Norovirus Oakwood Health &

Rehabilitation Adriane Biggio RN, BS, IP

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.

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.

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.

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

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.

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.

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

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

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

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

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.

Questions?

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.