Surviving Norovirus. Not Just a Cruise Ship Issue. Maria Wellisch, RN, LFNA Vice President of Corporate Education Morningside Ministries

Transcription

1 Surviving Norovirus Not Just a Cruise Ship Issue Maria Wellisch, RN, LFNA Vice President of Corporate Education Morningside Ministries

2 How Prevalent is Norovirus 21 million cases 71,000 individuals hospitalized 91,000 emergency visits 800 deaths

3 Foodborne Illness Outbreaks in the US Norovirus is responsible for more than 50% of all outbreaks

4 What is the cost of this virus? The cost for healthcare and lost productivity is $2 billion per year $1 billion per year $20 million per year

5 $2 Billion Dollars This is healthcare and lost productivity This does not measure the impact on the public perception of your facility if you have an out break.

6 Where is the most common setting for outbreaks? Healthcare facilities Cruise Ships Schools

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8 Why are long term care facilities so susceptible? 1. Communal / Social Activities 2. Congregate Meals 3. Dementia / hand washing

9 Clinical Symptoms 1. Short incubation usually 12:48 hours after exposure 2. Common symptoms acute onset of vomiting, watery, non-bloody diarrhea, abdominal cramping and nausea 3. Low-grade fever, headache and myalgia

10 Asymptomology 30% of infected individuals do not develop any symptoms

11 How long do symptoms last? Usually hours with most individuals recovering completely.

12 Most Serious Outcomes Seen in children under 2 Elderly Immunocompromised patients/ residents» Severe Dehydration» Hospitalization» Death

13 Treatment No specific treatment for norovirus gastoenteritis Dehydration is the most common complication that requires treatment Antimotility agents and antiemetics are generally not recommended Antibiotics have NO value this is a virus

14 Shedding This virus is shed primarily in the stool Vomitus is infectious Shedding peaks 4 days after exposure but can last up to 2-3 weeks Shedding can occur in non-symptomatic individuals

15 Person to person Transmission» Fecal-oral» Aerosolized Vomitus» Indirect contaminated items / the environment

16 Food Food handlers Contaminated Food (raspberries, oysters)

17 Contaminated drinking or recreational water A well contaminated by a septic tank Inadequate chlorination

18 Transmission in Healthcare Direct contact with infected persons Contaminated equipment

19 Highly Infectious When do we start to think about an outbreak?

20 Immediate Response As soon as you see the 1 st case (s) begin your investigation and implement precautions Collect data on both ill and exposed residents / patients and staff.» Date of Onset» Location» Work Assignment» Test Results» Outcomes

21 Prior to lab results Kaplan Criteria may be used to detect an outbreak

22 Kaplan Criteria Vomiting in more than ½ of the symptomatic cases Mean incubation period of hours Mean duration of illness is hours No bacterial pathogen isolated in stool culture

23 Lab Testing Check with your reference laboratory to determine what are the specimen requirements The (RT-PCR), reverse transciptase polymerase chain reaction The optimal specimen is a stool specimen while someone is acutely ill.

24 REMEMBER There are many causes for Gastroenteritis

25 What to do if you have an outbreak Notify health dept/public health know your states requirements and jurisdictions

26 Hand Washing

27 Staff Exclude ill staff until at least 48 hours after diarrhea and vomiting have stopped No floating Non-essential staff excluded from affected areas Hand washing instructions Review contact precautions

28 Residents 1. Start record for all symptomatic residents 2. Ill residents on contact precautions 3. No group activities 4. Do NOT move residents from affected to non-infected areas

29 Residents Maintain the same staff-to-resident assignments If resident transferred to hospital notify receiving site of the outbreak

30 Facility Consider halting new admissions until outbreak is over Review disinfectants and be sure you are using appropriate agents Quaternary ammonium compounds are NOT effective against noroviruses Clean and disinfect more frequently Review cleaning and disinfection with housekeeping and all staff

31 Facility (continued) Change mop heads Do not share common medical equipment unless disinfected between residents Change privacy curtains if soiled or after resident discharge Carpets and upholstery

32 Facility (continued) Soiled linens maximum cycle length, appropriate detergent Discontinue self-service or communal food/ beverages until outbreak over Disposable dishes/utensils NOT required Post signs facility is experiencing increase in gastrointestinal illness

33 Facility (continued) Be ready to discuss with media Be prepared to explain what you are doing with your family members

34 Visitors/Volunteers Encourage hand washing Postpone visits from children and elderly persons Ill family members and friends should be asked to avoid visitation Monitor Volunteers

35 Lesson Learned