CDC Expert Commentary

Preventing Norovirus Transmission: New Guidelines Released

Tara MacCannell, PhD

Disclosures

May 09, 2011

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Hello. I'm Dr. Taranisia MacCannell, Epidemiologist in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention. I'm pleased to speak with you today as part of the CDC Expert Video Commentary Series on Medscape about the new guidelines that have just been released by CDC and the CDC Healthcare Infection Control Practices Advisory Committee. These guidelines outline steps that should be taken to ensure the prevention and control of norovirus gastroenteritis outbreaks in healthcare settings.

CDC estimates that over 21 million cases of acute gastroenteritis occur every year and are caused by norovirus. Norovirus infection typically presents as an acute gastroenteritis, with persons experiencing sudden watery, nonbloody diarrhea with or without vomiting. Affected persons can also experience nausea, abdominal cramping, fever, myalgia, malaise, or headache. Norovirus can strike any population and outbreaks occur in households, communities, and institutions, but today we're talking about healthcare settings. So, what can you do to help safeguard your patients?

The new CDC guideline is an excellent place to start.

First and foremost, it is key to avoid exposure to vomitus and diarrhea. Contact precautions should be implemented and affected patients should be placed in a single-patient room if they have symptoms that are consistent with norovirus gastroenteritis. Personal protective equipment such as gloves, gowns, and possibly face masks, should be used when entering patient areas under contact precautions. Also, during outbreaks, symptomatic patients should be placed on these precautions for a minimum of 48 hours after resolution of symptoms to prevent transmission to other susceptible patients.

Secondly, consider minimizing patient movements within a ward or unit during outbreaks and consider suspending group activities (such as dining events) for the duration of the outbreak. If staff members become ill, exclude them from work for a minimum of 48 hours after the resolution of their last symptoms. Staff who have recovered and returned to work after recent norovirus infection may be best suited to care for symptomatic patients until the outbreak resolves.

As with many pathogens, proper hand hygiene is critical for norovirus prevention and should be actively promoted among healthcare personnel, patients, and visitors. During outbreaks, use soap and water for hand hygiene after providing care or having contact with patients suspected of or confirmed with having norovirus gastroenteritis. During outbreaks, consider ethanol-based hand sanitizers (60%-95%) as the preferred product for hand hygiene compared with other alcohol or nonalcohol-based hand sanitizer products. For complete details on recommended hand hygiene practices, please see the resource links on the CDC Website.

Not to be overlooked is the importance of environmental cleaning, including routine cleaning and disinfection of frequently touched environmental surfaces and equipment in isolation and cohorted areas -- as well as shared clinical areas. It is important to (1) clean and disinfect shared equipment between patients; (2) increase the frequency of cleaning and disinfection of patient care areas and frequently touched surfaces during outbreaks; and (3) consider discarding all disposable patient care items from affected patients' rooms upon discharge.

In my experience, I have seen how these simple techniques can have a profound impact on the well-being of our patients. To review the complete guideline and its full recommendations and for more information on how you can help prevent and control norovirus infections, please review the resources listed on this page. Thank you.

Web Resources

Norovirus Prevention Toolkit

Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings, 2011

CDC Norovirus in Healthcare Settings

CDC Division of Viral Diseases - Norovirus

HICPAC 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

US Environmental Protection Agency Office of Pesticide Programs.
Registered Antimicrobial Products Effective Against Norovirus

Tara MacCannell, PhD, is an epidemiologist on the Acute Care Team with the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention in Atlanta, Georgia. Dr. MacCannell entered public health after several years in infection control and hospital epidemiology in the acute care sector. During her 4 years with the CDC, Dr. MacCannell has focused her efforts in outbreak response within healthcare settings, the role of environmental burdens on disease transmission, and becoming the CDC author for the new HICPAC Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings. Other areas of focus include surveillance for bloodborne pathogen exposures and influenza vaccination among healthcare personnel, the promotion and translation of infection control in healthcare both domestically and abroad, and use of spatial analysis in infectious disease transmission.

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