Controlling a Norovirus outbreak
Whatever the setting, schools, coach travel, hotels, care homes, or child nurseries, controlling a potential outbreak requires policies, procedures, training and equipment. Immediate safe clean up of any body fluids (vomit, urine, feces, or blood) is the first part of controlling a viral outbreak of Norovirus. It is safe to always assume body fluids contain infections. The cleaning chemicals used to destroy the virus outside of the body also need to be proven effective against Norovirus while being safe to use on all surfaces. The need to train staff to recognize an outbreak and the appointment of outbreak managers, coordinators and clean up teams mean once an outbreak is suspected an action plan can be quickly actioned and reduce the risk of cross infection. The methods used to clean can play an important roll in the control of Norovirus outbreaks. Paying attention to frequently touched surfaces and bio-fogging can reduce the risk of cross infection and kill the virus.
All body fluids have the potential to be infectious
Transmission of Norovirus from surfaces
The virus can be active outside a host (person) on surfaces such as counters, toilets, sinks, doorknobs and even clothing. It is unknown exactly how long the virus can live on such surfaces, as this depends on the number of viral particles, temperature, and the nature of the environment. However, you can't catch anything by just touching a doorknob. You would have to put your hand into your mouth or on your nose afterward. Therefore, hand-washing is imperative to prevention of transmission.
The main reason for all the Norovirus outbreaks is poor hygiene, i.e., people defecating and not washing hands afterward, then contaminating surfaces or foods.
How Do You Get It?
C. diff bacteria actually exists all around us. It’s in the air, water, soil, and in the feces of humans and animals. Many people have the bacteria in their intestines and never have any symptoms.The bacteria is often spread in health care facilities, like hospitals or nursing homes, where workers are more likely to come into contact with it, and then with patients or residents. You can also become infected if you touch clothing, sheets, or other surfaces that have come in contact with feces and then touch your mouth or nose.
Older adults in health care facilities are most at risk, especially if they’re taking antibiotic. That’s because the human body contains thousands of different types of bacteria -- some good, some bad. If the antibiotics kill enough healthy bacteria, the ones that cause C. diff could grow unchecked and make you sick.
C. difficile spores, surviving for a long time on objects and surfaces, play a role in the spread of C.difficile infections (CDI). Appropriate cleaning and disinfection of the environment and equipment is an essential strategy for reducing CDI. Spores can be found throughout a room like light switches, door knobs, and bedside tables. Nursing homes should have educational programs, policies and procedures that outline schedules and responsibilities for cleaning practices. Nursing homes should monitor adherence to procedures, evaluate effectiveness of cleaning, and keep staff informed of the results.
Communicable diseases are caused by pathogens passed from one human to another. Pathogens are viral, bacterial, parasitic and fungal. Methods of transmission include mucus, blood, breath, saliva and sexual contact. Contaminated surfaces, such as doorknobs, counter tops and playground equipment, provide a medium for passing disease from one human to another.
The National Institute of Allergy and Infectious Diseases states that as of 2007, Americans have an estimated 1 billion colds each year. The age group most susceptible to repeated colds is children. People older than 60 average less than one cold a year. The common cold is a viral infection.
Viral gastroenteritis is a highly contagious disease spread by contact, such as sharing food or eating and drinking from contaminated utensils. Depending on the specific virus, gastroenteritis lasts from one to two days or up to 10 days. Two known causes of viral gastroenteritis are rotavirus and norovirus.
Strep throat is a communicable disease caused by group A streptococci bacteria. KidsHealth states that teens are particularly susceptible to strep throat during the school year. Strep throat bacteria spread easily by sneezing, coughing or shaking hands. A rapid strep test in the doctor's office will confirm whether the symptoms are because of strep throat or a viral sore throat.
Pink eye is a common name for a highly contagious form of bacterial or viral conjunctivitis. The virus that causes the common cold causes viral pink eye. Staphylococcus or streptococcus cause bacterial pink eye. To reduce the chances for spreading pink eye, avoid touching the infected eye, wash your hands frequently and avoid reusing towels or washcloths in contact with the eye.
