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Julie Reagan
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Julie Reagan, PhD, JD, MPH, holds a PhD in Management, Policy, and Community Health from the University of Texas Health Science Center, School of Public Health in Houston, Texas. She completed a Master's of Public Health degree from the same university. Dr. Reagan is also an attorney licensed to practice law in New Mexico and Texas (inactive status). She has been practicing law since 1993. She also holds degrees in health education and dental hygiene.


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Norovirus in Long-Term Care Facilities

An online continuing education course for nurses, medical health care professionals, and other interested individuals.

Norovirus is the predominant cause of acute gastroenteritis, causing both sporadic cases and outbreaks.  It is estimated to be the causative agent for over 23 million gastroenteritis cases occurring every year in the U.S.  Norovirus gastroenteritis infections commonly occur in healthcare settings.  In fact, healthcare institutions, such as hospitals and nursing homes, are the most frequently reported settings for norovirus outbreaks in the United States and other industrialized countries. 

Norovirus gastrointestinal infections can be particularly problematic in long-term care facilities.  Due to the close proximity of living quarters, communal spaces, the reduced levels of personal hygiene and mobility of residents,  along with the extreme contagious nature of the virus, norovirus can spread quickly in these types of facilities.  Most long-term care facilities are populated by elderly residents and/or individuals who have significant underlying medical conditions.  This makes them a susceptible and vulnerable group for norovirus infections. Due to these challenges, it is vitally important for long-term care facilities to implement measures and policies to prevent norovirus infections and take swift infection control actions if an outbreak is suspected. 

This instructional course has been designed primarily for nurses and infection prevention and control practitioners working and caring for residents in long-term care facilities.  However, other care providers such as epidemiologists, facility administrators, environmental services, and other long-term care staff members will find the course information useful.  The course is designed to be applicable to various types of long-term care settings and follows the recommendations of the Centers for Disease Control and Prevention’s latest 2011 HICPAC Guideline for the Prevention of Norovirus. 


Upon completion of this course, the participant will be able to:

  1. Describe norovirus viral gastroenteritis and it’s impact on the U.S. healthcare system.
  2. Describe specific challenges associated with norovirus outbreaks in long-term care facilities.
  3. Explain when and where norovirus gastroenteritis infections occur.
  4. List the symptoms of norovirus.
  5. Explain how noroviruses are transmitted in the healthcare setting.
  6. Describe the various methods for limiting the spread of norovirus through isolation, cohorting and contact precautions.
  7. Describe methods for closing wards and transferring patients during outbreak events.
  8. Identify personnel management strategies for preventing norovirus transmission.
  9. Recognize the importance of proper hand hygiene techniques for the prevention of norovirus infection.
  10. Describe federal mandates for food handlers in healthcare settings.
  11. Recognize diagnostic and clinical testing methods for the confirmation of norovirus outbreaks.
  12. Describe why increased environmental cleaning is necessary in norovirus outbreaks.
  13. Explain useful visitor policies during outbreak situations.
  14. Explain the importance of surveillance activities as a prevention measure. 
  15. Describe internal communication procedures during norovirus outbreaks.
  16. Explain how facilities can provide training for the prevention and management of norovirus.


Chapter 1 Norovirus in Healthcare Settings

  • Viral Gastroenteritis Description
  • Norovirus gastroenteritis infections are common in healthcare settings
  • Burden to U.S. Healthcare System
  • Importance of Infection Prevention and Control Measures
Chapter 2: Norovirus in Long-Term Care Facilities
  • Various Forms of Long-Term Care Facilities; Applicability of Course Presentation
  • Challenges Associated with Long-Term Care Facilities
Chapter 3: About Norovirus
  • Description
  • When and Where Norovirus Gastroenteritis Infections Occur
  • Symptoms
  • Transmission
  • Treatment
  • At-Risk Populations
Chapter 4:  Applicable Guidelines
  • CDC 2011 Norovirus Guideline
  • Key Issues
  • 2012 Toolkit
  • State Resources
  • Resources Specific to Norovirus in Long-Term Care Facilities
Chapter 5: Limiting the Spread of Norovirus
  • Preventing Exposure to Diarrhea and Vomitus
  • Room Assignments and Contact Precautions
  • Staff Cohorting
  • Duration Times for Isolation and Contact Precautions
  • Personal Protective Equipment
  • Limiting Patient Movement Within the Facility
Chapter 6: Closures and Transfers
  • Closures
  • Transfers
  • Discharges to Home Settings
Chapter 7: Policies for Infected Staff Members
  • Staff Risk of Infection
  • Ill Staff Exclusion From Work
  • Recovering Staff Suitable for Caring for Symptomatic Patients
  • Non-essential Staff, Students, and Volunteers
  • Non-staff Individuals Providing Services in The Facility
Chapter 8: Hand Hygiene
  • Promotion of Proper Hand Hygiene Practices
  • Use of Soap and Running Water
  • Resident Hand Hygiene
  • Hand Sanitizers
  • When To Wash Hands
Chapter 9: Food Handlers in Healthcare
  • Food and Water as Source of Norovirus Transmission
  • Food Handler Hand Hygiene
  • Exclusion of Food Handlers Experiencing Gastrointestinal Symptoms
  • Shared or Communal Foods
Chapter 10: Diagnostic Testing for Norovirus
  • Laboratory Diagnostic Protocols
  • Specimens Used for Testing
  • Kaplan's Clinical and Epidemiological Criteria
  • When is it an outbreak?
Chapter 11: Environmental Cleaning
  • Need for Increased Cleaning During Norovirus Outbreaks
  • Cleaning Sequence
  • Disposable and Non-disposable Items
  • Linens, Fabrics, Upholstered Items, Rugs
  • Products for Cleaning and Disinfection
  • Outside Contractors
Chapter 12: Visitor Policies
  • Visitor Restrictions
  • Screening
  • Hand Hygiene and Contact Precautions
  • Visitors Who May Be More Susceptible
Chapter 13: Surveillance and Regulatory Notification
  • Surveillance to Evaluate Fluctuations in Norovirus Incidence
  • Regulatory Notification
Chapter 14: Communication and Training
  • Internal Facility Communication
  • Contact Person
  • Signage
  • Training
Chapter 15: Resources

Course Snapshot

Cost: $ 30.00
Contact Hours: 3


After successful completion the licensed nurse: RN, LPN/LVN will receive 3.0 contact hours. Provider approved by the California Board of Registered Nursing, Provider # CEP 15467 and by the Florida Board of Nursing, CE Broker Tracking # is 20-355816.

This document must be retained by the licensee for a period of four years after the course concludes.
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