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HICprevent

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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

We’ve stopped the leaks: Seems we acquired a (noro) virus

January 12th, 2015

Sorry for the technical problems and various glitches, but we appear able to blog again and blog we shall. Whether this is perception or reality, we’ll find out shortly. Having stopped the leaks, so to speak, we look to history as our departing metaphor. As Titanic returns to theaters -- and the actual historical event approaches the 100th anniversary of the April 10, 1912 departure – we give the glass half full nod to the great disaster. Everything went wrong that could – except a norovirus outbreak. As nauseating transitions go, that’s what we are going with. Hey, it takes a while to get these words to line up right. Norovirus, the bane of modern cruise ships, is now the leading cause of hospital outbreaks. It is the most likely organism to trigger a shutdown of units in your hospital, affecting both staff and patients alike, according to a recent survey of infection preventionists.

“Norovirus is different from the other [health-care acquired] organisms because norovirus can affect employees, and in outbreaks many times does,” says lead author Emily Rhinehart, RN, MPH, CIC, vice president and division manager of the health care division of Chartis Global Loss Prevention in Atlanta.

In fact, norovirus outbreaks were as likely to occur in behavioral health and rehabilitation units as medical/surgical units, another contrast to other organisms. In those units, patients are more mobile, and therefore more likely to contract or transmit the disease, Rhinehart notes. “They’re walking around their environment and interacting with the environment and other patients and the employees are interacting with them,” she says. Norovirus outbreaks are easy to identify because they are often dramatic, with sudden onset of nausea, vomiting and diarrhea. Norovirus “has a very short incubation time, it’s very transmissible, and a lot of people can be infected in a short amount of time,” says Clifford McDonald, MD, medical epidemiologist at the Centers for Disease Control and Prevention. Here are some issues to keep in mind: Emphasize glove use and hand hygiene. Alcohol gel may not be as effective against norovirus as hand-washing – where have we heard that before? But while you can educate staff and encourage hand-washing, don’t try to completely revamp your hand hygiene program, says McDonald. Alcohol gel has been extremely effective in combating other organisms, and studies show it improves compliance with hand hygiene, notes McDonald. "You should emphasize glove use and changing gloves between patients, he says. “Glove use is only as good as your practice of changing gloves between patients,” he says. “If you don’t change them between patients, you’re doing nothing for patient safety.” It is also important for employees to remove the gloves in a way that prevents contamination of their hands and to perform hand hygiene after removal.

Monitor employee absences. If you see a pattern of digestive illness among employees, particularly in the same unit, that may be a clue about an outbreak. Being alert can help you detect norovirus and implement strategies to prevent its spread, says Rhinehart.

Don’t penalize employees for being sick. You want ill employees to stay home if they’re sick – and during an outbreak, you might require some exposed employees to stay home for a two- or three-day incubation period. Make sure your policies don’t penalize them for reporting symptoms or an exposure by requiring them to take time from a pool of paid time off. Some employers have used workers’ compensation or even a contingency fund to cover those payments for ill or exposed employees to stay home, Rhinehart says.