How to manage norovirus outbreak in psychiatric unit?

Question

Hello doctor,

I need your immediate help in managing the norovirus outbreak at our long-term psychiatric facility. Around 45 residents are affected, many with severe mental illness making isolation protocols impossible. Most concerning is my brother aged 42, who is schizophrenic is refusing oral intake of medicines and food due to paranoid delusions about contamination. His lithium levels are becoming toxic due to dehydration. Two residents with eating disorders have developed severe electrolyte imbalances. The facility's behavioral unit is understaffed - three nurses called in sick with symptoms. Some patients are removing their IV lines, and others become violent when asked to stay in their rooms. Should we transfer severe cases to the general hospital? What about involuntary fluid administration? Also, I am worried about medication compliance - many patients have not taken their psychiatric medicines for three days due to vomiting. Kindly suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Norovirus is a virus known to cause gastrointestinal infection - diarrhea, and vomiting. It is a self-limiting virus and lasts up to one to two weeks. It gets resolved on its own. There is no specific treatment for the virus, or vaccine available right now. However, supportive measures are a must like staying well hydrated - taking a lot of oral fluids, intravenous fluids, and juices, having a Paracetamol tablet for fever, a tablet of Domperidone, or an injection of Domperidone for nausea and vomiting.

Norovirus is spread through the fecal-oral route like one touching others' fecal matter, and oral things like left food, and saliva. Avoid touching one another and keep the bathrooms clean to prevent disease spread. Norovirus does not spread through air or air droplets, this can ease the present situation. This virus is resistant to alcohol, so alcohol-based sanitizers will not help. The virus is affected and neutralized by bleach so cleaning surfaces with bleach has the potential to control the virus. So cleaning with bleach only is recommended.

As psychiatric patients, the protocol medications need to be continued, but upon observation under psychiatrists, if medications can be halted for some time, this can be done and helps benefit in smoother recovery. If consent is not obtained then please continue medications along with supportive medications and measures.

I hope you find this information helpful.

Thank you.