Outbreak Management - From Noro to Influenza

1. Outbreak Management - From Noro to Influenza

2. Outbreaks There are many potential pathogens that can cause an outbreak of varying serverity • Clostridium difficile • Norovirus • Influenza type A and B • Infestation – body lice, flea, bed bugs (Cimicidae)

3. Outbreak Management - Noro The norovirus was originally named the Norwalk agent after Norwalk, Ohio, USA, where an outbreak of acute gastroenteritis occurred among children at Bronson Elementary School in November 1968 The name was shortened to norovirus after being identified in a number of outbreaks throughout the developed world

4. Outbreak Management - Noro • When a person becomes infected with norovirus, the virus begins to multiply within the small intestine. • The incubation period for the infection ranges from 4 to 72 hours but is usually 12 to 48 hours • Vomiting - is the predominant symptom but is not always present in all cases. When present the vomiting is often projectile with little or no warning

5. Outbreak Management - Noro Diarrhoea • this again can occur with little or no warning and be profuse • Other symptoms can include nausea, abdominal cramps, and “flu-like” symptoms such as headache, myalgia, chills or fever • Symptoms can last between 1 and 3 days, recovery being rapid thereafter • The infection is self limiting and usually mild

6. Outbreak Management - Noro • Severe illness is rare: although people frequently present at MIU’s, A&E departments etc. • Deaths attributed to Norovirus are estimated to be around 500-600 each year worldwide, with most of these occurring in the very young, elderly and persons with weakened immune systems • Symptoms may become life-threatening in these groups if dehydration is ignored or not treated

7. Outbreak Management - Noro TRANSMISSION The virus is transmitted • By person-to-person contact • Aerosolisation – vomiting or profuse diarrhoea • Faecally contaminated food or water

8. Outbreak Management - Noro • After infection, immunity to norovirus is usually incomplete and temporary. • There is an inherited predisposition to infection, and individuals with blood type O are more often infected, while blood types B and AB can confer partial protection against symptomatic infection.

9. Norovirus Toolkit The checklist is not a comprehensive tool but follows the approach of WHO Patient Safety Checklists in highlighting actions to be taken at critical points in the patient’s care pathway. The checklist is produced in a format that can be referred to readily and repeatedly by staff to ensure that all essential actions are performed. The checklist is not a comprehensive protocol and does not replace the organisations policy OR routine care.

11. Norovirus Toolkit The checklist can be: • Used as part of the patient care record • Reproduced as wall posters • Printed as individual staff aide memoirs • Included in outbreak kits • Adapted and revised for local use • Is available at the Infection Control Stand This checklist does not replace clinical guidance or clinical judgment.

12. Norovirus Toolkit NEVER send a sample of vomit as it is too HAZARDOUS to anaylise.

13. Bay/Side Room Area ALCOHOL GEL / DISPENSER BED BED LIGHT CEILING VENTS CHAIR CLINICAL WASTE BIN CURTAINS DOOR DOOR HANDLE HANDTOWEL DISPENSER HOUSEHOLD WASTE BIN INTERNAL GLAZING LOCKER LOW LEVEL DUSTING MIRROR PATIENT HAND BOOK PATIENT NAME PLATE PATIENT NOTES CLIP BOARD SINK SOAP DISPENSER SWITCHES TABLE TELEVISION WALL VENTS WINDOW LEDGES Sluice Area ALCOHOL GEL/ DISPENSER CEILING VENTS CLINICAL WASTE BIN DOOR DOOR HANDLE HANDTOWEL DISPENSER HOUSEHOLD WASTE BIN INTERNAL GLAZING LOW LEVEL DUSTING MIRROR SINK SOAP DISPENSER SWITCHES WALL VENTS WINDOW LEDGES Norovirus Toolkit NOROVIRUS Deep Clean Checklist Tiolet Area CEILING VENTS CLINICAL WASTE BIN DOOR DOOR HANDLE HANDTOWEL DISPENSER HOUSEHOLD WASTE BIN INTERNAL GLAZING LOW LEVEL DUSTING MIRROR SINK SOAP DISPENSER SWITCHES TOILET WALL VENTS WINDOW LEDGES

14. Outbreak Management - Flu In June 2009, the World Health Organization declared the new strain of swine-origin H1N1 as a pandemic. This strain is often called swine flu by the public media. This novel virus spread worldwide and had caused about 17,000 deaths by the start of 2010. On August 10, 2010, the World Health Organisation declared the H1N1 influenza pandemic over, saying worldwide flu activity had returned to typical seasonal patterns.

15. Outbreak Management - Flu 'Influenza' A is the most common cause of human influenza (flu). Some strains are endemic in humans and cause a small fraction of all influenza-like illness and a small fraction of all seasonal influenza. Typically, influenza is transmitted through the air by coughs or sneezes, creating aerosols containing the virus.

16. Outbreak Management - Flu Influenza can also be transmitted by direct contact with nasal secretions, or through contact with contaminated surfaces. Airborne aerosols have been thought to cause most infections, although which means of transmission is most important is not absolutely clear.

17. Outbreak Management - Flu Current health and safety guidance recommends that: Close contacts caring for a possible case of influenza should wear a surgical mask, plastic apron and gloves based on the likelihood of a person being a true case; Should an aerosol generating procedure be required close contacts caring for a probable or confirmed (laboratory confirmed swine influenza) cases of swine flu should wear an FFP3 respirator, gown, gloves and eye protection

19. Outbreak Management In Summary Can the Noro Tool Kit be used in a Flu outbreak? • Similar means of transmission – airborne, direct & indirect contact • Useful Checklist • PPE and HAND DECONTAMINATION essential • Flu Vaccine Programme – Monitor conditions closely – both infections can be life threatening and may require transfer to acute care

20. Outbreak Management Questions? Please ask at the Q&A session after the presentations