Winter vomiting bug shuts hospital wards

"Dozens of hospital wards closed over fears of norovirus outbreak," The Daily Telegraph has reported today. The paper said that health officials have issued a warning about the serious threat posed by the winter diarrhoea and vomiting bug, norovirus, after wards had to be closed at eight UK hospitals. Reports of closed wards have also hit the headlines of many local newspapers.

Norovirus is a highly contagious virus and the most common infectious cause of diarrhoea and vomiting in the UK. It is often called the ‘winter vomiting bug’ as its peak season is over the winter months. It is easily spread between people, usually by an infected person not washing their hands properly after using the toilet. The most effective prevention is thorough hand washing.

Outbreaks occur every year in environments where people are together in close proximity; for example, in hospital wards, schools, nursing homes and even cruise ships. Aside from hand washing, people who are infected should keep themselves isolated to try to stop others catching this highly contagious virus. When outbreaks occur in hospitals, closure of wards is often required to stop an outbreak spreading.

What is norovirus?

Norovirus, the winter vomiting bug, is a highly contagious virus and the most common cause of diarrhoea and vomiting (gastroenteritis) in the UK. The predominant symptoms of diarrhoea and vomiting may be accompanied by other symptoms such as stomach cramps, fever and headaches. The incubation period (from when a person catches the virus until they develop symptoms) is usually one to two days, and symptoms last from one to three days.

The infection is self-limiting, meaning a person should easily recover from the illness without treatment. However, with all diarrhoea and vomiting bugs, there is a risk of dehydration and certain individuals – particularly the elderly or those also suffering from medical conditions – can be at risk from a prolonged course of illness. This makes it important to try to limit outbreaks of such bugs at hospitals.

Why is the story in the news today?

The story has made the headlines today as there have been several reports from hospitals and NHS trusts that have closed wards and are trying to restrict visitors to prevent the virus spreading further to uninfected and vulnerable patients.

Hospitals currently reporting ward closures due to outbreaks include:

• Doncaster Royal Infirmary and Montagu Hospital have closed a number of wards to new patient admissions. They have advised visitors to stay away and avoid risking bringing infections into hospital where vulnerable patients may be affected. 
• North West London Hospitals say that they currently have a number of wards closed due to norovirus outbreaks, and similar to Doncaster, they advise that visitors should check with the hospital ward before visiting patients.
• South Warwickshire NHS trust reports that they have closed Malins and Nicholas Wards of Warwick Hospital to all non-essential visiting.
• Bedford Hospital reports that the Richard Wells Ward has been closed to stop the spread of norovirus among patients, visitors and staff. It also advises against non-essential visiting.

Hospitals advising otherwise healthy people who have the diarrhoea and vomiting illness not to come to hospital, include:

• St George’s Healthcare NHS trust has issued a bulletin urging otherwise healthy people with diarrhoea and vomiting to avoid coming into hospital if they are unwell – ‘for at least 48 hours after the symptoms have stopped. People bringing the virus into the hospital are putting vulnerable patients at risk.’
• Isle of Wight NHS Trust, which runs St Mary’s Hospital in Newport, has similar advice, asking for at least 48 hours to have passed since last symptoms before visiting. The trust is trying to treat as many people as possible who have symptoms in their own homes.
• Royal Free Hampstead NHS Trust are offering advice across north London on preventing norovirus infection and dealing with the symptoms at home if people suffer from the virus.

What does the Health Protection Agency say about hospital outbreaks of norovirus?

The Health Protection Agency (HPA) publishes regular updates throughout the year on the number of norovirus outbreaks that have occurred in hospitals. The latest figures from the HPA reported that between November 28 and December 11 2011, they received 15 reports of suspected or confirmed norovirus outbreaks in hospitals in England, and 12 of these (80%) had led to ward closures or restricted admissions.

The HPA reports in the overall number of norovirus outbreaks in last year’s season (running from July 2010 – June 2011) there were a total of 1,164 suspected or confirmed hospital outbreaks, of which 886 (76%) led to ward closures. Of these, 716 (62%) were confirmed to be due to norovirus through laboratory testing of faecal samples. The HPA said that so far, since July of this year there have been 1,505 reports of norovirus. Over the same time period last year there were only 1,129 reports, so this year has so far seen a 33% increase.

Why is it important to close hospital wards and limit hospital visiting?

Norovirus is highly contagious. It is easily spread from person-to-person, from hand-to-mouth, through the 'faecal-oral' route. This means that is it usually spread by someone who is infected with the virus shedding it in their bowel movements and not washing their hands thoroughly enough afterwards. They then transfer the virus either directly to other people or indirectly by the surfaces they touch.

What makes the virus even more contagious is that only a few viral particles need to be swallowed in order for a person to become ill, and the virus is highly resilient and can survive on surfaces for long periods. Therefore, you only need to touch something that is contaminated to transfer a few of these virus cells from your hand into your mouth in order to become ill. The virus can also be spread (less commonly) from particles of vomit becoming airborne and then being swallowed by another person.

Because it is so contagious the most important thing to do in a hospital where there is an outbreak, is to group people together who have the illness and prevent others from coming in who can then pick up the virus on their hands and either catch it themselves or spread it elsewhere.

How can I stop myself and others catching norovirus?

The two most important ways to prevent the spread of norovirus are thorough hand washing and isolation or exclusion of infected individuals until they have completely recovered from their symptoms.

If hands are washed and dried properly, they can be completely safe from viral and bacterial contamination. These hygiene tips should be followed:

• hands need to be rinsed and then enough liquid soap used to thoroughly cover all surfaces of the hand
• the hands then need to be rinsed again and dried thoroughly with paper towels or with an air drier as wet hands transmit microbes much more easily than dry hands
• avoid sharing a hand towel with someone who has been infected
• always wash your hands before and after eating, after using the toilet, and - if visiting a hospital - before and after entering a ward or unit, and before and after visiting an individual patient
• do not rely on alcohol hand gels alone

This advice should apply every day, not just when there has been outbreak of norovirus.

Anyone who has been infected should keep away from others – stay home from school, away from work, or in your room (if in a hospital ward or nursing home) until you are free from symptoms for 48 hours. This 48-hour rule applies to diarrhoea and vomiting illnesses from any cause. This is to prevent the risk of you spreading the virus to others.

The overall health messages to try to prevent and control the spread of outbreaks of norovirus in hospital or elsewhere are:

• always pay attention to hand washing and drying
• if you have had diarrhoea and vomiting yourself, stay at home and away from others until you have been free from symptoms for 48 hours
• if you are visiting someone in hospital, follow the hospital’s advice if there are any ward closures, and pay strict attention to hand hygiene