Transcript Viral Gastroenteritis: Prevention and Control in Long

Viral Gastroenteritis:
Prevention and Control in LongTerm Care Facilities
Daniel Golson, MPH
Epidemiologist
[email protected]
615-340-5651
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
Viral Gastroenteritis Outbreaks in Davidson County
• 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
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
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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
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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
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Over 175 illnesses in total
At least 8 hospitalizations, many ED visits
No fatalities
Attack rates among residents ranged from
16% to 73%
12
/2
12 7 /2
/2 00
12 8 /2 9
/2 00
12 9 /2 9
/3 009
12 0 /2
/3 00
1/ 9
2
1/ 00
1/ 9
2
1/ 01
2/ 0
2
1/ 01
3/ 0
2
1/ 01
4/ 0
2
1/ 01
5/ 0
2
1/ 01
6/ 0
2
1/ 01
7/ 0
2
1/ 01
8/ 0
2
1/ 01
9 0
1/ /20
10 1 0
1/ /20
11 10
1/ /20
12 10
1/ /20
13 10
/2
01
0
Number ill
Propagated Outbreak in 3 phases?
Norovirus G2 Outbreak at Assisted Living Facility TN 09-54
10
9
8
7
6
5
Staff
4
Residents
3
2
1
0
Onset
Questions?
www.health.nashville.gov/healthdata