NURSING AT McLEAN

YOU DON'T NEED TO TAKE A CRUISE TO GET NOROVIRUS!
BY
Paula Bolton, RN/NP
Infection Control

Norovirus is the frequent cause of outbreaks of gastroenteritis or "stomach flu". This virus gained notoriety after several outbreaks occurred on cruise ships affecting many people on vacation. Norovirus does spread very easily from person-to-person, especially in settings where people live in close quarters - like cruise ships - or dorms, nursing homes, and yes, even hospitals. In the past two years we have experienced a few small outbreaks of this viral infection here at McLean. Fortunately, the infections were mild and the spread was limited to one or two units. However, as we go through the winter, we want to take added steps to prevent this infection.

Norovirus, sometimes called Norwalk virus or Norwalk-like virus belongs to a group of viruses that cause illnesses of the GI tract. This virus is named after the original strain identified in Norwalk, Ohio. The symptoms of norovirus infection may include nausea, vomiting, diarrhea, and abdominal cramps (usually more vomiting is seen in the young, while adults tend to get more diarrhea symptoms). Occasionally, these symptoms are accompanied by headache, muscle aches and fever. The symptoms begin 1-2 days after exposure to the virus and typically last for 1-2 days.

Noroviruses are very contagious. Usually people infected with norovirus are contagious from their first day of illness to at least three days (and sometimes longer) after recovery. The virus is found in vomitus and stool, therefore good handwashing and personal hygiene is especially important when someone is ill.

People get infected with norovirus in a number of ways: eating food that has been prepared by an ill food handler, touching surfaces or objects that have been contaminated with norovirus and then touching their mouths; or having direct contact with an ill person. Diagnosis of norovirus infection is made by testing stool specimens (and in rare cases, vomitus) of infected persons.

There is no specific treatment for norovirus and people usually get better within a few days. Because of the risk for dehydration due to vomiting and diarrhea, oral rehydration is important.

To prevent norovirus infection, always wash your hands thoroughly with soap and water before and after any patient contact, before eating or preparing food, after using the toilet and after touching things in the environment of someone who is ill. There is some thought that antibacterial hand rubs are not as effective as handwashing in the prevention of norovirus. During an outbreak, try to wash your hands with soap and water as often as possible. After episodes of vomiting or diarrhea, be sure the area is disinfected (bleach wipes may be used and are available in the storeroom). For direct care givers, wearing a mask when caring for someone who is actively vomiting may prevent contact with any virus that is aerosolized.

Once two or more patients on one unit are noted to have symptoms of nausea, vomiting and/or diarrhea, Infection Control should be notified, handwashing efforts should be strengthened, patients should be encouraged to use good bathroom hygiene and to wash their hands before eating and after using the bathroom. It may be necessary to cohort (group together) patients who are ill to prevent them from contaminating other patients. Building Service will increase housekeeping efforts, including bleaching of all hand surfaces. Visitors to the unit should be informed of the need to wash their hands before leaving the unit.

By working together, we can prevent the spread of infections - including norovirus, and cruise through an outbreak-free winter!