containing norovirus lisa ritchie nurse consultant infection control
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Containing Norovirus
Lisa RitchieNurse Consultant Infection Control
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Norovirus:• Thought to be commonest cause of
acute gastroenteritis in humans• Usual incubation period is 12-48
hours• Usually manifests with acute onset
of vomiting and non-bloody diarrhoea with abdominal cramps and nausea
• Less frequent clinical manifestations include fever, headache and myalgia
• Symptoms usually last between 24-60 hours
• Infection is generally self-limiting• thought that up to 30% of infections
may be asymptomatic.
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ICT alerted and ward closed
Exporting outbreak to multiple wards
Decontaminate Ward(s)
Cross transmission occurs
People with norovirussymptoms admitted to the ward
Immediate isolation &containment?
No cross transmission
Outbreak prevented
Early outbreak signsrecognised?
Able to apply and sustainNorovirus Control
Measures?
New cases cease
Ward(s) reopened
ICT (eventually) alerted
Yes
No
No
Yes
Yes
No
Inability to gain control
Continuous exporting of outbreak
Inability of systems to cope
No
No
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Literature reviewLevels of Evidence and Category of Recommendation
SIGN levels of evidence3: Non-analytic studies, e.g. case reports, case series4: Expert opinion
SIGN grades of recommendationD Evidence level 3 or 4; or Extrapolated evidence fromStudies Rated as 2+
(SIGN. Key to evidence statements and grades of recommendations. SIGN50: a guideline developer’s handbook. Edinburgh: SIGN; 2008. Available at:http://www.sign.ac.uk/guidelines/fulltext/50/annexb.html (accessed:18/10/2010). Reproduced with permission)
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Control measures for Norovirus:• Wards should be closed to new admissions • The ward should remain closed until it has been
terminally cleaned to the satisfaction of the ward manager and ICT and, – There have been no new cases of possible norovirus
for 48 hours and, – There has been no vomiting or diarrhoea for a full 48
hours which is considered to be caused by norovirus. • Patients should be cohorted • Staff should be cohorted• Non-essential staff should be excluded from affected
wards
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Control measures for Norovirus:• Do not use alcohol based hand rub alone for routine
decontamination of hands when there is an outbreak of gastro-intestinal infection. Decontaminate hands by washing with liquid soap and warm water followed by alcohol based hand rub.
• A surgical face mask may be worn to minimise the risk of splash contamination and inhalation of norovirus and subsequent ingestion.
• 1000ppm available chlorine should be used for environmental cleaning to inactivate norovirus
• Carpets and soft furnishings should be steam cleaned or cleaned with water and detergent after an outbreak of norovirus
• Bed/window curtains should be removed and cleaned
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Control measures for Norovirus:
Visitors should for their own safety be advised: • To reduce the number of visits whilst the
outbreak lasts. • To wash hands on entry and exit to the ward.• Not to visit if they themselves are suffering from
an infection and until they are 48 hours symptom free.
• That children should not visit the ward during an outbreak.
• That they should not visit other people in the ward or other wards.
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Challenges:
• 4 hours on trolley in A&E• No designated ward / area available• Control measures• Change in symptom and behaviour of
Norovirus from season to season
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Norovirus season has
begun – media
warnings
Early experiences
Lessons learned
Changing experiences?