By Cindy Johnson RN/Infection Preventionist
Sierra Vista Hospital
Truth or Consequences and Sierra County are continuing to experience an outbreak of a severe intestinal virus known as Norovirus. This is a highly virulent intestinal virus. Noroviruses are highly contagious, and although the illness is generally short-lived and self-limiting, hospitalizations and deaths have occurred in other communities, especially among long-term care facility residents.
As a community, we need to become more aware of its presence and work together to stop its transmission.
Norovirus has an incubation period of 12 to 72 hours, usually 24-48 hours. It is characterized by acute onset of severe vomiting, watery, non-bloody diarrhea with abdominal cramps, and nausea. It is not your usual simple stomach virus. With Norovirus, you will have a very sudden onset, and multiple episodes (as many as 20 or more times per day). Myalgia (muscle pain), malaise (tiredness), and headache are also commonly reported. Low-grade fever is present in about half of cases. The vomiting and/or diarrhea usually last 24 to 60 hours (one to three days), but can last up to two weeks. Individuals are considered contagious up to 72 hours after their last episode of diarrhea.
Dehydration is the most common complication. It is extremely important to push lots of fluids, even though you may continue to be vomiting. Frequent episodes of vomiting and diarrhea can sometimes lead to dehydration in a short period of time. Most healthy individuals recover easily. However, the elderly, infants and young children, and those with chronic health problems are at high risk of developing dehydration or a severe electrolyte imbalance. If you become lethargic (extremely weak and sleepy), you may be dehydrated. If you experience painful muscle cramps or heart palpitations, you may have a severe electrolyte imbalance. Those most at risk of this are the elderly and very young children. Either of these symptoms would indicate a need to go to the Emergency Department.
People can become infected with the virus through:
•Direct contact with the feces of a person who is infected and showing symptoms (e.g., while caring for someone who is sick)
•Eating food, drinking liquids or using utensils contaminated with norovirus
•Touching surfaces or objects contaminated with norovirus, and then touching the face/mouth/mucous membranes
•Ingestion of airborne aerosolized virus particles that may occur with vomiting.
Persons at increased risk of spreading the disease include:
•Persons providing direct patient care in healthcare facilities
•Residents and visitors of healthcare facilities
•Children and staff in daycare centers and schools
•Other closed populations (e.g., cruise ship staff and passengers)
If you get sick, stay home. It is not necessary to see a physician unless you have symptoms of dehydration. Stay home. Do not contribute to spreading the virus to others. Push lots of fluids. If you are able to eat, use the BRAT diet – bananas, rice, applesauce and dry toast. Sanitize your home with a bleach/water solution. Be sure to wipe all frequently touched surfaces – doorknobs, faucets, telephones, stove and refrigerator handles, and light switches.
Practice proper hand hygiene. Conduct frequent and appropriate hand washing. Do not rely on hand sanitizers. While they are great for many bacteria and virus, they do not work against this virus. Wash your hands carefully with soap and water, especially after using the toilet, changing diapers, and always before eating or preparing food.
Clean and disinfect. Environmental surfaces that may be contaminated by norovirus should be disinfected using a chlorine bleach solution with a concentration of 25 tablespoons of household bleach [5.25 percent] per gallon of water. Most commercial cleaners do not kill this virus. For a list of ones that will, go to the CDC website shown below.
Do not prepare food while infected. People with norovirus illness, particularly food handlers (working in restaurants, facilities, catering businesses or any venue that provides food to the public) and healthcare providers, should not prepare food for others while they have symptoms and for 72 hours after recovering from their illness.
Wash laundry thoroughly. Immediately remove and wash clothing or linens that may be contaminated with stool or vomitus. Handle soiled items carefully – without agitating them – to avoid spreading the virus. If available, wear rubber or disposable gloves while handling soiled clothing or linens and wash your hands after handling. The items should be washed with detergent at the maximum available cycle length and then machine dried.
If you are a healthcare provider, work in a daycare facility or school, or work in any type of food preparation, and have symptoms of norovirus, stay home. People with norovirus should not return to work until 72 hours after their last episode of diarrhea and vomiting.
For more information about norovirus, visit the CDC online at: http://www.cdc.gov/Features/Norovirus, or contact your primary care physician.
Any facility or business who wishes more information may contact Cindy Johnson, Infection Preventionist at Sierra Vista Hospital, at (575) 894-2111 Ext. 331. I will gladly send you detailed information on preventing the spread of Norovirus. Just leave me your name, who you are with, and a fax number or e-mail address.