Viral Gastroenteritis in Long-term Care

It’s that time of year when viral gastroenteritis makes itself known in the community and in Long-term Care.  (See  CDC: Norovirus ) Here is a review of a common type of situation found in Long-term Care

You, the DSD, come on duty Monday morning and are told Sunday night three residents had several episodes of vomiting followed by diarrhea. A Nursing Assistant went home with the same symptoms.  What should you do with this information?

  • Consider the potential for a Norovirus- associated Gastroenteritis outbreak.
  • Notify DON, Medical Director, resident’s Physicians, Administration and staff; the Medical Director, DON or Administrator will report to the local County Health Department and 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 additional barriers, such as gowns and masks while the patient is symptomatic.  Why masks? Because the virus may become aerosolized while the patient is vomiting, transmitting the virus to anyone in close proximity.   
  • Assess all patients for similar signs and symptoms. Develop line listings and use outbreak surveillance forms for surveillance and tracking purposes; use separate tracking forms for residents and employees.
  • Meet with all staff and review the signs and symptoms of noroviruses; per the CDC, the 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 and as mentioned above, the virus may 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: Noroviruses

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