Many people, even healthcare professionals do not fully realize how long norovirus (gastroenteritis) survive on surfaces of items (e.g. kidney trays), and how difficult it is to remove / kill off these bacteria once they are settled or reproducing on a surface. This leads to a lack of use of disposable, clean medical supplies products in various generic product groups like carrying trays, hygiene wash products and hand/skin/clothing shielding apparel – in fact many Western hospitals are today very rarely or never using disposable, infection prevention products in relation to major risk areas like vomiting, faecal waste and urine handling.

As a medical devices and supplies company Curas reminds end-users, patients and other healthcare professionals that Norovirus outbreaks in institutional settings such as hospitals and nursing homes cause severe illnesses and frequently result in deaths where patients have severe underlying illnesses.

Norovirus 2001-2007, data from Germany.

The objective of health management of norovirus outbreaks is to physically interrupt any transmission and thus prevent further cases. In outbreaks that are spread from person-to-person, urgent infection prevention management will be needed to institute immediate infection control measures. Hospitals are sometimes with access to PPE products (e.g. Aprons), whereas other settings e.g. Nursing Homes and Home Healthcare may not have access and policies. Curas are promoting that Hospitals should increase the PPE products’ usage because there are still significant room for improvement of infection prevention, and ensures that the core product quality of e.g. an Apron is appropriate to offer an active shield to HAIs like Norovirus.

Transmission of norovirus (person-to-person) by the faecal-oral route and by contact with contaminated environmental surfaces (e.g. re-usable kidney dishes, vomit bowls etc.). Cross-contamination by contaminated (by touching e.g. re-usable bed pan) hands or ungloved hands can assist in further propagating norovirus in outbreak situations. Studies have shown that fingers contaminated with norovirus could sequentially transfer virus to up to seven (7) clean surfaces as well as from contaminated cleaning cloths (e.g. wash mittens) to clean hands and surfaces (e.g. re-usable urine bottles). Precautions and practices required in basic level infection prevention include:

• hand hygiene and cough etiquette (use lower arm, not hand)
• the use of personal protective equipment (wear gloves, visitor gowns, aprons etc.)
• routine environmental and patient cleaning (disposable wash gloves, wipes etc.)
• incorporation of safe practices for handling blood, body fluids and secretions as well as excretions (SAP by Curas™ Fluid Absorber).

In addition to standard precautions for outbreak management, Curas recommends that additional contact, droplet and air-borne precautions are urgently adopted to minimize the dissemination of the infectious agent to other people, staff, visitors or sub-contractors. The air-borne risks is a major reason for using disposable trays, bowls, dishes pans and urinals and the attached Norovirus Priority Product file offers additional guidance.

Hands & Body Hygiene:
Soap & water should be used wherever possible when washing hands, face, body or incontinence-related body areas during outbreaks. Alcohol disinfectants for use with hands (without water, e.g. 70–80% alcohol-based) can be used to decontaminate hands - only when hand washing facilities are not available. However, instant hand sanitizers do not replace the importance of hand/body washing with soap and water during outbreaks. But note also that alcohol preparations are not useful if hands are visibly contaminated with body fluids, faeces or vomit. Because norovirus cannot be cultured, the efficacy of alcohol-based preparations against this virus is difficult to determine but studies have shown that alcohol-based hand sanitizers containing 60-80% alcohol can reduce the infectivity titres of three non-enveloped viruses (rotavirus, adenovirus and rhinovirus) by 3 to 4 logs.

Noro viruses are highly infectious and a small number of particles in solid or aerosolized form of vomit can cause infection, and supports the default healthcare facility’s policy of disposable-medical-supplies-only when attending a vomiting person, or cleaning patients, areas or surfaces that are visibly contaminated by either vomit or faeces, hence disposable staff gowns, impermeable, PE aprons etc. from Curas should be worn each time there is a potential for splashing, splattering or spraying of vomit or faeces in relation to the nursing duties.

Finally in cases of vomitus contamination on linen that is to be washed / decontaminated it is the recommendation by Curas that the facility uses only dissolvable laundry bags in order to ensure that no further contamination is passed on along the supply chain.

Additional resources can be found when visiting this website http://www.cdc.gov/hicpac/pdf/norovirus/Norovirus-Guideline-2011.pdf

Norovirus ‘vomit bug’ also known as the “winter bug problem” (http://www.icjournal.org/)

Curas recommends the following list of medical products for an clinical and cost effective Infection Prevention facility: