Mary Crabtree, Workplace Safety Manager Peter A. Reinhardt, Director Department of Environment,...
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Mary Crabtree, Workplace Safety Manager Peter A. Reinhardt, Director Department of Environment, Health & Safety University of North Carolina at Chapel Hill Presented at the 50 th Anniversary International Conference of the Campus Safety, Health and Environmental Management Association, July 5 th , 2004 Norovirus Outbreak on Campus
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Transcript of Mary Crabtree, Workplace Safety Manager Peter A. Reinhardt, Director Department of Environment,...
Mary Crabtree, Workplace Safety Manager
Peter A. Reinhardt, Director
Department of Environment, Health & Safety
University of North Carolina at Chapel HillPresented at the 50th Anniversary International Conference of the Campus Safety, Health and Environmental Management Association, July 5th, 2004
Norovirus Outbreak on Campus
Presentation Objectives
• 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
• Two full dining facilities
• Four Snack facilities• ARAMARK:
Contractor for food services
• Serve 7,000 meals/day in full dining halls
Carolina Dining Services
Review of UNC’s Norovirus Outbreak
• On January 21, 2004, Sixty-six students reported to Student Health Services
• Symptoms: nausea, vomiting, diarrhea, acute gastroenteritis
0
20
40
60
80
100
120
Jan. 20 *Jan. 21* Jan. 22 Jan. 23
Initial Outbreak
SHSNot SeenTotal
Review of UNC’s Norovirus Outbreak
About Norovirus
Norovirus Infection Symptoms• 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• 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• “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• 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• 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.
0
5
10
15
20
Jan. 28 Jan. 29 Jan. 30
Second Peak – consistent with secondary Norovirus transmissions
SHS
Review of UNC’s Norovirus Outbreak
UNC Student Health Service Epicurve
• 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
Action Taken by Student Health Services
Initial Health Department Findings
Based on calls to students who came to SHS, their roommates and other contacts.
• 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.
Environment, Health & Safety
Action Taken Within UNC
Cleaning Guidelines for Housekeepers
• 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
Housekeeping Department
• 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)
Housing and Residential Education
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 Tuesday Wed Thursday
Friday Saturday
January 18 MLK Day 19Point
Source
20 2166 students sought treatment at SHS
22 23 24Virginia basketball game
25 26UNC Closed Winter Storm
27 28NCSU basketball game
29Norovirus confirmed
30 31
February 1 2OCHDidentifies source
3 4 5 6 7
8 9 Start of NCSU outbreak
10 11 12 13 14
Final Results, February 2, 2004:• 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
County Health Department’s Finding
• 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?
Debriefing Within UNC
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.
• 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.
Lessons Learned
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
• Strengthened internal and external relationships, communication and decisionmaking.
• 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.
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.”
