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Dealing with norovirus

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The elderly are at even greater risk than ever of contracting gastroenteritis. But this pandemic can be averted with the help of health professionals. 

The so-called ‘Sydney 2012’ strain of norovirus is behind the recent gastro-pandemic in the UK, with around 750,000 cases of acute vomiting and diarrhoea. The virus, which caused such havoc in the UK has already caused outbreaks in Australia.

The virus is a hybrid of two separate strains of norovirus, and it’s likely to cause widespread illness this winter, due to its novel presentation to the immune system.

Text book descriptions of norovirus call it a ‘mild and self-limiting illness’, and for the normally healthy population this may well be so, but for more vulnerable groups, such as those with pre-existing health conditions, the very young and the very elderly, the opposite may be true.

Stopping the norovirus

It should be much easier to limit the spread of norovirus than colds and flu due to the shorter, more intense duration of the illness. However, there are some key factors to be aware of, in order to prevent major outbreaks.

Most state guidelines recommend a 48-hour window after the last symptom of diarrhoea or vomiting before returning back to work, school, day-care and so on. The ‘48-hour’ guideline is in accordance with most international guidelines, however some states only recommend a 24-hour window.

It is also important to note that the Centre for Disease Control and Prevention in the USA actually suggests that the period of high infectivity can continue for up to 72 hours post-symptom resolution, and specifically requires food handlers to wait for 72 hours before returning to work.

Virus particles may be excreted for some time post-symptom resolution in faeces, particularly in those that have trouble ‘clearing’ the virus – usually those with compromised immune systems, the very young and the elderly.

How this applies to aged care

• Health care staff working in aged care will need to wait 48 hours before returning to work if they have had vomiting and or diarrhoea. Any symptoms of vomiting and diarrhoea must be assumed to be norovirus unless laboratory studies prove otherwise.

• It might be prudent to put up signs in aged care units alerting visitors to protocol of visiting soon after symptoms of norovirus, before an outbreak has a chance to occur.

• Bearing in mind food is a prime vector for norovirus transmission, any personnel who have recently been sick with norovirus that return to work after the 48 hour window must still take extreme care when preparing food for others.

• Hand washing is key to reducing norovirus transmission, both within places of work and the local community. A vigorous hand wash for at least 15 seconds is recommended. Alcohol-based hand sanitisers, although effective in killing other forms of gastroenteritis-causing pathogens such as rotavirus, haven’t shown significant efficacy in killing norovirus, but are recommended in the absence of an alternative.

• Thorough cleaning of an environment where there have been cases of norovirus is important, once symptoms have resolved. Water and detergent, followed by a wipe with diluted bleach is considered the best practice. Since the virus particles can be aerolised during a bout of vomiting or during a toilet flush, surrounding areas must be cleaned well. Norovirus particles are highly environmentally stable and have been shown to persist for long periods of time (lasting for weeks on some surfaces).

Closing thoughts …

All health care workers are in an excellent position to reduce the spread of norovirus in their place of work, and in their local community this winter.

But to really limit spread of the virus, cooperation of other community members is crucial. Reading up on ways to reduce the spread as well as actively engaging in dialogue with friends, family members and other work colleagues are ways to do this, helping to ensure that our elderly patients and family members are protected.

Naomi Cook is a registered nurse and author.

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