Management of a Gastroenteritis Outbreak Due to Norovirus

ISSUE: An increasing number of outbreaks of Norovirus (NV) gastroenteritis are occurring in hospitals but there are few published descriptions of how to manage a NV outbreak in hospital settings. We describe the process we used to contain a NV outbreak. PROJECT: An outbreak of acute gastroenteritis involving both healthcare workers (HCWs) and patients suggested NV as the possible cause. Accordingly, stool specimens were sent to reference laboratories for NV polymerase chain reaction (PCR) assays. A multidisciplinary ad hoc committee, which included representatives from Hospital Administration, Admitting, Infection Control and Environmental Services was formed, and met 3 to 5 times per week during the outbreak. Following a literature review, a case definition was developed. Nursing Managers faxed a list of symptomatic HCWs and patients to Infection Control daily using a standardized form. Affected HCWs were furloughed until 48 hours after their last episode of vomiting or diarrhea. Symptomatic patients were cohorted on several “affected wards” where universal glove and gown precautions were used. A cardiology ward with the greatest number of cases was closed to admissions, and later vacated and cleaned thoroughly. A 1:10 bleach solution was used to disinfect rooms of affected patients, communal bathrooms and kitchen areas. RESULTS: The outbreak lasted approximately 6 weeks and affected 165 health care workers and 124 patients. Of the 30 stool specimens tested, 3 were positive for NV. Twelve elective cardiac procedures were cancelled or delayed when the cardiology ward was closed. Problems encountered included: long turn-around times to obtain NV PCR results, difficulties in communicating rapidly changing information to HCWs, lack of sufficient telemetry beds during closure of the cardiology ward, food service workers who reported for work despite having diarrhea, and complaints by some HCWs regarding the strong odor of bleach. LESSONS LEARNED: Frequent meetings of the ad hoc multidisciplinary committee, close attention to hand hygiene, isolation precautions, cleaning procedures, closure of a ward with ongoing transmission, and daily active surveillance for signs and symptoms of viral gastroenteritis were important measures in containing the outbreak.