2 NEARLY 400 GUESTS BECAME ILL AT Great Escape Lodge & Indoor Water ParkNEARLY 400 GUESTS BECAME ILL ATSIX FLAGS GREAT ESCAPE LODGE & INDOOR WATERPARK IN QUEENSBURY, NEW YORK.
3 Great Escape Lodge & Indoor Water Park People were getting sick within 4 hours of checking-in.So many people were vomiting, the resort ran out of towels.We learned that people were getting sick within 4 hours of checking-in. One couple told of the fact that the facility had so many people vomiting that it was out of towns.
4 Great Escape Lodge & Indoor Water Park New York officials linked the Great Escape to the illnesses of nearly 200 people.More than 300 called the hotline to report symptoms of diarrhea and vomiting after visiting the resortThe mystery illness is looking more and more like Norovirus. New York officials have linked the Great Escape to the illnesses of nearly 200 people and more than 300 have called the departments hotline to report symptoms of diarrhea and vomiting after visiting the resort or to get more information.NOROVIRUS IS SUSPECTED
5 University of Connecticut Sorority 30 Sorority Women were treated at the Univ. of Conn’s infirmary after dining at the nearby Adams Mill Restaurant.A University of Connecticut sorority picked the wrong place to hold its banquet. About 30 sorority women were treated by UConn’s infirmary after dining at the nearby Adams Mill Restaurant. Norovirus is suspected.NOROVIRUS IS SUSPECTED
6 Villanova University Outbreak of gastrointestinal illness More than 100 students became sick January 23rd.Most recovered on their own, however, some required intravenous fluids.Villanova University is experiencing an outbreak of a gastrointestinal illness. School officials said it is most likely Norovirus, the so-called “cruise ship virus”. Students began getting sick January 23rd. Most of the 100 or so students recovered on their own, however, several went to local emergency departments because they were dehydrated. They received intravenous fluids, and they were released.NOROVIRUS IS SUSPECTED
7 Two Schools in New Jersey Sandwiches supplied to two schools caused illness…Sandwiches supplied to two schools in New Jersey were to blame for the Norovirus outbreak last week.NOROVIRUS IS SUSPECTED
8 Royal Caribbean Cruise Ship One passenger unleashed Norovirus that sickened 116 passengers.Ship returned to port and underwent deep cleansing & decontamination.Port Everglades, FL, a single passenger may have unleashed a Norovirus that sickened 116 passengers aboard a Royal Caribbean cruise and caused the ship to return to port to undergo a deep cleansing and decontamination process. The Miami Herald reported Sunday. The Herald said that cruise workers distributed letters to passengers who were preparing to board Saturday as the trip went back out on the sea, detailing the cleaning process and explaining the need for proper hand-washing. The cleaning involves the use of disinfectants, especially in “high-touch” areas such as countertops, railings, exercise equipment, remote controls, light switches, elevator buttons, and computer keyboards, according to the Herald.NOROVIRUS IS SUSPECTED
10 Norovirus is A common cause of food poisoning Belongs to a group of virusesCauses severe inflammation of the gastrointestinal tract (stomach flu)Strikes quickly, feel very sickRuns its course usually within 1-2 days.Norovirus is a group if viruses that are a common cause of food poisoning and acute inflammation of the gastrointestinal tract (many times referred to as “stomach flu”) that can strike quickely with force and make a person feel very sick, but which typically resolves within 2-3 days.
11 Symptoms of Norovirus Nausea Vomiting Diarrhea (not bloody) Abdominal crampingFever, if present, is low-gradeDehydration is main complication especially infants and the elderly.The characteristic symptoms are nausea, vomiting, diarrhea, and abdominal cramping. The diarrhea is not bloody. Fever, if present, is low-grade. Dehydration is the main complication, especially in infants and the elderly, and may need medical attention.
12 Spreading NorovirusPrimarily from one infected person to another (by the fecal-oral route)Kitchen workers can contaminate a salad or sandwich as they prepare itFishermen can contaminate oystersNorovirus infection has become a genuine plaque on cruise ships.The virus is spread primarily from one infected person to another (by the fecal-oral route). Infected kitchen workers can contaminate a salad or sandwich as they prepare it if they have the virus on their hands. Infected fishermen have contaminated oysters as they harvest them. Norovirus infection has become a veritable plague on cruise ships.
