Salt Lake County Find It
Health banner image

Salt Lake Valley Health Department

Quick Links | Clinics | File a Report | FAQ | Contact Us

Bureau of Epidemiology

Viral Gastroenteritis Norovirus

Guidelines for Environmental Cleaning and Disinfection of Norovirus

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 and fomite (inanimate object or substance that is capable of transmitting infectious organisms) contamination.

Materials Needed

  • Disposable gloves
  • Masks
  • Eye protection or face shields
  • Gown or protective clothing

Please don all materials before beginning cleaning procedure.

General Warning
Chlorine bleach may impact fabrics and other surfaces. Please spot test area before applying to visible surface.

This document contains information for:

  • Disinfection
  • Health concerns with using chlorine bleach
  • Specific clean-up procedures
  • Food service establishments
  • Healthcare/Hospital/Nursing home facilities
  • Schools/Daycares
  • References

Disinfection

(For non-visibly soiled areas, please refer to specific procedures for large spills)

Examples of items to disinfect

Doorknobs, faucets, sinks, toilets, commodes, bath rails, phones, counters, chairs (including backs), tables, hand rails, elevator buttons, light switches, mattress covers, aprons, uniforms, linens, bedding, and ice machines.

What works best: Chlorine bleach (sodium hypochlorite, NaOCl )

Chlorine bleach concentrations and mixing instructions:

200ppm (parts per million)

  • Use for stainless steel, food/mouth contact items, toys
  • 1 tablespoon of bleach in 1 gallon of water (1:250 dilution)

1000ppm (parts per million)

  • Use for non-porous surfaces, tile floors, countertops, sinks, toilets
  • 1/3 cup bleach in 1 gallon water (1:50 dilution)

5000ppm (parts per million)

  • Use for porous surfaces, wooden floors
  • 1 cup bleach plus 2/3 cup bleach in 1 gallon water (1:10 dilution)

Contact time

  • Leave bleach on surface for 10-20 minutes, and then rinse with clean water.

Stability of Chlorine Bleach

  • Open bottles of concentrated chlorine will lose effectiveness after 30 days. Change bottles of bleach every 30 days for accurate concentrations. For disinfecting, use an unopened bottle of chlorine bleach. Prepare a dilution of fresh bleach every day of use and discard unused portions.

Other effective disinfectants

  • A phenolic environmental disinfectant (Lysol® or Pinesol®) may be effective, but may require 2-4x more concentration than the manufacturer’s recommendation. The use of this product at the higher concentration may pose a significant health risk to children, workers, pets, or yourself. Use extreme caution when using these products. Please read the manufacturer’s warning.
  • EPA-registered disinfectants (Some of these products no include quaternary ammonia-based disinfectants but in combination with alcohols. These claims of effectiveness are based on in-vitro studies usually using feline calicivirus; field effectiveness in the context of outbreaks has not been evaluated.) NOT ALL DISINFECTANTS ON THE EPA LIST ARE APPROVED FOR USE IN FOOD FACILITIES.

Health Concerns with using Chlorine Bleach

Mixing hazards

  • USE ONLY IN WELL-VENTILATED AREAS. Adverse effects of inappropriate mixtures of household cleaners usually are caused by prolonged exposure to an irritant gas in a poorly ventilated area. The most common inappropriate mixtures of cleaning agents are bleach with acids (like vinegar) or ammonia (Windex ®). Potential irritants released from such mixtures are chlorine gas, chloramines, and ammonia gas.

Health hazards

  • Chlorine bleach is corrosive and irritating to all mucosal tissue, skin, eyes and upper and lower respiratory tract. Avoid spray bottle application with any disinfectant. However, "pour" or "pump" bottles that do not produce aerosols are highly recommended.

Personal protective equipment

  • Disposable gloves, masks, eye protection or face shields, and gown or protective clothing.
  • Environmental cleaning using a more concentrated disinfectant will require a heavier duty glove than a simple non-sterile latex/vinyl glove.

Specific Clean-up Procedures

For cleaning large spills of vomitus or stool, a two-step process should be used. Put on personal protective equipment before cleanup as specified in the CDC document:

  1. Precleaning of visible/organic debris should be cleaned up with absorbent material (double layer and placed in a plastic bag to minimize exposure to aerosols) should precede the disinfection process
  2. Liberally disinfect area and objects surrounding the contamination with an appropriate environmental disinfectant (multiple applications may be required).
  • Ensure appropriate dilution and contact time for the appropriate environmental disinfectant.

Hard surfaces

  • Disinfect with bleach, rinse with water if food preparation area.

Carpet / Upholstered Furniture

  • Visible debris should be cleaned with absorbent material (double layer) and discarded in a plastic bag to minimize aerosols - disinfecting with bleach may discolor carpet – steam clean (heat inactivation) 158°F for 5 minutes or 212°F for 1 minute for complete inactivation.

Linens / clothing / textiles

  • If soiled, vomit or stool should be carefully removed to minimize aerosols. Keep contaminated and uncontaminated clothes separated. Minimize disruption of soiled linens and laundry. Aerosols created may pose a risk for transmission. Wash items in a pre-wash cycle, then use a regular wash cycle using detergent and dried separately from uncontaminated clothing at high temperature greater than 170°F. Ensure segregation of clean and soiled linens/clothing/textiles.

Surfaces Corrodible/damageable by bleach

  • EPA registered phenolic solutions (concentrated Lysol® or concentrated Pinesol®) mixed at 2-4x the manufacturer’s recommended concentration.

