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Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings, 2011

GRADE Table Q3 What Patient Interventions Best Prevent Or Contain Norovirus Outbreaks In The Healthcare Setting?

Components of an Outbreak Prevention/Containment Program

Hand hygiene

Comparison Outcome Quantity and type of evidence Findings Starting grade Decrease GRADE Increase GRADE GRADE of Evidence for Outcome Overall GRADE of Evidence Base
S
t
u
d
y
 
Q
u
a
l
i
t
y
**
C
o
n
s
i
s
t
e
n
c
y
**
D
i
r
e
c
t
n
e
s
s
**
P
r
e
c
i
s
i
o
n
**
P
u
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l
i
c
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t
i
o
n
 
B
i
a
s
**
L
a
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g
e
 
M
a
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n
i
t
u
d
e
**
D
o
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e
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r
e
s
p
o
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C
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s

Soap and water

Symptomatic norovirus infection*

1 OBS 66
18 DES 63, 79, 85, 89, 102, 103, 165, 166, 168-171, 174-177, 183, 205

 

Handwashing was not associated with a significantly decreased risk in 1 OBS 66

Emphazised as an intervention in 17 DES 63, 79, 85, 89, 102, 103, 165, 166, 168-171, 174-177, 183, 205.

Involved wetting hands, using liquid soap, scrubbing 15 seconds, rinsing with water, and drying hands with a disposable paper towel in 1 DES in the healthcare setting 174.

Guests were encouraged to wash hands after using the bathroom and prior to each meal in 1 DES at a mother and child health clinic 63.

Hygiene measures were implemented without waiting for virological confirmation in 1 DES in the healthcare setting 175

Low

0

0

0

−1

0

0

0

0

Very Low

Very Low

Alcohol-based hand sanitizers

Symptomatic norovirus infection*

4 DES 87, 169, 171, 205

Mandatory hand disinfection with a product that has 95% ethanol in 2 DES in the healthcare setting  169, 171

70% alcohol handrub supplemented by routine handwashing in 1 DES 87

Alcohol based handrubs were available by every bedside in 1 DES in the healthcare setting 205

Very Low

0

0

0

0

0

0

0

0

Very Low

Very Low

Inactivation of FCV

4 BAS 189, 191, 193, 196

Ethanol was found to be superior to propanol as a handwashing agent in 2 BAS 193, 196

A new disinfectant with reduced ethanol content was more efficacious that ethanol and propranolol in 1 BAS 189

High

0

0

−1

0

0

0

0

0

Moderate

Artificial nails

Inactivation of FCV

1 BAS 197

1 BAS concluded that food handlers should refrain from using artificial fingernails, keep fingernails short, and scrub with soap and nailbrush when washing hands 197

Low

0

0

−1

0

0

0

0

0

Very Low

-

PPE

Comparison Outcome Quantity and type of evidence Findings Starting grade Decrease GRADE Increase GRADE GRADE of Evidence for Outcome Overall GRADE of Evidence Base
S
t
u
d
y
 
Q
u
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l
i
t
y
**
C
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s
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t
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n
c
y
**
D
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t
n
e
s
s
**
P
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c
i
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o
n
**
P
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B
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**
L
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M
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n
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t
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**
D
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-
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p
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s
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C
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f
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d
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s

PPE

Symptomatic norovirus infection*

1 OBS 66
13 DES 167-172, 176-179, 181, 183, 205

Wearing gowns was not associated with a significantly decreased risk among nursing staff in 1 OBS 66

Protective apparel like masks, gloves, gowns for staff especially when in contact with symptomatic patients were emphazised as an intervention in 13 DES 167-172, 176-179, 181, 183, 205

Protective apparel were recommended for both staff and visitors in 2 DES 169, 179

Low

0

0

0

−1

0

0

0

0

Very Low

Very Low

Leave policies for staff

Comparison Outcome Quantity and type of evidence Findings Starting grade Decrease GRADE Increase GRADE GRADE of Evidence for Outcome Overall GRADE of Evidence Base
S
t
u
d
y
 
Q
u
a
l
i
t
y
**
C
o
n
s
i
s
t
e
n
c
y
**
D
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r
e
c
t
n
e
s
s
**
P
r
e
c
i
s
i
o
n
**
P
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l
i
c
a
t
i
o
n
 
B
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s
**
L
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g
e
 
