Since the start of 2012, the S.C. Department of Health and Environmental Control has investigated more than twice the usual number of reported outbreaks thought to be associated with Norovirus, the agency announced February 24.

“These illnesses have occurred in a wide variety of institutional settings including schools, nursing homes and assisted living facilities,” said Jerry Gibson, M.D., state epidemiologist and director of DHEC’s Bureau of Disease Control. “Most of the illnesses have been caused by Norovirus, and this significant increase is similar to what we’re hearing is happening in other states.”

Dr. Gibson said symptoms of Norovirus include nausea, vomiting, diarrhea and stomach cramping. Sometimes symptoms can include a low-grade fever, chills, headache, muscle aches and a general sense of tiredness. Most people show symptoms within 48 hours of exposure to Norovirus, with the illness typically lasting one to two days.

“Norovirus is very infectious and easily spreads from person to person. Those who have the virus can continue to spread it to others up to two weeks after their recovery,” Dr. Gibson said. “Frequent hand washing with soap and warm water is the most effective way to stop transmission of illness from person to person. Commonly handled surfaces such as bathroom sink hardware, doorknobs and handrails can become contaminated by the unwashed hands of an ill person and further spread the illness. However, effective cleaning and control measures can easily stop the transmission of disease. Cleaning guidelines follow this article.

“In long term care facilities, we recommend a proactive approach and advise that all visitors wash their hands with soap and water when they go visit a loved one,” Dr. Gibson said. “We also encourage management to be vigilant and exclude any staff member who shows symptoms of Norovirus.”

According to Dr. Gibson, anyone experiencing diarrhea or vomiting is encouraged to stay home from work or school and wash their hands often to reduce the spread of disease.

“The great majority of people get over this in 48 hours with no doctor visits,” Dr. Gibson said. “Occasionally persons have severe illness requiring a medical visit and treatment for severe dehydration. This is more likely in the very young and the very old. The public can let us know about outbreaks by calling their local DHEC public health department.”

More information about Norovirus is available on DHEC’s website at: http://www.scdhec.gov/norovirus.

CLEANING GUIDELINES DURING OUTBREAKS OF NOROVIRUS/
GASTROENTERITIS: RECOMMENDATIONS AND PRECAUTIONS
• Encourage frequent hand washing with soap and warm water among all persons in facility.
• Provide and encourage use of alcohol based (62%) waterless hand sanitizers when entering facility. Alcohol hand sanitizer should not replace hand washing but can be used as an additional precaution.
• Do not allow symptomatic staff to work in facility.
• Assure glove use for handling of all ready-to-eat foods and eating utensils.
• Increase frequency of cleaning commonly touched surfaces.
• Use disposable cleaning cloths; use a new cloth for each room/area cleaned.
• Dispose of vacuum cleaner bags between uses. Note: if area is visibly soiled with fecal spillage or
vomit do not vacuum—either steam clean or use hot water and detergent.
• Do not enter food service area with items soiled with vomit or fecal spillage.
The following cleaning agents are recommended for use during an outbreak:
-Suggested Use: Porous surfaces such as wood floors or surfaces visibly soiled with vomit/feces; Suggested Cleaning Method: Chlorine bleach*; How to Make (1 cup = 240ml): 1 ½ cup bleach in 1 gallon water; Strength (parts per million): 5000ppm (1:10 dilution)
-Suggested Use: Non-porous surfaces such as: handrails, tile floors, counter-tops, sinks, toilets, doorknobs and other commonly handled items. See facility specific section for suggested items.; Suggested Cleaning Method: Chlorine bleach*; How to Make (1 cup = 240ml): 1/3 cup bleach in 1 gallon water; Strength (parts per million): 1000ppm (1:50 dilution)
-Suggested Use: Food/mouth contact items, stainless steel and toys mouthed by children; Suggested Cleaning Method: Chlorine bleach* then rinsed with water OR dishwasher at 170°F; How to Make (1 cup = 240ml):1 Tbsp. bleach in 1 gallon water; Strength (parts per million): 200ppm (1:250 dilution)
-Suggested Use: Carpet & upholstered fabrics visibly soiled with vomit or fecal spillage. Do not dry vacuum as viruses can become airborne; Suggested Cleaning Method: Hot water and detergent OR Steam clean.
*Bleach solution must: contain 5.25% Sodium Hypochlorite; be prepared fresh daily; have 10-20 minute surface contact time. Use unopened bleach for outbreak-related sanitization (open bottles lose effect after 30 days). EPA-registered disinfectants may also be used although effectiveness in outbreaks has not been evaluated.
Warnings:
1. Staff should wear protective items such as masks and heavy-duty gloves when handling chemicals.
2. Ventilate areas being sanitized appropriately when chemicals are in use.
3. Avoid spray bottle application of any chemical solution to reduce respiratory irritation caused by
aerosols—using a “pour” or “pump” bottle that does not produce aerosols is highly recommended.
4. Food preparation/food contact areas must be washed, rinsed and sanitized using standard protocol after cleaning with the stronger bleach solutions listed above.
Additional Recommendations for Healthcare/Assisted Living Facilities:
• Reinforce proper glove use when giving patient/resident care. Remove gloves before leaving ill patient’s/resident’s room and wash hands immediately.
• Do not “float” staff between units with ill patients/residents and units with non-ill patients/ residents.
• Assign staff members to care for only ill group or only non-ill group to help prevent transmission.
• Exclude non-essential personnel from units with ill patients/residents.
• Discontinue new admissions to the facility until the outbreak has ended.
• Confine ill patients/residents to their rooms until 72 hours after their symptoms end.
• Do not allow patients/residents from outbreak-affected units to enter/transfer to unaffected units, unless medically urgent to do so, until end of outbreak.
• Discontinue group activities (communal dining, etc.) until outbreak has ended.
• Limit visitation until outbreak has ended.
• Store and launder contaminated soiled linens separately from non-contaminated soiled linens.

