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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?

Virus Shedding

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
b
l
i
c
a
t
i
o
n
 
B
i
a
s
**
L
a
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g
e
 
M
a
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t
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d
e
**
D
o
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-
r
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p
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C
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Virus shedding

Duration of shedding

2 DES 149, 150

78% of infected cases were shedding virus on day 1 compared to 26% on day 22 in 1 DES 149. The rate was highest in newborns

An elderly woman shed norovirus on day 2 and day 5 after resolution of symptoms 150

High

0

0

0

−1

0

0

0

0

Moderate

-

Factors associated with shedding

1 OBS 148
1 DES 149

Age ≤ 6 months was a possible risk factor when compared with age > 1 year for increased viral shedding in 1 OBS 148

The rate was highest in newborns 1 DES 149

Low

0

0

0

0

0

0

0

0

Low

Asymptomatic shedding

3 DES 150-152

Asymptomatic shedding was reported in 3 DES 150-152

High

0

0

0

0

0

0

0

0

High

Recovery of norovirus

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
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b
l
i
c
a
t
i
o
n
 
B
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a
s
**
L
a
r
g
e
 
M
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n
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t
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e
**
D
o
s
e
-
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e
s
p
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C
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Fomites

Transfer of norovirus*

1 BAS 194

One BAS demonstrated that norovirus-contaminated surfaces can be readily transferred to other fomites (telephones, taps, door handles) via fingertips even when virus has been left to dry for 15 minutes in 30-50% of opportunities 194

High

0

0

−1

−1

0

0

0

0

Low

Low

Duration of Recovery

1 SR 153 of DES
1 OBS141

norovirus remained viable in carpets up to 12 days despite regular vacuuming in 1 SR 153

norovirus was undetectable in areas of previously known contamination after 5 months had elapsed 141

Low

0

0

0

0

0

0

0

0

Low

Location of norovirus/ FCV Recovery

1 SR 153 of DES
7 DES 154-159, 161 
1 BAS 163

36% of swabs were positive from curtains, cushions, carpets, lockers, commodes, toilet rims, seats and handles, taps, basins, telephones, door handles, physiotherapy instrument handles, and horizontal surfaces above 1.5 meters (i.e., mantle piece and light fittings where direct handling is unlikely) and below 1.5 meters (i.e., tables and ledges where direct handling may occur)  in 1 SR 153

Other environmental surfaces identified were bathroom surfaces like toilet seats, handrails and taps; horizontal surfaces near toilets like tables, mantel pieces, light fittings; kitchen surfaces like dining room tables; elevator buttons; bed rails; doorknobs; game consoles; instrument handles (e.g., ultrasound); soft furnishings like cushions and curtains; lockers  154, 155, 157-159, 161

FCV was recovered from computer keyboard and mouse; telephone buttons, receiver and wire in 1 DES 156

High

0

−1

0

0

0

0

0

0

Moderate

Foods and food preparation surfaces

Location of norovirus Recovery

3 BAS 112, 162, 163

Norovirus was transferred via gloved hands and detected on foods like lettuce, strawberry and ham. norovirus was also detected on food preparation surfaces like stainless steel, ceramic and formica surfaces; spatula; fork; cutting board 112, 162, 163

High

0

0

−1

0

0

0

0

0

Moderate

Low

Transfer of norovirus*

2 BAS 162, 163

Significantly higher transfer to wet lettuce (P<0.01). For dry lettuce, the transfer at time 0 was statistically significantly higher than at times 30 and 60 min (P<0.05). For wet lettuce, the transfer at time 0 was statistically significantly higher than at times 10, 30 and 60 min (P<0.05) 162

Transferred via gloved hands in 1 BAS 163

High

−0

0

−1

−1

0

0

0

0

Low

Factors associated with recovery

1 BAS 112

In 1 BAS 112, its recovery on ham was significantly greater when compared to other food and surface items.

High

−0

0

−1

−1

0

0

0

0

Low

Duration of Recovery

2 BAS 112, 162

At room temperature and 4°C, FCV titers were significantly reduced by Day 7 in 1 BAS 112

norovirus was detected on all plated sterile surfaces, with the most significant reduction in titer occurring after 24hrs without cleaning or disinfection.  Over 7 days, observed 6-7 log10 reduction in recovery in 1 BAS 162

High

0

0

−1

0

0

0

0

0

Moderate

Water

Recovery of norovirus

3 DES 155, 158, 160

norovirus was detected in water samples in 1 DES 160and not detected in 2 DES 155, 158

High

0

0

0

−1

0

0

0

0

Moderate

-

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