Surviving Norovirus Not Just a Cruise Ship Issue Maria Wellisch, RN, LFNA Vice President of Corporate Education Morningside Ministries
How Prevalent is Norovirus 21 million cases 71,000 individuals hospitalized 91,000 emergency visits 800 deaths
Foodborne Illness Outbreaks in the US Norovirus is responsible for more than 50% of all outbreaks
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
$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.
Where is the most common setting for outbreaks? Healthcare facilities Cruise Ships Schools
Why are long term care facilities so susceptible? 1. Communal / Social Activities 2. Congregate Meals 3. Dementia / hand washing
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
Asymptomology 30% of infected individuals do not develop any symptoms
How long do symptoms last? Usually 24-72 hours with most individuals recovering completely.
Most Serious Outcomes Seen in children under 2 Elderly Immunocompromised patients/ residents» Severe Dehydration» Hospitalization» Death
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
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
Person to person Transmission» Fecal-oral» Aerosolized Vomitus» Indirect contaminated items / the environment
Food Food handlers Contaminated Food (raspberries, oysters)
Contaminated drinking or recreational water A well contaminated by a septic tank Inadequate chlorination
Transmission in Healthcare Direct contact with infected persons Contaminated equipment
Highly Infectious When do we start to think about an outbreak?
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
Prior to lab results Kaplan Criteria may be used to detect an outbreak
Kaplan Criteria Vomiting in more than ½ of the symptomatic cases Mean incubation period of 24-48 hours Mean duration of illness is 12-60 hours No bacterial pathogen isolated in stool culture
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.
REMEMBER There are many causes for Gastroenteritis
What to do if you have an outbreak Notify health dept/public health know your states requirements and jurisdictions
Hand Washing
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
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
Residents Maintain the same staff-to-resident assignments If resident transferred to hospital notify receiving site of the outbreak
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
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
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
Facility (continued) Be ready to discuss with media Be prepared to explain what you are doing with your family members
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
Lesson Learned