Norovirus in Long Term Care Facilities Outbreak Checklist

Transcription

1 Norovirus in Long Term Care Facilities Outbreak Checklist Norovirus Description The typical symptoms are nausea, vomiting, fever, abdominal cramps, and watery non-bloody diarrhea. The usual incubation period is 1-2 days, but can be as short as 12 hours. Illness typically lasts hours and is self-limiting but extremely contagious. The virus is present in vomitus and stool, and can be shed in stool for up to two weeks after the symptoms resolve; asymptomatic persons can spread the virus. Outbreaks Outbreaks are likely when there are at least 3 patients/residents, students, and/or staff in a facility who are experiencing symptoms of this virus in a 48-hour period. Reporting an outbreak Any outbreak should be promptly reported to the New Mexico Department of Health by calling during business hours or during evenings, weekends and holidays and asking for the epidemiologist on-call. Outbreak Checklist 1) Inform the appropriate agencies within 24 hours of outbreak recognition. DHI: ABQ ED (if in ABQ): Hal Senke or Lorie Stoller at NMED (look up at NMED webpage-phone # for district office) Regional health office/public health nurse-may help collect specimens and get them over to SLD SLD-Virology Section (Adam or Judy ) if specimens are coming in to the lab for testing Other stakeholders as needed (Medical director of facility, corporate office etc.) 2) Staff, residents and visitors should wash hands vigorously with soap and warm water for at least 20 seconds before and after all contact do not rely exclusively on alcohol-based hand sanitizers. 3) Contact precautions should be used for any symptomatic residents. 4) Precaution signs should be hung on doors of those affected by the virus (see appendix). 5) Restrict ill patients to private rooms when possible. Observe contact isolation precautions. 6) Maintain line list (see R-drive folder): Monitor for ill staff and patients. Continue for 1 week after last case onset. 7) Ideally, specimens from at least 5 individuals should be obtained during outbreaks to confirm outbreak etiology. Stool or vomit can be collected within hours of symptom onset. Specimens should be labeled and stored in a refrigerator (4 C). See laboratory section for information regarding laboratory testing and consult SLD.

2 8) Exclude ill staff and visitors until 72 hours after last symptom. If transmission continues in the facility, screen employees who have been exposed and potentially incubating infection, to ensure rapid exclusion if symptoms develop. 9) Persons cleaning areas that are contaminated with vomitus or feces should wear gowns, gloves and surgical masks. 10) All vomit and fecal spillages must be promptly and carefully cleaned so that aerosols are minimized. 11) Refer to CDC/EPA norovirus cleaning guidelines for additional information. 12) Routine ward, bathroom and toilet cleaning should occur with increased frequency, especially common use bathrooms. A chlorine-based or other appropriate disinfectant should be used for non-porous surfaces. 13) Review food service/disinfection practices. Pay attention to staff hand washing and ice machines. 14) Restrict admissions and transfers (if needed) until outbreak is over (i.e., no new cases for at least 72 hours). 15) Limit staff from moving between affected and unaffected units and assign staff to work on the same wards or units as consistently as possible, until the outbreak has resolved. If feasible, maintain the same staff-to-resident assignments. Exclude any nonessential personnel from affected units. 16) Post notice for visitors: Restrict visitors to a single entry point, and monitor compliance with contact isolation precautions (see appendix). 17) Cancel or postpone group activities and serve meals in rooms until 72 hours after last case. 18) Educate staff and post signage around building reminding of precautions against the spread of disease. Laboratory Testing for Norovirus 1) Clinical Specimens (from: Stool Whole stool is the preferred clinical specimen for laboratory diagnosis of norovirus. Ideally, specimens should be collected during the acute phase of illness (within 48 to 72 hours after symptoms start) while stools are still liquid or semisolid. Virus is excreted in the greatest amount during this time. Stool must be collected in a container (e.g. urine cup) without transport media Norovirus can sometimes be detected in stool specimens that are collected later in the illness or after the symptoms have resolved (up to 7 to 10 days after onset). Whole stool specimens should be kept refrigerated at 39 F (4 C) if testing is done within 2 to 3 weeks. If the specimens are shipped to a laboratory for testing, each sample should be sealed in a separate bag, and kept on frozen refrigerant packs in an insulated, waterproof polystyrene container.

3 If testing will be done more than 3 weeks after the specimens are collected, they should be frozen at -4 F (-20 C) or -94 F (-70 C). When the specimens are stored in this way, norovirus can be detected after at least 5 years. Vomitus Vomitus can be collected to supplement stool specimens during an investigation. These specimens should be collected, stored, and shipped in the same way as stool specimens. Serum Serum specimens are not recommended for routine laboratory diagnosis of norovirus. 2) Food, Water, and Environmental Specimens Food and Water Specimens (CONSULT SLD FIRST!!!!) In principle, norovirus can be detected in water, food, and environmental specimens. However, the virus first needs to be concentrated or extracted or both from the specimen. Validated methods for these techniques are available only for water (at CDC) and shellfish [at the Gulf Coast Seafood Laboratory, Food and Drug Administration (FDA)]. If food or water is the suspected cause of a norovirus outbreak, samples should be collected as soon as possible after people were exposed. Food specimens should be stored frozen at -4 F (-20 C). Water can be tested for norovirus by processing large volumes (up to 100L) through specially designed filters. Water samples should be stored refrigerated or chilled on ice at 39 F (4 C). Environmental Specimens (CONSULT SLD FIRST!!!!) Norovirus RNA has been detected in swabs of environmental surfaces collected in specific outbreak settings. However, obtaining virus from swabs is highly variable. Results should be interpreted with caution and in the context of the available epidemiologic evidence. Contact CDC for additional guidance on testing water and environmental samples, and FDA for guidance on testing shellfish. Wrapping Up: Notify Joan or Chad of outbreak Follow-up daily with facility until outbreak is over Get results from SLD when ready Request hospital records for those who were hospitalized Get enough info for attack rate Develop epi curve Write name of outbreak on whiteboard list Create outbreak folder WRITE OUTBREAK REPORT!!!

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