Download Norovirus Outbreak on Campus - Environment, Health and Safety

Norovirus Outbreak on Campus
Mary Crabtree, Workplace Safety Manager
Peter A. Reinhardt, Director
Department of Environment, Health & Safety
University of North Carolina at Chapel Hill
Presented at the 50th Anniversary International Conference of the Campus
Safety, Health and Environmental Management Association, July 5th, 2004
Presentation Objectives
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General Information
Review of UNC’s Norovirus Outbreak
Actions taken within UNC
Debriefing within UNC
Attendance at NCSU’s Debriefing
Lessons Learned
Recommendations for Other Institutions
General Information
• In January 2004, EHS
implemented a Hand
Washing Campaign
with Orange County
Health Dept.
• Goal: To reduce
overall risk to
infectious diseases and
food-borne illnesses
Carolina Dining Services
• Two full dining
facilities
• Four Snack facilities
• ARAMARK:
Contractor for food
services
• Serve 7,000 meals/day
in full dining halls
Review of UNC’s Norovirus Outbreak
• On January 21,
2004, Sixty-six
students reported to
Student Health
Services
• Symptoms: nausea,
vomiting, diarrhea,
acute gastroenteritis
Review of UNC’s Norovirus Outbreak
Initial Outbreak
120
100
80
SHS
Not Seen
Total
60
40
20
0
Jan. 20
*Jan. 21*
Jan. 22
Jan. 23
About Norovirus
Norovirus Infection Symptoms
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Vomiting
Diarrhea
Nausea
Abdominal cramps
Headache, muscle aches
Fever (minority)
Dehydration
Up to 30% may be asymptomatic
Adapted from Strategies for Norovirus Infection Control Aboard Cruise Ships, Robert E. Wheeler, MD, 2003.
About Norovirus
Norovirus-Public Health Aspects
• 23-25 million cases in 2002
• About 8% of the U.S. population
• Restaurants, schools, dormitories at risk
Adapted from Strategies for Norovirus Infection Control Aboard Cruise Ships, Robert E. Wheeler, MD, 2003.
About Norovirus
Norovirus Infection
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Infectious dose of 10-100 virus particles
24-48 hour incubation period
12-60 hour duration of illness
A “mild” and short-lived illness
Treatment may indicate IV fluids
Viral shedding of 3 weeks or more
Adapted from Strategies for Norovirus Infection Control Aboard Cruise Ships, Robert E. Wheeler, MD, 2003.
About Norovirus
Transmission
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“Oral-fecal” route
Food (39%)
Hands, person-to-person (12%)
Water (3%)
Also environmental surfaces: carpets,
toilets, etc.
Adapted from Strategies for Norovirus Infection Control Aboard Cruise Ships, Robert E. Wheeler, MD, 2003.
About Norovirus
Modes of Transmission by Food
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Food sources (i.e., food arrives contaminated)
Preparation
Food handlers
Customers
Most at risk: ready-to-eat foods that require
handling but no subsequent cooking (e.g., salads)
Adapted from Strategies for Norovirus Infection Control Aboard Cruise Ships, Robert E. Wheeler, MD, 2003.
About Norovirus
Norovirus Characteristics
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Highly contagious
Multiple modes of transmission
Stable in the environment
Resistant to routine disinfection methods
Carriers may not be symptomatic
Adapted from Strategies for Norovirus Infection Control Aboard Cruise Ships, Robert E. Wheeler, MD, 2003.
Review of UNC’s Norovirus Outbreak
Second Peak – consistent with secondary
Norovirus transmissions
20
15
10
SHS
5
0
Jan. 28
Jan. 29
Jan. 30
UNC Student Health Service Epicurve
Action Taken by Student Health Services
• Immediately notified Orange County Health
Department, who began an investigation.
• Enacted Disaster Plan and notified EHS
• Assisted with Incident Communications
Plan
• Posted “Student Illness Update” on websites
Initial Health Department Findings
Based on calls to students who came to SHS, their roommates and other contacts.
Environment, Health & Safety
• Established contact with entities that would be
involved (i.e., Housekeeping, UEOHC, Athletics,
Housing & Residential Education)
• Coordinated Incident Communications Plan
• Prepared clean-up packets for Residential Halls
• Discussed clean-up procedures with Athletics
(Men’s Basketball Game January 24)
• Advice to student dinning operations to deal with
rumors, business impact, etc.
