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Difficulty: MediumInfection Control and Hospital-Acquired Conditions

A 54-year-old woman is hospitalized in an inpatient rehabilitation unit recovering from an ischemic stroke. Over the past 12 hours, she has developed acute-onset, severe nausea, nonbilious vomiting, and multiple episodes of nonbloody, watery diarrhea. Her temperature is 37.2°C (99.0°F), blood pressure is 110/70 mm Hg, and pulse is 98/min. Physical examination reveals a soft, nontender abdomen with hyperactive bowel sounds. Over the exact same 12-hour period, two other patients on the unit and one physical therapist have reported identical symptoms. The patient is immediately placed in a single room on contact precautions. Which of the following is the most appropriate additional infection control measure for this unit?

  1. Clean the affected patient care areas with a sodium hypochlorite-based solutionAnswer
  2. B
    Utilize alcohol-based hand sanitizer as the primary method for hand hygiene upon exiting the room
  3. C
    Obtain stool specimens for Clostridioides difficile toxin testing from all symptomatic individuals
  4. D
    Transfer the symptomatic patients to negative-pressure airborne infection isolation rooms
  5. E
    Initiate empiric oral vancomycin therapy for the symptomatic patients

Answer

The most appropriate additional infection control measure is to clean the affected patient care areas with a sodium hypochlorite-based solution.
The correct answer identifies the need to use a sodium hypochlorite (bleach) based solution for environmental cleaning. The clinical scenario describes an outbreak of acute nausea, vomiting, and watery diarrhea that simultaneously affects both patients and a healthy healthcare worker (physical therapist). This epidemiological pattern is classic for norovirus, a highly contagious, non-enveloped virus. Infection control for norovirus requires contact precautions, strict hand hygiene with soap and water (because alcohol-based hand rubs lack sufficient efficacy against non-enveloped viruses), and thorough environmental disinfection. Standard quaternary ammonium hospital disinfectants are ineffective against norovirus; therefore, an EPA-registered agent, typically a sodium hypochlorite (bleach) solution, must be used to clean patient care areas.

Step-by-Step Solution

1
Analyze the clinical presentation and outbreak epidemiology.
The scenario features acute onset of severe nausea, vomiting, and watery diarrhea affecting both hospitalized patients and healthy healthcare staff simultaneously.
Identifying the outbreak pattern is essential to differentiating between common hospital-acquired pathogens.
2
Determine the most likely causative pathogen.
The pathogen is highly suspected to be norovirus.
Norovirus has a short incubation period, features prominent vomiting, and easily infects healthy healthcare workers, unlike Clostridioides difficile, which rarely affects healthy staff and usually lacks prominent vomiting.
3
Select the specific environmental and infection control measures required for this pathogen.
Environmental cleaning must be performed with a sodium hypochlorite (bleach) based solution.
Norovirus is a non-enveloped virus that resists standard hospital disinfectants; it requires bleach for effective environmental decontamination.

Key Concept

Healthcare facility outbreaks of norovirus are characterized by rapid onset of vomiting and diarrhea affecting both patients and staff; management requires contact precautions, hand hygiene with soap and water, and environmental cleaning with sodium hypochlorite (bleach).
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Topics

Infection Control and Hospital-Acquired Conditions

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