G I Wish This Hadn't Happened: An Outbreak of Norovirus in Rehab and Psych Units

      ISSUE: At the height of a community outbreak of Norovirus in December 2006, the Infection Prevention and Control Department received notification that 2 patients from the Rehab department had stool culture results positive for Norovirus. Upon further investigation, 17 other patients and 5 staff on the Adolescent and Adult Psychiatric units from 2 floors below were exhibiting varying signs and symptoms of nausea, vomiting, diarrhea, fever, chills and abdominal cramps indicative of gastrointestinal illness. Since Infection Control had not been notified until after the first 2 positive stool cultures were obtained, immediate action was imperative.
      PROJECT: Patient and staff information was communicated to Public Health (PH) and Department of Health Services (DHS) through Risk Management. Nursing, Administration and Employee Health (EH) were also notified. The actions taken included recommendations from DHS and PH and are as follows. Symptomatic patients were placed on contact isolation regardless of stool culture result. The units were closed to admission, and discharging patients to other Long Term Care (LTC), Skilled Nursing Facility (SNF) and other facilities was halted. Symptomatic staff was restricted from work until 48 hours after they became symptom free. Cleaning the units with bleach solution at 4-hour intervals was also implemented and inservice was provided. Instructions were given to Food and Nutrition Services (FNS) regarding handling and cleaning of food carts. Infection Control gathered daily updates and provided Employee Heath with employee names, onset of symptoms. They approved the employee to return to work 24 hours after symptoms subside. Visitors were instructed not to visit the unit if they had gastrointestinal symptoms and signs were posted at the entrance of each unit regarding hand washing before and after visiting. Units were monitored daily for new episodes and containment. Specimens were collected from the patients and sent for culture. Not all symptomatic patients were positive for Norovirus. Forty-eight hours after the last patient and/or staff had symptoms a physical assessment, evaluation, and discussion with PH resulted in approval to reopen units for admission.
      RESULTS: A total of 38 patients and 36 staff were affected during this outbreak. Twelve days after initial notification the outbreak was contained and the 3 units in Rehab and Psych were reopened for admission and transfer.
      LESSONS LEARNED: Communication and collaboration is essential in the containment of spread in a gastrointestinal outbreak. This collaboration must include department managers, nursing staff, administration, and ancillary services from EVS, laboratory, FNS, EH as well as communication with PH and DHS. Vigilance in monitoring each case halted transmission in a rehab and psych unit as well as scrupulous hand hygiene and increased and scheduled environmental cleaning.