The Children's Hospital of Philadelphia states that fifth disease, a human parvovirus, is most common among children and spreads through direct contact with nasal and throat discharge. Exanthem, a skin rash or eruption, appears at onset of the disease. Fifth disease spreads easily because it is contagious before symptoms of the rash appear.
Rotavirus is a highly contagious infection that affects the gastrointestinal system of children. Symptoms include nausea, vomiting, fever and watery diarrhea. Rotavirus is a noted problem in daycare facilities. The virus spreads from the stool of infected individuals. Poor hand washing technique following toilet use easily spreads the rotavirus.
Whooping cough, or pertussis, is a highly communicable disease that affects all ages. The symptoms of whooping cough include respiratory infection, runny nose, low-grade fever and a mild cough that progresses to an uncontrollable cough with a high-pitched whoop.
Biological Pollutants as well as the chemical pollutants described above, various biological contaminants often contribute to cases of sick building syndrome. In fact biological factors are reported to be behind the majority of cases. These biological pollutants can cause illness through three different mechanisms:
There are many sources of biological pollution that can affect a building and many reasons why a building might become contaminated and cause illness in its occupants. The following are the main sources of this form of pollution:
Toxic Black Mold - is reported to be the leading cause of sick building syndrome and building related illness. Mold grows rapidly in warm and damp environments. If the indoor environment is too humid or if water damage occurs through leaks or rising damp, mold growth is very likely to occur.
Viruses & Bacteria - are common in every building, especially high occupancy buildings such as offices and schools. These micro-organisms can make a significant contribution to causing SBS. They become increasingly problematic if humidity levels are either too low or too high, as a result of how their growth is affected and the fact that our defenses against them are also affected by humidity levels.
Dust Mites - are highly allergenic and thrive on the constant supply of shed human skin cells that accumulate in carpeting, soft furnishings, and other areas. Like mold and bacteria, dust mites like the warm and relatively humid environment that we usually provide in our buildings.
Pollen - is another allergy causing substance that can accumulate in a building if proper ventilation and filtering is not maintained. Pollens from various trees and plants can be troublesome for a great number of people. Aside from being carried on breezes through open doors or windows, pollens can also be brought indoors on the occupants shoes and clothing.
Insect Body Parts - although not well known are especially potent allergens for some people. Cockroach allergens are particularly troublesome allergens and are commonly implicated as contributors to sick building syndrome. Usually become a problem only when sanitation is poor. The above are collectively known as bioaerosols. The common definition of a bioaerosol is any extremely small living organism or fragment of living things suspended in the air. They cannot be seen without a magnifying glass or microscope. Of course when a large growth of mold occurs, it does then become visible to the naked eye.
Disinfectants are commonly applied as fogs in the chilled food industry. Recent research has shown that fogging is effective in reducing the number of organisms on upward-facing surfaces but, in general, it is not effective on vertical or downward-facing surfaces. Fogging also reduces the number of viable airborne organisms, although the reason for this decrease is not understood. Numerical models of the dispersion of airborne particles have been used to simulate the fogging process. These models, with supporting experiments, showed that fogs should be most effective when the median diameter of the fog droplets lies between 10 and 20 μm. Droplets in this size range disperse well and settle within about 45 min. This gives good coverage and the fog clears from the air quickly enough not to pose major disruption to factory operations.
Protecting yourself from the flu is important not just for your health, but for those around you. You can be a carrier of the flu even without exhibiting flu symptoms, which means that even if you don’t get sick yourself, you can still infect those around you. This can be particularly dangerous for the elderly, small children, pregnant women, and those with medical conditions such as asthma. While most cases of the flu are mild, secondary complications such as pneumonia are common and can even be fatal. According to estimates by the World Health Organization, there are anywhere between 250,000 to 500,000 deaths influenza related deaths worldwide annually.
