Preparing for & dealing with Norwalk Virus Dave Phillips EHO Health Protection

WHAT IS NORWALK? A VIRUS-can’t be treated by antibiotics FROM GROUP CALLED SMALL ROUND STRUCTURED VIRUSES RENAMED NOROVIRUS VIABLE IN THE ENVIRONMENT FOR 2-3 WEEKS

Picture from an electron microscope

SYMPTOMS INCUBATION PERIOD OF HOURS USUALLY LASTS HOURS SYMPTOMS (SUDDEN ONSET) NAUSEA PROJECTILE VOMITING ABDOMINAL CRAMPS DIARRHOEA

CHARACTERISTICS VERY CONTAGIOUS 30 MILLION VIRAL PARTICLES RELEASED DURING 1 VOMITING INCIDENT 100 PARTICLES CAN CAUSE ILLNESS AFFECTED PERSON CAN REMAIN CONTAGEOUS FOR AT LEAST 48 HOURS AFTER SYMPTOMS STOP

SPREAD CONTAINED IN VOMIT AND STOOLS OF AFFECTED PERSON VIRUS BECOMES AIRBORNE SETTLES ON SURFACES AND FOOD PERSON TO PERSON SPREAD EATING CONTAMINATED FOOD

MANAGING A NORWALK OUTBREAK BE PREPARED – NOW! DECIDE IN ADVANCE - WHAT YOU ARE GOING TO DO - HOW YOU ARE GOING TO DO IT - WHO NEEDS TO BE INVOVED

MANAGING A NORWALK OUTBREAK EASILY SPREAD THROUGH STAFF & GUESTS IF NOT CONTROLLED FROM OUTSET NEW GUESTS ARRIVING WEEKLY MEANS THE OUTBREAK CAN CONTINUE OVER SEVERAL WEEKS OR LONGER TREAT SUDDEN CASES OF VOMITING OR DIARRHOEA AS POSSIBLE CASES OF NORWALK

CONTROL OF INFECTION TEAM ESTABLISH A “CIT” BEFORE OUTBREAKS e.g. MANAGER,DEPUTY MANAGER, HOUSEKEEPER, HEAD CHEF ETC. DON’T FORGET NIGHT SHIFT ! CO-ORDINATE CONTROL MEASURES -GATHER INFORMATION -ARRANGE FOR FAECAL SAMPLE -NOTIFY EHO’s -ARRANGE AND MONITOR CLEANING

COMMUNICATE ! KEEP PEOPLE INFORMED – STAFF HEALTH PROTECTION G.P.’S NEW GUESTS / EXISTING GUESTS TOUR OPERATORS

Control of Infection in Hotels Have procedures in place now and train staff Advise guests if you have a problem - need to stay in room while ill - observe good personal hygiene after symptoms stop Increase cleaning of public toilets, ‘touch points’, etc, using bleach solution. Exclusion policy for staff

Control of infection in Hotels Implement cleaning procedures in full - correct cleaning materials - use boiler suits and correct protective equipment - steam clean or launder soft furnishings

Laundry Commercial laundries must be notified if you are sending contaminated bedding ALL soft furnishings in contaminated rooms must be laundered or steam cleaned If contaminated bedding etc must be securely bagged and taken straight to laundry. Commercial laundries will supply red soluble laundry bags.

Laundry If using an in-house laundry, all contaminated items must be done after ‘usual’ items. Clean linen should be removed from the room to prevent cross contamination.

Laundry A hot wash followed by tumble drying is recommended. The laundry room must be thoroughly cleaned and disinfected after washing soiled items. Laundry staff must observe good personal hygiene at all times.

