Viral gastroenteritis policy/I;winword.policies.viral gastro.gastro policy v1.doc/09.02/ipcd.dwh.dj
VIRAL GASTRO-ENTERITIS POLICY
Author
Policy Ratified by
Classification
Area Applicable
Ref No:
Committee
OSHEU
University Wide
Date
Date Issued 15/02/05
Review
Date
Version No:
1
Disclaimer
When using this document please ensure that the version you are using is
the most up-to-date.
Occupational Safety, Health and Environment Unit/Updated September 2004/Viral Gastroenteritis
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IPCD Policy Number 13
CARDIFF AND VALE NHS
TRUST
YMDDIRIEDOLAETH GIG
CAERDYDD A’R FRO
H/10
Policy on Viral Gastro-Enteritis
(Norwalk, Norwalk-Like and Rota Viruses)
This policy was approved by
Cardiff and Vale NHS Trust Board …………
Date of review –
Central register Number
If the date at the time of reference to this Policy document is after the stated date for
review you must contact the author, or if absent, the Corporate Affairs Director, to check
that the content is current.
Out Of Date Policies Must Not Be Relied On
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Contents
Page
1.
2.
3.
4.
5.
6.
Summary
1.1
NLV’s
1.2
Rotaviruses
1.3
Actions
Introduction
2.1
Norwalk and Norwalk Like Viruses (NLV)
2.2
Rotavirus
Control measures
3.1
Admission of known or suspected case
3.2
Case reported after admission
3.3
Patient isolation
3.4
Additional measures in outbreak situations
Communication
Faecal samples
References
3
3
4
6
6
7
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1. Summary
1.1 NLV’s
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Norwalk and Norwalk-like Viruses (NLV’s) are one of the most common causes of outbreaks of
gastro-enteritis in hospitals and can lead to ward closures and major disruption in hospital
activities.
NLV’s may spread by several routes: faecal-oral; contact; vomiting/aerosols; food and water.
Outbreaks normally occur during the winter months-hence the name “winter vomiting disease”,
but are increasingly being seen throughout the year. Outbreaks can be explosive at their outset
particularly if projectile vomiting is a prominent feature.
Symptoms include nausea, vomiting, diarrhoea, abdominal pains/cramps and characteristically
last 24-48 hours.
1.2 Rotaviruses
Rotaviruses are the most frequent enteric pathogens found in young children and infants, the mode
of transmission is faecal-oral but contact and respiratory spread are possible
Symptoms include sudden onset of fever, abdominal pain and vomiting, and continues with
moderate or severe watery diarrhoea that usually lasts for 3-8 days.
1.3 Actions
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As with all other syndromes with infectious diarrhoea, a patient with known or suspected viral
gastro-enteritis infection should be admitted directly to a cubicle (preferably with its own toilet
facilities) and contact precautions instituted immediately.
STRICT COMPLIANCE WITH HAND HYGIENE TECHNIQUES MUST BE OBSERVED AT ALL
TIMES
Remove exposed food e.g. fruit.
Exclude affected staff immediately and until 48 hours symptom-free.
Clean and disinfect vomit/faeces spillages promptly using a chlorine releasing disinfectant.
Increase the frequency of routine ward, bathroom and toilet cleaning.
Avoid patient movement to unaffected areas unless medically urgent.
Staff must not consume food and drink in clinical areas at any time and this must be reenforced during clusters or outbreak situations, in line with Trust policy.
Collect fresh faecal samples from first diarrhoeal episodes if possible and submit immediately
for routine microbiology and virology investigations.
2. Introduction
2.1 Norwalk-like Viruses (NLV’s)
Norwalk-like Viruses (NLV’s) are one of the most common causes of outbreaks of gastro-enteritis
in hospitals and can lead to ward closure and major disruption in hospital activities. Several routes
may spread NLV’s: faecal-oral; contact; vomiting/aerosols; food and water. Viruses may be
introduced into the ward environment by any of these routes and then propagated by person-toperson spread.
