Public Health Info: Prevention and Control of Norovirus Gastroenteritis in Healthcare Settings

What You Need To Know

Key Points

• Gastroenteritis is an inflammation of the stomach and intestines that causes nausea, vomiting,abdominal cramps, and/or diarrhea due to a bacterial or viral infection.
• The most common cause of viral gastroenteritis outbreaks in healthcare facilities is norovirus.Norovirus outbreaks typically have a higher incidence from November through March.
• The virus can spread from person-to-person contact, food, water, and contaminated surfaces.
• The incubation period for norovirus is 12-48 hours and symptoms usually last 1-3 days.
• Norovirus is a very contagious virus, but the spread can be prevented or minimized by following these key infection prevention and control practices.

Action Items 

1. Patient/Resident Management 
   1. Monitor patients/residents for signs and symptoms of gastrointestinal (GI) illness.
   2. Place symptomatic patients/residents on Contact Precautions in a single room (if available) for a  minimum of 48 hours after the resolution of symptoms. Contact Precautions include minimizing  movement of the patient/resident to medically necessary care and not participating in  communal group activities. 
   3. If single rooms are not available, refer to cohorting policies—separate symptomatic and asymptomatic patients/residents. 
   4. Consider using disposable patient/resident care items that can be discarded upon termination of Contact Precautions when possible. Ensure all reusable supplies (e.g., linens, blood glucose  monitors, privacy curtains) are cleaned and disinfected per the manufacturer’s instruction for  use. 
   5. Consider closing or limiting admissions or transfers to impacted units to contain spread. 
2. Hand Hygiene 
   1. Ensure healthcare personnel (HCP), patients/residents, and visitors are educated on the proper  techniques and indications for hand hygiene – hand washing with soap and water and the use of  alcohol-based hand rubs. 
      1. For HCP, during outbreaks, use soap and water for hand hygiene after providing care or  having contact with patients/residents suspected or confirmed with norovirus  
         gastroenteritis. 
      2. Hand washing with soap and water, and at least 20 seconds of friction, is the preferred method in these scenarios: 
   2. After caring for a patient/resident with a suspected or confirmed GI illness 
      1. Before eating, preparing, or handling food
      2. After using the restroom 
      3. When hands are visibly soiled 
   3. Ensure that supplies for hand hygiene are available at the point of use. 
3. Personal Protective Equipment (PPE) 
   1. Contact Precautions require the use of a gown and gloves before entry to the patient/residents' care area. Additional PPE should be used as indicated, based on Standard Precautions.
   2. Ensure HCP doff and dispose of all PPE before leaving the patient/resident’s care area.
   3. Use a mask and eye protection if there is an anticipated risk of splashes to the face during the  care of patients/residents (e.g., cleaning up vomitus). 
4. Environmental Cleaning and Disinfection 
   1. Increase the frequency of cleaning and disinfection of high-touch surfaces (e.g., doorknobs,  countertops, toilets, faucets, bedrails), patient/resident care, and communal areas. Begin cleaning areas with a lower likelihood of contamination (e.g., countertops) before moving to  areas more likely to be contaminated (e.g., toilets). 
   2. Use EPA-registered disinfectants that are effective against norovirus (EPA List G) and follow the manufacturer’s instructions for use.
5. Dietary Practices
   1. Partner with the Dietary Director to review and audit safe food handling practices, including:
      1. Wash fruits and vegetables thoroughly before use 
      2. Regularly clean and sanitize kitchen utensils, cutting boards, counters, and surfaces b. Ensure food is properly cooked, prepared, handled, and stored to prevent contamination. Thorough cooking is important because noroviruses can survive temperatures as high as 145°F.  c. For more information refer to CDC Norovirus Fact Sheet for Food Workers.  
6. Staffing and Return to Work Criteria 
   1. Educate HCP on signs and symptoms of GI illness and call out procedures. Monitor the staff call out log to detect trends. 
   2. Exclude ill personnel from work for at least 48 hours after the resolution of symptoms. c. Cohort or dedicate HCP to care for ill patients/residents to minimize the risk of cross-contamination.
7. Reporting 
   1. Report an increase in GI illness by phone to your local health department immediately. An outbreak should be reported when it is suspected, and facilities should not wait for an outbreak  to be confirmed before reporting.