Nororvirus risk for waste handlers

Since the beginning of November 2010, the Health Protection Agency (HPA) has recorded 43 outbreaks of norovirus infection in hospitals. Of these, 39 have led to ward closures.
This is almost 50% more than the number recorded in October. Although people can suffer from norovirus at any time of the year, activity increases in the winter months.

The number and scale of these outbreaks – sufficient to force ward closures – and the likely corresponding rise in cases in care homes etc. It is inevitable that as a result of this, large volumes of highly infectious waste will be packaged in orange sacks, much of it vomit and watery diarrhoea, incontinence pads and contaminated towels etc.
Some of this waste may be managed as sanitary or offensive waste though risk assessment should identify without doubt a high risk of infection and upgrading to clinical waste for disposal in an orange sack.

The waste may be may wet, very wet, and free fluids may be leaking from the waste sacks. It will smell!

Expect the outside of the sacks to be contaminated.

There are now several reported cases of norovirus infection occurring in waste handlers who had contact only with waste sacks from affected centres. In the cases I have investigated glove use has been reasonable though hand hygiene was predictably poor. Most likely was secondary contamination of clothing from the contaminated surfaces of waste sacks and from free fluids draining from them. This defeated normal hand hygiene precautions as cleaned hands were quickly contaminated from contaminated clothing.

This is a clear risk for waste handlers and for hospital ancillary staff and porters etc, who are likely to fall outside teh arrangements for outbreak control. cases that do occur may be difficult to associate with a specific source and may be considered as sporadic cases of D&V. Spread of infection to work colleagues and/or the family group creates another new outbreak.

Hand hygiene is the key to effective prevention. Where handwashing facilities are not available on removal of gloves, use a proprietary antiseptic handrub product. Take care to avoid contamination of clothing and shoes. Minimise handling of waste containers and as far as is possible keep these at arms length to avoid contamination though be aware of back injury when carrying heavy sacks in this way. Consider a disposable apron to protect workwear.

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