Norovirus outbreaks in health care facilities are common November to April. Norovirus spreads easily from person to person in long term care facilities, hospitals, assisted living residences, and other health care settings.
About norovirus
Learn what norovirus is, how it makes you sick, how it spreads, and how you can prevent yourself and others from getting sick.
Reporting norovirus outbreaks
A norovirus outbreak is defined as an increase in people experiencing diarrhea or vomiting above what is normal for a facility, with regard to time and place. This includes illness in both patients/residents and staff. There does not need to be a diagnosis or laboratory testing for a group of ill people to be considered an outbreak.
Suspected norovirus outbreaks should be reported by health care facilities as soon as they are identified by completing the following online form: Gastrointestinal Illness Healthcare Cluster Reporting Form
After submitting the form, the local board of health or a DPH epidemiologist will call the submitter to provide guidance on outbreak management and control.
For any questions regarding the reporting, investigation, or control of suspected norovirus outbreaks, please contact your local board of health, or the DPH Division of Epidemiology at (617) 983-6800.
The following health care facilities have additional reporting requirements:
- Long term care facilities must also report norovirus outbreaks to the DPH Bureau of Health Care Safety and Quality using the web-based Health Care Facility Reporting System (HCFRS)
- Assisted living residences should also report incidents to the Assisted Living Certification Unit at the Executive Office of Aging and Independence (AGE) per 651CMR 12.04(11). All Reportable Assisted Living Incident Reports (individual and/or facility wide) should be submitted via AGEs Dynamics incident reporting system which is accessible to ALR staff with an enabled user account allowing access to the system. Information on the requirements for incident reporting to AGE should be sent to via email to ALRincidentreport@mass.gov
Prevention and control recommendations for norovirus outbreaks
Controlling outbreaks of norovirus in health care settings requires early recognition of symptoms and prompt infection prevention and control measures. These include the following:
- Cohort symptomatic patients/residents and minimize staff floating.
- Place symptomatic patients/residents on Standard plus Contact precautions for the duration of their illness. Symptomatic individuals should remain on precautions for 72 hours past the resolution of their symptoms during norovirus outbreaks.
- Adhere to personal protective equipment (PPE) use according to Contact and Standard Precautions: Don gowns and gloves upon room entry. Use a surgical or procedure mask and eye protection or a full-face shield if there is an anticipated risk of splashes to the face during the care of residents, particularly among those who are vomiting.
- Exclude staff and volunteers who are diagnosed with norovirus, or who are suspected to have norovirus (sudden onset of vomiting and/or diarrhea), from the following responsibilities until 72 hours after resolution of symptoms or date of specimen positive for norovirus, whichever occurs last (regulation 105 CMR 300):
- Handle or prepare food
- Handle clean dishes or utensils
- Dispense medication by hand
- Set up trays for patients to eat
- Feed or assist patients in eating
- Give oral medications
- Give mouth/denture care
- Dedicate equipment, or use disposable equipment, for patient/resident care to minimize transmission (i.e. stethoscope, blood pressure cuffs, vital sign machines, etc.). If this is not possible, equipment must be cleaned and disinfected according to the manufacturer’s instructions for use before every use with another patient/resident.
- Actively promote adherence to glove use and hand hygiene among health care personnel. Patients/residents and visitors should be educated about proper hand hygiene. Handwashing with soap and water is the most effective way to prevent norovirus in the setting of an outbreak. Hand sanitizer should be used as a supplement to handwashing, but not as a replacement during an outbreak. Hand sanitizer is not effective against norovirus.
- Increase the frequency of hand hygiene audits on affected units and provide feedback to staff.
- Increase environmental cleaning and disinfection. For norovirus outbreaks, the CDC recommends either diluted chlorine bleach or U.S. Environmental Protection Agency (EPA) approved disinfectants. A list of hospital disinfectants registered by the EPA with specific claims for activity against noroviruses can be found here: Registered Antimicrobial Products Effective Against Norovirus | EPA
- Consider temporarily pausing new admissions to the affected unit(s) in the facility during an outbreak.
- Notify family members and visitors of the outbreak and educate them about preventive behaviors, especially appropriate hand hygiene, if they visit.
- Consider pausing group activities and group dining, depending on how widespread the outbreak is.
- If patients/residents require transfer to another healthcare facility, notify EMS or patient transport and receiving facilities verbally and in writing to ensure continuation of contact precautions.
Exclusion of staff and volunteers
Staff and volunteers in health care settings who are diagnosed with norovirus, or who are suspected to have norovirus (sudden onset of vomiting and/or diarrhea) who have any of the following responsibilities must be excluded from performing them until 72 hours after resolution of symptoms or date of specimen positive for norovirus, whichever occurs last, per regulation 105 CMR 300:
- Handle or prepare food
- Handle clean dishes or utensils
- Dispense medication by hand
- Set up trays for patients to eat
- Feed or assist patients in eating
- Give oral medications
- Give mouth/denture care
Additional resources
- Infection prevention and control guidance in long term care settings | Mass.gov
- Norovirus Prevention and Control Guidelines for Healthcare Settings | CDC
- Key Infection Control Recommendations for the Control of Norovirus in Healthcare Settings |CDC
- Registered Antimicrobial Products Effective Against Norovirus | EPA