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Norovirus Control Recommendations Cheat Sheet (DRAFT) by [deleted]

Norovirus Control Recommendations

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Key recomm­end­ations for the Control of Norovirus Outbreaks in Healthcare Settings

Patient Cohorting and Isolation Precau­tions

Place patients with norovirus gastro­ent­eritis on Contact Precau­tions for a minimum of 48 hours after the resolution of symptoms.

When sympto­matic patients cannot be accomm­odated in single occupancy rooms, efforts should be made to separate them from asympt­omatic patients. These efforts may include placing patients in multi-­occ­upancy rooms, or design­ating patient care areas or contiguous sections within a facility for patient cohorts.

Staff who have recovered from recent suspected norovirus infection associated with an outbreak may be best suited to care for sympto­matic patients until the outbreak resolves.

Consider the following precau­tions:
Minimize patient movements within a ward or unit during norovirus outbreaks
Restrict sympto­matic and recovering patients from leaving the patien­t-care area unless it is for essential care or treatment
Suspend group activities (e.g., dining events) for the duration of a norovirus outbreak.

Hand Hygiene

Actively promote adherence to hand hygiene among healthcare personnel, patients, and visitors in patient care areas affected by outbreaks of norovirus gastro­ent­eritis.
During outbreaks, use soap and water for hand hygiene after providing care or having contact with patients suspected or confirmed with norovirus gastro­ent­eritis. *For all other hand hygiene indica­tions refer to the 2002 HICPAC
Guideline for Hand Hygiene in Health­-Care Settings (http:­//w­ww.c­dc.go­v/m­mwr­/PD­F/r­r/r­r51­16.p­df).

Personal Protective Equipment (PPE)

If norovirus infection is suspected, adherence to PPE use according to Contact and Standard Precau­tions is recomm­ended for indivi­duals entering the patient care area (i.e., gowns and gloves upon entry).

Patient Transfer and Ward Closure

Consider the closure of wards to new admissions or transfers as a measure to attenuate the magnitude of a norovirus outbreak.
Consider limiting transfers to those for which the receiving facility is able to maintain Contact Precau­tions; otherwise, it may be prudent to postpone transfers until patients no longer require Contact Precau­tions. During outbreaks, medically suitable indivi­duals recovering from norovirus gastro­ent­eritis can be discharged to their place of residence.


In the absence of clinical laboratory diagno­stics or in the case of delay in obtaining laboratory results, use Kaplan’s clinical and epidem­iologic criteria to identify a norovirus gastro­ent­eritis outbreak.

Kaplan’s Criteria:
1. Vomiting in more than half of sympto­matic cases, and
2. Mean (or median) incubation period of 24 to 48 hours, and
3. Mean (or median) duration of illness of 12 to 60 hours, and
4. No bacterial pathogen isolated from stool culture

Consider submitting stool specimens as early as possible during a suspected norovirus gastro­ent­eritis outbreak and ideally from indivi­duals during the acute phase of illness (within 2-3 days of onset).
Specimens obtained from vomitus may be submitted for laboratory identi­fic­ation of norovirus when fecal specimens are unavai­lable (consult with your lab). Testing of vomitus as compared to fecal specimens may be less sensitive due to lower detectable viral concen­tra­tions.
Routine collecting and processing of enviro­nmental swabs during a norovirus outbreak is not required.

Enviro­nmental Cleaning

Perform routine cleaning and disinf­ection of frequently touched enviro­nmental surfaces and equipment in isolation and cohorted areas, as well as high traffic clinical areas. Frequently touched surfaces include, but are not limited to, commodes, toilets, faucets, hand/b­edr­ailing, teleph­ones, door handles, computer equipment, and kitchen prepar­ation surfaces.
Increase the frequency of cleaning and disinf­ection of patient care areas and frequently touched surfaces during outbreaks of norovirus gastro­ent­eritis (e.g., increase ward/unit level cleaning twice daily to maintain cleanl­iness, with frequently touched surfaces cleaned and disinf­ected three times daily using EPA-ap­proved products for healthcare settings)
Clean and disinfect surfaces starting from the areas with a lower likelihood of norovirus contam­ination (e.g., tray tables, counter tops) to areas with highly contam­inated surfaces (e.g., toilets, bathroom fixtures). Change mop heads when new solutions are prepared, or after cleaning large spills of emesis or fecal material.
No additional provisions for using disposable patient service items such as utensils or dishware are suggested for patients with symptoms of norovirus infection. Silverware and dishware may undergo normal processing and cleaning using standard proced­ures.
Use Standard Precau­tions for handling soiled patien­t-s­ervice items or linens, which includes the approp­riate use of PPE.
Consider changing privacy curtains routinely and upon patient discharge or transfer.

Staff Leave and Policy

Exclude ill personnel from work for a minimum of 48 hours after the resolution of symptoms. Once personnel return to work, the importance of performing frequent hand hygiene should be reinfo­rced.
Establish protocols for staff cohorting in the event of an outbreak of norovirus. Ensure staff care for one patient cohort on their ward and do not move between patient cohorts (e.g., patient cohorts may include sympto­matic, asympt­omatic exposed, or asympt­omatic unexposed patient groups).
Exclude non-es­sential staff, students, and volunteers from working in areas experi­encing outbreaks of norovirus.

Commun­ication and Notifi­cation

Notify approp­riate local and state health depart­ments if an outbreak of norovirus gastro­ent­eritis is suspected.