Management of Norovirus - Region of Peel

PEEL PUBLIC HEALTH
SECTION 4-18
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
DISEASE/ORGANISM SPECIFIC
MANAGEMENT OF NOROVIRUS
Norovirus is a common cause of viral gastroenteritis and has been linked to
outbreaks of vomiting and/or diarrhea in institutions such as long term care
homes, child-care centres, camps, schools and cruise ships.
Humans are the only known reservoir of norovirus.
Incubation
Norovirus gastroenteritis has an average incubation period of 24-48 hours and
lasts 24-60 hours.
Symptoms
Illness is characterized by an acute onset of nausea, vomiting, abdominal cramps
and diarrhea. Headache, low grade fever and malaise are sometimes reported.
Residents can experience vomiting alone. The dose required for illness to occur
is relatively low (

PEEL PUBLIC HEALTH
SECTION 4-18
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
DISEASE/ORGANISM SPECIFIC
particles. Therefore the chance of isolating the virus is highest if the specimens
are obtained as soon as the symptoms appear. Facilities should have policies in
place that allow staff to collect specimens when symptomatic residents are
identified. The likelihood of identifying the virus decreases as the time from onset
increases. Specimens should be kept refrigerated after collection and during
transport to the laboratory. The Peel Public Health Department will coordinate
the submission of specimens with the Public Health Laboratory.
Additional Precautions
The following measures are recommended when norovirus is suspected:
1. Peel Public Health should immediately be notified if an outbreak is
suspected within the facility.
2. Frequent hand hygiene must be performed with alcohol based hand rub (if
hands are not visibly soiled) or with soap and water.
3. Gloves should be worn in addition to hand hygiene. This will reduce the
potential transfer of virus particles from clients to health care worker or
from patient-to-patient via health care workers’ hands. Gloves must be
changed between patient/client/resident contacts and hand hygiene
performed immediately after gloves are removed.
4. Contact precautions must be taken. Masks, fluid resistant gowns and
goggles should be considered for persons who provide personal care in
settings where spattering or aerosols of infectious material are present
(e.g., vomiting, cleaning soiled bedpans, toilets and laundry,
5. Contact precautions must also be taken by staff that clean areas
substantially contaminated by faeces or vomit.
6. Soiled linens should be handled as little as possible, and with minimum
agitation. They should be laundered with detergent at the maximum cycle
length and then machine dried.
7. Environmental surfaces that have been soiled should be cleaned
thoroughly, and then disinfected using an appropriate hospital grade
disinfectant.
8. Signage should be posted for visitors during times of high incidence in the
community. The signage should advise ill persons not to visit and to
encourage all visitors to clean hands upon entering the building.
Peel Public Health - Take Control Guide 2011

PEEL PUBLIC HEALTH
SECTION 4-18
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
DISEASE/ORGANISM SPECIFIC
9. Symptomatic residents should be placed on contact precautions (gown
and gloves) for direct care (e.g. bathing, changing incontinent residents).
Several reports have identified transmission during outbreaks due to
aerosolization when the resident vomits. For this reason, staff may choose
to wear a mask when cleaning body fluid spills (e.g. vomitus, feces).
10. Symptomatic residents should be cohorted if single room is not available.
Residents should remain in their rooms and have staff dedicated to their
care. Staff should not care for asymptomatic residents if assigned to
residents with possible norovirus.
11. The need for careful hand hygiene should be stressed with staff, residents
and visitors. Signs should be posted in visible locations throughout the
facility alerting staff and visitors of the need for good handwashing. Staff
should assist residents with washing their hands prior to participating in
meals and group activities. Use of alcohol based hand rub should be
encouraged to ensure compliance with hand hygiene by staff, residents
and visitors.
12. Strict attention should be paid to environmental cleaning especially
surfaces that are frequently touched (e.g. bedrails, bedside tables,
handrails, doorknobs). All surfaces that may come in contact with the
resident or health care staff must be cleaned daily or whenever visibly
soiled with an appropriate disinfectant. Symptomatic residents should not
share equipment with other residents. If this is not possible, all equipment
must be cleaned and disinfected with an appropriate disinfectant before
being used for other residents (e.g. commode chairs, lift canvases,
stethoscopes, BP cuffs, blood glucose monitor machines, thermometers).
Soiled laundry should be transported in closed plastic bags and promptly
machine washed with detergent and water at the maximum cycle length
and then machine dried.
13. Symptomatic residents should remain in their rooms and not attend group
activities (e.g. meals, social activities) until they have been asymptomatic
for 48-72 hours. Roommates of symptomatic residents should also be
restricted from attending group functions. The incubation period of the
virus is short and the roommate may well be infected but not yet
symptomatic.
14. The decision to restrict visitors or close the facility to admissions/transfers
should be made in consultation with Peel Public Health.
Peel Public Health - Take Control Guide 2011

PEEL PUBLIC HEALTH
SECTION 4-18
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
DISEASE/ORGANISM SPECIFIC
15. Any staff that develops symptoms must remain off duty until they have
been free of symptoms for 48 hours.
16. Contact precautions must be maintained for residents until they have been
symptom-free for 48-72 hours.
17. The above measures must remain in place until the facility has reviewed
the status with Peel Public Health and has been cleared.
Additional Resources:
Centers for Disease Control. 2010. Guideline for the Prevention and Control of
Norovirus Gastroenteritis Outbreaks in Healthcare Settings. Division of
Healthcare Quality Promotion. June 2010
Ontario Ministry of Health and Long Term Care. Noroviruses Fact Sheet. 2007
http://www.health.gov.on.ca/english/providers/pub/disease/noroviruses.html
Ontario Ministry of Health and Long Term Care. Position Statement:
Recommended Length of Exclusion for Cases Associated with Norovirus
Outbreaks and When to Declare Norovirus Outbreaks Over. September 2010
http://www.simcoemuskokahealth.org/Libraries/JFY_Health_Care_Professionals/
MOHLTC_Norovirus_Recommendations.sflb.ashx
American Public Health Association. 2008. Control of Communicable Disease,
19 edition, 2008. Heymann, David, editor. Washington, DC, USA
Peel Health website at: Norovirus facts www.peelregion.ca
Peel Public Health - Take Control Guide 2011