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Infection Control

Preventing A Norovirus Outbreak

February 08, 2012
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As a public health and sanitation consultant, I''m often asked, "What''s the next big public health risk or bug du jour with which cleaning professionals should be concerned?"

While it''s not every year that there is a unique answer, the one constant public health risk that everyone faces year after year is norovirus.

What Is Norovirus?

Norovirus is a group of viruses that cause what is often referred to as the stomach flu or acute gastroenteritis.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that, each year, more than 20 million cases of acute gastroenteritis are due to norovirus infection.

That means about one in every 15 Americans becomes sick with this particular group of viruses each year.

The symptoms usually include nausea, vomiting, diarrhea and stomach cramping.

The illness often begins suddenly with symptoms typically lasting one to three days; however, infected persons can carry the virus up to four weeks after symptoms dissipate.

How Do People Become Infected?

Norovirus is very contagious and can spread rapidly from person to person, which is why this is a significant health concern for cleaning professionals.

People can become infected by:

  • Eating food or drinking liquids that are contaminated with norovirus
  • Touching surfaces or objects contaminated with norovirus and then placing their hand in their mouth
  • Having direct contact with another person who is infected and showing symptoms.
Follow Preventative Measures

Given this widespread concern and recent advances in norovirus epidemiology, immunology and infection control, last year, the CDC updated its guidelines for norovirus outbreak management and disease prevention.

It is essential to adhere to these guidelines and take preventive measures to ensure cleanliness, including:

  • Be vigilant and always operate as though norovirus is prevalent in one''s place of business by regularly cleaning and disinfecting surfaces and areas
  • Always use a U.S. Environmental Protection Agency (EPA) registered disinfectant that is effective against norovirus specifically.
  • Enforce frequent handwashing habits — with soap and warm water — as an automatic behavior for employees, especially after using the restroom, before meals, between interactions with people or whenever they become soiled
  • Exclude and isolate infected or potentially infected persons; do not allow employees who have signs and symptoms of gastroenteritis — vomiting and/or diarrhea — to work
  • Regularly clean and disinfect highly touched surfaces, particularly those in the restroom — not forgetting to clean and disinfect the often overlooked underside of handles and stair rails where fingers often touch
  • Immediately remove and wash clothing or linens that may be contaminated with the virus after an episode of illness occurs
  • Thoroughly clean and disinfect surfaces that have been contaminated by vomiting and diarrheal events. All institutional establishments should have procedures to follow when responding to these events. The procedures should address actions to be taken that minimize the spread of contamination and the exposure of employees, consumers and food to these potentially hazardous bodily fluids.
Emergency Plans And Procedures

Due to the high concentrations of norovirus found in the vomit and feces of infected individuals, the U.S. Food and Drug Administration (FDA) is now mandating that vomiting and diarrheal events be considered emergencies in restaurants and food service establishments and that these fluids be treated as though they contain norovirus.

I advise customers that all facility types should treat vomit and diarrheal events as emergencies for this same reason.

One of the key approaches to interrupting norovirus transmission from contaminated surfaces in the environment is through the use of chemical disinfectants. An EPA-registered disinfectant that is effective against norovirus is recommended by the CDC to disinfect highly touched surfaces where norovirus may be present.

Some sanitation suppliers offer bodily fluid cleanup kits that contain procedures, tools, disinfectants, personal protective equipment (PPE) and other items that meet requirements in the FDA''s most recent version of the model Food Code.

It is recommended that these cleanup kits be mounted or stored in a convenient location along with standard usage procedures.

Cleaning professionals operating in establishments of any type should use an EPA-registered disinfectant that is effective against norovirus.

There are multipurpose products currently available that will both clean a surface and disinfect against norovirus.

Using an effective multipurpose product streamlines and simplifies the cleaning and disinfecting procedures, often resulting in better results and less re-work.

Establishments should also have emergency plans and procedures in place to effectively and efficiently respond to a norovirus outbreak.

The following are basic guidelines that should be followed:

  • Cooperate with a regulatory authority to investigate and develop a recovery plan
  • Execute the recovery plan
  • Clean and disinfect affected areas of the establishment using an EPA-registered disinfectant that is effective against norovirus specifically
  • Conduct employee training where necessary, such as proper handwashing and cleaning and disinfecting techniques
  • Isolate potentially sick employees
  • Cooperate with a regulatory authority to investigate the cause of an outbreak
  • Establish new cleaning and disinfecting procedures and policies or revise existing ones to ensure the prevention of norovirus transmission in the future.
Cleaning professionals should always work with their cleaning and sanitation product supplier to ensure they have the necessary tools, products and procedures in place to mitigate the transmission of norovirus, as well as respond and recover in the event of an emergency.

Ultimately, following the proper prevention procedures and using the most effective products is the industry''s best defense to protect professionals and the people they serve, as there currently isn''t any medication for or vaccine to prevent norovirus infections.


Jeff Anderson, Ph.D. is a public health and sanitation consultant at Procter & Gamble Professional, the away-from-home division of Procter & Gamble (P&G). In this role, Anderson helps customers mitigate public health risk factors within their operations using science-based strategies, and provides food safety education and certification to foodservice managers throughout the U.S. Anderson has authored and co-authored 15 technical papers in scientific publications related to topics in infection control, microbiology and chemistry.

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