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Review
. 2014 Sep;15(5):176-180.
doi: 10.1177/1757177414545390.

Vomiting Larry: a simulated vomiting system for assessing environmental contamination from projectile vomiting related to norovirus infection

Catherine Makison Booth  1
Affiliations
Review

Vomiting Larry: a simulated vomiting system for assessing environmental contamination from projectile vomiting related to norovirus infection

Catherine Makison Booth. J Infect Prev. 2014 Sep.

Abstract

Infectious diseases such as norovirus can induce emesis (vomiting), which can be of a projectile nature. Although studies have been carried out on transmission, prevalence and decontamination of such micro-organisms within various environments, little is known about the extent to which the surrounding environment is contaminated when an individual vomits. This is an important consideration for infection control purposes. The aim of this study was to develop a simulated vomiting system (Vomiting Larry) to be used for assessing the extent to which projected fluid can contaminate the environment. Vomiting Larry was set up within a Controlled Atmosphere Chamber (CAC) facility at the Health and Safety Laboratory (HSL). Simulated vomiting was undertaken using water as a vomitus substitute containing a fluorescent marker enabling small splashes, ordinarily missed, to be visualised using UV lighting. Experiments revealed that splashes and droplets produced during an episode of projectile vomiting can travel great distances (>3 m forward spread and 2.6 m lateral spread). The research highlighted that small droplets can be hard to see and therefore cleaning all contaminated surfaces is difficult to achieve. Evidence from this study suggests that areas of at least 7.8 m2 should be decontaminated following an episode of projectile vomiting.

Keywords: Emesis; Vomiting Larry; environmental contamination; infection control; norovirus; vomiting.

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Conflict of interest statement

Declaration of conflicting interest: The author declares that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
The simulated vomiting system (Vomiting Larry) a: Airway Larry b: Blocked off bronchioles of Airway Larry c: Outlet pipe connected to Airway Larry d: Cylinder containing 1 L of fluid e: Piston f: Air inlet to push piston down g: Pneumatic ram h: Air inlet to push piston up
Figure 2.
Figure 2.
Images (a–-e) are sequential photographs of simulated vomiting taken 10 ms apart under UV light. a: Release of droplets prior to main bulk fluid b: ‘Strings’ of fluid and droplet fallout c: Mid flow of fluid d: Less droplet formation e: Fluid travelling less far towards end of simulation
Figure 3.
Figure 3.
Rebounding fluid (highlighted at A) from the initial impact during simulated vomiting (scale: grid sections = 20 cm x 20 cm) creates widespread splash. a: Rebounding splash upon fluid impact with floor surface
Figure 4.
Figure 4.
Spread of splash post-simulated vomiting (scale: grid sections = 20 cm x 20 cm)
See this image and copyright information in PMC

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