Norovirus – a dangerous and underestimated threat: what nurses have to know

Norovirus, a highly contagious virus that causes acute gastrointestinal illness, is becoming increasingly known throughout the United States. Symptoms often begin 12 to 48 hours after exposure and last one to 3 days and include diarrhea, vomiting, nausea and abdominal pain.

According to the Centers for Disease Control and Prevention (CDC), within the second half of 2024 nearly 500 norovirus outbreakswhich is a big increase from the identical period in 2023. These outbreaks have occurred in healthcare facilities, restaurants, schools and on cruise ships and can proceed to occur in 2025. Norovirus can also be the leading reason for foodborne illness outbreaks within the United States , but it surely is just not simply a foodborne or food contamination issue. In reality, the transmission of norovirus is more complex and due to this fact its impact on human health, including patients and healthcare staff, is usually underestimated.

Susceptibility of health care facilities to norovirus.

This illustration, based on electron microscopy images, shows a 3D graphical representation of an array of norovirus virions. CDC/Jessica A. Allen

Let’s have a look at some explanation why norovirus represents a specific problem in health care. Healthcare facilities are particularly vulnerable to norovirus outbreaks as a result of the close proximity of patients, frequent contact with healthcare staff, and the presence of vulnerable populations resembling the elderly and immunocompromised people. A nurse or healthcare employee who develops symptoms may unknowingly spread the virus to multiple patients through direct contact or through contaminated surfaces. Illnesses in those accountable for handling and preparing food can also be involved in transmission. To this end, many individuals in health care settings play a task in prevention.

The important challenges in stopping and controlling norovirus in health care include how norovirus is transmitted, difficulty in removing it from the environment and from the hands of health care staff, consistent application of basic infection prevention practices, disease surveillance and reporting, and rapid response when disease outbreaks are suspected or recognized.

Norovirus transmission

One of probably the most under-recognized elements of norovirus treatment is its low infectious dose – just just a few 10 to 100 viral particles may cause infection. This signifies that even just a few virus particles on surfaces or hands could cause transmission. Infected people can shed billions of virus particles of their stool and vomit, even after symptoms disappear. Vomiting aerosolizes these particles and surrounding areas may grow to be highly contaminated even in the event that they will not be visibly dirty. The virus can take as much as two weeks to shed, although persons are most contagious once they have symptoms. The high rate of shedding combined with the minimal infectious dose makes the control of norovirus extremely difficult, especially in healthcare settings.

Pollution of the environment and hands

The composition of the virus itself makes it difficult to regulate environmental infections and hand contamination. Unfortunately, norovirus is proof against some commonly used disinfectants. Disinfectants effective against noroviruses are listed by the Environmental Protection Agency (EPA) and should be labeled as effective against human norovirus or feline calicivirus, a surrogate virus used to check the effectiveness of a disinfectant. Disinfectants suitable for combating norovirus include sodium hypochlorite, hydrogen peroxide and quaternary ammonium compounds together with alcohol. Ensuring that effective products are utilized by environmental health services personnel, in addition to others helping to wash and disinfect the environment, is critical to stopping and controlling norovirus. Unlike many other viruses, norovirus doesn’t have a lipid envelope, which makes it proof against alcohol. Most alcohol-based hand sanitizers only partially inactivate norovirus and don’t reliably prevent transmission. Mechanical removal by washing hands with soap and water physically removes virus particles from the skin. For this reason, in some circumstances, especially within the case of norovirus, hand washing could also be advisable as a substitute of alcohol-based hand rubs.

Basics of infection prevention and control

Use standard precautions stopping contact with the patient’s body fluids is a basic measure to stop infections. The most significant thing is to make use of personal protective equipment to stop contact with body fluids and wash your hands to remove contamination and forestall transmission of the virus to other surfaces, patients or yourself. Early identification of a patient with gastrointestinal symptoms and initiation of isolation until the etiology is decided can also be a fundamental infection control practice and relies on the judgment of nursing staff and their rapid response.

Disease surveillance and reporting

Rapidly reporting illnesses in patients and employees helps prevent disease transmission and discover potential outbreak situations. Contacting infection control departments when patients are symptomatic, and reporting health care illnesses to medical examiners/occupational health departments helps maintain rapid surveillance and response efforts. Collection of samples for testing needs to be done in cooperation with infection control, public health and microbiology authorities.

Quick response to the epidemic

A single case of norovirus poses a threat to the protection of patients and medical staff. Rapid case recognition and notification of healthcare providers, infection prevention and control, community services and native public health can mean the difference between a single case and an epidemic and forestall serious health outcomes amongst vulnerable patients.

Nursing considerations for prevention and response.

Given this data about norovirus, nurses can take specific actions to enhance prevention and response:

1. Immediately report gastrointestinal symptoms experienced by patients to Infection Prevention and Control and your partner to attenuate risk to other patients and healthcare staff. This communication must also include community services if a change to the disinfectant utilized in a given patient care area is essential.
2. Standard precautions, including gloves and other barrier precautions, needs to be used in any respect times to stop contact with the patient’s body fluids. If the patient vomits, recognize the chance of vomit aerosol formation and, if essential, initiate the usage of additional personal protective equipment (e.g. mask as a barrier).
3. Be aware of the importance of washing your hands with soap and water when coping with norovirus. Communicate with others when the patient is experiencing gastrointestinal symptoms in order that the complete team caring for the patient can wash their hands.
4. Facilitate notification of facility quality and infection control teams in order that they are aware and may ensure rapid implementation of increased public health interventions and communication.
5. If you experience gastrointestinal symptoms, stay home and share details about your illness along with your occupational/worker health care provider.
6. Be aware of diseases occurring in local communities. Remember that nurses are consistently recognized as probably the most trusted healthcare professionals, and patients and others can come to you with questions. Moreover, patients and others may use your infection control practices as a model, so ensure you might be consistently implementing best practices.

For more CDC information on norovirus for the general public and physicians, click Here.

Ruth Carrico, Ph.D., FNP-C, CIC, FSHEA, FNAP, FAAN, is an assistant professor within the Department of Infectious Diseases on the University of Louisville School of Medicine and a board-certified family nurse practitioner. He has worked in the sector of infection prevention and control for over 30 years and is board certified in infection prevention and control. Her research and clinical practice deal with disease prevention in all settings where care is provided and include public health and the care of vulnerable populations. Ruth’s last post on this blog was, “The Critical Role of Nurses in Conserving Intravenous Fluids.”