By Joshua Schwartz
Many Americans learned about the impact of infectious diseases in long-term care settings only after witnessing the devastation Covid-19 inflicted on residents. But for the industry itself, it was just the latest manifestation of an all too familiar challenge.
For the last thirteen years, high infection rates have ranked as the most common reason why regulators cite long-term care facilities. Even 40% of America’s most highly rated nursing homes have been cited for infection control. Norovirus, the leading cause of acute gastroenteritis (or stomach flu, despite there being no scientific connection to influenza) has long been one of the leading reasons why.
Long-term care facilities account for over three-fifths of norovirus outbreaks, and residents are four times likelier to succumb to the virus. These older individuals, often living with multiple comorbidities, are also at an elevated risk for long-term health complications that outlive the infection itself.
Much like the coronavirus, norovirus is easy to spread and hard to kill. Combatting it requires staff members to focus on the best way of curtailing an outbreak: stopping it before it even starts. Here are three prevention strategies to get started.
With person-to-person transmission accounting for over 90% of norovirus infections, prevention starts with a strong culture of hand-washing and personal hygiene, especially among staff. That might seem basic, but there is significant room for improvement in this regard. One study found compliance with the World Health Organizations’ (WHO) hand hygiene standards as low as 17%.
It’s worth considering ways management can not only reinforce the importance of handwashing during training, but also how to make it easier for staff to do the right thing in practice. For example, install sinks or hand sanitizing stations at strategic locations—where staff members commonly work with residents—to make hand hygiene more convenient.
Improve Cleaning And Disinfection
Another aspect of norovirus that makes it difficult to prevent outbreaks is the small concentration of virus particles needed to cause infection. Even miniscule amounts of vomit or fecal matter are enough.
Particularly concerning in this vein is evidence that fecal matter is rampant in long-term care facilities. In the study of 337 high-touch surfaces across eleven separate long-term care facilities, over 90% tested positive for a fecal indicator virus or had organic material levels that resulted in failing ATP cleanliness cores.
Any prevention plan is therefore incomplete without giving your staff adequate tools for environmental cleaning and disinfection. Unfortunately, identifying such tools can be a bit of a landmine. Many cleaning products contain volatile organic compounds (VOCs), which cause infertility, cancer, liver and damage, among other serious health complications.
Counterintuitively, alternatives labeled as green, sustainable, or eco-friendly—slippery terms that virtually any company can co-opt for branding—are not necessarily any better. Multiple studies have shown that VOCs and other toxic chemicals are just about as likely to be found in so-called green products as any other.
Thankfully, options do exist that are sustainable in fact as well as in name. To take just one example, onsite generation of electrolyzed water solutions can produce a hospital-grade cleaner and disinfectant free of harmful chemicals. As a result, it can be applied frequently without downside risk to residents’ health, making it an intriguing tool for improving environmental cleanliness.
Respond Quickly To Norovirus Incidents
As anyone with experience in the long-term care setting can attest, it’s hardly realistic to expect to eradicate norovirus from an environment where vulnerable residents live in close quarters. Far more attainable is the goal of preventing the spark of an isolated case from turning into the wildfire of a full-blown outbreak—defined by the WHO as a higher-than-expected incidence of disease in a given population.
This means it’s critical to manage active cases effectively. And because those with norovirus—especially the elderly—don’t always make it to a bathroom in time, that often involves responding to unpleasant messes in the form of vomit or diarrhea.
Staff members should respond by clearing the area in order to thoroughly clean and disinfect it with the help of protective equipment like gloves and masks. Then, they need to ensure that all residents in the vicinity receive help they need to wash their hands and/or bathe to prevent further transmission. Gloves, masks, etc. should be disposed of and clothing washed as soon as possible after the job is done.
Given how readily norovirus spreads, it’s essential that staff be prepared to carry out this process quickly and without mistakes. To that end, it’s better not to leave anything to chance. Incorporating these recommendations into a broader plan that staff members commit to memory before an incident takes place will help the process go off without a hitch.
With that plan in place, senior care facilities will have delivered a cleaner, healthier environment for the men and women they serve.
Schwartz is the President and a Co-Founder of Viking Pure Solutions, a sustainable cleaning innovation company that is changing the way facilities clean and disinfect with all-natural, on-demand solutions that are better for people and the environment.