UK: New guidelines for the management of norovirus
Posted: November 26th, 2011 - 6:10pm
Source: Health Protection Agency
The Health Protection Agency (HPA), together with other professional bodies from the norovirus working group have today launched the new ‘Guidelines for the management of Norovirus outbreaks in acute and community health and social care settings’.
The norovirus working group includes members from the British Infection Association, Healthcare Infection Society, Infection Prevention Society, NHS Confederation, Sowerby Centre for Health Informatics and the National Concern for Healthcare.
Norovirus is highly contagious and can be transmitted by contact with an infected person; by consuming contaminated food or water or by contact with contaminated surfaces or objects.
The virus spreads rapidly in closed environments such as hospitals, schools, cruise ships, nursing and residential homes and hotels. Outbreaks in hospitals are estimated to cost the NHS in excess of £100 million each year.
Its symptoms include a sudden onset of vomiting and/or diarrhoea. Some people may also have a temperature, headache and stomach cramps. The illness usually completely resolves in one or two days and there are no long-term effects. Unless someone is severely dehydrated there is no need to attend hospital for treatment.
Although guidance on how to manage outbreaks has been in place for a number of years this new report draws on current practice that shows that cases should be managed in single rooms and bays in the first instance if this is possible. This will allow some flexibility in the response and also for cleaning to take place allowing smaller wards to be able to re-open more quickly. If managing the cases at the single room or bay level fails to control the outbreak then the outbreak control team (OCT) can consider closing the whole ward.
This approach would not work in ‘Nightingale’ style wards where all the beds are in one room and segregation of those who have the virus would not be possible. In these cases the ward would need to be closed.
The guidance also details other recommendations that need to be undertaken in the event of an outbreak. This includes closing the affected bays to admissions and transfers and closing doors to side rooms and bays. Other measures are to have signage on doors informing all visitors that the ward is closed and restricting staff and essential social visitors only to the affected area and planning a deep clean at the earliest possible date.
There are separate recommendations for healthcare workers who are integral to the response. This covers the need for all staff to be aware of the norovirus outbreak and how the virus is transmitted. They also need to ensure that all staff are aware of the work exclusion policy and the need to go off duty at the first sign of symptoms and to allocate staff to duties in either affected or non-affected areas but not both.
Dr Bharat Patel, the HPA’s Lead Consultant Medical Microbiologist and one of the authors on the report said: “Managing norovirus outbreaks is very hard owing to the nature of the virus and how quickly it spreads. Any outbreak causes widespread disruption and it is very important that appropriate control measures are implemented quickly.
“This guidance gives very clear recommendations on how to manage outbreaks within the hospital and community setting. It will be greatly beneficial to staff to know that there is now the option of trying to manage the outbreak at the single room and bay level which will reduce the pressure that closing wards has on both staff and patients.”
The report can be seen ahttp://www.hpa.org.uk/Publications/InfectiousDiseases/InfectionControl/