13 Are Noroviruses Contagious? YES !Extremely contagiousSpreads easily from person to personTake particular care of children in diapers with diarrhea.Noroviruses are very contagious and can spread easily from person to person. Both stool and vomit are infectious. Particular care should be taken with young children in diapers who may have diarrhea.
14 How Long are People Contagious? From the moment they begin feeling ill to at least 3 days after recoverySome may be contagious for as long as 2 weeks after recoveryHow long are people contagious? People infected with Norovirus are contagious from the moment they begin feeling ill to at least 3 days after recovery. Therefore, it is particularly important for people to use good hand washing and other hygienic practices after they have recently recovered from Norovirus illness.USE GOOD HAND WASHING PRACTICES AND OTHER HYGIENIC PRACTICES AFTER RECOVERING FROM NOROVIRUS
15 How Do People Become Infected with Noroviruses? By eating food or drinking liquids that are contaminated with NorovirusTouching surfaces or objects and placing their hand in their mouthDirect contact with another person who is infectedNoroviruses are found in the stool or vomit of infected people. People can become infected with the virus in several ways including: 1) eating food or drinking liquids that are contaminated with Norovirus 2) Touching surfaces or objects contaminated with Norovirus and then placing their hand in their mouth. 3) having direct contact with another person who is infected and showing symptoms (for example, when caring for someone with illness, or sharing food or eating utensils with someone who is ill).
16 How Do People Become Infected with Noroviruses? Day-Care Centers and Nursing Home employees should pay special attention to children or residents who have Norovirus illness.The virus is very contagious and can spread rapidly throughout such environments.Persons working in day-care centers or nursing homes should pay special attention to children or residents who have Norovirus illness. This virus is very contagious and can spread rapidly throughout such environments.
17 How Serious is Norovirus? No long-term health effectsPeople feel very sick & vomit for 1 or 2 daysMay be unable to drink enough liquids to replace lost liquidsDehydration may require medical attentionPeople may feel very sick and vomit many times a day but most people get better within 1 or 2 days, and they have no long-term health effects related to their illness. However, sometimes people are unable to drink enough liquids to replace the liquids they lost because of vomiting and diarrhea. These persons can become dehydrated and may need special medical attention. This problem with dehydration is usually only seen among the very young, the elderly, and persons with weakened immune systems.
18 Community Associated Methicillin-Resistant Staphylococcus Aureus Infections (CA-MRSA or MRSA)MRSA Magnified 20,000 x
19 Staphylococcus Aureus Bacteria commonly carried on the skin or in the nose25-30% population is colonized with “staph”Cause of infectionsMinor (skin and soft tissue)Major infections (blood, pneumonia, surgical site)Staph is the most common cause of skin infectionsDiscuss difference between infection and colonization, and its implications for transmission
20 Methicillin Resistant Staphylococcus Aureus- MRSA The staphylococcus bacteria has developed resistance to antibiotics that are normally used to treat infections (methicillin, oxacillin, penicillin, amoxacillin)1% population is “colonized” with MRSA
21 Reported Outbreaks of MRSA Close-contact sportsFootballWrestlingRugbySoccerFencingCorrectional FacilitiesIV drug-usersMilitary BasesDaycare FacilitiesUnited States
22 Risk factors for the spread of MRSA Close skin-skin contactOpenings in the skin such as cuts or abrasionsExposure to contaminated items or surfacesCrowded living conditionsPoor hygiene
27 MRSA Modes of Transmission HANDS which become contaminated by contact with:Colonized or infected individualsContaminated devices, items, or environmental surfacesDirect skin-to-skin contactNot unlike HA-MRSA transmission occurs via contamination with MRSA infected hands, surfaces
28 CA-MRSA Risk Groups Children Athletes (high school and college) Daycare (attendees/care givers/family members)Elementary School (attendees/teachers/family members)Residential School for Developmentally Delayed (attendees/teachers/care givers)Athletes (high school and college)FootballWrestlingOther = fencing, kayaking, etc.Prison InmatesJailPrisonMilitary RecruitsHomeless IndividualsInjecting Drug UsersMen who have Sex with MenHere listed are reported outbreaks and clusters of CA MRSA. We’ll be discussing two incidents that occurred in here in Michigan in 2005
29 MRSA Risk Factors Previous MRSA Infection/Colonization Close skin-to-skin contactBreaks in skin (cuts, abrasions, skin disease, surgical sites)Contaminated items and surfacesCrowded living conditionsInadequate personal hygieneCorrections officer’s comment about transmission in his household between his daughters who shared the community razor in the shower and bar soap.
