Preparing for &

dealing withNorwalk Virus

Dave Phillips

EHO

Health Protection

The States of Jersey Department for

Health & Social ServicesHealth Protection

Public Health Department

Guidelines for dealing with Norwalk&

Norwalk-like viruses in Hotels and GuestHouses

January 2006

WHAT IS NORWALK?

A VIRUS-can’t be treated by antibiotics FROM GROUP CALLED SMALL ROUND

STRUCTURED VIRUSES RENAMED NOROVIRUS VIABLE IN THE ENVIRONMENT FOR 2-3

WEEKS

Picture from an electron microscope

SYMPTOMS

INCUBATION PERIOD OF 12-48 HOURS

USUALLY LASTS 12-60 HOURS

SYMPTOMS (SUDDEN ONSET) NAUSEA

PROJECTILE VOMITINGABDOMINAL CRAMPSDIARRHOEA

CHARACTERISTICS

VERY CONTAGIOUS 30 MILLION VIRAL PARTICLES

RELEASED DURING 1 VOMITING INCIDENT

100 PARTICLES CAN CAUSE ILLNESS AFFECTED PERSON CAN REMAIN

CONTAGEOUS FOR AT LEAST 48 HOURS AFTER SYMPTOMS STOP

SPREAD

CONTAINED IN VOMIT AND STOOLS OF AFFECTED PERSON

VIRUS BECOMES AIRBORNE SETTLES ON SURFACES

AND FOOD PERSON TO PERSON

SPREAD EATING CONTAMINATED

FOOD

MANAGING A NORWALK OUTBREAK

BE PREPARED – NOW!

DECIDE IN ADVANCE

- WHAT YOU ARE GOING TO DO

- HOW YOU ARE GOING TO DO IT

- WHO NEEDS TO BE INVOVED

MANAGING A NORWALK OUTBREAK

EASILY SPREAD THROUGH STAFF & GUESTS IF NOT CONTROLLED FROM OUTSET

NEW GUESTS ARRIVING WEEKLY MEANS THE OUTBREAK CAN CONTINUE OVER SEVERAL WEEKS OR LONGER

TREAT SUDDEN CASES OF VOMITING OR DIARRHOEA AS POSSIBLE CASES OF NORWALK

CONTROL OF INFECTION TEAM

ESTABLISH A “CIT” BEFORE OUTBREAKS e.g. MANAGER,DEPUTY MANAGER,

HOUSEKEEPER, HEAD CHEF ETC. DON’T FORGET NIGHT SHIFT ! CO-ORDINATE CONTROL MEASURES-GATHER INFORMATION-ARRANGE FOR FAECAL SAMPLE-NOTIFY EHO’s-ARRANGE AND MONITOR CLEANING

COMMUNICATE !

KEEP PEOPLE INFORMED –

STAFF HEALTH PROTECTION G.P.’S NEW GUESTS / EXISTING GUESTS TOUR OPERATORS

Control of Infection in Hotels

Have procedures in place now and train staff

Advise guests if you have a problem- need to stay in room while ill- observe good personal hygiene after symptoms stop

Increase cleaning of public toilets, ‘touch points’, etc, using bleach solution.

Exclusion policy for staff

Control of infection in Hotels

Implement cleaning procedures in full

- correct cleaning materials

- use boiler suits and correct protective equipment

- steam clean or launder soft furnishings

Laundry

Commercial laundries must be notified if you are sending contaminated bedding

ALL soft furnishings in contaminated rooms must be laundered or steam cleaned

If contaminated bedding etc must be securely bagged and taken straight to laundry. Commercial laundries will supply red soluble laundry bags.

Laundry

If using an in-house laundry, all contaminated items must be done after ‘usual’ items.

Clean linen should be removed from the room to prevent cross contamination.

Laundry

A hot wash followed by tumble drying is recommended.

The laundry room must be thoroughly cleaned and disinfected after washing soiled items.

Laundry staff must observe good personal hygiene at all times.

Summary

The virus is very contagious and easily spread

Prompt action is needed to control the spread

The Guidelines should be read and followed closely

Inform HP if you have cases so that help and advice can be provided

FORM AN OUTBREAK CONTROL TEAM Including key individuals e.g. General Manager, Heads of

Departments, Cleaning Supervisor

FORM AN OUTBREAK CONTROL TEAM Including key individuals e.g. General Manager, Heads of

