Oakwood Health & Rehabilitation Adriane Biggio RN, BS, IP

 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.

 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.

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.

 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

 Symptoms of norovirus typically begin 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.

 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.

 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

 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

 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

 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

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

Pyrek, K. M. (2013). Norovirus control and prevention strategies. Infection Control Today, 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.