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Implementation of Universal Precautions during Norovirus Outbreak at One County Long Term Care Facility

      ISSUE: Noroviruses are very common: they account for 93% of nonbacterial gastroenteritis reported to the Centers for Disease Control and Prevention (CDC) for which a cause is identified. Outbreaks in long-term care facilities are not uncommon. In one recent two-year period, 80% of norovirus outbreaks were in skilled nursing facilities. Taking specific steps to prevent the virus from being transmitted from person to person can control outbreaks. CONTROL OF AN OUTBREAK OF VIRAL GASTROENTERITIS 1. Interrupt person-to-person transmission; 2. Limit transmission when initial cases are suspected; 3. Institute infection control measures without waiting for diagnostic confirmation.
      PROJECT: LIMIT TRANSMISSION WHEN INITIAL CASES ARE SUSPECTED:
      • 1.
        Close doors to long term care nursing unit;
      • 2.
        Notify medical director;
      • 3.
        Place the isolation station over the entrace door to the long term care nursing unit, Masks, gowns, gloves, hand hygiene supplies;
      • 3.
        Place do not enter signs on door to the long term care nursing unit;
      • 4.
        Place isolation stations over door of each symptomatic resident room;
      • 5.
        Discontinue staff “floating”;
      • 6.
        Ask family of symptomatic residents to avoid visitation;
      • 7.
        Notify the Dept of Public Health Disease Control and Prevention and Dept of Health Services Division of Communicable Disease Control in Conjunction with Licensing and Certification;
      • 8.
        Begin line listing of residents who are symptomatic.
      INSTITUTE INFECTION CONTROL MEASURES WITHOUT WAITING FOR DIAGNOSTIC CONFIRMATION:
      • 1.
        Do not admit to the unit;
      • 2.
        Do not discharge from the unit;
      • 3.
        Dedicate patient care equipment to a single resident or among symptomatic residents, adequate clean and disinfect before use for another resident;
      • 4.
        Exclude non-essential personnel from the affected unit;
      • 5.
        Clean hands before and after glove use;
      • 6.
        Wear gowns and change between each resident contact;
      • 7.
        Cancel or postpone group activities;
      • 8.
        Increase frequency of routine ward bathroom and toilet cleaning;
      • 9.
        Use EPA approved disinfectant to disinfect surfaces;
      • 10.
        Consider antiemetics for patients with vomiting;
      • 11.
        Clean carpets and soft furnishings if contaminated.
      RESULTS: There were 12 resident cases and 11 employee cases. Long term care unit was released from outbreak restrictions by the Dept of Public Health, Disease Control and Prevention, in 8 days. Reference: http://www.dhs.ca.gov/ps/dcdc/ Recommendations for the Prevention and Control of Viral Gastroenteritis Outbreaks in California Long Term Care Settings; www.aboutinfectioncontrol.com, the SF Bay Area APIC Chapter website, red button RESOURCES, GI Checklist.