Food Service Establishments

Ill Employees (all documents refer to SLVHD Health Regulation #5)

  1. Exclusion: Food handlers who are ill with gastrointestinal symptoms MUST NOT prepare or serve food for others under any circumstances. Any employee with vomiting of diarrhea must be sent home immediately, unless their symptoms are a result of a noninfectious condition (e.g. pregnancy or Crohn's Disease) (4.2.6.i.a)
  2. Removal of exclusion:
    • Suspected norovirus: Employees ill with suspected norovirus MUST NOT return to work until 24 hours after symptoms have ended or MUST provide medical documentation that the symptom is fron a noninfectious condition (4.2.7.i.a); however, it is highly recommended that employees ill with suspected norovirus do not return to work until 48-72 hours after symptoms have ended.
    • Confirmed norovirus in a food handler serving a non-highly susceptible population: Employees who have been diagnosed with norovirus may return to work on a restricted basis (i.e. restricted from working with exposed food, clean equipment, utensils, linens, and unwrapped single-service and single-use articles) in the food establishment no sooner than 24 hours after symptoms resolve (4.2.7.i.b.i). They remain restricted until they meet the following conditions:
      • Approval is obtained from the Regulatory Authority (4.2.7.iv), AND
      • They have been medically cleared (4.2.7.iv.a), OR
      • More than 48 hours have passed since the employee's symptoms have resolved (4.2.7.iv.b), OR
      • They did not develop symptoms and more than 48 hours have passed since diagnosis (4.2.7.iv.c).
    • Confirmed norovirus in a food handler serving a highly susceptible population: Employees who have been diagnosed with norovirus are excluded from work until they meet the following requirements:
      • Approval is obtained from the Regulatory Authority (4.2.7.iv), AND
      • They have been medically cleared (4.2.7.iv.a), OR
      • More than 48 hours have passed since the employee's symptoms have resolved (4.2.7.iv.b), OR
      • They did not develop symptoms and more than 48 hours have passed since diagnosis (4.2.7.iv.c).  

Hand washing

  • After using the restroom, sneezing, coughing, before and after food preparation, all employees should wash hands with warm running water and soap, using friction for 20 seconds. Hands should be dried with a single-service paper towel or air dryer.
  • It is recommended that persons involved in busing tables, handling of used utensils; cups or any dishes exercise regular thorough hand washing, particularly before eating or handling food or clean utensils.

Disinfection precautions

  • NOT ALL DISINFECTANTS ON EPA LIST ARE APPROVED FOR USE IN FOOD FACILITIES
  • Product label must contain language stating approval for use in (FDA or USDA) food facilities AND provide appropriate directions for use/application rates in these settings. Consult the manufacturer for further information on approval for use on food contact surfaces and/or in food service facilities.
  • Any pesticide product intended for sanitizing inanimate food contact surfaces must be approved by FDA under 21CFR178.1010. See here for approved chemicals.

Healthcare/Hospital/Nursing Home Facilities

Occupational Health Policies

EPA-registered Hospital-use Disinfectant

  • Ensure appropriate use of EPA-registered hospital-use disinfectant (see Disinfection section).

Medical Equipment Cleaning Precautions

  • Medical equipment used for care of norovirus infected patients, should be either dedicated to that room for the duration of isolation or be thoroughly disinfected upon removal from the room. Please consult terminal cleaning recommendations for your facility. Selection of appropriate cleaning agent should be consistent with the equipment manufacturer’s recommendation for compatibility.

Cleaning Procedures

  • Routine environmental cleaning measures, at proper time intervals, and proper disinfection order, with the recommended concentration and contact time should be used.
  • For cleaning procedures (i.e. changing water / wash cloths, sequence of cleaning) refer to HICPAC Environmental Infection Control for Healthcare Facilities, 2003: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Enviro_guide_03.pdf, pgs. 71-88.

Laundry Concerns

  • Do not shake soiled linens and laundry. Aerosols created may pose a risk for transmission. Soiled linens should be placed directly into a bag at the point of removal.
  • Ensure proper segregation of clean and soiled laundry.
  • For additional laundry information, refer to: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Enviro_guide_03.pdf, pgs. 98-104.

Ice Machines

Schools/Daycare

Hand washing

  • All employees should wash hands with warm running water and soap, using friction for 20 seconds, paying special attention to under fingernails. Dry hands with a single-service paper towel or air dryer.
  • Hands should be washed after using the restroom, sneezing, coughing, changing diapers, before any food preparation or service.

Toy cleaning

  • Toys should be cleaned and disinfected daily.
  • Any toy that enter a child’s mouth (rubber or plastic blocks, balls, etc.) must be disinfected with 200ppm bleach, rinsed thoroughly and air dried or run through dishwasher with high temperature (170°F).
  • Remove organic matter on softer toys that have been soiled by vomit (see Disinfection section). Launder toy as directed or discard if necessary.

Keeping Diaper Changing Surfaces Clean

  • Surfaces should have a plastic covered pad without cracks.
  • Use disposable material to cover the pad on changing tables such as shelf paper, wax paper, scrap computer paper, cut up paper bags. Discard after each diaper change.
  • Clean the surface after every diaper change by washing with detergent, water and friction, rinsing with clean water.
  • Caregivers must wash their hands immediately.
  • After changing a diaper, the diapered child’s hands should be washed also.

References

See the PDF of this document (375 kb) for reference information.