The Centers for Disease Control and Prevention (CDC) estimates that each year in the United States, noroviruses are responsible for approximately 23 million infections, resulting in more than 50,000 hospitalizations. This checklist covers how to prevent transmission of the virus at your establishment and best practices for disinfection.

How People Become Infected

Noroviruses are transmitted primarily through food or water contaminated with fecal material, but can also spread via droplets of vomit. Transmission can occur indirectly from hands to mouth after touching contaminated surfaces.

How to Limit Norovirus Transmission

  • Practice good hand hygiene. After using the restroom, sneezing, coughing, and before and after food preparation, all employees should:
    • Wash their hands with warm running water and soap, using friction for 15-20 seconds, and then dry hands with a single-service paper towel or air dryer.
    • If soap and water are not available, use a waterless, alcohol-based hand rub with a minimum ethanol concentration of 60 percent.
  • After handling contaminated materials, all employees should:
    • Avoid touching their faces, especially their mouths.
    • Avoid eating, drinking, smoking, applying lip balm or any facial cosmetics.
  • Wear disposable mask, gloves, eye shield and plastic disposable apron:
    • When there is the possibility of splashes that might lead to contamination of clothing
    • When cleaning areas heavily contaminated with vomit or feces
  • Clean and disinfect any surface (porous or non-porous) that is likely to have been touched or contaminated by an infected person.

Effective disinfectants

The CDC recommends using either chlorine bleach or EPA-approved disinfectants to control norovirus outbreaks. For maximum effectiveness, all visible debris should be removed prior to disinfecting a contaminated surface.

Chlorine Bleach: Concentrations and Mixing Instructions

  • For surfaces likely to come in contact with food or mouths, such as a child’s toy, use1 tablespoon of bleach in 1 gallon of water (1:250 dilution).
  • For most non-porous surfaces, use 1/3 cup of bleach in 1 gallon of water (1:50 dilution).
  • For heavily contaminated non-porous surfaces, use 1-2/3 cups of bleach in 1 gallon of water (1:10 dilution).

Contact time: Leave bleach solution on surface for 10-20 minutes and then rinse thoroughly with clean water.

Effective shelf life of chlorine bleach:

  • Once opened, bottles of household bleach will lose effectiveness after 30 days.
  • Use a new, unopened bottle of bleach every 30 days for preparing diluted disinfectant solutions.
  • Prepare a fresh dilution of bleach (only from bleach bottles that have not been open for more than 30 days) every day of use and discard unused portions.

General Procedures for Disinfecting Surfaces and Objects

Cleaning large spills of vomit or feces

  • Visible debris should be removed carefully to minimize airborne particles. Use double-layered absorbent material and discard in a sealed plastic bag.
  • Disinfect area and objects surrounding the contamination with an appropriate chlorine bleach solution or EPA-registered disinfectant (multiple applications may be required).
  • Ensure appropriate dilution and contact time for the disinfectant.
  • The area where such an incident has occurred should be closed or cordoned off for at least one hour, and all windows opened to allow thorough air circulation.

Non-porous or hard surfaces

  • Examples include bath rails, chairs (all wooden, plastic and steel parts), counters, doorknobs, elevator buttons, faucets, handrails, light switches, phones, tables, toilets and sinks
  • Disinfect with chlorine bleach. After disinfecting, rinse with water in food preparation areas.

Porous surfaces: Carpets/Upholstered Furniture

  • Visible debris should be cleaned with an absorbent material (double layer) and discarded in a plastic bag to minimize airborne particles.
  • Steam clean (heat inactivation) at 158° F for five minutes or at 212° F for one minute for complete inactivation. Disinfecting with bleach may discolor carpets and/or upholstered furniture.

Other porous surfaces: Clothing/linens/textiles

  • Examples include aprons, bedding, linens, mattress covers, uniforms and window coverings
  • If soiled, vomit or feces should be carefully removed to minimize airborne particles that may pose a risk for transmission. Do not shake soiled linens and laundry. Soiled linens should be placed directly into a bag at the point of removal.
  • Ensure proper separation of clean and soiled laundry.
  • Wash items in a pre-wash cycle, then run a regular wash cycle with detergent.
  • Dry contaminated material separately at a temperature greater than 170° F.
  • In some cases, it may be best to discard certain soiled materials rather than risk exposure during cleaning.

Best Practices for Cleaning Guest Rooms

In addition to routine housekeeping practices, employees should:

  • Be on the lookout for common cross contamination issues (for example, using the same rag to clean bathroom surfaces and wipe down ice buckets). Correct these issues and share the information with managers to standardize better cleaning methods.
  • Use disposable cleaning cloths.
  • Use one cloth for cleaning and a different cloth for disinfecting surfaces.
  • Use separate, distinctly colored cloths in toilet areas.
  • Use a new set of cloths for each guest room.
  • Clean and sanitize high-touch areas 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.

Best Practices for Cleaning Common Areas

In addition to routine cleaning activities, employees should:

  • Increase frequency of cleaning and disinfecting the handles of hand sinks and doors in public restrooms, employee restrooms and throughout all kitchens to once per hour during periods of frequent use.
  • Increase frequency of cleaning and disinfecting employee restrooms to once per hour during periods of frequent use.
  • Use disposable cleaning cloths.
  • Use separate, distinctly colored cloths in toilet areas.
  • Clean and disinfect high-touch areas such as slot machine buttons and handles, coin trays and buckets, drinking fountains, telephones, ATMs, chips, door handles and push plates, contact areas of gaming tables, and elevator buttons and panels.
  • Frequently clean and disinfect public stair rails, balcony/mezzanine rails, escalator roller bars and bar rails.
  • Frequently clean and disinfect parking validation clocks, ATMs, courtesy phones, casino cage counters, self-serve coin redemption kiosks, gaming chair backs, gaming tables, table game cup holders, restaurant menus and similar high-contact surfaces throughout the facility. Carefully follow all manufacturer instructions on cleaning, rinsing and sanitizing equipment, being careful not to damage sensitive electronic components.
  • Clean and disinfect floor surfaces in all public areas.
  • Remove bags from vacuum cleaners; disinfect the vacuum bags and then replace the bags with HEPA filter bags before subsequent use.
  • Discard the ice in all ice machines once per week throughout all kitchen facilities, and then thoroughly clean and disinfect the machine.

Source: CDC, OSHA