Olaf Stolz

Preventing Infection

Norovirus in nursing homes: “Raise awareness of effective hygiene measures”

Every year, noroviruses pose considerable challenges to the staff of medical and long-term care facilities, particularly in the months from October to April. Statistics from reporting systems show that children under the age of five and adults over the age of 70 are the most affected. Olaf Stolz is a freelance hygiene specialist and advises care facilities and nursing homes, among others, on hygiene issues. We spoke with him about difficulties as well as solutions when dealing with noroviruses in nursing homes.

Mr Stolz, you are experienced in dealing with the practical and everyday hygiene challenges in care facilities. In your opinion, what is the best way to prevent or respond to a norovirus outbreak?

Olaf Stolz: In this context, the most urgent challenge is raising awareness of how quickly germs are transmitted. The very first thing I do is describe the special characteristics of these pathogens to the staff. Where surfaces are not sufficiently disinfected, noroviruses can survive for up to seven days. And even the smallest quantities of the virus, even just 10 to 100 virions, can trigger an infection. Most people don’t realise that. In the next step, I explain how quickly transmission takes place by using a practical example: Imagine you’ve been called into a room where a patient has an undiagnosed norovirus infection. The patient has just used the toilet and, while returning to bed, has touched or leaned on various objects or pieces of furniture. You place the patient file on a table that is not in the immediate vicinity of the patient. Then you have direct contact with the person, for example by straightening the pillow. After correct hand hygiene and disinfection, you pick up the patient file and leave the room. You then hand the file over to your colleague who is assigned with patient care. This short scenario alone illustrates a number of hygiene weaknesses: The patient did not disinfect his or her hands after going to the toilet and touched the table. The patient file was placed on this surface, which was not disinfected so it was contaminated with viruses. The germs are transferred from the medical record to your colleague.

What recommendations do you have for nursing facilities?

Stolz: I can’t overstress how important the availability of disinfectants is. However, in nursing homes where residents with dementia are cared for, this means that disinfectant agents are not available in the rooms. In such cases, personnel must bring along hand and surface disinfectants. It is also important to inform residents and their relatives when and how they should perform hand hygiene. In addition, I propose the so-called “accompanied toilet hygiene” for residents without mobility restrictions. This means that residents are encouraged to ring the bell before going to the toilet. The staff then support them in all aspects of hygiene, which means they disinfect the hands and all surfaces touched by the sick resident, including the toilet. Here, it is advisable to soak toilet paper with a surface disinfectant that has proven effectiveness against noroviruses and then dispose of the paper in the toilet following disinfection. Pre-soaked disinfectant wipes made of non-woven material should not be used because they clog the sewage pipes.

Which problems do you repeatedly encounter regarding disinfection in care facilities and nursing homes?

Stolz: It’s critical to convey that there is a very big difference between “cleaning” and “disinfecting”. Often care facilities and nursing homes work with cleaning-service providers whose staff is trained by the service provider and not by the institution itself. In such cases, the service provider’s facility management must work with the facility’s housekeeping management to check how the external personnel are performing their tasks. This is best done through repeated process controls, which are immensely important in my view. Quality control should be carried out by both internal and external personnel. This is where another aspect comes into play – the perception of leadership roles by the nursing home and its household management. In addition to clear and good communication, high-quality training – with compulsory attendance – must be carried out. All participants need to budget time for team organisation and quality control as well. Here, dialogue with the respective service providers also requires leadership skills.

You mention training. In your opinion, what does effective hygiene training look like?

Stolz: It’s essential that you present a balanced mix of theory and practice. In any case, target groups, such as medical and nursing staff, should be trained separately from cleaning staff. You also have to schedule sufficient time for the subject of disinfection and cleaning. If someone says that only 15 minutes are available, I will object. You need a minimum of 30 minutes for this topic and attendance must be compulsory. In addition to the theoretical knowledge, practical application is key. One proven method is to carry out an inspection of the premises with the personnel in small teams. Here, where necessary, the staff can make corrections to their colleagues’ actions themselves. This supports individual initiative along with team spirit – and leads to an open and constructive culture that addresses and corrects errors.

The norovirus season is quickly approaching. Is there any other key advice you have for care facilities and nursing homes?

Stolz: Give your staff detailed information that they can apply every day, and explain it using examples that are easy to understand! When your team implements necessary measures correctly, remember to give positive feedback! The example with the transmission of noroviruses via the patient file shows that gaps exist, but also where the potential is for improvement. Noroviruses are highly infectious, so a prompt and structured approach is essential. This is the main message – and raising awareness has to include everyone, no matter how much or how little they already know.

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