Norovirus infection risks for waste handlers

Norovirus gastroenteritis can occur year-round but is more common during the winter months. It can occur in persons of any age and is seen widely in the community, but outbreaks of norovirus gastroenteritis are common in semi-closed environments such as hospitals, nursing homes, schools and cruise ships. These can be difficult to control and long lasting because norovirus is easily transmitted from one person to another and the virus can survive in the environment.

NorovirusInfection in the elderly or those with underlying health issues, infection may be severe. The incubation period is anything from four hours to three days, and symptoms usually last 12-60 hours. The onset is sudden, and those affected often experience extreme nausea and start vomiting. Over half also suffer abdominal cramps and one in three have headache, muscle pain, a raised temperature and loss of appetite. Diarrhoea is usually mild and watery, with no blood or mucus present.

In otherwise healthy individuals, recovery generally occurs within two or three days, but individuals remain infectious for 48 hours, and even up to 72 hours, after symptoms stop. Careful personal hygiene with frequent handwashing with soap and water, and the use of bleach disinfectants of the environment, are essential. Gloves should be worn when handling infectious potentially material

  1. Careful handwashing is the most important prevention measure that you can take. Wash hands thoroughly with soap and warm water and dry afterwards. Do not share towels.
  2. Use gloves when handling soiled articles from ill people. Wash soiled clothing and bed linen on ‘hot cycle’.
  3. If looking after someone with gastroenteritis, carefully disinfect toilet seats, flush handles, wash-hand basin taps and toilet door handles daily and after use. Use a bleach-based household cleaner, diluted according to the manufacturer’s instructions.
  4. Maintain good personal hygiene and hygienic preparation and serving of food.
  5. If you have gastroenteritis, don’t return to school or work until you have been symptom-free for 48 hours. Don’t visit patients in local hospitals and long-term care facilities. While many people tend to feel better sooner, illness can still be spread if they return to work or school within 48 hours since the last symptom.

Waste handlers working with domestic wastes may be exposed if infectious material is placed in the domestic waste stream but this is perhaps not the obvious disposal route and exposure is probably unlikely.

For waste handlers collecting clinical and incontinence or sanitary/offensive wastes from healthcare premises and residential homes, nurseries etc, exposure is far more likely. Disposable paper vomit bowls and incontinence sheets will find their way into waste sacks unless each unit has access to a bedpan washer/macerator. Even then, a large outbreak may result in the amount of material for disposal exceeding the capacity of the washer macerator and the remaining wastes will be bagged.

These wastes may retain the categorisation of incontinence or sanitary/offensive wastes but the risk of infection is high and the wastes should really be reclassified accordingly. Whatever the described waste category, transmission of infection to waste handlers is likely unless standards of personal hygiene are high. Glove use and thorough handwashing, preferably with soap and water are essential; alcohol hand rubs have limited activity against Norovirus and may be inactivated when used on heavily soiled hands.

It is almost inevitable that the outer surface of waste containers will be contaminated, even if visible contamination of leakage has not occurred. On removal, gloves should be stored away from areas when cross-contamination is possible. Do not take gloves into a vehicle cab, or carry them with you. Avoid contaminating other surfaces. Handle waste containers with great care to avoid spillage. Manage any spillage with great care, using diluted bleach.

If spillage contaminates clothing, this should be removed and laundered separately on a standard hot wash. Wash hands after handling contaminated clothing – do not continue to work or go home while still wearing contaminated clothes as this provides an opportunity to spread infection to others.

Report all incidents of D&V. Norovirus infection is a real risk for waste handlers, but is generally unrecognised and unreported, or dismissed as an unrelated community-acquired infection. Several cases are on record, and though records are scarce and the epidemiology difficult to define, many more cases are likely to be linked to handling of infectious wastes. Though simple plastic bags, even heavy duty sacks, may be inadequate for wastes with a high wet weight, as always personal hygiene offers the best protection. Take care with glove use, glove removal, and hand hygiene.

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