Suspected Norovirus Outbreak on a Shared Care Unit
On a 32-bed medical unit, six residents developed vomiting and watery diarrhea within 24 hours. Each four-room cluster shares one bathroom. One resident with dementia walks into other rooms and uses the shared bathroom repeatedly. Two staff called in sick with similar symptoms. The unit has 10 gowns and two boxes of gloves left; housekeeping is short-staffed. A new admission is expected from the emergency department in two hours. The unit manager is off-site and reachable by phone. The nurse notices a personal support worker wiping a commode with a cloth and placing it back in the hallway. No single rooms are available. The outbreak poster is not up. The nurse has not yet notified infection prevention and control (IPAC).
1. What is the nurse's first priority action?
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The first priority is to stop transmission: place all symptomatic residents on contact precautions, dedicate equipment and staff where possible, perform hand hygiene, and notify IPAC and the manager immediately. Do not wait for laboratory confirmation to isolate. Stop new admissions to the affected area until IPAC advises; the incoming ED patient may need another unit. Clean shared surfaces with a bleach-based product. The nurse should also correct the PSW cleaning the commode in the hallway, because that equipment should not be reused without disinfection.
2. How should the nurse manage the shared bathroom and the wandering resident?
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Cohort symptomatic residents together and give them a dedicated commode or bathroom if possible. If a shared bathroom must be used, schedule it and clean with bleach between residents. The wandering resident needs frequent redirection and a dedicated staff member, because she will otherwise contaminate shared spaces. Close group activities and remove shared food and utensils. Assign staff who care for symptomatic residents only if staffing permits; if not, care for them last and change PPE. Document the plan.
3. What surveillance and communication steps are required?
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Start a line list of cases, symptoms, onset, and location, and monitor for 48 to 72 hours after the last new case. Exclude symptomatic staff for 48 hours after symptoms resolve, per policy. Post outbreak signage, restrict visitors as advised, and communicate with IPAC and public health. Ensure cleaning schedules are increased, PPE is ordered, and the manager is updated. Collect stool specimens only if IPAC requests them. The goal is early detection and breaking fecal-oral spread.