Departments, Cleaning Supervisor

DEVELOP AN ACTION PLANPut key points in writing

DEVELOP AN ACTION PLANPut key points in writing

PROVIDE INFORMATION AND INSTRUCTION TO ALL STAFF RE: ACTION PLAN AND REPOIRTING OF SICKNESS

INCIDENTSE.g. including housekeeping staff, food handlers, coach drivers,

night staff, reception, porters

PROVIDE INFORMATION AND INSTRUCTION TO ALL STAFF RE: ACTION PLAN AND REPOIRTING OF SICKNESS

INCIDENTSE.g. including housekeeping staff, food handlers, coach drivers,

night staff, reception, porters

TRAIN RELEVANT STAFF IN CLEANING METHODSE.g. dilutions, correct use of equipment

TRAIN RELEVANT STAFF IN CLEANING METHODSE.g. dilutions, correct use of equipment

PURCHASE A SUPPLY OF NECESSARY CLEANING EQUIPMENT,

CLEANING CHEMICALS & PROTECTIVE CLOTHING

PURCHASE A SUPPLY OF NECESSARY CLEANING EQUIPMENT,

CLEANING CHEMICALS & PROTECTIVE CLOTHING

PERIODICALLY CHECK SUPPLIES OF CLEANING CHEMICALS TO ENSURE THEY

ARE PROPERLY STORED AND WITHIN DATE

PERIODICALLY CHECK SUPPLIES OF CLEANING CHEMICALS TO ENSURE THEY

ARE PROPERLY STORED AND WITHIN DATE

CONTACT SUPPORT ORGANISATIONS

GP, Health Protection Department, Visitors Clinic,

Contract Cleaners

CONTACT SUPPORT ORGANISATIONS

GP, Health Protection Department, Visitors Clinic,

Contract Cleaners

FORM A CLEANING ‘HIT SQUAD’FORM A CLEANING ‘HIT SQUAD’

FLOW CHART SHOWING ACTION PLAN BEFORE ANOUTBREAK OF VIRAL GASTROENTERITIS OCCURS

FLOW CHART SHOWING ACTION PLAN WHERE ANOUTBREAK OF VIRAL GASTROENTERITIS OCCURS

Q. Are two or more cases with symptoms of viral Gastro-enteritis linked or unaccountably exceed the expected number?

Q. Are two or more cases with symptoms of viral Gastro-enteritis linked or unaccountably exceed the expected number? Monitor situation for new cases of illness

Monitor situation for new cases of illness

CONTACT HEALTH PROTECTION DEPARTMENTCONTACT HEALTH PROTECTION DEPARTMENT

CALL TOGETHER THE OUTBREAK CONTROL TEAM

CALL TOGETHER THE OUTBREAK CONTROL TEAM

Interview Sick Persons Complete Illness Report FormInterview Sick Persons Complete Illness Report Form

Call GP for medical advice where necessary. Request samples to be taken. For subsequent

cases contact the Health Protection Department.

Call GP for medical advice where necessary. Request samples to be taken. For subsequent

cases contact the Health Protection Department.

Activate the cleaning ‘Hit Squad’Activate the cleaning ‘Hit Squad’

Inform staffInform staff

Give information re: good personal hygiene

Give information re: good personal hygiene

Keep sick staff off workKeep sick staff off work

“Persuade” sick persons to remain isolated from other guests

“Persuade” sick persons to remain isolated from other guests

Ensure necessary cleaning equipment is available and used

Ensure necessary cleaning equipment is available and used

Implement Outbreak Control Cleaning Procedures

Implement Outbreak Control Cleaning Procedures

Undertake regular checks of Public Areas and upgrade

cleaning arrangements

Undertake regular checks of Public Areas and upgrade

cleaning arrangements

IS THE OUTBREAK ONGOING?IS THE OUTBREAK ONGOING?

Keep ill staff off work until they have been symptom free for a minimum of 48 hours

Keep ill staff off work until they have been symptom free for a minimum of 48 hours

Interview staff prior to returning to work to ensure they have been symptom free for a minimum of

48 hours

Interview staff prior to returning to work to ensure they have been symptom free for a minimum of

48 hours

1.REVIEW CLEANING PROCEDURES2.PROVIDE GENERAL INFORMATION TO ALL GUESTS (EXISTING AND NEW)3.IT IS RECOMMENDED THAT YOU SPEAK TO YOUR OPERATORS AND ADVANCED BOOKINGS4.CONSIDER COMPLETE/PART CLOSURE OF PREMISES FOR FULL ENVIRONMENTAL DECONTAMINATION e.g. fogging

1.REVIEW CLEANING PROCEDURES2.PROVIDE GENERAL INFORMATION TO ALL GUESTS (EXISTING AND NEW)3.IT IS RECOMMENDED THAT YOU SPEAK TO YOUR OPERATORS AND ADVANCED BOOKINGS4.CONSIDER COMPLETE/PART CLOSURE OF PREMISES FOR FULL ENVIRONMENTAL DECONTAMINATION e.g. fogging

Remain vigilant and monitor situation

Remain vigilant and monitor situation

IF NO FURTHER CASES revert to normal operating

procedures

IF NO FURTHER CASES revert to normal operating

procedures

NO

YESNO

YES

OTHER GUIDANCE

•Dealing with Norwalk - Advice for Coach Operators•Dealing with Norwalk – advice for suppliers and industrial cleaners

FLU, AVIAN FLU & PANDEMIC FLU

SEASONAL FLU-the “usual flu that occurs every winter-vaccination for vulnerable groups

AVIAN FLU-affects birds-is not pandemic flu- is not human flu

PANDEMIC FLU-no current pandemic, though preparations always in place in case of outbreak-caused by human flu virus