Outbreaks normally occur during the winter months-hence the name “winter vomiting disease”, but
are increasingly being seen throughout the year. Diagnosis can usually be made rapidly and
confidently on clinical and epidemiological grounds especially if vomiting is a prominent symptom.
Diarrhoea tends to be short-lived and less severe than with other causes of gastro-enteritis.
Outbreaks can be explosive at their outset particularly if projectile vomiting is a prominent feature.
Duration of the illness is usually between 12-60 hours, with an incubation period of between 15-48
hours, and both staff and patients can be affected.
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Symptoms include nausea, vomiting, diarrhoea, abdominal pains/cramps, myalgia, headache,
malaise, chills, low-grade fever or a combination of these symptoms.
G.I. symptoms
characteristically last 24-48 hours. Recovery is usually rapid thereafter. It is recognised that NLV
infection results in short-term immunity only (usually up to 14 weeks).
2.2 Rotavirus
Rotaviruses are the most frequent enteric pathogens found in young children and infants and are a
major cause of nosocomial diarrhoea of newborns and infants. Infection of adults is usually subclinical, but outbreaks of clinical disease can occur in Care of the Elderly units. Infection rates tend
to follow a seasonal pattern with peak instances in winter and spring and lowest incidence in the
summer months. Susceptibility is greatest between ages of 6 and 24 months, by 3 years of age
most individuals have acquired rotavirus antibody.
The mode of transmission is faecal-oral but contact and respiratory spread are possible. The
incubation period is between 24-72 hours.
Symptoms include sudden onset of fever, abdominal pain and vomiting, and continues with
moderate or severe watery diarrhoea that usually lasts for 3-8 days.
The guidance given in this policy refers essentially to NLV infection but can also be utilised for
Rotavirus infection.
3. Control Measures
3.1 Admission of known or suspected cases
As with all other syndromes with infectious diarrhoea, a patient with known or suspected viral
gastro-enteritis infection admitted from home, or transferred from another ward or hospital should
be admitted directly to a cubicle (preferably with its own toilet facilities) and contact precautions
instituted immediately, with proper hand hygiene. If no cubicle is available then the patient should
be admitted to the least busy area of the ward, but contact precautions must be maintained.
3.2 Case reported after admission
If the patient had not been isolated, then he/she should be moved into a cubicle (preferably with
toilet facilities) whenever possible and contact precautions instituted immediately.
3.3 Patient isolation
“Contact Precautions” should be commenced immediately. A single room preferably with their own
toilet facilities should be used; if no toilet facilities are available then use a designated commode. If
there are several affected patients, the Infection Prevention and Control Department will consider
co-horting, as grouping these patients in an individual ward with designated staff is preferable to
side-rooms of different wards. Contact precautions should be of the same standard whether the
patient is in a cubicle or a ward area.
 Visitors and members of staff from other departments must report to the Nurse-in-Charge
before entering the room.
 The door of the room should be kept closed at all times unless the clinical need of the patient
dictates otherwise.
 A contact isolation sign (orange) should be displayed on the door.
 Patients should not leave the room/ward area to attend other departments without prior
arrangement/notification to the receiving department.
 Gloves should be worn if there is any risk from contamination with infected materials.
 Plastic aprons must be worn when soiling is likely.
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Facemasks with integrated visor (or equivalent) e.g. Tecnol Fluid Shield Mask should be worn
when in close proximity to or contact with affected patients especially if vomiting is a symptom
or suspected.
Hands must be washed with soap and water and then disinfected with an approved hand
disinfectant (e.g. alcohol gel) before entering the room, after patient contact, after contact with
potentially infected materials, and after removal of disposable gloves.
There is no need for the patient to be issued with disposable cutlery and crockery whilst in
isolation.
STRICT COMPLIANCE WITH HAND HYGIENE TECHNIQUES MUST BE OBSERVED AT ALL
TIMES
3.4 Additional measures in outbreak situations
INFORM THE INFECTION PREVENTION AND CONTROL TEAM OF ANY SUSPECT CASES
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Isolate or cohort symptomatic individuals.
