outbreaks of gastroenteritis in institutions are caused by norovirus, and the
following control guidelines apply to viral gastro outbreaks (including
norovirus, rotavirus and sapovirus). However, it is also important to consider
toxigenic pathogens (C. perfringens and C. difficile), and bacterial pathogens
(Salmonella and Campylobacter), as possible causes of gastroenteritis outbreaks
in hospitals and aged care facilities.
In the event of a gastroenteritis outbreak there are a number of precautions that will prevent the spread of infection and control the outbreak.
Planning and management
Form an outbreak team to enable decisions, communication and
development of strategies to manage the outbreak.
- Hand hygiene is the most
effective way of controlling gastroenteritis pathogens. Hand hygiene must be
performed before and after all patient contact. Hand hygiene should occur
following contact with the affected patient’s immediate environment and following
all specimen contact, regardless of whether hands are visibly soiled. If
visibly soiled hand washing with soap and water is recommended.
- Hands should always be washed
after personal toileting, before preparing or eating food, and after removing
gloves or other personal protective equipment (PPE).
- Hands should be washed vigorously
with liquid soap and water for a minimum of 15 seconds rubbing all surfaces of
the hands and wrists.
- Nails should be kept short. False
fingernails, nail extenders, nail polish and jewellery can restrict adequate
cleaning of hands and harbour microorganisms including the virus and are
therefore not recommended.
- Refer to the NSW Health website for information on hand hygiene and to the NSW Infection Prevention and Control Practice Handbook
- Patients must be educated on the
importance of hand hygiene and given access to hand hygiene facilities.
Standard and additional (transmission-based) precautions
- Standard precautions should be
used for ALL patients.
- Additional precautions (outlined
below) should be used for any patient suspected or confirmed to be infected.
- Contact and droplet precautions
- Contact precautions includes
wearing gloves and a plastic apron or impervious gown when having contact with
the patient or the patient’s environment, especially when attending to patient
toileting and hygiene.
- Protective eyewear and mask must
be worn when there is the potential of vomit or faecal splashing.
- A mask should also be worn when
there is the potential for aerosol dissemination. This may occur when attending
a vomiting patient, toileting an affected patient, changing and handling soiled
linen or any faecal soiled waste, attending a patient’s personal hygiene care,
disposing of faeces, or cleaning an affected patient’s room or environment.
- If the toilet has a lid, the lid
of the toilet should be closed before flushing to stop faecal aerosols being
- PPE should be removed before
leaving the affected patient’s room. Hands should be washed after removing PPE
in the room and after leaving the room, following the sequence for removing
from the Infection Prevention and Control Practice Handbook
Personal Protective Equipment (PPE)
- It is important that staff are
competent in the correct wearing and removal of PPE to avoid inadvertently
- PPE should be donned before
entering the affected isolation area. Note that cloth gowns should not be worn
as they are not impervious or fluid resistant.
- PPE must be removed in a way that
does not allow transmission of gastroenteritis virus to the wearer. Gloves are
likely to be heavily contaminated and should be removed first.
- The steps in removing personal
protective equipment are:
- Remove gloves by rolling back from the wrist. Do not touch
- Wash hands.
- Remove mask by touching the tapes only, avoiding contact
with the front of the mask, and discard in the waste bin.
- Remove goggles/visor/shield.
- Remove gown and fold carefully with contaminated side in and
place in the waste bin.
- Immediately decontaminate hands well using an antimicrobial
skin cleanser and water. If not immediately available, use an alcohol hand gel
or rub, and wash hands as soon as possible.
Patient movement/single room or cohort
- Affected (suspected or confirmed)
patients should be nursed in isolation with designated toilet/bathroom
facilities, or cohorted with other affected patients. Caution is required when
cohorting patients because gastroenteritis may be caused by different infectious
- Suspected or confirmed patients
with gastro must not attend shared areas such as eating areas, gymnasiums or
- Avoid transfer of affected
patients to unaffected areas to prevent spread of the infection.
