Norovirus Disease Alert
Norovirus is a common cause of gastrointestinal illness, and has caused several large epidemics in Washoe County in recent years. Norovirus is highly contagious through person-to-person contact, in food and beverages, and on environmental surfaces and objects contaminated with human feces.
The Washoe County Health District (WCHD) is recommending the following prevention strategies for managers of food establishments and hotel/motels:
- Intensify a strict handwashing policy for food handlers to reduce potential contamination of food, ice, and food contact surfaces. Food handlers include not only those handling and preparing food, but also wait staff, bus persons, bar backs, bartenders, cocktail servers, and others performing similar tasks. In general, all employees including those from housekeeping, maintenance, front desk, and check-in, should practice strict handwashing procedures.
Handwashing is the single most important procedure for preventing the spread of infection between you, your coworkers and your guests. It will help break the recontamination cycle. Handwashing is especially important before eating and after using the restroom. Instructional signs should be posted in all employee and public restrooms and guest room bathrooms, in relevant languages.
- Intensify sanitation of all food contact surfaces, utensils, and equipment. Make sure all dishwashing machines' sanitation cycles are in good working order. The usual 200 ppm hypochlorite solution is not effective against Norovirus. Apply 1000 ppm (approximately 1/3 to 1/2 cup) of hypochlorite (bleach) and then rinse with potable water. Proper cooking, holding, and serving temperatures of food should be strictly adhered to.
- Any potentially contaminated food, beverages and ice should be removed from service. Serving utensils in buffet lines should be frequently changed or buffet lines may be changed from self-service to a served buffet line.
- All ill employees with symptoms of vomiting, diarrhea, or "stomach flu" must not be allowed to return to work until 72 hours after their symptoms have been resolved. This is to reduce possible disease transmission by asymptomatic employees. After using the restroom, all employees should wash their hands with hot, soapy water for at least 20 seconds, thoroughly rinse with clean water and dry their hands with a disposable paper towel. The paper towel should then be used to shut off the water faucet and open the restroom door to prevent the recontamination of the hands, and be disposed of in an appropriate receptacle.
- Staff should wear disposable gloves and aprons when cleaning up after ill guests, especially when handling vomit, diarrhea, or other bodily wastes. It is recommended that persons who clean areas substantially contaminated by feces and/or vomitus wear masks because spattering or aerosols of infectious material might result in disease transmission. Use of cleaning cloths and other items used to clean toilets should only be used for that purpose and should not be used from room to room. Do not use these items to clean other surfaces. Effective virucides should be used in bathrooms and high hand-contact areas in guest rooms such as taps, faucets, door and drawer handles, door latches, toilet or bath rails, telephones, rails on balconies, light and lamp switches, thermostats, remote controls, curtain pulls and wands, covers on guest information books, alarm clock buttons, hair dryers, irons, and pens.
- Staff should promptly bag and clean soiled linens or dispose of them as infectious waste. Linens soiled with vomit or feces should be washed in a hot wash and dried at high temperature (drier temperature >170° F).
- When responding to a Public Vomiting Incident (PVI), the area within at least a 25-foot radius should be cleaned and disinfected using the above procedures.
- Staff should wash hands thoroughly using soap and water and then dry them thoroughly after completing the clean-up procedure and again after completing the disposal procedure.
- Ice buckets placed in hotel rooms for use by guests should be cleaned and sanitized on a daily basis using an automatic dishwasher or replaced with disposable, single-use ice buckets.
- Public areas should receive a daily cleaning including disinfection of heavy hand-contact areas such as telephones, handrails, door handles, push plates, elevator buttons, keyboards, pens, pencils, casino chips, menus, table tents, salt and pepper shakers, cards, slot machines, sports equipment, counters, and tables. Lounge chairs, swimming pools, hot tubs, gymnasium equipment, and children's areas should be disinfected. Carpet may be steam cleaned (minimum 170° F) after disinfection.
- When selecting a disinfectant, it is important to consider the product's entire formulation since there may be significant disinfectant interaction produced by the specific combination of ingredients. Request the manufacturer to provide data that supports the product's efficacy claims against noroviruses. Effective virucides are those effective against feline calicivirus (FCV) including: Virkon ® (Biosafety USA), Accel ® (Virox Technologies), Eco Tru, and Mikro BAC 3 ® (Ecolab).
- Plumbing cross-connections allow the potential for potable water to be cross-contaminated with non-potable water. It is recommended to eliminate the cross-connection through the use of a certified plumbing specialist. A list is available from the Washoe County Health District.
The WCHD recommends having a trained "decontamination team" with the right chemicals and equipment at all times for the clean-up of biohazardous (vomitus or feces) accidents. Ensure that only properly protected and trained staff are cleaning and disinfecting affected areas.
Report unusual numbers of guest or employees ill with symptoms of gastroenteritis (vomiting and/or diarrhea) to the Washoe County Health District at 328-2434, or after hours at 328-2436.
For more information, contact us at 328-2434. Information on Norovirus Disease is available at the Center for Disease Control and Prevention's Norovirus information page.
- Washoe County Health District, Epi News Vol. 24, No. 19
- Southern Nevada Health District, Norovirus Outbreak Prevention Guidelines for Hotels/Casinos, 10/27/04
- National Park Service, US Department of Interior, Norovirus Response and Cleaning Factsheet