Date of Award


Document Type


Degree Name

Master of Science (MS)

Legacy Department

Food, Nutrition, and Culinary Science

Committee Member

Dr. Angela Fraser, Committee Chair

Committee Member

Dr. Julia L. Sharp

Committee Member

Dr. Felix H. Barron


Long-term care facilities (LTCF) are the most common setting for human norovirus (HuNoV) outbreaks in United States. We identified presence of prevention and control strategies for HuNoV in LTCF in South Carolina (SC) under non-outbreak conditions. A convenience sample of 26 LTCF was visited and directors were interviewed to determine facility prevention and control practices. A facility audit in one commons area and food preparation area was conducted to assess sanitary conditions. Institutional policies and procedures were collected to determine alignment with Centers for Disease Prevention and Control (CDC) recommendations and to determine readability based on Federal Plain Language Guidelines and Microsoft Word readability statistics. Findings of director interview responses showed presence of gaps in prevention and control practices. Most Directors had little knowledge of proper sanitizing and disinfecting products and reported missing written procedures for cleaning staff/visitor bathrooms. Many used the wrong products for pathogen removal after vomit/fecal events, had no written procedures for cleaning contaminated soft surfaces, did not remove other individuals during clean-up of vomit/fecal episodes, and did not clean a large area surrounding vomit/fecal episodes. Most did not assign specific staff to care for sick; not designate specific toilets for sick during an outbreak. All kitchens and commons areas in participating facilities were in good sanitary condition. However, possible environmental risk factors for HuNoV transmission in commons areas were identified. Most contained upholstered, rather than hard-surface chairs and some had carpeted floors. Quaternary ammonium-based disinfectants were used in most commons areas. Handwashing signage was not posted in some staff/visitor bathrooms, and a few staff/visitor bathrooms were accessible to residents. Inconsistencies were identified in hand hygiene, outbreak management and environmental sanitation procedures. Most facilities had procedures for hand hygiene but recommendations for handwashing events and duration varied greatly. Few had separate procedures devoted to HuNoV outbreak control. Both hand hygiene and bodily fluid clean-up procedures had low mean scores for readability. Our study results can be used for development of better quality interventions for prevention and control of HuNoV in LTCF.



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