Health Advisory
GASTROINTESTINAL ILLNESS AMONG RESIDENTS OF LONG TERM CARE FACILITIES

Background

Delaware Division of Public Health (DPH) would like to alert the medical community about an increase in gastrointestinal illnesses noted in long term care facilities in Delaware. Gastrointestinal illness usually increases during the winter months. Investigation has determined that the length of illness has been relatively short at (24-48 hours) and involves nausea, vomiting and diarrhea which could indicate a viral pathogen. DPH has received reports from three facilities. These reports are being investigated and infection control recommendations have been provided to each facility.

Laboratory Findings

Norovirus has been detected from specimens submitted to the DPH Laboratory from two of the three facilities involved. Norovirus is transmitted by the fecal-oral route. Airborne transmission by fomites has been suggested to explain the rapid spread in hospital settings. Community outbreaks have been caused by food and water vehicles. The incubation period is 24-48 hours. Patients are communicable during the acute stage of illness and up to 48 hours after diarrhea stops.

DPH Recommended Infection Control Measures

• Increased handwashing and use of alcohol based sanitizers among patients, staff and visitors
• Strict enteric precautions
• Increased terminal cleaning throughout the facility
• Consider cancelling group activities and communal dining
• Restrict residents to units – if possible cohort ill residents
• Meal service utilizing disposable products – residents to eat in rooms
• Consider cancelling visitation (except for special circumstances)
• Increase surveillance for ill patient care givers and/or food service workers and have a low threshold for excluding ill employees
• Collect stools for testing
• Maintain measures until 2 full incubations periods have passed without any new cases

Laboratory Testing

DPH Laboratory (DPHL) has the capability to test for Norovirus and other viral pathogens. Arrangements for laboratory testing must be made through DPH Epidemiology.

For Further Information

Contact DPH, Epidemiology office at 302-744-4541 or 1-888-295-5156 to report possible clusters, to arrange for laboratory testing, and questions.