Diarrhoea and vomiting (D&V)

Diarrhoea and/or vomiting (D&V) can be caused by infectious or non-infectious agents; however, all cases of gastroenteritis or D&V should be regarded as infectious unless good evidence suggests otherwise.

Although several different organisms can cause D&V outbreaks, norovirus is probably the most common cause. However, it is important to consider other causes, especially those which are more likely to be spread by contaminated food, such as salmonella and campylobacter.

The symptoms caused by noroviruses are usually a sudden onset of non-bloody, watery diarrhoea and /or vomiting which can be projectile.

Transmission

Norovirus can spread quickly from symptomatic people and contaminated surfaces through faecal oral transmission. Hands should be washed with soap and water as hand gel will not kill the viruses that cause diarrhoea and vomiting. Effective hand hygiene is key to stopping the spread.

Surfaces can get contaminated with norovirus in many ways, including when:

  • An infected person touches the surface that have faeces or vomit particles on them.
  • An infected person vomits or has diarrhoea that splashes on surfaces.
  • Food, water, or objects that are contaminated with norovirus are placed on surfaces.
  • Tiny particles of vomit spray through the air and land on surfaces or enter a person’s mouth, then he or she swallows it.

Outbreak management

  • If an outbreak of diarrhoea and vomiting is suspected inform UKHSA and IPC team as they can offer support and advice.
  • Isolate symptomatic residents until 48 hours from latest episode.
  • Staff must remain off work until they are 48 hours symptom free.
  • Stool samples should be obtained as soon as possible to rule out other causes.
  • It is advised to complete PCR testing to rule out COVID-19.
  • Commence stool charts for those affected.
  • Visiting and new admissions should be restricted to exceptional circumstances only (essential care givers and end of life).
  • Minimise staff movement and footfall throughout the home.
  • Ensure clear communication regarding effective handwashing and PPE is covered in handovers/safety huddles.
  • Declutter for easier cleaning.
  • Increase cleaning frequency using chlorine-based products.
  • Treat waste as infectious and dispose of appropriately.
  • Wash clothes and bedding separately to other laundry using the red-hot water-soluble bags.
  • A deep clean will be required once 48 hours clear of latest episode and before easing restrictions.
  • Encourage fluids and if necessary complete a fluid chart for those at risk of dehydration.
  • Inform GP of any concerns or changes.

Online end of outbreak documents

Terminal decontamination checklist

Online post infection review

Resources and contacts

UKHSA

UKHSA North-West - 0344 225 0562
UKHSA Out of hours - 0151 434 4819
clhpt@phe.gov.uk

IPC Team

infectionprevention@lancashire.gov.uk

NHS guidance

Norovirus (vomiting bug) - (NHS) 

Care home outbreak procedure

Documents