Norovirus Strikes Nursing Homes, Prisons, and Hotels

There has been a lot of press recently concerning the Norovirus. The virus seems to be more prevalent, particularly in convalescent homes. On Jan 19th, 2007, the Dulles Airport Hilton hotel was temporarily closed after 15 employees and more than 100 guests were sickened due to the virus. The Norovirus is highly contagious, requiring as little as 100 virus particles to cause an infection. The Norovirus can be transmitted through exposure to bodily fluids, person-to-person, or directly through fecal contamination of food and water. It can also spread through contact with infected surfaces. The Norovirus can cause acute vomiting, diarrhea with severe cramping, and nausea. It often causes fatigue, headache, and a low-grade fever. The average incubation period is 12-48 hours. The virus itself is not considered lethal. In healthy adults, the virus is comparable to having the flu. However, for young children, the elderly, and those with weakened immune systems, the virus can cause side effects such as dehydration that can lead to a more serious illness, and possibly contribute to the death of the patient.

Are Emergency Medical Service (EMS) providers unknowingly contributing to the spread of the Norovirus? I think they are. Many people don't realize that in addition to responding to medical emergencies, ambulance companies also provide transportation services, taking patients back and forth between medical facilities. In fact, a large portion of their business is the transportation of elderly patients to and from convalescent homes and skilled nursing facilities.

Here's why I think EMS may be a contributing factor. As a California licensed Emergency Medical Technician (EMT) and a Certified Nursing Assistant (CNA), I have worked in both environments. When I worked for a local hospital as a CNA, we were required to practice what is called "Contact Precautions", meaning we had to wear a disposable gown and gloves any time we entered the room of a patient who was diagnosed or suspected to be infected with a contagious disease. We also washed our hands before and after every single patient contact. Basic equipment such as thermometers, stethoscopes, and blood pressure cuffs all had to be disposable or thoroughly disinfected. Food trays, drinking cups, and linen had to be handled separately from the rest.

But when I worked as an EMT, I noticed something very disturbing. Even though a patient's room was clearly marked for "Contact Precautions", the way that we handled the patient was entirely different from the way I was accustomed to. We never used disposable gowns. We wore gloves, but they were put on before contacting the patient and not taken off until after the patient was transported. We would take our gurney directly into the patient's potentially contaminated room. When large or non-ambulatory patients need to be transferred from their bed to the gurney, it is common practice to use the bottom bed sheet to lift and move the patient. The patient is then placed onto the gurney, along with the sheet. We frequently transported patients to and from convalescent homes and skilled nursing facilities, even when the facility was under a "no visitors" quarantine for Norovirus.

At the completion of every run, the gurney is stripped of the disposable linens, and a fresh set is put on the gurney. Of course, if the gurney was obviously contaminated with blood, vomit, urine, or feces, the entire gurney was wiped down with disinfectants. We always tried to keep everything sanitary, but the nature of EMS doesn't always allow enough time to do a thorough job. On busy days, when the EMS system is overloaded, it was not uncommon for things like stethoscopes and blood pressure cuffs to get put back into service without being cleaned. The gurney itself is often put immediately back into service without being properly disinfected. The work done by EMT's and Paramedics is vital to our healthcare systems, and the people who work in that industry are frequently over-worked and under-appreciated (which is why I changed careers.) But there is definitely something wrong with the way our healthcare transportation system deals with infectious disease and nobody seems to be looking at the role EMS practices and procedures play in spreading this and other contagious viruses.