[iceNICUnurse]

We have an outbrake of Norwalk(Noro) virus now in my NICU.
I am just wondering if anyone has had the same problem and how it was solved.


Bye iceNICUnurse

[Kayde]

Can you tell me a good site to learn about this? Ive heard our physicians talking about this and honestly havent heard about it before . Thank youl

[iceNICUnurse]

I am so sorry but all the information I have is in Icelandic, so not much use to you. Norwalk is a tummy flu virus, the simptoms are watery stools and vomiting.

This is transmitted by the fecal-oral rute and is a common couse for outbrakes in hospitals, hotels and other crowded places.

The babies in my unit are not sick from this...exept for a red bottom from all the watery stools. Some of them are not gaining much weight though. This is so easely transmitted that we had babies in all of our rooms geting this, and a few of the staff as well.
We have no idea how this got to our unit. The infections control in the hospital takes this pretty seriusly and wanted us to close the unit for admissions while this blows over, but no can do...This is the only NICU in the country so we have now moved all the infected babies to another unit that was empty.

Hope this helped you a little.

[LauraLou]

I just read an article today in Nursing 2003 about the Norwalk virus.

It said the virus was a self-limiting, acute virus that occurs 1 to 2 days after someone consumes contaiminated food or water or after contact with an infected person's stool or vomit. Water from municipal supplies, wells, lakes and swimming pools is the most common source of outbreaks. It also occurs among large groups of people in closed settings, such as nursing homes and cruise ships.

Symptoms include nausea, vomitting, cramps, diarrhea, myalgia and low grade fever. Symptons last 1 to 3 days, however reinfection can occur. An infected person is contagious for 3 days to 2 weeks after recovery.

Hope this helps.

[NICU_Nurse]

I remember that those cruise ship outbreaks that were happening in the last year were attributed to the Norwalk virus. Seems that even those ships that were quarantined and scrubbed from top to bottom carried it, and people continued to be re-infected despite sanitizing measures.

Have any of the staff come down with this?

With any infectious virus, you have to consider means of transmission. I'd take a closer look at handwashing procedures, and insist that they be strictly adhered to (now is not the time to be slacking off with this!). Ask if you can get some of the alchohol gel or Epi-Klenz on the unit to use as a secondary method of handcleaning. Make sure all multi-use instruments are being cleaned properly (this includes door handles, telephones and phone keypads, countertops, syringe pumps and other portable equipment, isolettes, radiant warmers, laryngoscopes, etc.). Make all non-NICU personell (Xray techs, OT/PT, etc.) and parents/family wash fully and use alchohol gel before touching the baby and after, prior to leaving the baby's area. No personal effects in the baby rooms, no food or drink containers, no bottles of water or soda, etc. All diapers should be properly disposed of in biohazard bags, all diaper scales should be cleaned properly as should the counter areas around them and anything that might be touched during diaper changes (ie, the lid of the laundry container that has to be lifted to drop the soiled blankets in, etc.). The linens should be treated as isolation linens would until this has passed. Get yourself some Kleen foam spray- this stuff is fantastic and a quick way to clean surfaces. Put a can in every room and replace it as needed. Clean all scales between use.

[iceNICUnurse]

Thanks NICU_NURSE.
This is just what we are doing. We are runnng around with detergents and 70% alcohol all the time now. We have the alcogel and use it all the time as well as handwashing so much that the skin on our hands is totally going away:scrying

We use glowes when changing diapers and have thrown away all toys and ohter stuff that can not be boiled or dipped in alcohol.
We devide the kiddos to "clean," "unknown" and "infected" the staff is not supposed to tuch any other babies then their own, it is so hard when you just happen to be passing by and a baby is crying (or trying to pull up their ETT) not to be allowed to tuch it.

I think maby the docs are carrying this around...I have noticed that they sometimes do not wash their hands. We are trying to work on this part but have not had much progress with that, maby they think that the virus can not stick on them or when then you finish medical school you get a antivirus sheld

:

[iceNICUnurse]

Sorry forgot to answer your question.
Some of the staff has had the tummy flu but that was before the first baby was diagnosed with the virus.

[NICU_Nurse]

LOL! An antivirus shield! I need to get one of those.

This will probably be the hardest part, if your doctors are like the ones I've worked with. I'd get my charge nurse and the ID nurse to enforce this- post signs on every area you can, over sinks, before entrances, etc. to wash hands and clean stethoscopes before using them. have gloves handy, and if they're going to be coming to your baby, be waiting with a pair or gloves and an alchohol pad.

"Doctor, here is a pair of gloves for you."

or

"Doctor, here is an alchohol pad to clean your stethoscope."

Don't ask them, "WILL YOU clean your steth...?", but say it politely and with a smile. When I have a particularly hardheaded doctor, I have actually offered to clean it for them. I have never had anyone turn me down, but usually they will clean it themselves- sometimes they huff, but I am as adamant as i can be while still remaining polite and friendly. I just say, sweetly, "If you hand me your stethoscope, I'd be happy to clean it while you wash your hands..." and they usually do one of the following: Give it to me to clean, clean it themselves, or use mine (which I clean religiously between patient uses). If they give you a hard time, go to your charge nurse or ID nurse and get some support from them.

We had a problem with this at the last facility I worked at, and actually managed to trace down an infectious strain to a resident who refused to abide by our practices. It was suspicious how only certain babies from a certain medical school were getting infected and ALL of them had come by this resident during his rounds. We cracked down on it and managed to clear it up, but not before our babies got awfully sick. They won't like it necessarily, but hopefully with gentle reminders (respectful reminders!) they'll get the hint and start doing it on their own.

[NICU_Nurse]

I wanted to say one last thing- you mentioned that the babies weren't sick from this with the exception of the watery stools, but the symptoms they're experiencing can be serious in an infant! Diarrhea and watery stools leads to poor nutrient absorption, fluid loss and electrolyte imbalances, and broken/chapped skin from the exposure that opens them up for further infection. No laughing matter in an infant! If those doctors are saying that those kids aren't sick, they need to open their eyes! Or maybe that antivirus shield comes with protective glasses, too.