Key Points

Background

Norovirus is a frequent cause of infectious gastroenteritis in Northern Ireland. The virus was previously known as ‘Small Round Structured Virus’ or SRSV. Norovirus may cause vomiting, diarrhoea, nausea and abdominal cramping. Norovirus is usually spread by the faecal-oral route. Vomiting causes widespread contamination of the environment leading to indirect person-person spread. Outbreaks are common in environments such as hospitals, nursing homes, schools and cruise ships.

Definition

A Case of Gastroenteritis may be defined as a patient (or member of staff) presenting with diarrhoea, vomiting, nausea or cramps that is not thought to be due to a non-infective medical condition or medical therapy. Nausea and cramps may be the only symptoms.

General Approach

General Approach to Norovirus Management

Prevent outbreaks. Patients presenting to hospital with symptoms suggestive of Norovirus, particularly if there is a history of other cases in the household, should be admitted directly into a single room, until an alternative cause for the illness is established.

Identify outbreaks. Wards/ facilities should inform the Infection Prevention Control team (IPCT) immediately whenever there are 2 or more cases of unexplained vomiting and diarrhoea amongst patients or staff.

Specimens. Faeces or vomitus should be obtained from patients or staff. The first six samples from an outbreak should be sent, via your local laboratory, to the regional virology laboratory at the Royal Hospitals, Belfast. Click here for the form that must be used for specimens. Specimens may not be processed unless the IPCT or CCDC have been consulted.

Guidance

General

 

• Hand Hygiene. Wash hands with soap and water after contact with affected patients or their environment and after removal of gloves and aprons.

 

• Gloves and Aprons. Use gloves & aprons for all contact with patients, their environment, and when dealing with body fluids.

 

• Isolation. All cases of gastroenteritis such as Norovirus should be isolated in a single room or cohorted into one area.

 

• Record keeping. Make a list of affected patients with date of onset of diarrhoea or vomiting. Note the date and reason for admission. Note whether on laxatives or on antibiotics.

 

• Take advice. Inform the Infection Prevention Control Team (IPCT) if you suspect gastroenteritis. In non-hospital healthcare settings the first contact for advice may be the ward/ unit manager, the GP or the CCDC/ public health department.

 

• Are other patients or staff affected? If an outbreak is suspected, follow guidance in policy for Outbreak Management.

 

• Samples. If Norovirus is suspected send specimens to Virology. Diarrhoeal stools from hospital patients should also be sent for culture and C. difficile toxin testing.

 

• Visitors. Visitors need not wear protective clothing, but should be advised to wash their hands or use alcohol handrub before entering or leaving the room and not to visit other patients.

 

• Transfer of patients. Symptomatic patients should not be moved to other wards, hospitals or facilities. Medically urgent cases may be transferred after discussion with the IPCT. The receiving hospital/ residential facility must be advised of the situation.

Ward Management in Norovirus Outbreaks

• Remove clutter from the environment. It is particularly important to remove foodstuffs from the patients’ locker tops.

 

• In significant outbreaks it may be necessary to close a ward/ unit to new admissions. This decision is made in consultation with the Infection Prevention Control Team.

 

• Ensure that the domestic supervisor is informed of the situation as soon as it arises. Extra cleaning and domestic staff may be needed. Cleaning frequency in the affected area should be increased.

 

• The room (and any associated patient equipment e.g. commode) must be cleaned at least daily and disinfected using a solution of a chlorine releasing agent (1000 ppm available chlorine) then rinsed and dried.

 

• Visiting may need to be restricted.

Staff Management in Norovirus Outbreaks

• Norovirus frequently affects staff as well as patients.

 

• A staff member with symptoms should go off work promptly and not return until symptom free for 48 hours.

 

• Staff should leave and return to work on the advice of the occupational health department. Staff should submit specimens if requested as this may help define the cause of the outbreak.

 

• Staff movement may need to be restricted during an outbreak and staff from affected areas should not work in unaffected areas. If an outbreak has been declared the rotation of staff should be discussed with the IPCT/ CCDC.

References

1. Communicable Disease Surveillance Centre NI (CDSC-NI). The outbreak form to be completed when submitting samples to the Regional Virology Laboratory, Belfast.

2. Health Protection Agency. General advice on Infections such as Norovirus: (look at Infectious diseases tab, then Healthcare associated Infection section.)