A wave of vomiting and diarrhea has swept through wards at two Boston hospitals in the past month, leaving more than 70 patients and staff members ill from a germ whose spread can be slowed by thorough hand-washing.
The outbreaks of norovirus spawned several days of gastrointestinal misery at Brigham and Women's and Massachusetts General hospitals and at a day-care facility run by Children's Hospital Boston, where 33 children and employees fell ill.
No long-lasting health consequences were reported, disease trackers said.
The cases, especially those involving staff members, highlight the challenge of making sure that doctors, nurses, and other medical workers routinely and rigorously clean their hands. Previous winters have delivered comparable outbreaks of norovirus at hospitals, clinics, and nursing homes across Massachusetts.
"This is a virus that is highly transmissible and therefore the slightest lapse in protocol by any member of the healthcare team can cause this flash fire to take place," said Karen Nelson, senior vice president for clinical affairs at the Massachusetts Hospital Association.
Dr. Anita Barry, the infectious disease specialist whose job it is to track disease outbreaks in Boston, said it has long been recognized that hospitals need to do better at ensuring that workers have germ-free hands.
But even at hospitals recognized for their efforts to promote hand-washing, such as Mass. General, norovirus proves a formidable foe, with just a few viral particles capable of sickening otherwise healthy people.
"It's known this virus can survive on environmental surfaces for a number of hours," said Dr. David Hooper, chief of the infection control unit at Mass. General.
At that hospital, where 31 staff members and 13 patients fell ill, the floors and serving tables were doused with a bleach-based cleaning agent during the outbreak. Patient charts and computer keyboards were cleaned, too.
The stricken medical ward stopped accepting patients for four days, to ensure that the virus had run its course and to give the depleted workforce time to recover from the infection, which typically lasts a day or two. Staff members were not allowed to return to their jobs until three days after their symptoms abated, and anyone visiting a patient ill with norovirus had to don a gown and gloves.
At the Brigham, similar measures were adopted in the cardiac care unit that reported eight patient and 22 staff illnesses. Infectious disease specialists used the outbreak as an opportunity to remind workers about the basics of norovirus and to urge them to clean their hands with alcohol-based gel or soap and water before and after visiting every patient.
"We tried to make it really clear to them that anything less than perfect use of the hand-gel product was going to give the virus an opportunity to take advantage of the situation," said Dr. Deborah Yokoe, hospital epidemiologist at the Brigham.
The outbreak at the child-care center run by Children's proved so relentless that the facility was shuttered for four days the week of Dec. 17.
To increase compliance with hand-washing rules, all healthcare facilities need to monitor workers' habits and correct misconceptions they might have, said Dr. Don Goldmann, senior vice president at the Institute for Healthcare Improvement, a Cambridge think tank that works with hospitals to improve safety and efficiency. Alcohol-based gels, for example, don't cause dry skin, despite what some hospital workers may believe, he said.
Hospital administrators need to do their part, too.
"If I have to trip over the ventilator to find the gel, that's not making my life easier," Goldmann said. "So having all dispensers filled and making sure they're at the point of care where you need them, that's the hospital's responsibility."
Stephen Smith can be reached at stsmith@globe.com.
