Practice No.
451
Reference:
10/06
Version 1
HCC AS 31/00
HCC AS 10/06 403
HCC AS 10/06 404
HCC AS 10/06 406
HCC AS 10/06 407
HCC AS 10/06 410
HCC AS 10/06 412
HCC AS 10/06 413
HCC AS 10/06 414
HCC AS 10/06 415
Page 1 of 6
New
September 2010
Health & social Care Act NMC Code of Professional
2008 (Regulated
Conduct
Activities) Regulations
GSCC Code of Practice
2010
Managing Norovirus Infection in Residential, Day and Community Care
This summarises the nature, cause and effect of Norovirus and the management of
incidences which may occur in residential and community care.
1.
WHAT IS NOROVIRUS AND IS IT IMPORTANT IN THE COMMUNITY?
1.1
Norovirus (Caliciviridae norovirus G1 – GV) is also known as ‘winter
vomiting virus’, ‘gastric flu’, SRSV (small round structured virus), Norwalk
virus and the ‘Cruise Ship bug’. Noroviruses are a group of very contagious
and hardy viruses that cause severe stomach upsets (gastroenteritis) in
human and other animals. Because the different strains are constantly
evolving, it makes specific treatment difficult.
1.2
Norovirus is believed to be the source of up to 50% of food borne
gastroenteritis and is particularly prevalent in ‘closed’ or ‘semi closed’
communities, such as care homes, schools and cruise ships.
1.3
The usual habitat of the norovirus is in the small intestine and it is not able
to multiply outside of a living host. However, Norovirus particles on food
can survive in a normal environment for days and can withstand freezing for
several months, some even survive the pasteurisation (heat treatment) of
milk and the low levels of chlorine used to sanitize drinking water.
1.4
Because only very small numbers of particles are needed to cause
infection, the virus is highly infectious and difficult to control. Infection
occurs in all age groups and outbreaks are relatively common, with the
virus surviving for several days in contaminated areas.
2.
HOW DOES THE INFECTION SPREAD?
2.1
2.2
As few as 10 Norovirus particles may be enough to infect a healthy person.
An infected person sheds tens of thousands of particles and can easily
transmit the virus to other people through sharing their food, utensils, drinks
or touching common surfaces.
Common routes of infection are : Contamination by Dirty Hands of
Food; Utensils; surfaces e.g. toilet seats and
food preparation area
 Contaminated water
Drinking; washing vegetables, shellfish gathered
from areas contaminated by sewage
 Exposure to vomit or diarrhoea of an infected person,
especially when cleaning up. Infection often causes
uncontrollable projectile vomiting which may spray the
particles over a wide area
HAND WASHING IS THE SINGLE MOST EFFECTIVE PREVENTION
OF INFECTION BY NOROVIRUS.
3.
ADMISSION OF A NEW RESIDENT OR SERVICE USER WITH
SYMPTOMS OF NOROVIRUS INFECTION
3.1
If it is known that a potential or new resident has symptoms of Norovirus
infection the following people must be informed :
 The Registered Unit Manager
 The Service Manager
 The Member of the management team with responsibility for
infection control
 The Care Manager
3.2
Individuals with symptoms of Norovirus infection must not be admitted to
residential homes until the third day after they have been clear of the
symptoms of infection.
3.3
Individuals with Norovirus will not be accepted for attendance at a day
service until the third day after they have been clear of the symptoms of
infection.
3.4
Individuals in the care of, or discharged into the care of, the Community
Response Service will be risk assessed by the Team leader, to determine
the most appropriate management of their care.
4.
CARE OF A RESIDENT WITH NOROVIRUS INFECTION
4.1
All work bases must have a designated member of staff to deal with
infection control matters and to ensure that the manager’s responsibilities to
provide adequate arrangements for prevention of infections in the home,
under Regulation 12 Health & Social Care Act (Regulated Activities )
Regulations 2010. (Code of Practice for health and adult social care on the
prevention and control of infection and related guidance)
4.2
Any outbreak of infection must be reported to : Care Quality Commission
 HCC Adult Services Incident reporting system
(see guideline 306)
4.3
Staff must practice good hygiene at all times.
Hands must be washed thoroughly with water and bactericidal hand
wash, following any physical contact with an infected individual, contact
with any items within the vicinity of the service user, before preparing food,
after using the toilet and at any other time in which they might have been in
contact with contaminated material. Do not rely solely on alcohol gel as
research suggests this is not fully effective against Noroviruses
because of their structure. The efficiency with which this type of virus is
spread and cross infects, cannot be overstated.
4.4
The symptoms of norovirus infection are: Nausea and vomiting (often projectile)
 Diarrhoea
 Abdominal pain
 Lethargy
 Aching muscles
 Headache
 Low grade fever in some cases
 Loss of taste in some cases.
4.5
If Norovirus infection is suspected or evident, immediate action must be
taken to contain the infection. Infected residents must be isolated and all
staff having contact with them must wear protective clothing, (gloves and
aprons). This is particularly important when dealing with bedpans,
commodes or cleaning toilets. Where possible it may be appropriate to
designate specific staff to undertake the care of an individual with Norovirus,
to minimise the risk of cross infection. (see guideline 406)
4.6
Care must be taken to provide the infected individual with information
regarding the reason for isolation, to avoid creating unnecessary additional
stress. Relatives and friends must also receive information and instruction in
hygiene precautions and the need to wear protective clothing, to avoid
carrying the infection into the community.
