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Diseases & Topics


Outbreak Management in Child Care Facilities

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. Norovirus is very contagious and can also be spread through tiny droplets of material in the air (aerosols).

Control Measures

If a child care center has staff or children with symptoms of norovirus, it is vitally important to control the spread of norovirus to others. You can reduce the number of people that get sick by reducing their exposure to sick persons and surfaces contaminated with the virus:

1. Social Distancing

If a child or child care worker has symptoms of norovirus, they should not come to the child care facility until they have been symptom-free for 48 hours. In addition, all patrons and visitors to the child care facility should be screened for symptoms.

2. Cleaning Procedures

If someone in the child care facility has been exposed to and has symptoms of a norovirus, it is important to thoroughly clean and disinfect the facility.

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 (see Concentrations), using fresh bleach each day. Discard unused portions. (Use a new bottle of bleach every 30 days for accurate concentrations, as open bottles of concentrated chlorine bleach will lose effectiveness after 30 days.) 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 bleach solution to visible surfaces.


  • 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 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:

  • Carefully remove any vomit or stool to minimize aerosols.
  • Keep contaminated and uncontaminated clothes and linens separate.
  • Handle soiled linens and laundry as little as possible.
  • 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, Feb. 2009. Reviewed and adapted by Division of Public Health, N.C. Department of Health and Human Services, Oct. 2011.