Preventing spread – care of soiled articles
At home an ill person should normally use the toilet. If urinals and bedpans have to be used, the carer should wear CE marked disposable gloves and a disposable apron when attending the patient.
Bedpans and urinals should be emptied into a toilet bowl or slop-hopper. They should ideally be heat disinfected using a bedpan washer-disinfector. If not available, wash using detergent and warm water, then disinfect using a chlorine-releasing product, rinse and dry.
Avoid rough handling of soiled laundry as this may disperse the virus to nearby surfaces, providing an opportunity for spread of infection.
Soiled clothing and bed linen should be washed separately in a washing machine on the hottest cycle the material can withstand‘. If the washing machine does not have a sluice cycle, flush away heavy soiling into the toilet bowl.
After loading, clean the outer surfaces of the washing machine with detergent and hot water.
When finished, wash and dry your hands .
Use of hypochlorite bleach
A chlorine-releasing product is recommended for use against norovirus. If a bleach is used, a good quality chlorine based (hypochlorite) bleach made to a British Standard (BS 5197 or 6424) is required.
Dilution to 1000 parts per million is recommended for surface disinfection (1:100ey). Follow the manufacturer’s instructions and never mix different types of chemical as the fumes can be dangerous.
Store chemicals safely and ensure that children do not have access to these solutions.
Bleach and other chlorine-releasing agents will bleach the colour from fabrics and floor coverings and can burn the skin.
Reporting cases and accessing further information
Report suspected outbreaks to the local health protection unit as soon as possible.
Further information can be obtained from:
· Local Community Infection Prevention and Control Team
· Local Health Protection Unit
· NHS Direct
This leaflet was produced by a working group comprised of NHS South West, NHS North Somerset, NHS Somerset and Health Protection Agency South West. It was based on a leaflet developed by HPA North West, with thanks to Salford Primary Care Trust Infection Control Team
An information leaflet for health and social care staff
Norovirus is a common cause of viral gastro-enteritis. It is often known as ‘winter vomiting disease’. Although it is true that there is an increase in winter months, unfortunately, cases occur in all seasons.
Norovirus is highly infectious and easily spread within communities and particularly in establishments where people mix such as hospitals, care homes, schools, hotels, holiday resorts, and cruise ships.
Outbreaks occurring in these settings lead to disruption of services, such as ward closures and cancelled admissions. It is important to avoid introducing norovirus into these establishments if possible and taking measures to reduce the spread of infection.
The illness characteristically starts with the sudden onset of vomiting, which can be severe and projectile. Some people may develop diarrhoea.
After exposure to the virus, illness may start between 12 and 48 hours later. Norovirus is not caught from animals. In general the symptoms last for about 24 – 48 hours, after which the person may feel lethargic or washed-out for another day or so.
There are no long-term effects of norovirus infection and antibiotic treatment has no effect on norovirus and should be avoided. Most people will make a full recovery within 48 hours.
The frail, elderly and very young can become dehydrated, so people with symptoms of norovirus should drink plenty of fluids.
Norovirus is highly infectious and may be caught by:
· Contact with an infected person, especially their vomit or diarrhoea, including being close to a person while they are vomiting. Hand washing is essential in preventing spread.
· Contact with surfaces that have been contaminated by the virus, e.g. around the toilet or near where someone has vomited, or touched by contaminated hands. Norovirus can survive for several days on surfaces, so cleaning and disinfection is essential.
· Eating food, such as fruit and salads, which has been touched by someone with symptoms.
· Eating food high risk foods, such as oysters.
Preventing spread – segregation of cases
People with symptoms of norovirus should stay at home and not go to work, school or pre-school until they have been completely free from symptoms for at least 48 hours (this includes nausea).
Ideally cases of norovirus should be nursed at home, and admission to hospital, or visits to the GP or A&E avoided where possible. Where this is unavoidable, telephone ahead so that the staff can make arrangements to isolate the patient.
In communities such as care homes and boarding schools people with symptoms should be nursed in a single room or isolation until they have been symptom free for at least 48 hours. During outbreaks care homes may need to be closed to admissions and transfers until the outbreak is over.
Preventing spread – hand washing
Good hand washing is essential to control the spread of norovirus:
o preparing or serving food
o eating meals
o leaving the house
o going to the toilet
o dealing with sick people
o handling contaminated clothes or bedding
o contact with “sick room” equipment
o changing nappies
o preparing food
o cleaning up / doing housework
Use liquid soap and water to wash all surfaces of the hands, rinse under running water and dry thoroughly. Alcohol hand gel is not effective against norovirus.
People with symptoms should use separate towels and ideally have their own toilet until they have fully recovered.
Preventing spread – food handling
People with symptoms of norovirus should notprepare or handle food for others until they have been completely free of symptoms for at least 48 hours (this includes nausea).
If someone vomits in a food handling area, the area must be thoroughly cleaned with detergent and hot water and then sanitised using a hypochlorite (or bleach) solution (1000ppm) or a combined detergent / hypochlorite product.
Edible items, such as fruit or salads, in the proximity of a person while vomiting should be thrown away as a precaution.
Preventing spread – toilets and hand wash basins
When outbreaks are suspected in an establishment the frequency of cleaning toilets, hand wash basins and bathrooms should be increased to at least twice a day and after use by an affected person. See the cleaning and disinfection section.
Use disposable cloths and pay particular attention to:
· Toilets, including seats and flush handles
· Door handles and contact plates
· Wash hand basins, including the taps
· Low level horizontal surfaces
· Light switches
Preventing spread – cleaning and disinfection
Norovirus is highly infectious, so care is needed when handling diarrhoea or vomit and when undertaking the following cleaning and disinfecting procedures:
· Ventilate the area thoroughly by opening windows
· Wear disposable gloves and apron
· Keep the area of contamination as small as possible. Cover spills of vomit/diarrhoea with paper towels or kitchen tissue. This may be flushed down the toilet
· Waste may be wrapped in a plastic bag and discarded
· Wash the area thoroughly withdetergent and water. Then disinfect the surface using by a hypochlorite bleach solution (1000ppm) or a combined detergent / hypochlorite product
· Rinse the area with clean water and allow it to dry
· Ensure that horizontal surfaces up to two metres of the visually contaminated area is cleaned and disinfected because the virus can land several metres away
· For hard surfaces, like baths and door handles, a bathroom cleanser should be used
· Contaminated carpets may be cleaned using a proprietary carpet shampoo or steam cleaner, if available. In the absence of this type of equipment a thorough cleaning with hot water and detergent will suffice. Always rinse with clean water and allow the carpet to dry before using the area again
· After cleaning, place disposable plastic aprons and gloves in a refuse bin. Wash any equipment used in detergent and hot water and allow them to dry
· Regular cleaning of toilet seats, flush handles, wash-hand basin taps, surfaces and toilet door handles will help stop the spread of infection and it is best to use hot water and detergent
· After removing gloves and apron, wash and dry hands using soap and water