title: Preventing and controlling human noroviruses in South Carolina long-term care facilities: An analysis of institutional policies and procedures.
abstract: BACKGROUND
  Long-term care (LTC) facilities are the number one setting for human norovirus (HuNoV) outbreaks in the United States (60%).
  
  
  METHODS
  We aimed to determine alignment of policies and procedures in LTC facilities in South Carolina with Centers for Disease Control and Prevention (CDC) recommendations and to determine readability based on Federal Plain Language Guidelines and Microsoft Word readability statistics.
  
  
  RESULTS
  Most facilities (n = 21) had procedures for hand hygiene, but recommendations for handwashing events and duration varied greatly. Less than half (n = 11) had separate procedures devoted to HuNoV outbreak control. Fifteen required disinfection of bodily fluids. Seven had procedures for exclusion of sick staff during an outbreak. Both hand hygiene and bodily fluid cleanup procedures had low mean scores for readability. Mean Flesch Reading Ease and Flesch-Kincaid Grade Level for both procedures were in the range of difficult to understand.
  
  
  CONCLUSIONS
  Most LTC policies and procedures were not consistent with CDC recommendations for HuNoV. Moreover, readability of all procedures is needed so LTC workers can easily understand and implement prevention and control procedures.
authors.affiliation: Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC.
authors.forename: Lalani
authors.initials: L
authors.lastname: Jayasekara
authors.affiliation: Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC.
authors.forename: Cortney M
authors.initials: CM
authors.lastname: Leone
authors.affiliation: Department of Mathematical Sciences, Clemson University, Clemson, SC.
authors.forename: Julia
authors.initials: J
authors.lastname: Sharp
authors.affiliation: Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC. Electronic address: afraser@clemson.edu.
authors.forename: Angela
authors.initials: A
authors.lastname: Fraser
mesh_terms: D001826:Body Fluids; D017250:Caliciviridae Infections / Q000517:prevention & control*; D002487:Centers for Disease Control and Prevention, U.S.; D032882:Comprehension; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006235:Hand Disinfection; D006268:Health Facilities; D058016:Health Facility Administration; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D008297:Male; D029322:Norovirus / Q000502:physiology*; D016134:Organizational Policy; D013022:South Carolina; D014481:United States
keywords: Human noroviruses; Long-term care; Policies; Procedures