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Giving outbreaks the serve

It’s the word we dare not say in the kitchen. Gaye Philpott tackles the dreaded norovirus.

Norovirus has become a buzz-word in my region in recent months due to a number of outbreaks. Several wards at the main hospital and a number of aged-care facilities have been in lock-down due to this highly infectious form of gastroenteritis.

Norovirus is noted for its sudden onset and the short duration of its symptoms. On average the incubation period is 24 hours with symptoms lasting between 24 and 60 hours.

Most, but not all, people who contract norovirus will experience symptoms, which may include any or all of the following: nausea, vomiting, stomach cramps, diarrhoea, fever and headache. Vomiting is more common in the young, and diarrhoea in adults.

Norovirus is usually introduced into a facility by a single person such as a staff member, a new resident or a short-term visitor. Faecal-oral spread is the usual means by which it is transmitted, though inhaling small droplets of vomit which are suspended in the air or touching contaminated surfaces can also cause its spread.

The goal of managing norovirus once an outbreak occurs is to confine it and minimise its spread. Isolating people with symptoms, stringent hand-washing and good procedures for cleaning and sanitising soiled clothing, linen and environmental surfaces are essential.

Three aspects of norovirus deserve special mention.

Firstly, as mentioned, some people with norovirus are asymptomatic (they are infectious but have no symptoms to indicate that they are).

Secondly, people can remain infectious for up to 10 days after their symptoms subside.

And thirdly, immunity following infection is short-lived. This means that no one can be complacent when it comes to hand washing, no matter whether they have or haven’t had symptoms during an outbreak, have just got over norovirus or had norovirus some time ago.

The nature of a norovirus outbreak also means that residents will be at different stages of illness and recuperation over a two-week period and some won’t become unwell at all. As a result, appetites and the food and fluid needs of residents in the facility will vary. Planning can help ensure that all residents have access to what they need.

When an outbreak is confirmed, arranging a meeting between management, the clinical team leader and the kitchen manager to review and temporarily amend the menu may smooth the way for all concerned.

Incorporating foods which are dominantly liquid, such as soups, simple broths and jelly will be useful for helping keep residents hydrated. Being organised so that the kitchen is able to satisfy an increased demand for these foods will also be useful. For example, jelly might not be a standard menu item in your facility, but would be a useful food to have ready access to during an outbreak of norovirus. Because it takes at least six hours for jelly to set, planning is required.

Easy access to a range of dry, starchy foods such as crackers, toast and simple, sweet biscuits at any time of the day may also be useful for those who feel nauseous.

Temporarily removing fried foods and foods which contain a high fat content, such as pastry and rich desserts, will also be appropriate during this time. For example, bacon and egg pie could be replaced with poached eggs on toast or scrambled eggs served with mashed potato. Battered or crumbed fish served with chips might be replaced with potato-topped fish pie. Canned fruit and custard or milk puddings could replace cheesecake.

Those recovering from diarrhoea might like to avoid large quantities of fibrous vegetables such as peas, corn and mixed vegetables, and vegetables known to cause wind such as cooked cabbage, coleslaw and onions. Removing these vegetables temporarily from the menu during an outbreak of norovirus and replacing them with less fibrous varieties such as silverbeet, green beans, pumpkin and root vegetables is likely to be appreciated. Likewise, replacing baked beans with spaghetti, and omitting dried fruit from baked goods would be appropriate.

Once residents are well and appetites have improved, these temporary changes can cease and the menu should return to normal.

In the coming months it will be useful to track the weight of residents who had norovirus. While the appetites of younger people usually return to normal quickly after an acute illnesses such as gastroenteritis, it can take longer for the appetites of older people to improve and, in some cases, appetites may become set at a new, lower level.

Observing food intakes and diligently carrying out monthly weighs will be important in identifying residents with changed appetites and a reduced food intake. Where this occurs, high-energy extras such as protein drinks or nutritional supplements can be offered to boost protein and reduced energy intakes.

Gaye Philpott is registered New Zealand dietitian. Email [email protected]

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