Norovirus Guidance and Advice

As the Winter is upon us again, this time of the year often sees an increase in the winter vomiting bug commonly known as Norovirus (Norwalk Virus). Norovirus is contagious and can spread very fast. It is therefore imperative that adequate controls are put in place to prevent an outbreak from occurring and to contain it’s possible spread. We revisit practical guidance to managing the spread of the bug and how you can minimise the risk of a Norovirus outbreak in your organisation.

The main symptoms of the Norovirus illness usually include nausea, vomiting, diarrhoea and some stomach cramping which can occur after 12 to 48 hours of being exposed to the virus and usually last about 1 or 2 days.

Norovirus has been implicated in fatalities involving vulnerable groups including the elderly, children, expectant mothers and persons with suppressed immune systems.

People can become infected with Norovirus in several ways including:

• Eating food or drinking liquids that are contaminated with norovirus
• Shellfish such as mussels and oysters can be contaminated with Norovirus at source. It is therefore critical that these foods are purchased from reputable suppliers who can confirm that the necessary quality assurance checks (including microbiological tests) have been carried out. The supplier must also provide a health mark upon delivery. This is important for traceability purposes
• 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 (for example, when caring for someone with the illness, sharing foods or eating utensils with someone who is ill)
• Recent research has implicated infected food handlers as being a significant reason for the spread of Norovirus in the hospitality sector. The importance of strict personal hygiene, illness reporting and return to work procedures cannot be emphasised enough.

What should you do if you suspect a Norovirus outbreak within your operation?

A time line must be kept of all reports of illness, confirmed cases of Norovirus and corrective action taken to contain the spread of the virus. The containment of Norovirus is mainly focused on increased hygiene levels and exclusion measures to prevent further spread.

All staff members should be informed of the absolute importance of maintaining very high levels of hygiene throughout the unit.  All usual cleaning routines are to be increased.  Clean all areas with a disinfectant solution using 500ppm hypochlorite.

In the control of an outbreak, the important points are:

1. Increase and if necessary, reinforce all hygiene standards.
2. Locate and safely dispose of any vomit. One use body spill kits must be used in line with manufacturers instructions, risk assessment and personal protective equipment for this purpose. (Remember disposable gloves, disposable aprons, disposable face masks!)
3. The affected surface must then be sprayed with viricide.
4. Restrict the movements of affected people.
5. Implement robust disinfection procedures; particularly of hand contact points; door handles, hand rails, lift buttons, telephones etc.
6. Ensure ready to eat foods such as fruit and salads are carefully washed and/or removed from service to avoid transmission.
7. All staff members told to report any symptoms, however minimal.
8. All sick staff to be placed off-duty until they are at least 48 hours clear of all symptoms.
9. All staff, particularly those affected, to be fastidious over personal hygiene.
10. Staff to immediately report any soiled areas.
11. Provide sanitising gel packs for staff and make available for guests.
12. Notices to be placed in toilets requesting regular hand washing and the reporting of any dirty areas discovered in toilets.

What to do if you suspect a Norovirus outbreak in staff accommodation or guest accommodation:

In shared accommodation, a likely source of the illness could be via a member or members of staff that could spread between staff via shared toilet and bathroom facilities in the staff accommodation on site.

If this is the case, then the following measure need to be put in place:

1. The staff toilets in the business and the staff accommodation bathroom(s) and toilet(s) should be immediately cleaned and sanitised (use of a fogging machine will be the most effective measure).
2. Staff bedrooms will have to be fogged if staff have been sick in the room(s).
3. Temporary staff accommodation may need to be provided for staff who are not sick to prevent the spread of the illness to further members of staff who are staying in staff accommodation.
4. Staff MUST NOT come into the hotel and start work when they are already feeling nauseous or have been sick or suffering from diarrhoea in the staff accommodation.
5. Staff should immediately report the matter and stay in their room and facilities cleaned and sanitised to prevent the spread of illness between staff sharing common facilities.
6. The correct type of chemical should be used at the business and in the staff accommodation. Milton can be used in spray bottles, but must be used at the correct concentration. Milton 2% (typically available at chemists/supermarkets) should be used at a dilution of 1 in 20, i.e., 50 ml of Milton added to 1 litre of water. This concentration level can also be used in fogging machines.

General Advice 

1. Hotel guests complaining of ill effects should remain in the room until check out with the room fogged immediately after it is vacated.
2. All rooms identified as being stayed in by guests complaining of norovirus symptoms should be fogged immediately even though they may have been hand cleaned before.
3. The fogging machine will ensure that all surfaces are misted with the viricide to ensure that the virus does not survive in the environment to infect someone else up to 10 days later.
4. Continue with the hand contact surface cleaning (with the viricide spray) in the hotel at least twice a day.
5. Ensure that all food handlers with any symptoms are kept off work and any areas where infected food handlers have worked are thoroughly cleaned and sanitised (using viricide).
6. Ensure that the hotel bedroom and staff accommodation toilet brushes are placed in a bucket of Milton to soak or replaced with new brushes if appropriate.
7. All vomit discovered at the hotel and in staff accommodation should be cleaned up immediately using one use body spill kits and the affected surface sprayed with viricide. (Remember to consult your risk assessment and use the required PPE!).

In confirmed Norovirus cases, contacting the EHO/ Public Health England is advised. This will show that you are being proactive in dealing with the situation and ensuring public health.

Remember that as a business operator you have to ensure that the wellbeing of your staff and guests alike are given the top priority and that all measures are taken to ensure that your establishment is protected against the risk of Norovirus. A Norovirus standard operating procedure and effective staff training will go a long way in ensuring that your business is kept safe! It is important that key members of your team know what to do in the event of an outbreak.

If you need advice on what actions to take to limit the spread of Norovirus please contact the CSC helpline for assistance.