- If a non-symptomatic patient in a
non-closed ward of a hospital or aged care facility in the midst of a
gastroenteritis outbreak is to be transferred from the facility, a transfer
letter should accompany the patient advising the new hospital or aged care
facility of the outbreak at the old facility. The ambulance or transport
services should also be notified before transferring patients. The new facility
can then monitor the patient and implement the gastro pack immediately on any
development of gastro symptoms without waiting for an additional case to occur.
- Hospital wards or aged care
facilities with an outbreak that have transferred patient to acute facilities
(such as hospital or intensive care) should have strategies in place to receive
patients back even if outbreak persists.
- Any shared patient care or mobile
equipment must either be designated to the affected patient or cleaned prior to
using on another patient.
- PPE, including mask, should be
worn by people cleaning areas contaminated with faeces or vomitus.
- Once an outbreak has been
identified, the cleaning of the affected area should be increased to twice
daily. Particular attention should be given to environmental surfaces
frequently touched such as door handles, taps.
- When cleaning toilet and bathroom
areas, special attention should be given to cleaning all potentially
contaminated areas, including toilet roll dispenser, toilet seats and lid,
flushing handle or flushing mechanism, safety handles, shower chair, light
switches, regardless of whether they are visibly soiled or not.
- Soiling due to vomiting and
diarrhoea should be cleaned immediately with water and neutral detergent. It is
then recommended that a clean environmental disinfection of the area be
performed, e.g. freshly prepared bleach solution which provides a concentration
of 1000ppm of available chlorine. Note that some hypochlorites are corrosive
and may bleach furnishings and fabrics. Contaminated carpets should be cleaned
with neutral detergent and hot water, then steam cleaned.
- Those responsible for
decontamination and cleaning should not be food handlers.
- Isolation areas should be cleaned
using yellow colour coded equipment designated for the affected area. The
detergent and disinfectant used must be effective against gastroenteritis
- PPE should be worn when handling
used linen from an infected patient.
- Used linen, whether visibly
soiled or not, should not be agitated to cause the spread of the virus through
- Linen should be bagged and tied
at the point of generation.
- Linen soiled with vomitus or
faeces should be bagged, transported and stored in leak proof bags.
- The laundering of linen must be
consistent with Australian Standard AS/NZS 4146: Laundry Practice.
- Minimise as much as possible the
circulation of staff between affected and unaffected areas. Where possible
designated staff should care for affected patients.
- Staff with gastrointestinal
symptoms should leave work immediately and not return to work until 48 hours
after their last episode of vomiting or diarrhoea.
- Food handlers should be excluded
from food preparation until at least 48 hours after their last episode of
vomiting or diarrhoea.
- During the course of an outbreak,
staff who develop symptoms prior to commencing work should inform their
- Recuperating staff may shed the
virus for a number of weeks after their symptoms have disappeared, therefore
the importance of hand hygiene and personal hygiene on returning to work should
- Visiting should be minimised and
patients informed of the required precautions.
- Children and immunocompromised
individuals should be discouraged, where possible, from visiting during an
- Visitors should be instructed on
the application and removal of PPE, hand hygiene and about appropriate intimate
contact such as kissing.
- Closure/re-opening of a ward
- Temporary closure of an affected
facility or ward may be necessary to allow for adequate cleaning and
disinfection after the last affected patient has recovered.
- A closed facility or ward may be
reopened 48 hours after the last episode of vomiting and diarrhoea of the last
Closure/re-opening of a ward
closure of an affected facility or ward may be necessary to allow for adequate
cleaning and disinfection after the last affected patient has recovered.
closed facility or ward may be reopened 48 hours after the last episode of
vomiting and diarrhoea of the last affected patient.
- Eating utensils, such as
crockery, cutlery and food trays, should be washed and cleaned in the normal
manner using hot water and detergent. No special requirements are necessary.
Staff delivering or collecting food trays should wash their hands with liquid
soap and running water or use alcohol based rub on leaving the patient area.
These guidelines should be read in conjunction with
For further information please call your local Public Health
Unit on 1300 066 055.