Norovirus

Key points

• Norovirus is a common gastrointestinal infection that tends to occur during autumn and winter.
• Noroviruses are highly infectious and are transmitted easily from person to person, contaminated food or water or by contact with contaminated surfaces or objects.
• Outbreaks are common in areas such as hospitals, care homes and schools due to population proximity.
• Although norovirus gastroenteritis is generally mild and of short duration, the illness can be severe among vulnerable population groups such as young children and the elderly.

Symptoms

• Acute onset of non-bloody watery diarrhoea and vomiting which may be projectile.
• Abdominal cramps.
• Muscle pains.
• Headache.
• Malaise.
• Low grade fever.

Transmission

• Contact via hands.
• Person to person via faecal to oral route.
• The virus particles can be inhaled or ingested when a patient vomits.
• Ingestion of contaminated food and drink.
• Environmental contamination from faeces or vomit.

Incubation period

Typically, between 12 to 48 hours.

Period of infectivity

Whilst individuals are symptomatic and for a further 48 hours after the cessation of symptoms.

Prolonged shedding of the virus can occur in persons that are immunocompromised and young children.

Treatment

• Dehydration is the most common complication and the avoidance of, or correction of this is the mainstay of clinical treatment.
• The elderly and immunosuppressed are particularly vulnerable to the effects of dehydration and should be monitored and treated accordingly.

IPC precautions

• Standard precautions required. A face mask must be worn if patient is vomiting.
• Obtain sample.
• Isolate patient in a single room or cohort several patients with the same infection in a bay until patient is asymptomatic for 48 hours
• Use liquid soap and water for hand hygiene.
• Treat linen as contaminated (red alginate bag) and waste as infectious (orange waste bags).
• Twice daily environmental cleaning with chlor-clean (1,000 ppm).
• Decontaminate patient equipment thoroughly with Clinell universal wipes.
• Terminal clean of the room required when isolation is discontinued.
• Dedicated commode if room is not en-suite.
• Notify the IPC team of any suspected or confirmed inpatient cases:
  • Email: rdash.ipcteam@nhs.net
  • Telephone: 03000 214872

Additional advice

• Symptomatic patients must not be routinely transferred to other healthcare facilities and routine investigations should be postponed if possible. If unavoidable the ward or department at the receiving facility must be informed, as well as the transport or ambulance service.
• Patients should only be discharged to a residential setting when they have been asymptomatic for at least 48 hours. Patients can be discharged to their own home if they still have diarrhoea but must be improving clinically.
• Visitors should be advised to postpone their visit although the wellbeing of the patient should also be considered. They must be informed of the infection risk and provided with advice on minimising risk.

Page last reviewed: March 12, 2024
Next review due: March 12, 2025