Managing the challenge of an acute gastroenteritis outbreak caused by a Norwalk-like virus in a 239 bed long-term care facility

Abstract

Outbreak management in long-term care facilities (LTCFs) highlights the differences between the 'ideal' and 'real' practicalities of implementing appropriate control measures. Infection control practitioners must develop workable strategies in an environment where it may not be possible to adopt traditional outbreak management procedures. This paper documents events during a large, prolonged outbreak of Norwalk-like virus, genotype II, affecting residents and staff of a 239 bed LTCF in Queensland. Diagnosis was confirmed from one faecal specimen. The case rate was 37 per cent with a total of 76 residents and 25 staff and volunteers meeting the criteria set in the case definition. Three peaks of infection were noted. Implementing standard mechanisms to isolate and cohort affected residents was not possible due to psychosocial and environmental factors in the setting. In addition, staffing shortages already in existence were compounded due to illness. The lack of facility-specific outbreak policies and procedures contributed to the slow resolution of the outbreak. An education programme focused on developing a collaborative, problem solving relationship among all disciplines. The result was the development of specific gastroenteritis outbreak management guidelines that reflect the realities of managing an outbreak event in a LTCF. This article outlines the management issues, solutions and outcomes associated with this outbreak.