Viral Gastroenteritis:Prevention and Control in Long-

Term Care Facilities

Daniel Golson, MPHEpidemiologistdaniel.golson@nashville.gov615-340-5651

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