Don’t: Neglect Your Yearly Vaccinations.While the flu shot is far from perfect, getting a timely vaccination improve your chances of avoiding the flu by 60 to 70 percent. Even if you do get the flu after receiving a vaccination, your symptoms are likely to be lessened and your recovery time quickened. It is critical to get revaccinated every year. While many vaccines are good for a lifetime, the flu virus evolves particularly quickly, meaning lasts years shot will not be effective at fighting this year’s strains. If you have small children or are a primary caretaker for an elderly relative, it is even more imperative to make sure they are immunized, as these populations are particularly vulnerable to serious complications.
Do: Wash Your Hands Throughout the Day. Simply washing your hands after using the restroom may not be enough. The flu virus spreads easily on commonly touched public areas and can stay active on a surface for up to two hours at a time. Think hand rails, elevator buttons and other common spaces that may be touched by hundreds of different people a day or more. Wash your hands multiple times a day for at least 15 to 20 seconds at a time. Do so thoroughly with soap and water, preferably with a sink with an automatic faucet and an automatic dryer. Sing the happy birthday song to yourself while you wash and make sure you get through at least one rendition before you turn off the faucet. This is a particularly useful tip to share with young children who are already at a heightened risk of catching the flu as well as experiencing serious or even life-threatening complications. Other important hygienic practices to use are sneezing into your elbow rather than your hand and avoid unnecessary physical contact with other people such as handshakes and kisses on the cheek.
Don’t: rub your eyes, mouth or nose with your hands.This is a prime way to introduce viruses into your system. Pay close attention to what your hands are doing, and try your best to keep them away from your face. This will help prevent the virus from gaining easy access into your vulnerable immune system.
Do: Take Advantage of Your Sick Time. While you may be able to power through a cold, coming down with the flu mandates an absolute stay-at-home day. How do you tell the difference when so many cold and flu symptoms overlap? Both will typically start with a sore throat and may include symptoms including sneezing, a stuffy nose and general fatigue. However, with the flu, symptoms typically start much stronger and faster. You may experience extreme exhaustion and headaches. If you have a temperature of 100 to 102 degrees Fahrenheit, you have the flu, and it is time to cash in on that sick time. Even with all precautions in place, there is still a chance you may come down with the flu. If you do end up getting sick, stay home. The flu is highly contagious. If your kids get sick, keep them home from school. If you are sick, do your coworkers a favor and stay out of the office. Not only will overexerting yourself when you are sick likely hinder your body’s natural healing process, you are also likely to spread the virus to vulnerable friends and coworkers. Stay home, rest, drink soup and stay hydrated until your fever is gone and you can safely return back to your normal routine. Do yourself a favor and get your shots, wash your hands, and prioritize your health if needed. Taking these necessary precautions will significantly increase your chances of staying healthy this flu season.
Both restaurants have addressed these issues, with the Virginia location shuttering briefly to sanitize, and the Texas restaurant sealing up the rodents' entry point. But by that point, the damage was done. Chipotle shares have fallen nearly 12 percent since last Tuesday, when the news broke, and Chipotle's food safety policies are once again up for debate."If another chain had a norovirus outbreak, I am pretty sure that it would not have gained the national exposure the way that Chipotle had in this last outbreak," Martin Bucknavage, senior food safety extension associate at the Pennsylvania State University, told CNBC via email. "So yes, we are hyperaware of their issues. That being said, the entire system of retail operations should have been hyperaware of employee health issues."The company said Tuesday in their earnings conference call that they believe an employee was the cause of the outbreak. "We conducted a thorough investigation, and it revealed that our leadership there didn't strictly adhere to our company protocols," CEO Steve Ells said during the call. Discussions among Reddit users had suggested that some Chipotle locations are not adhering to the company's safety guidelines. By not following guidelines, conditions are created that would make a norovirus or similar outbreak seem "eminently predictable," Stuyvesant Square Consultancy Managing Director J.G. Collins, who writes frequently about the restaurant industry, told CNBC via email. A self-identified Chipotle employee alleged in a Reddit post last month