Foodborne Norovirus in Elder Care Facilities: An Integrated Approach to Prevention and Control

NON-TECHNICAL SUMMARY: Human noroviruses are a major cause of foodborne disease and are frequently associated with outbreaks in institutional settings. Of recent concern have been elder care facilities, in which norovirus outbreaks have caused thousands of cases of illness and even death in some residents. This project seeks to improve our understanding of risks and potential controls of foodborne norovirus infections in elder care facilities, and thus, will aid in the development of more effective and targeted interventions for illness prevention. Identification of control strategies will be achieved using a combination of laboratory-based research and risk assessment. These strategies will serve as the foundation for a multi-media educational intervention targeting workers and residents in nursing home and elder care facilities. The goals of this project will be achieved by: (1) characterization of biological properties of norovirus and its behavior in the environment; (2) identification of factors that impact the risk of exposure using observational studies; (3) development of a mathematical model to determine the risk of norovirus exposure in elder care facilities and identify specific risk factors upon which targeted interventions can be designed; (4) development of a targeted multi-media educational intervention to prevent and control norovirus infections in these facilities; and (5) delivering and evaluation of the educational intervention with a convenience sample of elder care facilities for its eventual dissemination across the U.S. The research team believes that developing interventions based on specific risks in this environment will reduce the incidence of norovirus infection within this highly susceptible population.

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APPROACH: There are four objectives: (1) Five representative elder care facilities each in Michigan and South Carolina will be recruited to obtain information about the types of food, the flow of regular activities, food safety plans, menus, number of residents, and size of facility. Direct observations will also be conducted to determine regular traffic flow of staff and residents, and to assess how food is handled and served. Also, the NoV will be characterized when suspended in simulated gastric fluid and under simulated vomiting conditions, and the effectiveness of candidate disinfection methods. Persistence and transfer studies will be carried out on environmental surfaces and foods. (2) From the derived transmission paths in these facilities and generated laboratory data an exposure model which characterizes the quantity of NoV that a resident may be exposed will be developed based on the different transmission paths. (3) An Advisory Panel will be formed to review the findings from Objectives 1 and 2, and give input to the team designing the training package which can include online games, social media, music, scientific visualizations, podcasts and vodcasts for on-line food safety training DVDs. (4) The training instrument will be given to the person-in-charge at each facility on how to use the material, and a time-frame for training each staff member, which may take multiple sessions. An important outcome of the training is the development of a plan for each facility to prevent and control NoV infections. The purpose of this educational intervention is to change the culture and environment in elder care facilities so that the risk for NoV infections is decreased. Thus, a food safety plan, based on HACCP principles, must be developed by the facility operators. Training will be effective if a good quality plan is developed and properly implemented. Three months after completion of the plan, each facility will be audited using the facility plan as a base to determine how well the plan is being implemented with monitoring, record-keeping, and corrective actions. We expect to see more frequent and thorough washing of hands, monitoring residents for potential NoV infections, and effective clean up after a fecal accident or vomiting event. Based on the evaluation findings, revisions will be made to the intervention. Once revisions are complete to the satisfaction of the Advisory Panel, an electronic version of the educational intervention, with instructions and background on the research and risks of NoV infections, will be offered to the appropriate State regulatory agencies and shared with their federal counterparts for dissemination to elder care facilities. Results will be published in scientific journals but also in publications where those in charge of elder care facilities are likely to read.