Viral Gastroenteritis:Prevention and Control in Long-
Term Care Facilities
Daniel Golson, [email protected]
Practical Guidance for LTCFs
www.health.nashville.gov/healthdata
Development of Document
• early 2009 – 4 confirmed norovirus outbreaks – LTCF, retirement community, restaurant, social
gathering
• only one was determined to be foodborne • internal work group formed
– internal communication, outbreak response, guidance for public facilities (e.g. hotels and LTCFs)
– CDIs, environmentalists, & epidemiologists– Food Division, Public Facilities, Epidemiology
And Then....
• Swine flu!
Next Thing You Know...Fall 2009
• 5* Assisted Living facilities• 2** Retirement communities• 2 Social gatherings
– wedding (confirmed norovirus G2 etiology)– work environment (confirmed norovirus G2 etiology)
*1 confirmed etiology – norovirus G2
**1 confirmed etiology – norovirus G2
Viral Gastroenteritis Outbreaks in Davidson County
Lessons Learned
• Some large institutions have very clear control protocols
• Many do not
• Many HCWs lackadasical about viral gastroenteritis – “it’s going around”
• Closed communities must be prepared
Guidance Needed for LTCFs
• Prepare for eventuality of a viral gastroenteritis outbreak
• When to suspect an outbreak
• Control measures
• Info to collect for CDIs, epi’s
• Notification the LHD
• Examples of info to hand out to residents & signs to discourage visitors
Guidance Needed for LTCFs
• Isolation practices• Dining facilities & community activities• Ill staff• Home-health workers• Transfers, EMS transports• New admissions• Environmental cleaning & disinfection• Flexible step by step guide
Outbreaks
• ≥2 residents or staff with new onset of V and/or D w/n 48 hrs of each other suspect norovirus
• early recognition critical to control
• aggressive implementation of control measures
Preparation is Critical!
• Review guidance & share with staff• Think about what info your audience will want
during an outbreak – be transparent in your communications
• Prepare for specific audiences:– residents– residents’ families/friends– staff (food, maintenance, volunteers, home-health
workers, etc)– the media?
You suspect an outbreak, now what?
Notification – Everyone plays a role– Residents, Staff – Report SxS to Mgmt– Mgmt or ICP
• Consult with MPHD (615-340-5632)• Log cases daily using line list• Alert “sister” facilities, hospitals, hospice, EMS• Provide staff, residents, family, visitors with fact
sheet on norovirus
Isolation and Case Management
• 48 hrs rule – isolate those with SxS until 48 hrs SxS-free– send ill staff home until 48 hrs SxS-free– discontinue communal activities until 48 hrs
after last case ID’d– close dining facility until 48 hrs after last case
• Limit staff to one area of assignment• Postpone transfers & new admissions• Discourage visitors
Managing the Environment• Norovirus resistant to most disinfectants• Clean & disinfect (C&D) contaminated areas
promptly• Step up C&D and continue enhanced C&D ≥72 hrs
after last case ID’d
• Chlorine bleach is best
Lysol® 409® Pinesol®
Managing the Environment
• Do Not bring non-essential equip into contaminated areas
• Do Not vacuum until after steam cleaning (carpets, rugs, furnishings)
• Segregate clean & soiled linens/laundry
• Wear PPE when handling soiled laundry
Viral Gastroenteritis Outbreaks in Davidson County since Fall 2009
• Over 175 illnesses in total
• At least 8 hospitalizations, many ED visits
• No fatalities
• Attack rates among residents ranged from 16% to 73%
Propagated Outbreak in 3 phases?
Norovirus G2 Outbreak at Assisted Living Facility TN 09-54
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Questions?
www.health.nashville.gov/healthdata
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