Action Taken Within UNC
Cleaning Guidelines for Housekeepers
Housekeeping Department
• EHS met with Housekeeping Zone Managers
– Review Clean-up procedures
– Identification of areas which students exhibit illness
• Verify that available cleaners are sufficient
• Required cleaning may exceed staff capabilities
• Need feedback from housekeepers as to extent of
cleaning needs
Housing and Residential Education
• Distributed EHS clean-up kits to residential
halls
• Assisted with Incident Communications
Plan
• Prepared & distributed illness survey
(for students who did not go to SHS for
treatment)
Carolina Dining and ARAMARK
• Placed “Hand Wash” tents on
dining tables
• Placed additional hand washing
stations throughout dining halls
• Reviewed staff absenteeism
records
• Fully assisted health investigators
• ARAMARK’s SOP is to save food
samples
• ARAMARK offered corporate
investigation and communication
resources
Calendar of Outbreak Events
Sunday
Monday
January 18
MLK Day 19
Point
Source
20
26
UNC Closed
Winter
Storm
27
2
3
10
25
February 1
Tuesday
Wed
Thursday
21
22
Friday
Saturday
23
66
students
sought
treatment
at SHS
24
Virginia
basketball
game
28
29
Norovirus
confirmed
30
31
4
5
6
7
11
12
13
14
NCSU
basketball
game
OCHD
identifies
source
8
9
Start of
NCSU
outbreak
County Health Department’s Finding
Final Results, February 2, 2004:
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Overall, about 250 students became ill during this outbreak
Outbreak from a single source
Time limited
Common environmental exposure
Five times more likely in one location of dining hall
Four times more likely if the student ate salad bar
No point to a specific salad item
No procedural problems found with the Dining Services
Debriefing Within UNC
• UNC’s Debriefing was conducted on
March 2nd
• Parties involved:
– Environment, Health & Safety
– Student Health Services
– Carolina Dining Services (including
ARAMARK)
– Housing & Residential Education
– Housekeeping Services
Debriefing Within UNC
• Reviewed Orange County Health Department
Findings
• Effectiveness of Communications
• Involvement of key groups for decision making
• What if any other potential resources were
needed?
– Further analysis by the UNC School of Public Health
• What other action can be taken to prevent/
mitigate reoccurrence?
Attendance at NCSU’s Debriefing
• Compare experiences
and share best
practices.
• NCSU conducted a
highly visible
handwashing
campaign
Attendance at NCSU’s Debriefing
• Paralleled UNC’s case
• After 6th case at SHS,
implemented survey—
a best practice UNC
could adopt.
• Saw 410 students from
February 9th to March
4th—longer duration.
• No source identified.
Lessons Learned
• Delay in Health Department investigation results
limited University’s response, so—to compliment
the Health Department—we plan to initiate
medical survey at the time of complaint.
• Immediately review geographic data–who ate
where and when.
• Consider using epidemiology resources from
UNC’s School of Public Health.
• Continue contingency planning with outside
parties.
Other Plans of Action
• Presentation to the North Carolina Public Health
Training and Information Network
• Plans for a more aggressive hand washing
campaign for winter of 2004-5, including
additional hand cleaners in dinning halls in
strategic locations.
• Consider arrangements to purchase and acquire
effective cleaners overnight.
• If UNC staff cannot manage cleaning, consider
hiring cleaning contractor.
Recommendations for Other Institutions
• Establish emergency communication procedures
• Openly discuss contingency plans and
responsibilities internally and with public health
officials
• Conduct drills (i.e. table top) to identify needs
• Review contracts of food service and establish a
working partnership
• Implement stronger health campaigns
• Share information
How Our 2003 SARS Experience Helped
• Chancellor’s SARS Task
Force—Fall 2003
– Promote handwashing
– Housing workshop on
response to communicable
disease outbreak
• Everyone better
understands resources
available at the University,
County and the State.
• However, we would rather
not make an “outbreak”
presentation at the 2005
CSHEMA conference.
• Strengthened internal and
external relationships,
communication and
decisionmaking. Mark Stinson, an auto mechanic from
Chatham County NC, has survived four
lightning strikes—in 1985, 1993, 2000 and
2002. Although his resulting disabilities are
“a never-ending nightmare,” he says, “I’m
still fascinated by lightning.”