Viral Gastroenteritis

Objective:

To increase awareness of viral gastroenteritis (particularly Norovirus) in care settings, and to promote effective prevention and management to protect residents, staff, and visitors.

Further information: Preventing Infection Workbook - Page 73

What is Norovirus?

• Norovirus is a highly contagious virus and the most common cause of viral gastroenteritis.
• It spreads easily in closed environments such as care homes, hospitals, and schools.
• Illness is usually self-limiting but can be more serious for older adults, very young children, and those with underlying health conditions.

Symptoms

• Sudden onset of nausea.
• Vomiting ("projectile" in many cases).
• Diarrhoea.
• Abdominal cramps.
• Low-grade fever, headache, muscle aches.

Individuals remain infectious for at least 48 hours after symptoms stop/no loose stools. In a care home setting many people are still infectious in the 72-hour period after their symptoms have stopped.

Routes of Transmission

• Person-to-person via the faecal-oral route.
• Consuming contaminated food or water.
• Contact with contaminated surfaces or objects.

Prevention and Control

• Hand hygiene: Wash with soap and water only.

Note: Hand rubs should not be used when providing care to a resident with vomiting and/or diarrhoea. When caring for these residents, hand hygiene should always be performed using non antimicrobial liquid soap and water.

• Isolation: Residents who are confirmed, suspected cases and those at high risk of acquisition and adverse outcomes from Healthcare Associated Infection, e.g., immunosuppressed have been prioritised for single room accommodation with ensuite facilities.
• Staff exclusion: Staff must not return to work until 48 hours after symptoms resolve.
• Environmental cleaning: Use chlorine-releasing agents (e.g. 1,000ppm available chlorine) to clean vomit/diarrhoea incidents and frequently touched surfaces.
• Laundry management: Wash contaminated linen immediately on the hottest cycle suitable. Handle with care to avoid aerosolisation.
• Outbreak reporting: Suspected outbreaks (defined as 2 or more residents and/or staff with similar symptoms) in care homes must be promptly reported to PHW AWARe.This is because the population being older and likely to have more underlying health conditions this puts them at greater risk of more severe illness, and the opportunities for infections to spread quickly throughout the facility due to the communal nature of the setting.

If you suspect a resident has a GI illness of infectious nature you should:

• Inform the person in charge immediately.
• Ensure transmission-based precautions are applied.
• Encourage and assist residents and those providing meaningful contact to practice good hand hygiene.
• Use the appropriate personal protective equipment (PPE) when carrying out direct care.
• Ensure timely collection of specimens for symptomatic residents which may include faecal or vomit samples.

Key Responsibilities for Care Settings

• Ensure staff are trained in outbreak recognition and reporting.
• Maintain clear cleaning and decontamination protocols.
• Have an outbreak management plan in place.
• Communicate with families and visitors during outbreaks to reduce spread.

Resources   
PTHB/PCC Gastroinfection Outbreak Checklist: GI IPC Outbreak Checklist Audit Tool (PDF, 158 KB)
Infection Prevention Control Viral Gastroenteritis Factsheet: Viral gastroenteritis Factsheet 
Norovirus Care Home Poster Norovirus-care-home-poster.pdf

References and Further Guidance Links:  
UK Health Security Agency (UKHSA) - Norovirus: guidance, data and analysis: Norovirus: guidance, data and analysis - GOV.UK 
Principles and Practice Recommendations for the Public Health Management of Gastrointestinal Pathogens 2019: Management of Gastrointestinal Infections 2019 
NHS - Norovirus (vomiting bug): Norovirus (vomiting bug) - NHS