Facility-specific List of Suggested Items to Sanitize with 1000ppm bleach solution
(1/3 cup bleach in 1 gallon water)
This is a list of suggested items to sanitize in order to reduce the number of illnesses during a gastroenteritis outbreak. This list is not exhaustive and your facility may have additional items in need of sanitation.
General:
• Doorknobs, water fountains, bathroom stall and sink hardware, paper towel dispenser, soap dispenser, handrails, countertops, light switches, and other common items shared among staff/patrons.
Restaurants/Food Service:
• Doorknobs, water fountains, bathroom stall and sink hardware, paper towel dispenser, soap dispenser, handrails, countertops, light switches, common telephones, menus, table placards, folders for credit cards, trays, tray stands, baskets, salt & pepper shakers, table bottle of ketchup and other condiments, sugar packet dispensers, booths, tables, exposed parts of buffet line, sneeze guards, and other common items shared among staff/patrons.
Healthcare Facilities:
• Doorknobs, water fountains, bathroom stall and sink hardware, paper towel dispenser, soap dispenser, handrails, bedrails, countertops, common telephones, cards/games in common room, common craft materials, TV remote controls, computer keyboards, drawer/cabinet pulls, light/lamp switches, recliner chair handles, dining hall tables and chairs, dining hall salt/pepper shakers, walkers, wheelchair handles, any physical therapy shared items, and other common items shared among staff/patients/residents.
Schools/Childcare Facilities:
• Doorknobs, water fountains, bathroom stall and sink hardware, paper towel dispenser, soap dispenser, handrails, countertops, light switches, common telephones, shared games/books/toys, playground equipment, diaper changing table, diaper changing pad, locker hardware, shared classroom equipment (microscopes, musical instruments, computer keyboards), physical education shared equipment, cafeteria tables and chairs, cafeteria salt/pepper shakers, and other common items shared among staff/students.
• Cloth items unable to withstand bleach sanitization (plush toys, pillows, etc.) should be laundered in hot water or discarded if laundering/sanitization not possible.
CONTACT THE LOCAL HEALTH DEPARTMENT IF YOU SUSPECT AN OUTBREAK IN YOUR FACILITY.