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Hand Hygiene / Infection Control / Disinfection / Infection Control
February 2013 Cover Story

Combating A Norovirus Outbreak

More advantageous than just helping control an epidemic, regimented hygiene can help in keeping norovirus out of your facilities and away from your staffs and building occupants.

February 04, 2013
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Norovirus is a highly contagious strain of microorganisms that cause inflammation of the stomach and large intestine, otherwise known as acute gastroenteritis.

The leading cause of gastroenteritis in the U.S., norovirus was originally called the Norwalk virus after the town of Norwalk, Ohio, the location of the first confirmed outbreak in 1972.

According to Jeff Anderson, Ph.D., public health and sanitation science manager for Procter & Gamble Professional, institutional settings are the most common types of facilities associated with outbreaks because they are generally occupied my large numbers of people.

Combat norovirus with proper hygiene and sanitation“Given their nature, institutional settings simply have more opportunities for the virus to enter the facility on infected individuals, food and water, which can then be transmitted to high numbers of individuals via food, contaminated surfaces, contaminated water and through person-to-person interaction.”

Symptoms, which include stomach pain, nausea, diarrhea and vomiting, are best avoided by proper and frequent handwashing and by adhering to general cleanliness and hygiene guidelines, as there are no specific medicinal treatments to cure norovirus.

Nick Pangaro, operations manager for KBM Facility Solutions, asserts, “You don’t have to stand in a restroom for long to see how many people don’t wash their hands; proper handwashing is one of the most effective lines of defense against norovirus and, unfortunately, many people don’t do it.”

But, it is wholly impractical for one to wash and/or sanitize his or her hands after every surface they touch — we would be a population of perpetual handwashers with no time to do anything else.

According to Kim LaFreniere, Ph.D., associate research fellow for Clorox Professional Products Company, norovirus outbreaks are difficult to contain and eliminate because of the highly contagious nature of the virus.

“It takes as few as 18 virus particles to cause an infection and, once infected, a person is capable of quickly infecting many others,” notes LaFreniere.

Therefore, the only solution is regimentation through proper, frequent cleaning and disinfection, with particular attention paid to high-touch surfaces.

“Not just any disinfectant will deactivate novovirus,” stresses Anderson. “Because they can be a challenging organism to deactivate, only disinfectants approved by the U.S. Environmental Protection Agency (EPA) that are registered for norovirus should be used to disinfect surfaces and help prevent and eradicate outbreaks.”

Stick To A Plan

If your department or company already adheres to established infection control guidelines — you use a disinfectant with a noted kill claim for norovirus and allow for the allotted dwell time, sufficient personal protective equipment (PPE) is utilized by applicable personnel, staffs are continuously trained and educated on emerging pathogens and best practices, etc. — then managing a norovirus outbreak in your indoor environment may require little to no changes in protocol.

“Facilities managers need to make sure their buildings are cleaned for health and not just for appearance,” offers Pangaro. “More businesses are opting for appearance-based cleaning, which basically just ensures the building looks good and cleaning occurs where the dirt is visible instead of where the germs and bacteria are present.”

However, if you are waiting and addressing germs, bacteria and viruses after they breach your guard and negatively affect the wellbeing of building occupants and staffs, it would be wise to create some guiding principles.

As Steven Powers, product specialist for Genesan LLC, points out, simple measures beyond proper hand hygiene that can be taken to conquer a norovirus outbreak include cleaning and disinfecting contaminated surfaces with either a bleach-based cleaner or a hospital-grade disinfectant that has a norovirus efficacy claim.

Combat norovirus with proper hygiene and sanitationPowers adds, “Once infected, people should minimize contact with others for three days after recovering.”

Although the practice of quarantining infected populations is often employed as a way to reduce the spread of norovirus and allow custodial professionals to thoroughly disinfect surfaces without hindrance, some would argue that isolation is not necessary.

“A common misconception about norovirus and the procedures necessary to eradicate an outbreak is that sick people need to be isolated from the general population,” says Darrel Hicks, director of environmental services for St. Luke’s Hospital and the author of Infection Prevention for Dummies.

Hicks cautions that norovirus can strike any building, facility or institution where cleaning staffs are not properly equipped or trained on proper cleaning and disinfection procedures — regardless if sick individuals are present or not.

Norovirus and other pathogenic outbreaks have become an unintended consequence of surviving the economic downturn; to remain profitable, many companies and organizations are trimming their workforces and asking more of those who remain employed.

“The cleanable square footage of hospitals, nursing homes and other healthcare facilities doesn’t get smaller when staffs are reduced,” proclaims Meaghan Brown, healthcare industry account executive for S. Freedman & Sons Inc. “Now, there just aren’t enough workers to cover an increase in cleaning frequency during high-risk periods.”

According to Pangaro, bacteria counts double every 15 minutes, so when you start making cuts to save a few dollars, it can come at a risk to building occupants.

An Evolving Bug

While norovirus outbreaks occur year round, surveillance data from the U.S. Centers for Disease Control and Prevention (CDC) shows that outbreaks occur much more frequently in winter months, which is why many have dubbed norovirus “the winter vomiting bug.”

Just like influenza and other seasonal sicknesses, instances of norovirus change from year to year based on what strains are present and whether or not people have resistance to the pathogens.

“Some of the largest outbreaks occurred from 2002 to 2006 when new strains of norovirus emerged,” communicates Captain Jaret Ames, chief of the CDC Vessel Sanitation Program.

Anderson explains, “We may experience an unusually high outbreak season when new variants emerge to which the population has not yet developed immunity.”

Experts from the World Health Organization (WHO) warn that, based on what they have seen thus far in the current norovirus season, a new strain of the bug is sickening more than double the typical number of individuals.

Combat norovirus with proper hygiene and sanitationBecause norovirus is a living, evolving organism whose eradication and prevention requires steadfast attention, it is important that building occupants and staffs receive up-to-date information and are being continuously trained on the newest procedures and utilizing the most effective products.

“Although proper handwashing is a key factor in battling the spread of norovirus, it is not the only thing that can be done,” quips Brown. “In a hospital or long-term care facility, for instance, steps need to be taken to ensure frequent cleaning and disinfecting of high-touch surfaces, proper laundering of personal clothes and bed linens and safeguarding staffs by providing sufficient PPE.”

Despite the many resources at the industry’s disposal, some are simply unaware of how a norovirus outbreak should be handled due to gross misinformation or outright ignorance.

“Green cleaners aren’t designed to kill microorganisms,” declares Pangaro. “It’s important to not get so wrapped up with green cleaning ideals that we endanger public health.”

Hicks concludes, “Combating norovirus requires staffs that are properly trained — for their safety and that of the larger population — who understand the nature of the virus and why certain products and procedures are necessary instead of just how to spray a disinfectant and wipe it off.”

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