Norovirus is the leading cause of acute gastroenteritis outbreaks in the United States. Long-term care facilities (LTCFs), home for nearly 2.5 million people, are the most common setting for such outbreaks. Epidemiologic studies have identified vomiting, which occurs among more than 50% of symptomatic norovirus cases, to be a strong risk factor for norovirus transmission. Vomitus clean-up guidelines are available but the underpinning evidence base is limited resulting in procedural steps being insufficiently detailed (e.g., radius of clean up and disinfection procedures for carpet). This lack of detail could result in multiple interpretations of how to execute a clean-up step possibly resulting in the ineffective removal of norovirus, necessary to interrupting transmission. We assert that detailed, ordered procedural steps are the foundation of proper implementation. In this multi-disciplinary study, we will conduct translational research to fill key knowledge gaps impeding development of detailed infection control procedures for vomitus. By filling these knowledge gaps we will be poised to recommend detailed procedural steps for vomitus clean-up. Specifically, we propose four research aims:
Aim 1 : Quantify the role of vomiting as a route of transmission in LTCF norovirus outbreaks. Sophisticated analytical methods will be employed to analyze existing outbreak data to quantify the role of vomiting in norovirus transmission in LTCFs.
Aim 2 : Measure dispersion of vomitus into the environment. Laboratory-controlled experiments will be performed to measure dispersion of fluorecein-containing simulated vomitus on surfaces and in air using full- size simulated vomiting system.
Aim 3 : Determine the efficacy of broad-spectrum disinfection strategies on carpet. The efficacy of chemical- based and non-chemical-based disinfection strategies will be tested on contaminated carpet using norovirus surrogates and C. difficile.
Aim 4 : Determine norovirus persistence in the environment. The persistence of human noroviruses on hard and soft surfaces will be determined using a very new culture system for norovirus available only in two laboratories (Baylor College of Medicine and the Centers for Disease Control and Prevention). The findings from these four studies will be used to populate the evidence base to inform procedural changes that can ultimately decrease disease and death attributed to norovirus transmission in LTCFs. The vomitus clean-up procedures developed through our work can also be applied to all healthcare settings, including LTCFs, thereby broadening the impact of this work.
Long-term care facilities, home for nearly 5 million people, are the most common setting for norovirus outbreaks. Epidemiologic studies have identified vomiting, which occurs among more than 50% of symptomatic norovirus cases, to be a strong risk factor for norovirus transmission. Filling knowledge gaps that impede the development of evidence-based, detailed vomitus clean-up will allow us to move towards the goal of preventing norovirus-associated disease and deaths resulting from improper environmental sanitation.