Summary The virus is very contagious and easily spread Prompt action is needed to control the spread The Guidelines should be read and followed closely Inform HP if you have cases so that help and advice can be provided

FORM AN OUTBREAK CONTROL TEAM Including key individuals e.g. General Manager, Heads of Departments, Cleaning Supervisor FORM AN OUTBREAK CONTROL TEAM Including key individuals e.g. General Manager, Heads of Departments, Cleaning Supervisor DEVELOP AN ACTION PLAN Put key points in writing DEVELOP AN ACTION PLAN Put key points in writing PROVIDE INFORMATION AND INSTRUCTION TO ALL STAFF RE: ACTION PLAN AND REPOIRTING OF SICKNESS INCIDENTS E.g. including housekeeping staff, food handlers, coach drivers, night staff, reception, porters PROVIDE INFORMATION AND INSTRUCTION TO ALL STAFF RE: ACTION PLAN AND REPOIRTING OF SICKNESS INCIDENTS E.g. including housekeeping staff, food handlers, coach drivers, night staff, reception, porters TRAIN RELEVANT STAFF IN CLEANING METHODS E.g. dilutions, correct use of equipment TRAIN RELEVANT STAFF IN CLEANING METHODS E.g. dilutions, correct use of equipment PURCHASE A SUPPLY OF NECESSARY CLEANING EQUIPMENT, CLEANING CHEMICALS & PROTECTIVE CLOTHING PERIODICALLY CHECK SUPPLIES OF CLEANING CHEMICALS TO ENSURE THEY ARE PROPERLY STORED AND WITHIN DATE CONTACT SUPPORT ORGANISATIONS GP, Health Protection Department, Visitors Clinic, Contract Cleaners CONTACT SUPPORT ORGANISATIONS GP, Health Protection Department, Visitors Clinic, Contract Cleaners FORM A CLEANING ‘HIT SQUAD’

Q. Are two or more cases with symptoms of viral Gastro-enteritis linked or unaccountably exceed the expected number? Monitor situation for new cases of illness CONTACT HEALTH PROTECTION DEPARTMENT CALL TOGETHER THE OUTBREAK CONTROL TEAM Interview Sick Persons Complete Illness Report Form Call GP for medical advice where necessary. Request samples to be taken. For subsequent cases contact the Health Protection Department. Activate the cleaning ‘Hit Squad’ Inform staff Give information re: good personal hygiene Keep sick staff off work “Persuade” sick persons to remain isolated from other guests Ensure necessary cleaning equipment is available and used Implement Outbreak Control Cleaning Procedures Undertake regular checks of Public Areas and upgrade cleaning arrangements IS THE OUTBREAK ONGOING? Keep ill staff off work until they have been symptom free for a minimum of 48 hours Interview staff prior to returning to work to ensure they have been symptom free for a minimum of 48 hours 1.REVIEW CLEANING PROCEDURES 2.PROVIDE GENERAL INFORMATION TO ALL GUESTS (EXISTING AND NEW) 3.IT IS RECOMMENDED THAT YOU SPEAK TO YOUR OPERATORS AND ADVANCED BOOKINGS 4.CONSIDER COMPLETE/PART CLOSURE OF PREMISES FOR FULL ENVIRONMENTAL DECONTAMINATION e.g. fogging 1.REVIEW CLEANING PROCEDURES 2.PROVIDE GENERAL INFORMATION TO ALL GUESTS (EXISTING AND NEW) 3.IT IS RECOMMENDED THAT YOU SPEAK TO YOUR OPERATORS AND ADVANCED BOOKINGS 4.CONSIDER COMPLETE/PART CLOSURE OF PREMISES FOR FULL ENVIRONMENTAL DECONTAMINATION e.g. fogging Remain vigilant and monitor situation IF NO FURTHER CASES revert to normal operating procedures IF NO FURTHER CASES revert to normal operating procedures NO YES NO YES

OTHER GUIDANCE Dealing with Norwalk - Advice for Coach Operators Dealing with Norwalk – advice for suppliers and industrial cleaners

FLU, AVIAN FLU & PANDEMIC FLU SEASONAL FLU-the “usual flu that occurs every winter-vaccination for vulnerable groups AVIAN FLU-affects birds-is not pandemic flu- is not human flu PANDEMIC FLU-no current pandemic, though preparations always in place in case of outbreak-caused by human flu virus