Key infection control recommendations for the control of norovirus outbreaks in healthcare settings^a

Patient cohorting and isolation precautions Place patients with norovirus gastroenteritis on contact precautions for a minimum of 48 h after the resolution of symptoms. When symptomatic patients cannot be accommodated in single occupancy rooms, efforts should be made to cohort patients into separate groups (e.g. grouped among those who are symptomatic, exposed but asymptomatic, and unexposed). Minimize patient movements within a ward or unit during norovirus outbreaks. Symptomatic and recovering patients should not leave the patient care area unless it is for essential care or treatment. Consider suspending group activities. Healthcare personnel who have recovered from recent suspected norovirus infection associated with this outbreak may be best suited to care for exposed or symptomatic patients.

Hand hygiene Actively promote adherence to hand hygiene among healthcare personnel, patients, and visitors in patient care areas affected by outbreaks of norovirus gastroenteritis. During outbreaks, prioritize hand hygiene with soap and water after providing care or having contact with patients suspected or confirmed with norovirus gastroenteritis.

Personal protective equipment (PPE) If norovirus infection is suspected, individuals entering the patient care area should wear PPE according to contact and standard precautions (i.e. gowns and gloves, and among vomiting patients, face masks).

Environmental cleaning Perform routine cleaning and disinfection of frequently touched environmental surfaces. Increase the frequency of cleaning and disinfection of patient care areas and frequently touched surfaces during outbreaks of norovirus gastroenteritis. Clean and disinfect surfaces, starting from the areas with a lower likelihood of norovirus contamination, then to areas with greater likelihood. Use standard precautions for handling soiled patient-service items or linens, which includes the appropriate use of PPE. Consider changing privacy curtains routinely and upon patient discharge or transfer.

Patient transfer and ward closure Closure of wards to new admissions or transfers may be a measure to attenuate the magnitude of a norovirus outbreak. Consider patient transfers only if receiving facilities are able to maintain contact precautions. During outbreaks, medically suitable individuals recovering from norovirus gastroenteritis can be discharged to their place of residence.

Personnel leave Exclude ill personnel from work for a minimum of 48 h after the resolution of symptoms. Once personnel return to work, strict adherence to hand hygiene must be maintained. Establish protocols for staff cohorting in the event of a norovirus outbreak. Exclude non-essential healthcare providers, students, and volunteers from working in areas experiencing outbreaks of norovirus.

Visitors Restrict non-essential visitors from affected areas during outbreaks. For those facilities where it is necessary to have continued visitation privileges, screen and exclude visitors with symptoms consistent with norovirus infection.

Diagnostics Submit stool specimens as early as possible during a suspected norovirus gastroenteritis outbreak and ideally from individuals during the acute phase of illness. In the absence of clinical laboratory diagnostics for norovirus, or in the case of delay in obtaining laboratory results, use Kaplan’s clinical and epidemiologic criteria to identify a norovirus gastroenteritis outbreak.

^aAdapted from MacCannell et al.⁵⁷