Norovirus – what to do when the superbug strikes your practice

Its beginning. The season of the stealthy virus that turns the body into a temporary zombie explosion, an infection whose symptoms most closely resemble the force and velocity of a volcanic eruption. Norovirus

Norovirus may be snaking its way round your office, or your kids may have dragged it back home from school – kicking and, well, puking.

Norovirus is notorious for sinking the stomachs of holiday makers on cruise ships. It is often dubbed ‘the winter vomiting bug’, although it can strike at any time – often unannounced. It’s more common in the winter months due to people spending more time in doors – turning cheery classrooms, hospitals and other shared spaces into germ-breeding factories and, to add fire to flame, norovirus has been deemed the ‘superhero’ of bugs for its sheer infectiousness and indestructability.

Forget alcohol-based hand sanitisers – ethanol can’t break down the ‘capsid’ or barrier protecting the virus. Norovirus just hangs out on your skin until you ingest it or spread it onto a surface for some other unsuspecting soul to ingest instead – like your postie, your neighbour’s three-year-old or your Grandma.

Norovirus is a particular hazard for the health service. Symptoms such as projectile vomiting and diarrhoea, although dramatic at the time, are usually short lived and, ultimately, harmless; but this virus will cling to surfaces with tremendous sticking power, meaning it’s the gift that keeps on giving…and giving.

News outlets bewail the closure of vital hospital wards in the name of norovirus – where patients are most vulnerable. Whole schools shut their doors with the aim of eradicating the plague clinging to their corridors for good. And, although the healthy bounce back quickly, the elderly and the very young may be left dangerously dehydrated and in need of hospital care. The tabloids will have you believe its puking Armageddon but, when Norovirus unleashes itself on your practice or family, the alarming thing is, they aren’t far wrong.

So – what can a practice do to prevent norovirus infection and, when it does strike, how can staff protect themselves and their patients from a truly miserable few days?

Disinfecting a practice or home crawling with norovirus

You’ve probably heard this before but here are three cleaning tips for extra stringency – because that’s the key with norovirus.

1. Bleach! It’s the only disinfectant that will obliterate norovirus for good. Clean all contaminated surfaces with a 0.1% bleach solution, including hard surfaces, toilets, sinks, and door handles.
2. If someone has vomited on the floor of the practice, use paper towels to soak up the liquid and remove the visible contamination. Place the dirty paper towels in a sealable plastic bag. Steam-clean carpets to 80 degrees celsius (or 170 fahrenheit) for five minutes or 100C (212F) for one minute to inactivate the virus. Do all the above wearing disposable gloves.
3. When finished cleaning the toilet, flush it with the lid and toilet seat down so particles aren’t aerosolised and allowed to settle on surrounding surfaces – the floor, the sink, the hand dryer, and so on.

How to help your patients and staff understand proper hand washing

1. Consider putting a poster up in your practice that advises patients with symptoms of vomiting or diarrhoea to call NHS 111 or their GP for advice instead of coming into the surgery; this stops infected people spreading norovirus to others. If symptoms persist for longer than 48 hours or are worrisome (bloody vomit, diarrhoea), make an in-person appointment for further evaluation and treatment if necessary.
2. Another helpful poster is one which demonstrates the correct hand-washing method. It only takes one glance at this article to realise most people are unsanitary oafs covered by an astonishingly thin veneer of civilisation. Apparently, a whopping 34% of people don’t wash their hands after visiting the bathroom. If that doesn’t have you clutching your stomach in agony, then norovirus will.
3. Keep infected staff off work for a minimum of 72 hours. I know, ouch. But it might just stop an impending employee diarrhoea domino reaction at the first fallen, feverish staff member.
4. Offer norovirus training or norovirus refresher training to your staff – especially non-clinicians who may not have received this training before.

Finally, spare a thought for the emetophobes (those with a diagnosable phobia of vomit or vomiting) out there for whom norovirus season is legitimately more terrifying than an alien invasion; this writer is a card-holding emetophobic and can vouch for this. Pointing these anxious patients in the right direction – such as counselling – may really change someone’s life. The one thing worse than norovirus is being cripplingly afraid of it.

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