Nurses and Norovirus


Nurses and Norovirus

What to do if the dreaded norovirus strikes your unit

By Collette Hendler
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During the course of my career, I’ve worked as a critical care nurse and as an infection preventionist, taking care of patients with a variety of illnesses and injuries. I’ve assisted a neurosurgeon as he drilled burr holes into a patient’s skull and a cardiothoracic surgeon as he opened a patient’s chest. I’ve stuck my hands into countless wounds and gathered leeches as they reduced a neck hematoma. However, nothing has made me more squeamish or turned me into more of a germaphobe than the dreaded norovirus.

People in Close Proximity

Norovirus is a highly contagious virus that spreads quickly, especially in schools, healthcare facilities, day care centers and on cruise ships — anyplace where people are in close proximity.

Just how contagious is norovirus? According to the Journal of Medical Virology, as few as 18 norovirus particles are enough to cause illness. Translation: The number of norovirus particles needed to infect more than 1,000 people would only fill the head of a pin. Pretty virulent stuff!

Anyone can become infected by norovirus, even people who were previously infected. Because there are so many strains, post-infection immunity to one particular strain may not protect against others.

How Norovirus is Spread:

◗  Through consumption of food, water or other liquids contaminated by the virus

◗  By touching virus-contaminated objects and then touching your fingers to your mouth

◗  Via contact with an infected person.

According to the Centers for Disease Control and Prevention, norovirus is the leading cause of contaminated-food-related illness and outbreaks in the United States. Most outbreaks occur in restaurants and other establishments that serve food. The source of the outbreaks is typically an infected food handler touching ready-to-eat food like raw fruits or vegetables with their bare hands before serving. However, any food that’s served raw or handled after cooking can become contaminated.

Norovirus outbreaks can also occur when foods such as oysters, fruits and vegetables are contaminated where they’re grown or when they’re harvested.

Telltale Signs

Norovirus typically causes illness 12 to 48 hours after exposure, resulting in gastroenteritis: inflammation of the stomach, intestines or both. Symptoms include:

◗  Abdominal pain

◗  Diarrhea

◗  Nausea

◗  Vomiting.

These symptoms may be accompanied by chills, fatigue, headache, low-grade fever and myalgia.

Symptoms typically come on suddenly, beginning with episodes of frequent vomiting or diarrhea. Those episodes can quickly cause dehydration, particularly in the elderly, young children and people with other medical conditions.

Signs of dehydration include decreased urine output, dry mouth and throat and dizziness when standing. Young children may become lethargic or unusually irritable and produce no or few tears when crying.

Treating Dehydration

Because norovirus infection is viral, not bacterial, there’s no pharmacological remedy for the infection. Instead, treatment focuses on preventing or treating dehydration.

Anyone who is infected should take measures to prevent dehydration, including drinking plenty of fluids to replace those lost from vomiting and diarrhea. Sports drinks and other non-caffeinated electrolyte drinks can also help with mild dehydration. If dehydration becomes severe, hospitalization and treatment with IV fluids may be necessary.

People generally recover from norovirus infection within two days of the onset of symptoms. However, young children, the elderly and people with other medical conditions may experience more severe symptoms and need a more prolonged convalescence.

Preventing the Spread at Your Hospital

Because of close person-to-person contact, healthcare facilities are at high risk for norovirus outbreaks. To prevent the spread in a hospital, it’s important to follow meticulous infection control and prevention measures, including:

◗  Placing patients who exhibit signs of norovirus infection in a private room (or in a room with another patient infected with norovirus) and instituting contact precautions as well as standard precautions.

◗  Practicing hand hygiene using soap and water after performing patient care or contact with patients suspected or confirmed to be infected with norovirus, particularly during outbreaks.

◗  Limiting patient transfers.

◗  Where medically appropriate, discharging patients to their residences, particularly during an outbreak.

◗  If possible, changing privacy curtains routinely and whenever a patient is transferred or discharged.

◗  Cleaning and disinfecting patient care areas two times a day and high-touch surfaces three times a day using an Environmental Protection Agency-approved disinfectant with a label claim for norovirus. Click here for a current list. When cleaning and disinfecting surfaces, remember to begin with areas at lower risk of contamination and then progress to more highly contaminated surfaces. Always change mop heads after cleaning up large areas of emesis or feces or when preparing new disinfectant solutions.

In the event of an outbreak on your unit:

◗  Cohort staff and don’t allow staff to provide care for other cohorts’ patients.

◗  Close the unit to transfers and new admissions and stop any group activities.

◗  Restrict any infected staff members from work until at least 48 hours after their symptoms resolve.

◗  Remind staff members about the importance of frequent hand hygiene, particularly before and after each contact with a patient or the patient’s environment.

◗  Don’t allow volunteers, students or nonessential staff into outbreak areas.

◗  Notify your local public health department of any known or suspected norovirus outbreak.

Preventing the Spread at Home

What if you receive that dreaded phone call from your child’s school nurse informing you that your child is vomiting and that norovirus has been going around the school?

You can help to prevent the spread of norovirus in your home by following these measures:

◗  Whenever your hands become visibly soiled, scrub them vigorously with soap and water for at least 20 seconds.

◗  Wash your hands with soap and water before eating, before preparing or handling food and after using the toilet or changing diapers.

◗  Use an alcohol-based hand sanitizer frequently, rubbing all surfaces of your hands until the agent dries.

◗  Thoroughly wash fruits and vegetables before consuming them.

◗  Discard any foods that might be contaminated with the virus

◗  Prevent sick children from going into areas where food handling and preparation are taking place.

◗  Clean and disinfect any contaminated objects or surfaces with chlorine bleach or another disinfectant effective against norovirus.

◗  Immediately wash any clothing or linens that may be contaminated. Wear disposable gloves during handling and wash your hands immediately afterwards. Wash clothing or linens with detergent for the maximum cycle-time available and then machine-dry them.

◗  If you become ill, avoid preparing food and don’t provide care for others.

Keep in mind that even when you feel better, you can still spread the virus to others. In fact, you are most contagious both when you are ill and during the first few days after you feel better. Also, you can shed the virus in your stool for two weeks or longer after you’ve recovered.

Again, hand hygiene is the single most important thing you can do to prevent the spread of any infection!   

Collette Bishop Hendler, RN, MS, CIC, (CCRN alumnus status), is a freelance medical writer with more than 30 years of nursing experience as an infection preventionist, critical care nurse and senior clinical editor.


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