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Controlling gastroenteritis
By Jim Montalto, News Editor
Published: 06/23/2008

Humanscale The folks at the Infectious Diseases in Corrections Report open their summer issue with a short history of noroviruses. They then dive into how this nasty group of related viruses impact the incarcerated. Sadly, the writers and editorial staff at IDCR never seem to have the luxury of researching how swimming at the beach or vacationing on a tropical island affect the imprisoned; probably because inmates don’t have those opportunities either.

Nonetheless, Joseph Bick, chief deputy of clinical services at the California Department of Corrections and Rehabilitation’s medical facility, provides abundant detail on the signs and symptoms, transmission and diagnosis of viral gastroenteritis in his article, Control of Viral Gastroenteritis within Jails and Prisons.

According to Bick, also IDCR’s new editor in chief, gastroenteritis outbreaks caused by noroviruses are common among those living or working together in areas such as hospitals, long term care facilities, military barracks, summer camps, and cruise ships. More recently, he notes, noroviruses also have been “identified as the cause of gastroenteritis outbreaks in jails, prisons, and detention facilities.”

As a result, “norovirus outbreaks have the potential for significant morbidity, occasional mortality, and disruption in the routine operation of correctional facilities.”

Inmates can be an easy target for viral and bacterial gastroenteritis because of their tendency to store food in their cells or living areas, which usually do not have refrigeration or cooking appliances. Bick states that the incubation period for norovirus following infection is about 12-48 hours, with mild symptoms lasting about 12-60 hours. Symptoms such as nausea, vomiting, abdominal cramps, diarrhea, low-grade fever, headache, chills, and muscle pain can occur.

While viral gastroenteritis usually enters a facility through employees, visitors, volunteers, or inmates recently transferred in, contaminated food also can introduce the virus. Regardless of entry, Bick says the most important step in managing gastroenteritis is to “remain vigilant, especially when norovirus is known to be circulating in the outside community. Once viral gastroenteritis is suspected, a rapid definitive diagnosis of the causative agent will help guide strategies for infection control and containment.”

Bick says an outbreak should be suspected if more than two inmates or employees concurrently develop nausea, vomiting, and diarrhea. The presence of both vomiting and diarrhea can be a pretty sure sign of norovirus.

“During a suspected outbreak, fresh stool should be collected from six to twelve persons. In addition to testing specimens for norovirus, stool should be cultured for campylobacter, salmonella, and shigella.”

Bick continues with methods of diagnosis and treatment, of which there is little, with re-hydration being sufficient in most cases. Controlling the infection is probably the most important step a facility can take when faced with a norovirus, and collaborating with medical and custody staff are vital.

Bick recommends limiting movement in and out of the impacted housing units, and temporarily suspending indoor group activities such as visitation, education classes, and religious services. He also suggests keeping ill employees away from work until they have been symptom free for at least 48 hours.

“Sick inmates should be fed in their cell, dorm, or housing unit. If possible, well inmates should eat in groups by unit. The placement of alcohol-based hand cleansers at the beginning of feeding lines should be considered. Dining areas should be cleaned and then wiped with bleach solution between seatings,” he adds.

The article then details housecleaning and hand hygiene procedures during gastroenteritis outbreaks.

“Routine housecleaning efforts should be intensified, including the cleaning of walls, floors, table tops, handrails, sinks, toilets, and door knobs in day rooms, communal restrooms, dining facilities, and showers. In addition to environmental surfaces, medical and custodial equipment such as blood pressure cuffs, stethoscopes, and restraint gear should be routinely sanitized.”

Communicating to staff, inmates and the public through methods such as peer educations, brochures, posters, in-house cable channels, and inmate advisory counsels are also encouraged. Most important, Bick believes, is a coordinated response to managing the outbreak that involves on-site medical and custody staff, and as needed, local, county, and state public health resources. He says this can be an effective way to minimize the impact gastroenteritis will have.

“Jail and prison administrators would be prudent to establish policies and procedures in advance of these outbreaks to help facilitate the best possible outcome.”

Click here for the full June report, which also includes a chart on preparing bleach disinfectant solutions.


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