Wear appropriate protective clothing (see patient isolation) when in contact with the
contaminated environment or a patient especially if vomiting is present or likely to occur.
Wash hands with soap and water then apply alcohol gel before and after contact with affected
patients or their environment and after removing gloves and apron.
Remove exposed food e.g. fruit.
Exclude affected staff immediately and until 48 hours symptom-free.
Exclude non-essential personnel.
Caution visitors and emphasize hand hygiene/washing.
Clean and disinfect vomit/faeces spillages promptly using a chlorine releasing disinfectant e.g.
Sodium dichloroisocyanurate (NaDcc) granules in accordance with Trust Decontamination
Policy.
Commodes should be cleaned/disinfected after each use according to Trust Decontamination
Policy.
Increase the frequency of routine ward, bathroom and toilet cleaning. Use freshly prepared
chlorine releasing disinfectants 0.1% (1,000ppm) after initial cleaning.
The Director of Infection Prevention and Control or on site Infection Prevention and Control
Staff will determine the need for ward closure and/or re-opening in conjunction with clinical staff
of the affected area.
Thorough cleaning of the ward and change of bed curtains, if contaminated, should be
undertaken before re-opening. The timing of the terminal cleaning process should ideally be at
least 72 hours post-resolution of the last case. This takes into account the period of maximum
infectivity (48 hours) plus the typical incubation period (24 hours) for any newly infected
individuals.
Staff working in affected areas should not work in unaffected areas for 48 hours. This includes
staff that work for Bank and Agency.
Avoid patient movement to unaffected areas unless medically urgent and after consultation with
IPCD.
Staff must not consume food and drink in clinical areas at any time and this must be reenforced during outbreak situations, in line with Trust policy.
Staff Room—do not eat food which has been prepared or brought in by someone other than
yourself.
Place alcohol gel in a prominent position at the entrance to the ward area (where situation
allows) and at strategically placed positions on the ward, if safe to do so, along with a notice to
visitors and staff advising of the situation. Always encourage hand washing with soap and
water before gel application.
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Essential medical and paramedical staff (e.g. physiotherapists) should wherever possible be
dedicated to the affected ward(s) during an outbreak and not work in other areas. When this is
not possible unaffected wards should be visited first before affected ward areas.
If staff shortages require the use of outside/agency staff, they should be booked to work for a
block of several days or more to anticipate staffing requirements, even though this may result in
direct early costs.
4. Communication
The Infection Prevention and Control Department should be informed immediately whenever there
is a cluster of any gastroenteritis cases (two or more) of unexplained vomiting or diarrhoea or both,
among patients or staff, this will allow rapid institution of control measures after assessment by the
team.
The Director of Infection Prevention and Control or on-site lead Team member for Infection
Prevention and Control should ensure that the Consultant in Communicable Disease Control
(CCDC) is informed where
 One or more ward is affected, or
 The staffing of the hospital is compromised, or
 The operational capacity of the hospital is affected.
The following departments should also be informed
 Bed management if there is a possible/probable/imminent ward closure
 Occupational Health should be alerted for potential symptoms among staff
 All relevant departments should be informed in accordance with the Trust Infectious Incident
and Outbreak Plan.
 The Virology Department should be informed of suspected cluster/outbreak.
5. Faecal Specimens
In situations where there is a cluster of cases or an outbreak, collect fresh faecal samples from first
diarrhoeal episode if possible, divide into two separate containers, and submit immediately for:  Routine microbiology investigation, including Clostridium difficile.
 Virology investigations.
Not all faecal specimens submitted for virological investigations (NLV-PCR) will be tested; a triage
system exists where a selection of unformed stools submitted, as close to the date of onset of the
illness will be investigated.
Vomitus should not be submitted
Samples from sporadic cases of gastro-enteritis in adults should not be sent for Virology testing.
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6. References
1. Management of hospital outbreaks of Gastro-enteritis due to small round structure viruses:
Journal of Hospital Infection (2000); 45:1-10.
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