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Diseases & Topics

Norovirus

Outbreak Management in Food Service Establishments

Noroviruses are a group of viruses that cause acute gastroenteritis in humans. The symptoms of norovirus infection include nausea, vomiting, diarrhea, cramping and low-grade fever. Noroviruses are transmitted through the fecal-oral route — either by consumption of fecally contaminated food or water, direct person-to-person spread, or environmental contamination.

Food Service Workers

All food service workers who are symptomatic should be excluded from the food service facility until they are asymptomatic for at least 48 hours or have a physician's note. All food that has been potentially contaminated by a symptomatic food worker should be discarded. Food service workers who have close contacts (e.g., children, roommates, family members, etc.) experiencing symptoms of gastroenteritis should be reminded of the importance of frequent and thorough hand washing as a way to protect themselves and others from becoming infected.

Cleaning Procedures

If a food service establishment has been exposed to employees or customers with symptoms of a norovirus, it is important to thoroughly clean and disinfect the establishment.

Preparation is important. Be sure to use disposable gloves, a mask, a form of eye protection and protective clothing while thoroughly cleaning.

It is best to use chlorine bleach (sodium hypochlorite-NaOCl) as the main disinfecting agent. For disinfecting, use an unopened bottle of chlorine bleach. Prepare the solution as indicated below under "Concentrations" using fresh bleach each day. Discard unused portions of cleaning solution. Open bottles of concentrated chlorine will lose effectiveness after 30 days, so use a new bottle of bleach every 30 days for accurate concentrations. Disinfectants such as quaternary compounds, ethanol or anionic compounds are ineffective at disinfecting an environment exposed to noroviruses. Warning: Chlorine bleach may damage fabrics and other surfaces. Please spot-test the area before applying to visible surfaces.

Concentrations:

• For stainless steel, food/mouth contact items: 1 tablespoon of chlorine bleach in 1 gallon of water.
• For non-porous surfaces such as tile floors, counter-tops, sinks, etc.: one-third (1/3) cup of chlorine bleach in 1 gallon of water.
• For porous surfaces such as wooden floors: one and two-thirds (1 2/3) cups of chlorine bleach in 1 gallon of water.

Leave the bleach solution on the surface for 10 to 20 minutes, and then rinse the area well with clean water. After the disinfection process is complete, close off the area, if possible, for at least one hour. If there are windows, air out the area.

Wash and sanitize hands thoroughly before resuming work.

Cleaning Procedures for Special Cases and Areas

For "hot spots" (areas most likely to become environmentally-contaminated with viral particles and then spread through subsequent use):

• Emphasize hand-washing for all employees, including wait and bus staff.
• Maintain clean restroom areas to prevent the potential for cross-contamination.
• Install supplemental hand wash signs in restrooms to encourage customers to wash their hands.
• Install hand-sanitizer stations in the dining area and close to children's play areas. Emphasize their use with signage.
• Monitor the customer self-service areas (e.g., buffet bar) to prevent contamination, or eliminate self-service.
• Consider wrapping ready-to-eat items individually to reduce the chance of transmission.
• Change serving utensils often.
• Ensure thorough cleaning and sanitization of plates, tableware, utensils, etc.
• Wash raw fruits and vegetables thoroughly.
• Repeat disinfection of heavy hand-contact areas and surfaces daily.

For areas exposed to vomiting or feces contamination:

• Use paper towels to soak up as much of the contaminated material as possible, being careful not to drip or splash the material.
• Clean and disinfect the entire area with disposable cloths.
• Dispose of all waste material in sealed plastic bags.

For carpeted areas:

• Remove all visible debris with absorbent material. Discard in a plastic bag to minimize aerosols.
• Steam-clean the carpet to 170 degrees Fahrenheit for five minutes or 212 degrees Fahrenheit for one minute to completely inactivate the virus.

For linens, clothing or textiles:

• If soiled, vomit or stool should be carefully removed to minimize aerosols.
• Keep contaminated and uncontaminated clothes separate.
• Reduce disruption of soiled linens and laundry.
• Wash items in a pre-wash cycle. Then, use a regular wash cycle—using detergent and dry separately from uncontaminated clothing at high temperature (greater than 170 degrees Fahrenheit).
• Make sure clean and soiled linens, clothing or textiles remain separated.

For surfaces corrodible or damageable by bleach:

The Environmental Protection Agency recommends phenolic solutions (such as concentrated Lysol® or concentrated Pinesol®), mixed at two to four times the manufacturer's recommended concentration, as best for surfaces that could be damaged by bleach.

Source: Division of Environmental Health, N.C. Department of Environment and Natural Resources, Dec. 2008. Reviewed and adapted by Division of Public Health, N.C. Department of Health and Human Services, Oct. 2011.