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Noroviruses. Marion County Public Health Department. What are noroviruses?. Group of viruses that cause the “ stomach flu, ” or gastroenteritis The term norovirus was recently approved as the official name for this group of viruses. Approximately 23 million cases each year in U.S.
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Noroviruses Marion County Public Health Department
What are noroviruses? • Group of viruses that cause the “stomach flu,” or gastroenteritis • The term norovirus was recently approved as the official name for this group of viruses. • Approximately 23 million cases each year in U.S. • Leading cause of outbreaks of gastroenteritis
Symptoms • Nausea, vomiting, diarrhea, abdominal cramps • Sometimes low-grade fever, chills, headache, myalgia, fatigue • Often begins suddenly, and the infected person may feel very sick
Incubation, Duration, Communicability • Incubation period: 12 - 48 hours (median in outbreaks is 33 - 36 hours) • Duration of illness: 24 - 60 hours • Period of communicability: onset through 72 hours after recovery
Transmission • Found in the stool and vomit of infected people • Infective dose as few as 100 viral particles • Can be transmitted several ways: • Eating food or drinking liquids that are contaminated with norovirus • Direct person-to-person spread • Airborne and fomite transmission in droplets contaminating surfaces or entering the mouth and being swallowed
How serious is it? • Usually not serious, although people may feel very sick and vomit many times a day • Most get better within 1 or 2 days, and they have no long-term health effects related to their illness • Can be serious for the very young, the elderly, and persons with weakened immune systems due to dehydration
Treatment • Drink plenty of fluids to prevent dehydration • No antiviral medication • No vaccine to prevent infection • Cannot be treated with antibiotics because antibiotics work to fight bacteria and not viruses
Immunity • Limited immunity, may be strain specific and last only a few months • Can recur throughout a person’s lifetime • Some people are more likely to become infected and develop more severe illness than others • Example: people with O blood group most susceptible
Critical Characteristics • Highly contagious • Multiple modes of transmission • Stable in the environment • Resistant to routine disinfection methods • Asymptomatic infections • Limited immunity
Definition of a Gastroenteritis Outbreak • An outbreak is a higher number of ill cases above baseline • 2-3 ill cases with vomiting or diarrhea at a facility maybe a signal that an outbreak is starting • Facilities are required by law to report any suspected outbreak of disease and are permitted to provide information on illnesses per HIPAA
Hand Washing • After using restrooms and before eating • Before and after direct contact with residents • Hand wash sinks have warm water, soap, and paper towels • Alcohol-based hand sanitizer to supplement hand washing
Hand washing is the single most important practice to prevent the spread of outbreaks! • HANDS MUST BE WASHED: • Whenever they are visibly soiled or there has been contact with stool. • Between contact with different residents. • Before putting on gloves and after removing gloves. • After using the toilet. • Before eating or smoking. • Before handling or preparing food. • A PROPER HAND WASH INCLUDES: • Using warm running water and soap with plenty of friction for 20 seconds. • Using a clean paper towel to dry your hands and to turn off the tap. • Use of a waterless hand sanitizer may be substituted for hand washing only if adequate sink facilities are not immediately accessible and hands are not visibly soiled.
General Staff Guidelines • Educate regular and agency staff about infection control practice • Eliminate floating staff from affected to unaffected areas • Notify supervisor immediately if ill • Furlough ill staff for 72 hours after symptoms resolve • Ill food service workers and servers should not prepare or handle food
General Staff Guidelines • Wear gloves, gowns, and mask during contact with ill residents • Pairing employees who have recovered from the illness with currently ill residents • Exclude non-essential personnel
Residents and Visitors • Recommend no new admissions • Confine ill residents to rooms until 72 hours after symptoms resolve • Place ill resident on contact precautions • Cancel group activities (dining room) • Do not transfer residents from affected areas to unaffected areas • Post signs to inform visitors of outbreak • Do not allow children to visit
General Cleaning Principles • Wear disposable gloves, gowns, and mask when cleaning up vomit or diarrhea • Clean soiled areas with detergent and hot water first • Always clean with paper towels or disposable cloths and dispose in infectious waste bags. • Disinfect with freshly-made (daily) bleach solution of 1/2 cup of 6% household bleach to one gallon of water
Cleaning Specific Things • Increase routine cleaning • Contaminated hard surfaces: soak up excess liquid with paper towels, thoroughly clean with hot water and detergent, and disinfect with a bleach solution • Contaminated carpets: soak up excess liquid with paper towels, clean with hot water and detergent, then disinfect with bleach solution (if bleach-resistant) or steam clean
Cleaning Specific Things • Frequently clean hand contact surfaces, e.g. door handles, railings, tabletops, etc. with bleach solution
Virkon Disinfectant • Potassium peroxymonosulfate and Sodium chloride (equivalent to 9.75% available chlorine) • Currently available Wilco Farm Stores • Check Marion County Health website: http://health.co.marion.or.us/ph/epid
Laundry Staff • Wear disposable gloves, gowns, and mask when handling contaminated laundry • Maintain separate bins for dirty and clean laundry • Place contaminated laundry in impermeable bags for transportation to laundry room
Kitchen Staff • Furlough ill staff for 72 hours after symptoms resolve. After returning to work, restrict from handling kitchenware and ready-to-eat food for another 72 hours • Double hand wash after using restroom, eating, breaks • Use single-use gloves in addition to hand washing • Limit access of bin-style ice machine to kitchen staff • Keep food covered when transporting • Discard any food handled by an infected worker • Disinfect food prep areas with bleach solution
Vomiting Incidents in the Kitchen • Carefully remove all visible vomit. • Disinfect food preparation area with ½ cup of bleach to one gallon of water. • Discard exposed food or single-serve articles within a 25-foot radius of the incident. • Food contact surface disinfection should be followed with a clear-water rinse and a final wipe down of 1 tablespoon of bleach to one gallon of water.
Dining • Post signs encouraging hand washing before eating • Discontinue self-service salad bars, family style dining, communal fruit bowls • Provide alcohol-based hand sanitizer to supplement hand washing
Public Restrooms • Discourage use when possible • Clean frequently using a freshly made bleach solution of 1/2 cup of 6% household bleach to one gallon of water Bleach
Marion County Health Department Follow Up • Collecting data on Gastroenteritis Case Log until Norovirus is identified • Collecting stool samples • Putting control measures into place for staff, residents, volunteers, and visitors • Site visit by Environmental Health • Working with Oregon Health Division • Daily monitoring of outbreak
Addition information and forms on MCHD website: http://health.co.marion.or.us/ph/epid
Collecting Stool Specimens • 5-6 stools from ill or recently ill resident and staff. • Collect stool specimen, the size of a walnut in a clean container with a lid. • Label container with name, dob, and date collected. • Refrigerate until specimen can be brought in to the health department.
Seven days must pass without new cases before an outbreak of Norovirus-like gastroenteritis is declared over Outbreak Declared Over
Partnership with other agencies • Reinforcing the same control measures • Building continuity of care • Promoting communication between the health department and other agencies
Sources Robert E. Wheeler, MD, FACEP. Voyager Medical Seminars