Evaluation of the presence of prevention and control stratergies for noroviruses in skilled nursing facilities in South Carolina

Background: Noroviruses (NoV) cause 21 million cases of acute gastroenteritis every year in the U.S.  Most (60%) occur in long-term care facilities (LTCF). Noroviruses spread rapidly in LTCFs due to the low infectious dose and its persistence in environment.  The Centers for Disease Control and Prevention (CDC) recommend hand hygiene, environmental disinfection, and exclusion and isolation of sick individuals as the best strategies to prevent and control norovirus outbreaks. The purpose of this study was to evaluate the presence of CDC recommended prevention and control strategies for noroviruses in skilled nursing facilities in South Carolina.

Method: Site visits were made to a convenience sample of 26 skilled nursing facilities in South Carolina during July-November 2013. Facility directors were interviewed to determine hand-washing, vomit/fecal matter clean up, outbreak response, and environmental sanitation practices. The CDC recommendations were used as the framework for best practices.  Relative frequencies were examined.

Results:  All facilities (100%) required workers to wash their hands after certain activities.   However, only 23% followed CDC guidelines for proper hand washing. Most facilities reported that they cohort ill patients (85%) and exclude sick employees (96%). Some (31%) designate specific staff to only care for sick residents and 42% limit visitation during outbreaks. For environmental sanitation, only 19% and 39% of facilities indicated using chlorine-based sanitizers for food-contact and other hard surfaces, respectively.

Conclusions: This study shows that most skilled-nursing facilities are not fully compliant with CDC prevention and control strategies and lack specific norovirus outbreak procedures.