30 This is not a Spider-bite! Often time wounds like this will be attributed to a spider bite, or pimple but are usually caused by CA-MRSA. Culturing the wound is key to determine appropriate antibiotic coverage. May just require good wound care protocol.
32 MRSA Prevention- Athletics Keep hands clean (soap & water or alcohol-based hand sanitizer), especially after contact with a woundShower after working outKeep cuts and abrasions clean and covered until healedDiscard used bandages and tape in garbageAvoid contact with other people’s wounds & bandagesAvoid sharing personal items (towels, washcloths, bar soap, razors, balms, lotions, clothing, uniforms, equipment)Use barrier between skin and shared equipmentGeneral prevention principles apply for all potential environments
33 MRSA Prevention (2)-Athletics Clean and disinfect shared items, equipment, surfaces between use with:Soap and warm waterBleachLysolWash clothes, towels, sheets with warm/hot water and laundry detergentDry clothes, towels, sheets in a hot dryer (no air-drying)Report persistent draining, non-healing woundsInfected individual should refrain from public contact (no school, no sports, no common areas) if wound drainage cannot be contained under a bandageMDCH in Association with MARR are developing informational brochures for public information on reduction strategiesAlso prescribing habits will follow local antibiogram data
34 #1 Prevention is Primary A two pronged approach to prevent antimicrobial resistance is judicious use of antibiotics and sound infection control principles. ASK DAWN TO TALK ABOUT MICHIGAN 4TH VRSA CASE if time permitsProtect patients…protect healthcare personnel…promote quality healthcare!
35 Hand Hygiene Turn on the water slowly do not use hot water Apply soap to the hands and wristsVigorously rub hands in a rotary motion paying special attention to between fingers, knuckles and nailsWash hands for a minimum of 15 secondsHold the hands and wrists down under the running water allowing the water to rinseDry hands using a single paper towelUse the paper towel to turn off faucetDiscard paper towel
36 When to Wash Hands Before going off duty Before and after performing a bodily function i.e. tissue, contact with the face, contacts, hair, use of toiletBefore preparing, serving, or eating foodBefore preparing or administering medicineAfter direct or indirect contact with patient excretions, secretions, or blood even if with glovesAfter removal of glovesWhen hand are visibly soiled.
37 Once Infected With MRSA, Prevent the Spread Cover the woundClean the handsDo not share personal items (towels, soap, razor, tweezers, clothing)Notify new or additional healthcare providers of the history of MRSA
38 Infection Control in Recreation Areas Do not share towels, soap, ointments, or other personal items.Shower after participating in close-contact skin-to-skin activities.
40 The Dow Chemical Company Foundation This Children's Environmental Health presentation was made possible through a grant fromThe Dow Chemical Company Foundation
41 CreditsCharles Lichon, R.S., M.P.H., Creator of Children’s EH Program, Midland County Health Department (CHD) MichiganNancy Atwood, M.S., Midland CHD (MI) SanitarianChristine Rogers, Meth Response Coordinator, Kalamazoo CHD, MIRobert Wolfe, R.S., Midland CHD (MI) SanitarianJohn Demerjian and Linda Van Orden, Wayne CHD, MI, Body ArtNational Environmental Health Association (NEHA.org) for website storage and oversight.NOTE: Permission to use this and all Children’s EH Power Point presentations is granted thru NEHA, however, all grant and credit notices and informational slides must be used during each presentation.
42 Other presentations include: Body ArtCareers in Environmental HealthFood Safe IssuesHousehold Hazardous WasteMeth & TeensRecreational WaterSun WiseNorovirus & MRSAContact NEHA.org for more information
43 For more Information about this presentation, contact: (Local Health Dept Name here)