
Pyrek, K. M. (2013). Norovirus control and prevention strategies. Infection Control Today, 1-20.
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Background, cont.
1 in 14 Americans, 21 million cases annually
Norovirus is the most common cause of acute gastroenteritis.
Pyrek, K. M. (2013). Norovirus control and prevention strategies. Infection Control Today, 1-20.
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Transmission
Found in vomit or stool of infected people. Transmission is primarily fecal-oral, direct
person-to-person spread, or via fecally contaminated food or water
Also spread via droplet from vomitus
Pyrek, K. M. (2013). Norovirus control and prevention strategies. Infection Control Today, 1-20.
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Outbreaks February 5, 2013 – February 11, 2013
(12 residents, 12 staff) March 1, 2013 – March 16, 2013 (44
residents, 23 staff) March 24, 2013 – April 11, 2013 (3
residents, 11 staff) 59 residents, 46 staff > half of residents and ~ half of staff experienced Norovirus-like symptoms
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Symptoms Symptoms of norovirus typically begin 12-48
hours post-exposure Nausea Vomiting Watery diarrhea Stomach cramping Low-grade fever Chills Headache Muscle aches Virginia Department of Health (VDH). (2011). Summary of guidelines for the control of a suspected or
confirmed outbreak of viral gastroenteritis (norovirus) in an assisted living facility or nursing home, 1-4.
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Treatment No cure, no vaccine Treatment is supportive, hydration and rest Illness is usually brief, lasting 1-2 days, 4-6
in the elderly or those who have been hospitalized.
Virus can be detected for up to four weeks following infection, peak viral shedding occurs 2-5 days after infection
Virginia Department of Health (VDH). (2011). Summary of guidelines for the control of a suspected or confirmed outbreak of viral gastroenteritis (norovirus) in an assisted living facility or nursing home, 1-4.
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How to contain it Started testing – took min. 6 days, stool
sent to California Contacted local health department to
report In-serviced Oakwood staff and
Environmental Services Contained symptomatic residents to their
rooms, initiated Contact Enteric Precautions Signs to alert visitors of illness-educated
about hand washing
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How to contain it, cont. Limited, then stopped all group
activities-closed dining areas Held admissions on symptomatic floors Advised staff to stay home and not cook
for loved ones for 48˚ post symptoms Encouraged nursing staff to clean carts
twice per shift and common areas nursing station countertops, phones, charts, etc. with bleach
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How to contain it, cont. Kept nursing staff on same units to limit
transmission Added free standing alcohol-based dispensers
to each dining area Reminded staff to clean the hands of
residents after toileting Updated Infectious Disease physician daily 24 hour report included times of last
symptoms Beds/chairs/surface areas of all symptomatic
residents were cleaned daily – linens changed
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Issues Administration questioned holding
admissions. OT for healthy. To use or not to use alcohol-based sanitizer? How often do those water pitchers get
cleaned anyway? -provided disposable cups during this time
Are staff really sick? Staff held accountable for attendance. Is it okay to ask staff their symptoms?
tracking
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Two residents threatened to leave because they were contained to their room.
Postponed nursing student rotations. Residents were not allowed to leave
their units.
Issues, cont.
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Questions?
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References
Pyrek, K. M. (2013). Norovirus control and prevention strategies. Infection Control Today, 1-20.
Virginia Department of Health (VDH). (2011). Summary of guidelines for the control of a suspected or confirmed outbreak of viral gastroenteritis (norovirus) in an assisted living facility or nursing home, 1-4.