Cleaners have been busy at Nanaimo Regional General Hospital, trying to keep ahead of an outbreak of Norovirus.

The News Bulletin
Aug 24 2006

It has been a busy couple of weeks for Dan Costello, infection, prevention and control practitioner at Nanaimo Regional General Hospital.

Costello, Dr. David Forrest, infection prevention and control associate director for the Vancouver Island Health Authority and staff have been dealing with a Norovirus outbreak in the hospital, trying to stay one step ahead in the cleaning process.

The suspected cause was the visit of one person to NRGH with the virus during a busy time in the emergency department.

ìThereís a high incident of this gastro-intestinal virus in the community and many people required assistance in the emergency department since early August,î said Costello.

ìIt wasnít identified but during the time, with diarrhea and vomiting, thereís a lot of mess around and regardless of how hard you attempt to keep up with it in terms of cleaning, thereís always traces.î

Costello said it takes anywhere from eight hours to three days for the virus to show itself and during the visit to the ER, people who have been around this one person are admitted to hospital for other reasons and are unknowingly infected.

ìAnd in three days, you can almost set your clock by it, people are popping up all over the hospital who have this unexplained gastro,î he said.

ìAnd when theyíre sick in the room, that contaminates the room and other patients get it.

ìYou have incidental contact through shared bathrooms, incidental contact through equipment that is shared and at that moment of time, you donít know it is Norwalk.î

Not fully understanding how much the virus has spread, Costello said they pull out all the stops.

ìStaff begin wearing gowns and gloves when dealing with anybody we believe has come from the community (with the virus) and through the ER until we can see if they develop signs or symptoms, and face shields are worn when caring for infected patients,î he said.

ìThese are people who might unexpectedly vomit, and they do, and if youíre in their presence, you do not want it on your lips because then youíre infected.

ìWe want to protect staff to keep them well so they can take care of patients.î

The gastro virus is difficult to kill with routine cleaning agents, so once identified, the bug is battled with household bleach and VIROX (accelerated hydrogen peroxide).

ìWhen you have gastro, regardless of an outbreak or not, the room gets bleach after a VIROX cleaning,î said Costello.

ìDuring an outbreak, every floor, every ward, nursing stations, staff bathrooms, kitchenettes, railing on the beds is washed with VIROX and followed with bleach. And in doing so, we hope we have eliminated all viral particles.

ìItís hard to always get them all, but you reduce them down to a level you will not pass it on by incidental contact.î

Once patients are recognized as getting better (beyond four days of illness), beds and curtains are stripped down, walls washed and the head-of-bed equipment including oxygen and suction gets cleaned with VIROX and bleach.

ìWe attempt to leave no stone unturned and get all the places where the virus might be hiding out,î said Costello.

ìWe donít want the next patient to come in and there is incidental contact.î

As for visitor restriction to the hospital, Costello said they havenít said absolutely no visitors to the hospital.

ìThis is not like SARS (Sudden Acute Respiratory Syndrome), we are not banning people from the hospital,î he said.

ìWe are saying people might want to reconsider. Do they really need to be here?

If someone is very ill and would benefit from a visit, come in, wash your hands, wear a gown, sit at the bedside and visit nowhere else.

ìWe have to balance the risk. There is always a way to allow visitation for compassionate reasons but not everyone should come freely and bring three friends with them.î

Costello said it tends to take a long time to get Norwalk out of the hospital.

ìAnd the reasons are not related to containment measures in place but the increased activity of the illness in the community,î he said.

ìWe continue to see people come to the hospital and need care, need to be admitted and you donít need much of it to move from person to person.

ìItís difficult to say we are actually free of it, but that is a reality of healthcare.î