Confined to quarters – preventing gastro in residential care

Preventing the spread of gastroenteritis can be difficult in aged care facilities. People live close to each other, there are numerous visitors, and staff move from resident to resident providing personal care.
Auckland Regional Public Health Service medical officer Dr Jay Harrower said the service had 635 cases of gastro reported in 34 long term care facilities in 2018.

“It is pretty hard to prevent a gastro outbreak, but some facilities do manage them better and stop the spread. Rest homes or private hospitals that get on top of an outbreak early do the best. They recognise a person with vomiting or diarrhoea (called a case) as potentially contagious, isolate the person, and implement infection control practices quickly.

“There have also been occasions when an outbreak has spread in an aged care facility because they haven’t used the right cleaning products. This is not a time for fragrant detergents, but for hypochlorite at the right strength, and used frequently,” Dr Harrower said.

Gastroenteritis is usually caused by viral infections like norovirus, with food poisoning from bacteria less common than most people think.
This virus is transmitted through faeces and vomit, surviving on surfaces even after cleaning with some disinfectants. People with norovirus are infectious for at least three days after the symptoms stop, sometimes up to two weeks.
Norovirus can be spread in many ways:

  • Consuming contaminated food or drinks .
  • Touching contaminated surfaces or objects and then putting your fingers in your mouth.
  • Having direct contact with an infected person (eg, by sharing food or eating from the same plate or cutlery).
  • Through the air (when vomiting sends tiny particles into the air).
  • The most important key to prevention is hand hygiene, and this is also key to stopping the spread of the virus as well, especially for staff.

So when is it called an outbreak, and when to call public health? An outbreak is when there are two or more cases with symptoms of diarrhoea and/or vomiting with one other symptom in a specific unit or floor within a two day period, or two or more units/floors having a case of diarrhoea and/or vomiting within 48 hours.

“You then call Public Health and notify an outbreak, and we’ll provide advice,” said Dr Harrower. As well as sending off sick residents’ stool samples for testing, a facility should implement strict infection control procedures.

This means:

  • Reinforce meticulous hand hygiene – and not with hand sanitisers
  • Environmental decontamination with 1 % hypochlorite solution.
  • Exclude ill staff until symptom free for 48 hours, and health care assistants shouldn’t prepare food.
  • Isolate residents in their room until symptom free 48 hours.
  • Restrict the movement of staff and residents and don’t transfer a well resident into an area with unwell people.
  • Restrict visitors.

“It really helps to keep really good records in an outbreak, by keeping a case log to track test results from stool samples, infectious periods and how the disease is spreading,” Dr Harrower said.

Apart from hand hygiene, daily cleaning with 1 percent hypochlorite solution is important, but this should happen more often in bathrooms and toilets in affected areas (and a stronger hypochlorite solution can be used).

Telling staff, family members, and contractors about the outbreak also helps to control the spread. Put a sign on the door alerting visitors to the outbreak. It can also mean talking to Public Health about a response for media, in the event of escalating numbers.

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