Norovirus Outbreak in Canyon - Coconino County Guidelines For River Trippers
Hey river trippers, there has been an outbreak of the dreaded Norovirus in the Canyon this year. The following guide has been prepared by Coconino County to help river runners prevent and deal with this very unpleasant disease.
If you have a trip planned for this year, or really for any year, it would be good for trip leaders and everyone on the trip be familiar with the causes, symptoms and ways to manage and treat a trip that has members who have contracted this nasty disease.
Norovirus on the River: Protect your Paricipants, and Yourself
BACKGROUND: Norovirus is a very contagious virus that infects over 20 million people in the US every year. You can get norovirus from an infected person, contaminated food and water, or by touching contaminated surfaces. Norovirus causes sudden-onset vomiting and diarrhea that lasts about 24-48 hours. On rafts and in camps, norovirus can spread quickly. The best way to prevent norovirus is to practice proper hand washing and general cleanliness.
Each season, there are multiple river trips that are affected by norovirus. So far in 2012, the number of infected trips is about average. Large outbreaks of norovirus can be prevented if you do the following:
BEFORE AN OUTBREAK: Guests or guides may bring norovirus from home or from their travels. Many people who carry norovirus do not have symptoms. You may not be able to prevent the first case of norovirus on your trip, but you can prevent its spread by practicing good health habits from day one.
Handwashing. Explain and enforce good handwashing habits in your group. Use test strips to ensure that you have the right amount of chlorine in your hand-wash water. Offer hand sanitizer post-wash.
Food service. Offer hand sanitizer on the boat before serving snacks. If you are sharing something from a common bag or box (e.g. trail mix), have guests pour the contents into their hands, rather than reaching into the bag/box. At meals, encourage everyone to wash their hands before eating.
Drinking water. Make sure guests don’t touch the nozzle of water dispensers. Wipe the nozzle with bleach solution twice a day. If you are filtering water from the river, remember that norovirus is tiny and can pass through filters. Treat drinking water (2-5 drops of bleach per gallon of water) and set aside for at least 30 minutes before using.
Setting up camp. When you enter a camp, observe whether it appears to have been occupied by ill people recently. Cat-holes, vomit, etc., may indicate a sick trip before you. Be careful about where you set up your tents, toilets, chairs, and kitchen. Avoid setting up sleeping camps in questionable areas. Assume that norovirus contamination may be present at all beaches and take appropriate precautions.
Toilets. Only crew members should set up toilets.
Wear eye protection (e.g. sunglasses) and two pairs of disposable gloves. Before putting on gloves squirt a small dollop of hand soap on the back of one of your hands for hand washing afterwards
Don’t use toilet brushes. They carry contamination.
Keep bleach solution in the toilet kit to disinfect the toilet seat, toilet box, and handles. Don’t use the same bottle for your dish-wash/potable water – have a separate bleach bottle for toilets.
After you properly store the toilet seat in a separate plastic bag in the toilet kit and place the toilet lid back on the toilet, remove and discard the outer pair of disposable gloves.
Wipe down the hand soap, toilet “key”, toilet paper container, etc. with the bleach solution, using a disposable paper towel.
Lastly, take off your gloves, and use the dollop of soap on the back of your hand to wash hands thoroughly at the hand wash station followed by a hand sanitizer.
IN THE EVENT OF ILLNESS
Supplies. If someone is sick, make a bleach solution (5-25 tablespoons per gallon of water) each day. Do not use this for food surfaces or hand-washing. It is for cleaning contaminated non-food surfaces only.
“Spill” clean-up. Try to avoid putting vomit or feces in the river. Don’t leave vomit or feces on a beach, and don’t bury it. Put it in a toilet or trash container. If you use a trash container, use extra trash bags to close and seal the vomit away. If you use a toilet, reserve that toilet for sick people only.
If you don’t have room to carry all the vomit or feces with you on the rest of the trip, scoop it into a five-gallon bucket, and saturate it with the bleach solution as specified above. After 15-20 minutes, throw it into the main current of the river and rinse the bucket with the bleach solution. (Try to limit any damage to resources during clean-up, especially if you’re in an arch site.)
Isolate ill individuals and gear. Have ill folks sit on the same boat or same area of a rig. Wash the boat and other potentially contaminated equipment frequently with the bleach solution. If clothing is soiled with vomit or feces, store it in a dry, labeled bag. Paco pads, tents, etc. must stay with the people who were sick for the rest of the trip. Have sick people stay in the same area of camp, if possible.
Toilets. Consider taking extra disposable toilet bags (“wag bags”) to provide for ill passengers to use in camp or in case of sudden emergency. If you have day-tripper ammo cans, consider creating an additional one (or two) for sick passengers.
Set up a “sick” toilet and hand-washing area for those who are ill or recovering
If feces or vomit are on the toilet seat or on the outside of the toilet box, clean with a bleach wipe, discard it in the toilet, and then rinse the surface with the bleach solution. Wipe with a disposable paper towel and dispose in toilet.
Never wash off fecal material in the river or side tributaries. Get it into a toilet.
If you have an ill person, enhance food prep safety. Wash your hands more frequently followed by a hand sanitizer. Wear non-latex disposable gloves. Do not allow any guests (even ones who aren’t sick) to help in the kitchen. Have a guide who does not have symptoms serve all food so only one person touches serving utensils. Make simple meals (e.g. sandwiches) for the sick people and serve them so they don’t have to touch anything. Do not save unused food. Wipe down the outsides of condiment containers with a weak bleach solution (1-2 teaspoons of bleach per gallon of water). If all of the guides are sick, pick a very simple menu and ask a responsible guest (preferably one who hasn’t been sick in the past two weeks) to do the hands-on prep, with a guide supervising.
Reporting: Report trips with one or two ill passengers at the end of your trip. Report a trip with three or more ill passengers to your concession manager via sat phone ASAP. Be sure to complete the Confidential Illness Report Forms for all ill guests and guides.
After the trip: Hold your toilets for testing at the end of the trip. Sanitize all equipment using the bleach solution or steam/hot water (same water used to prevent quagga mussels, >140 degrees). Launder sleeping bags and other soft goods in hot water and hot dry. Don’t forget to clean all items that have hard surfaces, such as the ammo can that holds your library.