Infection control measures promoted by the public health center for “housing for the elderly” facilities during norovirus cluster outbreaks

Objective: “Housing for the elderly” is a type of facility where a few healthcare staff and care workers provide long-term care to residents. This study aimed to explore the infection control measures promoted by the public health centers (PHC) when a cluster of norovirus cases occurred in this type of facility. Materials and Methods: This study involved a prefectural office in Japan and collected the records of PHC surveys/instructions of norovirus cluster cases that occurred in “housing for the elderly” facilities between 2017 and 2019. The records provided information about the case characteristics (cluster periods and number of infected individuals) and instructions for infection control by the PHC. We tabulated the case characteristics and performed a descriptive qualitative analysis to extract the instructions from the PHC. Results: Twelve clusters of cases were included in the study. Approximately 16% of the residents and care workers in each facility were infected, and it took an average of 23 days from the start of the outbreak to the end. Nine categories of PHC instructions emerged after the data analysis. “Collaboration with community healthcare workers” included instructions by the PHC to share information with external physicians and home-visiting nurses. In “precautions when caring for elderly residents with functional decline”, the procedure for changing diapers and infection control measures considering the behavior of residents with dementia were advised. If the contents of the infection control manuals were deemed to be inadequate, an “improvement of the infection control manuals” was instructed. Conclusion: To implement effective infection control by care workers at “housing for the elderly” facilities, the PHC should promote the involvement of community physicians and nurses and advise on clear procedures based on residents’ functional decline.