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Dealing with the dreaded Norovirus

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The infection control team and the Royal Free Hospital on the secrets of a successful battle against the norovirus outbreak

As a trust we have had a good record of minimal ward closures during Norovirus season. So far we have only had one ward closed at any one time due to the virus. As a team we think this is due to the quick action, teamwork and engagement of ward staff in applying special measures to wards which have multiple patients with symptoms of diarrhoea and vomiting.

The call arrives… The IPC team go to the ward and discuss the issues with the ward team, checking symptoms of all patients on the ward, both by checking documentation and talking to the patients. It is not unusual at this stage to identify further symptomatic patients.

Once a detailed picture has been obtained, a meeting is held to discuss the situation and possible closure of the ward, this is done prior to confirmation by laboratory testing if the numbers of patients affected with symptoms is indicative of a viral outbreak.

These meetings continue daily throughout a ward closure, with updated minutes sent to all relevant areas and clinical leads within the trust and the Health Protection Agency.

The input from the practice educators in these situations is vital. The PEs start a saturation of education and knowledge within the area

  • daily Glo box education for all multi-disciplinary team (MDT) staff on ward,
  • daily update of all patients bowel movements on stool chart,
  • liaison with nurse in charge of the ward,
  • co-ordination of cleaning with patient environment managers (PEMs),
  • signage on ward doors to inform visitors to the ward about the situation,
  • encourage ward staff to call patients’ next of kin about ward closure,
  • placement of mobile sinks at entrance of ward to facilitate handwashing on entry and exit,
  • challenge staff and visitors and support ward staff to do this themselves,
  • information lists for staff about practical issues during a ward outbreak/closure.

Hitting the ward en masse as an infection prevention and control team gives ward staff the support to challenge visitors and staff. This practice then continues following the outbreak when the ward returns to ‘normality’ and raises the profile of good infection control practices.

Teaching of ward staff is varied, with both practical observation and by quizzes enhancing and promoting good infection prevention and control practices. All the MDT, including student nurses, are involved in the teaching, providing knowledge for current practices and future ward placements.

The practice educators are so visible on the ward that “elusive” staff are unable to hide and are more exposed to observation of clinical practices and inclusion in skill development initiatives.

The six-step handwashing technique is promoted to all staff, including consultants and junior doctors (not three steps!)

“Bare below the elbows” policy is enforced and adhered to with removal of jackets and watches, visiting medical teams are asked to change into scrub suits prior to visiting their patients, and this ensures adherence to this policy.

The infection control notice board on the ward is updated according to the nature of the outbreak on the ward with information for staff, patients and visitors.

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