1. Oakwood Health & Rehabilitation Adriane Biggio RN, BS, IP

2.  Noroviruses are a group of related, single-stranded RNA, non-enveloped viruses that cause acute gastroenteritits in humans.  A.K.A. Norwalk Virus, stomach flu  Norovirus is highly contagious and very hardy (can survive freezing and heating to 140˚F). Pyrek, K. M. (2013). Norovirus control and prevention strategies. Infection Control Today, 1-20.

3.  1 in 14 Americans, 21 million cases annually  Norovirus is the most common cause of acute gastroenteritis. Pyrek, K. M. (2013). Norovirus control and prevention strategies. Infection Control Today, 1-20.

4. Found in vomit or stool of infected people.  Transmission is primarily fecal-oral, direct person-to-person spread, or via fecally contaminated food or water  Also spread via droplet from vomitus Pyrek, K. M. (2013). Norovirus control and prevention strategies. Infection Control Today, 1-20.

5.  February 5, 2013 – February 11, 2013 (12 residents, 12 staff)  March 1, 2013 – March 16, 2013 (44 residents, 23 staff)  March 24, 2013 – April 11, 2013 (3 residents, 11 staff) 59 residents, 46 staff > half of residents and ~ half of staff experienced Norovirus-like symptoms

6.  Symptoms of norovirus typically begin 12- 48 hours post-exposure  Nausea  Vomiting  Watery diarrhea  Stomach cramping  Low-grade fever  Chills  Headache  Muscle aches Virginia Department of Health (VDH). (2011). Summary of guidelines for the control of a suspected or confirmed outbreak of viral gastroenteritis (norovirus) in an assisted living facility or nursing home, 1-4.

7.  No cure, no vaccine  Treatment is supportive, hydration and rest  Illness is usually brief, lasting 1-2 days, 4-6 in the elderly or those who have been hospitalized.  Virus can be detected for up to four weeks following infection, peak viral shedding occurs 2-5 days after infection Virginia Department of Health (VDH). (2011). Summary of guidelines for the control of a suspected or confirmed outbreak of viral gastroenteritis (norovirus) in an assisted living facility or nursing home, 1-4.

8.  Started testing – took min. 6 days, stool sent to California  Contacted local health department to report  In-serviced Oakwood staff and Environmental Services  Contained symptomatic residents to their rooms, initiated Contact Enteric Precautions  Signs to alert visitors of illness-educated about hand washing

9.  Limited, then stopped all group activities- closed dining areas  Held admissions on symptomatic floors  Advised staff to stay home and not cook for loved ones for 48˚ post symptoms  Encouraged nursing staff to clean carts twice per shift and common areas nursing station countertops, phones, charts, etc. with bleach

10.  Kept nursing staff on same units to limit transmission  Added free standing alcohol-based dispensers to each dining area  Reminded staff to clean the hands of residents after toileting  Updated Infectious Disease physician daily  24 hour report included times of last symptoms  Beds/chairs/surface areas of all symptomatic residents were cleaned daily – linens changed

11.  Administration questioned holding admissions. OT for healthy.  To use or not to use alcohol-based sanitizer?  How often do those water pitchers get cleaned anyway? -provided disposable cups during this time  Are staff really sick?  Staff held accountable for attendance.  Is it okay to ask staff their symptoms? tracking

12.  Two residents threatened to leave because they were contained to their room.  Postponed nursing student rotations.  Residents were not allowed to leave their units.

15. Pyrek, K. M. (2013). Norovirus control and prevention strategies. Infection Control Today, 1-20. Virginia Department of Health (VDH). (2011). Summary of guidelines for the control of a suspected or confirmed outbreak of viral gastroenteritis (norovirus) in an assisted living facility or nursing home, 1-4.