4.7
Clear instructions must be posted outside of the resident’s room, explaining
the need to avoid non essential visitors and how to use the protective
clothing. (see guideline 406)
4.8
Environments must be kept clean at all times. All surfaces must be cleaned
with TECare. This product comes in two parts, a spray bottle of solution and
a pack of cleaning wipes and must be used according to instructions and
designated safety measures. (see guideline 415)
4.9
Where en suite facilities are not available a separate toilet and bathroom
must be reserved for the infected person. Communal facilities must not be
used in cases of Norovirus infection.
4.10
All bedding and clothing must be collected in a hot water soluble laundry
bag and placed in a red laundry bag to indicate it is contaminated linen. At
the time of writing, information suggests the following : Wash at 40C using a bleach-based laundry product.
Or
 Wash at 60C or above (using any laundry product, however,
this will not necessarily guarantee that 100% of the spores will
be destroyed. It is advisable to wash bedding and clothing at as
high a temperature as possible.
(see guideline 410)
4.11
Where possible single use food containers and utensils must be used to
enable them to be disposed of as hazardous waste.
4.12
All other materials must be collected in a orange hazardous waste bag and
disposed of by incineration.
4.13
Whilst all of these precautions are of some effect in themselves, they
are totally ineffective without effective hand washing by all staff and
visitors.
4.14
When the individual has been symptom free for 48 hours, it may be
assumed that the infection has been cleared. However, this does not mean
that the environment or the individual is clear of particles, and acquired
immunity is incomplete and temporary. The room and contents must be
thoroughly deep cleaned as directed in the cleaning manual and guideline
406. All disposable items must be incinerated as hazardous waste
4.15
5.
As a basic rule for management of this infection : S = suspect
 I = isolate
 G = gloves / aprons
 H = hand washing
RISK FACTORS AND TREATMENT IN THE CARE OF RESIDENTS WITH
NOROVIRUS INFECTION
5.1 The is no treatment for norovirus infection, it is therefore particularly important
to monitor the symptoms and control the concomitant risks, especially in very
young, elderly and immunity compromised individuals.
5.2
Because there is copious vomiting and diarrhoea, the major risk is that of
dehydration. For all residents with these symptoms, a fluid intake and output
record must be maintained until the resident is symptom free.
5.3 The resident’s GP must be informed and requested to prescribe suitable
analgesia to control any symptoms of pain. An observation record must be
initiated and maintained (4 hourly temperature recording for the first 48 hours)
If the temperature rises above 37 C or falls below 35.5 C, the GP must be
informed without delay.
5.4 Frequent small amounts of water, lightly flavoured if this can be tolerated,
must be offered and encouraged until the resident regains an appetite for
liquids. Sparkling water or lemon flavoured sips will help to refresh the mouth
when mouth care may not be tolerable. Sparkling water may initially be used
as a mouth wash before offering a drink.
5.5 During recovery, the amounts of fluid should be increased and a light diet
offered until a full diet can be tolerated.
5.6 Particular attention should be given to care of the skin, which may become
sore and will generally become dry and more susceptible to damage if the
individual is becoming dehydrated
6.
SUSPECTED NOROVIRUS IN THE DAY SERVICE
6.1 If Norovirus is suspected in a service user of a day service, the service user
and their carer must be informed that they may not attend the service until
they have been clear of symptoms for at least 48 hours.
6.2 Where the symptoms become apparent during attendance at the day service,
the service user must be sent home without delay.
6.3 Until they leave the unit, all precautions must be taken to minimize cross
infection by : designating a single member of staff to attend the individual
 isolating the individual until they are collected
 Guidelines must be followed as 4.7, 4.8, 4.9, 4.10, 4.11 above
 The carers of all service users of the day service must be
notified of the possibility of an outbreak and be alerted to
checking for the symptoms
 No service user will be permitted to attend the day service until
they have been clear of symptoms of the infection for at least 48
hours.
7.
MANAGEMENT OF STAFF WITH SUSPECTED NOROVIRUS
Where staff have been absent with suspected Norovirus infection, managers
should refer to Practice guideline 407 and manage staff as for Gastroenteritis.
Ref:
Online
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Norovirus/ online@21/9/2010
Online
http://www.nhs.uk/Conditions/Norovirus online@21/9/2010
Online
http://www.food.gov.uk/foodindustry/guidancenotes/hygguid/foodhandlersguide
online@21/9/2010
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_110435.pdf
PLEASE READ: IMPORTANT NOTICE FOR
VISITORS
Norovirus alert
Case(s) of norovirus have been identified within the
home. This is a gastric infection, and for any affected
individual their General Practitioner will be informed, the
appropriate diagnosis made and treatment given.
If you have been in contact with any person who has, or
may have, ‘gastric ‘flu’ ‘stomach bug’ or similar
infection, whether or not this has been identified as
norovirus, we should be grateful if you would inform the
duty manager as soon as possible, but this eventuality,
please do not visit until you have been clear of the
infection for at least 48 hours. We shall be very happy
to assist with maintaining contact by telephone during
any period of infection or potential infection.
If you would like further information regarding the
infection control precautions being undertaken by the
home, please see the manager or duty manager.
PLEASE CONTINUE TO USE THE ANTI BACTERIAL
GEL ON ARRIVAL AT THE HOME AND BEFORE
LEAVING AS A MATTER OF ROUTINE, BUT ALSO
ENSURE THAT YOU WASH YOUR HANDS WITH
SOAP AND WATER WHICH IS A MORE EFFECTIVE
FORM OF PROTECTION .
We assure you that we are taking all necessary action
to prevent further cases and to maintain appropriate
standards of care.
Thank you for your assistance.
____________________
Registered Manager