The Preventionist

Posted By Chris on March 10, 2010

You, the DSD, come on duty Monday morning and are told Sunday night three residents began having several episodes of vomiting and Diarrhea and a Nursing Assistant went home with the same symptoms.  What should you do with this information?

• Consider this a potential Norovirus- associated Gastroenteritis outbreak.
• First notify DON, Medical Director, resident’s Physicians, Administration and staff; the Medical Director, DON or Administrator will report to local County Health Department and DHS Licensing. An outbreak exists when there is an increase in the expected baseline level of cases in a facility; a sudden occurrence of more than the usual  expected cases is the definition of outbreak; all outbreaks are reportable.    
• Place symptomatic patients on contact isolation and stop social activities until symptom free for 48 hours.  Use gowns, gloves and masks if there is vomiting. 
• Assess all patients for similar signs and symptoms. Develop line listings/outbreak surveillance Forms for surveillance and tracking purposes; use separate tracking forms for residents and employees.
• Meet with all staff; review signs and symptoms of noroviruses; per CDC incubation period is 12-48 hours; duration 24-60 hrs and 30 % of affected patients may be asymptomatic. Transmission is by direct person to person contact, the oral/fecal route, or contamination of water or food by infected persons; the virus may also become aerosolized when patients are vomiting. 
• Re-enforce strict hand washing guidelines and use of Personal Protective Equipment (PPE).
• Environmental Disinfection; the CDC recommends Chlorine Bleach solutions or EPA approved disinfection products.  (http://www.cdc.gov/ncidod/dhqp/id_norovirusfs.html)
• Instruct visitors on precautions and limit visitations if necessary.
• Document signs and symptoms, notification of physicians and all new orders.  
• Maintain and hold staff rotations until outbreak is resolved. Continue monitoring cases until there are no further signs and symptoms consistent with Norovirus-associated Gastroenteritis cases in your building.  

Resource:CDC Noro-virus in Health Care Facilities  

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Tags: vominting/diarrhea/Norovirus/Gastroenteritis