that a manager required them to work while sick. My boss has told me that I have no option but to come in tomorrow, and it's been heavily implied that my job will be in jeopardy if I don't come in," the user wrote last month."Isn't it against company policy to work with a fever anyway? Today I was told I was not allowed to blow my nose during peak for about an hour and a half. If I'm dripping snot, shouldn't that constitute too sick to work with food anyway? "This Reddit user, who is from Missouri, wished to remain anonymous but told CNBC by email Friday that they did not lose their job, but their absence was "frowned upon.""I've since had one of my managers tell us that they only abide by the sick policy about 40 percent of the time," this person said. "Apparently since the sick policy worked for two years its 'no longer necessary' to make sure sick employees stay home."Chipotle has a paid sick-leave policy to ensure employees stay home when they are ill. "We have policies that preclude people from coming to work sick, and are one of few restaurant companies that provides paid sick days for our employees (including hourly employees)," Chris Arnold, a Chipotle spokesman, told CNBC by email."We have added a HACCP (hazard analysis critical control points) program to all of our restaurants, and that program begins with a daily wellness check where employees in our restaurants are asked screening questions to be sure no one is working while sick. If any employees report symptoms of illness, [they] are excused from work until they are feeling better."However, not all managers seem to abide by this standard. A Chipotle employee who works in a Virginia location — not the Sterling location — told CNBC by email that it was only after the norovirus outbreak last week that their manager began enforcing the sick policy."Two weeks ago [I] came to work, felt like I was going to puke, just felt awful," they said. "One of my managers told me if I don't find someone to cover my shift, I'm going to have to stay. Mind you, my position was on line working with food."Chipotle's sick policy may not be the only one that managers are overlooking. Collins said that a few Reddit users who reported working for Chipotle said that management within their restaurants had not complied with the company's safety protocols. Collins first wrote about these posts in a Seeking Alpha article published last month.One user alleged that their manager "makes us pretend we're doing things the right way when Ecosure [the company's food safety auditor] is there," but doesn't blanch the produce when the inspector is not present. Another one said that their general manager had them falsify food safety sheets. The Virginia employee told CNBC that his location blanches their avocados, onions, peppers, lemons, limes and jalapeños every morning, as specified by Chipotle's food safety guidelines. Chipotle has taken a number of measures to prevent foodborne illnesses, including shifting some preparation to its central kitchens, blanching ingredients, and making modifications to how it marinates steak and chicken."Clearly, they have hired some well-known food safety experts to help with their programs, so I would expect that their programs would not be drastically different than what occurs at other operations," Bucknavage said. "Their size is not much different than any other large foodservice operation (McDonald's, Panera, Chick-fil-a, etc)."However, Chipotle's commitment to locally sourced ingredients, a defining part of their business model, is what poses one of the largest threats to the chain."[It] creates problems with tracability and consistency of supply," David Henkes, principal at Technomic, told CNBC via email.Despite these food safety initiatives Henkes said that there is always a risk of employees "short cutting the system.""You're asking an 18- or 19-year-old kid to replicate the recipes of a [Culinary Institute of America]-trained chef in a kitchen — chopping, cooking, serving, — with very limited supervision and to maintain some fairly stringent food safety standards," Stuyvesant's Collins told CNBC via email. Collins said that Chipotle's food safety practices are hard to replicate in its more than 2,200 restaurants nationwide, especially as the brand continues to grow. And he's not the only one to see scale as a major issue for Chipotle."Chipotle is damaged goods," Dana Blankenhorn, an analyst at InvestorPlace.com, told CNBC via email. "There's a reason why McDonald's freezes its meat. This is the reason. Fresh food prep like this does not scale.
Cryptosporidium is resistant to chlorine disinfection so it is tougher to kill than most disease-causing germs. The usual disinfectants, including most commonly used bleach solutions, have little effect on the parasite. An application of hydrogen peroxide seems to work best. If an outbreak of Crypto occurs in the childcare setting:
Note: Cryptosporidium is not killed by alcohol gels and hand sanitizers so these materials are of little use in controlling an outbreak.