national guidelines on the management of outbreaks of norovirus ...
national guidelines on the management of outbreaks of norovirus ...
national guidelines on the management of outbreaks of norovirus ...
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Nati<strong>on</strong>al Guidelines <strong>on</strong> <strong>the</strong> Management <strong>of</strong> Outbreaks <strong>of</strong> Norovirus Infecti<strong>on</strong> in Healthcare Settings NDSC<br />
EXECUTIVE SUMMARY<br />
Infecti<strong>on</strong> due to <strong>norovirus</strong> is extremely comm<strong>on</strong> in <strong>the</strong> community with as many as <strong>on</strong>e in <strong>on</strong>e hundred<br />
people becoming ill each year. Noroviruses are highly infectious agents, capable <strong>of</strong> being spread directly<br />
from pers<strong>on</strong>-to-pers<strong>on</strong>, by food and water and through <strong>the</strong> air. The virus is very resilient and can survive for<br />
l<strong>on</strong>g periods in <strong>the</strong> envir<strong>on</strong>ment and <strong>on</strong> surfaces such as door handles or worktops. Because <strong>of</strong> <strong>the</strong>se<br />
features, <strong>norovirus</strong>es can cause widespread and intractable <strong>outbreaks</strong> especially where people are ga<strong>the</strong>red<br />
closely toge<strong>the</strong>r. Since it is a community infecti<strong>on</strong>, <strong>outbreaks</strong> in c<strong>on</strong>gregate settings such as hospitals are<br />
simply a reflecti<strong>on</strong> and a gauge <strong>of</strong> what is happening in <strong>the</strong> community.<br />
Hospitals and residential instituti<strong>on</strong>s are comm<strong>on</strong> locati<strong>on</strong>s for <strong>outbreaks</strong> <strong>of</strong> infecti<strong>on</strong> by <strong>norovirus</strong>es and can<br />
cause extensive disrupti<strong>on</strong> to a very vulnerable group <strong>of</strong> individuals. The number <strong>of</strong> <strong>outbreaks</strong> and <strong>the</strong>ir<br />
extent within <strong>the</strong> acute and residential healthcare sectors can place a c<strong>on</strong>siderable burden <strong>on</strong> <strong>the</strong> health<br />
system. Despite this, <strong>the</strong> illness caused by <strong>the</strong> virus is relatively mild, with more severe cases appearing <strong>on</strong>ly<br />
occasi<strong>on</strong>ally.<br />
Outbreaks due to <strong>norovirus</strong> are not eradicable, but <strong>the</strong>y are c<strong>on</strong>trollable. There is a growing body <strong>of</strong><br />
inter<str<strong>on</strong>g>nati<strong>on</strong>al</str<strong>on</strong>g> evidence that indicates interventi<strong>on</strong>s that will minimise <strong>the</strong> effects <strong>of</strong> <strong>the</strong> virus. Within hospitals<br />
and o<strong>the</strong>r healthcare settings, an early, rapid resp<strong>on</strong>se to an outbreak due to <strong>norovirus</strong> is <strong>the</strong> key to its<br />
c<strong>on</strong>trol. Having an agreed hospital/residential home outbreak plan in place is <strong>the</strong> best method for ensuring<br />
uniformity and effectiveness <strong>of</strong> resp<strong>on</strong>se.<br />
Prompt establishment <strong>of</strong> an outbreak c<strong>on</strong>trol team that is resp<strong>on</strong>sible for c<strong>on</strong>trolling <strong>the</strong> spread <strong>of</strong> infecti<strong>on</strong><br />
and coordinating <strong>the</strong> investigati<strong>on</strong> <strong>of</strong> and resp<strong>on</strong>ses to an outbreak is essential. Early communicati<strong>on</strong> and<br />
<strong>the</strong> rapid instituti<strong>on</strong> <strong>of</strong> early c<strong>on</strong>trol measures will aid this.<br />
The essential early steps in c<strong>on</strong>trol <strong>of</strong> an outbreak will include immediate cleaning and envir<strong>on</strong>mental<br />
dec<strong>on</strong>taminati<strong>on</strong> <strong>of</strong> soiled areas, frequent hand washing with warm water and soap for all staff and patients,<br />
segregati<strong>on</strong> <strong>of</strong> those who are ill from those who are not (cohorting), limitati<strong>on</strong> <strong>of</strong> movement <strong>of</strong> staff and<br />
patients, exclusi<strong>on</strong> <strong>of</strong> ill staff from work for 48 hours after <strong>the</strong>ir last episode <strong>of</strong> vomiting and/or diarrhoea and<br />
sensible <strong>management</strong> <strong>of</strong> hospital visiting.<br />
Increased hospital attendance is a factor in <strong>the</strong> development and sustaining <strong>of</strong> <strong>outbreaks</strong> <strong>of</strong> illness due to<br />
<strong>norovirus</strong>. The effects <strong>of</strong> noroviral infecti<strong>on</strong>, however, can be minimised by reducti<strong>on</strong> <strong>of</strong> <strong>the</strong> susceptible pool<br />
<strong>of</strong> patients (particularly elderly patients) by <strong>the</strong>ir discharge or transfer to step-down facilities. This will also<br />
provide increased capacity within hospitals to allow more effective cohorting <strong>of</strong> patients.<br />
Given its ability to be shed by c<strong>on</strong>valescing cases for a minimum <strong>of</strong> 48 hours after symptoms subside,<br />
effective c<strong>on</strong>trol will involve ensuring that affected staff leave <strong>the</strong> ward and go <strong>of</strong>f duty immediately <strong>the</strong>y<br />
develop gastrointestinal symptoms and remain <strong>of</strong>f work for a minimum <strong>of</strong> 48 hours after <strong>the</strong>ir last episode <strong>of</strong><br />
vomiting or diarrhoea. There must be <strong>the</strong> provisi<strong>on</strong> by agencies to ensure that ill staff can remain <strong>of</strong>f duty for<br />
<strong>the</strong> necessary time period, o<strong>the</strong>rwise infecti<strong>on</strong> will be reintroduced.<br />
Hospital cleaning is essential in preventing and c<strong>on</strong>trolling <strong>of</strong> <strong>outbreaks</strong> <strong>of</strong> illness due to <strong>norovirus</strong>. There<br />
should be provisi<strong>on</strong> by agencies to ensure that regular cleaning schedules and protocols agreed with<br />
infecti<strong>on</strong> c<strong>on</strong>trol pr<strong>of</strong>essi<strong>on</strong>als should be guaranteed and safeguarded. And during <strong>outbreaks</strong> <strong>the</strong>se should<br />
be enhanced to meet <strong>the</strong> increased need for cleansing.<br />
This guidance is intended for use and adaptati<strong>on</strong> in all healthcare settings. Local arrangements can be put in<br />
place to match local needs, but <strong>the</strong> above principles should guide decisi<strong>on</strong> making in all circumstances.<br />
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