M
a
g
n
i
t
u
d
e
**
D
o
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-
r
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p
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C
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f
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s

Leave policies for staff

Symptomatic norovirus infection*

17 DES 84, 85, 92, 165, 167-169, 172, 174, 176, 177, 179-181, 183, 184, 205

Emphazised as an intervention in 17 DES 84, 85, 92, 165, 167-169, 172, 174, 176, 177, 179-181, 183, 184, 205

Staff were excluded from work until symptom free for 24 hours in 1 DES 85

Staff were excluded from work until symptom free for 48 hours in 11 DES 84, 92, 167, 169, 172, 176, 177, 179, 180, 183, 184

Staff were excluded from work until symptom free for 72 hours in 1 DES 168

Very Low

0

0

0

0

0

0

0

0

Very Low

Very Low

Isolation/cohorting of symptomatic patients

Comparison Outcome Quantity and type of evidence Findings Starting grade Decrease GRADE Increase GRADE GRADE of Evidence for Outcome Overall GRADE of Evidence Base
S
t
u
d
y
 
Q
u
a
l
i
t
y
**
C
o
n
s
i
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t
e
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c
y
**
D
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c
t
n
e
s
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**
P
r
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c
i
s
i
o
n
**
P
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c
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n
 
B
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**
L
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M
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**
D
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C
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Isolation of affected patients

Symptomatic norovirus infection*

15 DES 87, 166-171, 176, 177, 179-182, 184, 205

Emphasized as an intervention in 15 DES 87, 166-171, 176, 177, 179-182, 184, 205

In 1 DES that provided detailed description of the intervention, all symptomatic patients were isolated, while those who remained asymptomatic were kept in the original ward and isolated only when they subsequently developed clinical symptoms 170

Very Low

0

0

0

0

0

0

0

0

Very Low

Very Low

Staff cohorting

Comparison Outcome Quantity and type of evidence Findings Starting grade Decrease GRADE Increase GRADE GRADE of Evidence for Outcome Overall GRADE of Evidence Base
S
t
u
d
y
 
Q
u
a
l
i
t
y
**
C
o
n
s
i
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t
e
n
c
y
**
D
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r
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c
t
n
e
s
s
**
P
r
e
c
i
s
i
o
n
**
P
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l
i
c
a
t
i
o
n
 
B
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**
L
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e
 
M
a
g
n
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u
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e
**
D
o
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r
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p
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C
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f
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d
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Staff cohorting

Symptomatic norovirus infection*

13 DES 87, 103, 165, 168-170, 172, 177, 179, 180, 182, 183, 205

Emphasized as an intervention in 13 DES 87, 103, 165, 168-170, 172, 177, 179, 180, 182, 183, 205

Nurses on affected floors cohorted in 1 DES - one group cared for symptomatic patients and a second group for asymptomatic patients 168

Essential medical and paramedical staff who worked in affected ward were not allowed to work in unaffected clinical areas and non-essential personnel were not allowed to enter the affected ward in 1 DES 170

Staff without symptoms working in affected ward did not work anywhere else until 48 hours after completion of work in affected ward in 1 DES 177

Very Low

0

0

0

0

0

0

0

0

Very Low

Very Low

Ward closure

Comparison Outcome Quantity and type of evidence Findings Starting grade Decrease GRADE Increase GRADE GRADE of Evidence for Outcome Overall GRADE of Evidence Base
S
t
u
d
y
 
Q
u
a
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i
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C
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t
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D
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P
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c
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**
P
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B
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L
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M
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D
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C
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Ward closure

Symptomatic norovirus infection*

 

1 OBS 164
11 DES 85, 165, 166, 168, 176-179, 183, 184, 205

Emphasized as an intervention in 1 OBS 164 and 11 DES 85, 165, 166, 168, 176-179, 183, 184, 205

Outbreaks were contained significantly sooner when units were closed to new admissions within 4 days in 1 OBS 164

Hospital was closed 6 days after outbreak initiation until 4 days after the last case was symptom free in 1 DES 184

A hotel was closed for 8 h to permit thorough cleaning of all food service areas and guest rooms in 1 DES. New guests were not accepted until all guestrooms, bathrooms, and common rooms were thoroughly cleaned 7 days after initial cases 85

Low

0

0

0

−1

0

1

0

0

Low

Low

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