HomeMy WebLinkAboutacute-viral-gastroenteritis-outbreak-recommendations-for-long-term-care-facilities-cover-sheetAcute Viral Gastroenteritis Outbreak
Recommendations for Long-Term Care Facilities
COVER SHEET
This guidance was created by the Alameda County Public Health Department (ACPHD) and is intended for use by long-term care facilities (LTCF) for the management and containment of norovirus/viral gastroenteritis outbreaks. More detailed guidance is available on the California Department of Public Health (CDPH) website. Report all suspected or confirmed norovirus/viral gastroenteritis outbreaks to Alameda County Public Health Department by calling (510) 267-3250. To report on evenings, weekends and holidays, call Alameda County Dispatch at (925) 422-7595 and ask to speak with the On Call Public Health Duty Officer. If your facility is experiencing a suspected or confirmed norovirus/viral gastroenteritis outbreak, review the following information and implement this guidance.
Norovirus/Viral Gastroenteritis Recommendations Checklist for Facilities (ACPHD, 2025)
Recommendations for the Prevention and Control of Viral Gastroenteritis Outbreaks in CaliforniaLong-Term Care Facilities (CDPH, 2006)
Line List of New Cases, to be sent in daily (ACPHD, 2025)
Stool Specimen Collection Instructions (ACPHD, 2025)
Norovirus Outbreak Specimen Submittal Form (CDPH, 2011)
Interfacility Infection Control Transfer Form (ACPHD, 2025)
Norovirus Clean-Up and Disinfection Infographics (Somerset County Public Health Department, 2015)
o Cleaning and disinfection after a vomiting or diarrhea incident, English and Spanish
o General cleaning and disinfection during an outbreak, English and Spanish
Cleaning and Disinfection Instructions (ACPHD, 2025)
Handwashing and Approved Disinfectants (ACPHD, 2025)
Norovirus: What You Need to Know, information for staff, residents and their families (CDPH, 2025)
Norovirus Facts for Food Workers in English and Spanish, for facility food service staff (CDC, 2024)
Please return the following via fax to (510) 273-3744 or by secure encrypted email to AcuteCD@acgov.org:
•A copy of the floor plan of your facility with room numbers
•Completed Line List, to be submitted daily
Note: Privacy Rule (HIPAA) permits covered entities to disclose PHI without authorization to public health authorities or other entities who are legally authorized to receive such reports for the purpose of preventing or controlling disease. This includes the reporting of disease, conducting public surveillance, investigations, or interventions.
v.10.2025
Health.AlamedaCountyCA.gov/ACPHD
v.10.2025
This checklist is to be used to implement outbreak control, in supplementation to “Recommendations for the Prevention and Control of Viral Gastroenteritis Outbreaks (CDPH, 2006)”
Recommendations Instruct residents and staff to immediately report symptoms of vomiting or diarrhea to the facility infection preventionist or a facility designee. acute vomiting and/or diarrhea within one to two days.
•Report to ACPHD by phone at (510) 267-3250. If calling in the evening or on weekends or holidays, callAlameda County Dispatch at (925) 422-7595 and ask to speak with the On Call Public Health Duty Officer.
•Facilities licensed by CDPH Licensing and Certification must report outbreaks to the East Bay District Office.
•Facilities licensed by CDSS must report outbreaks to Community Care Licensing and Certification RegionalOffice: (510) 286-4201 and CCLASCPOaklandRO@dss.ca.govencrypted email to AcuteCD@acgov.org on a daily basis to report all newly symptomatic residents and staff. If there are no new illnesses to report, check the “No New Illnesses” box. stakeholders including the facility infection preventionist, administrator, medical director, health services director, staff, primary care providers of residents, and the residents, family, and visitors. and instructing them not to enter if they have recently had symptoms of vomiting and/or diarrhea. norovirus/gastroenteritis fact sheet for food workers to food service staff, available in English and Spanish.
Limit transmission when initial case of viral gastroenteritis is suspected
Limit new admission while the outbreak is active. If new admissions are necessary, admit to an unaffected unit or to a unit that
has had no new cases for at least 2 days.
symptoms of viral gastroenteritis
should immediately report the symptoms to their supervisor or nurse. New cases of viral gastroenteritis must be reported to
48 hours after they no longer have
vomiting or diarrhea.
24 hours after they no longer have vomiting or diarrhea.
the appropriate procedure for putting on and removing gowns, gloves, masks/eye protection (if resident is vomiting) and should
arrange for specimen collection kits and pick up at (510) 267-3250. Please use the attached “Norovirus Outbreak Specimen “”
acute gastroenteritis outbreak is underway in your facility and use the “Interfacility Infection Control Transfer Form”.
Norovirus/Viral Gastroenteritis Recommendations Checklist for Facilities
v.10.2025
Begin control measures when a viral gastroenteritis outbreak is suspected without waiting for diagnostic confirmation
possibility of sprays or splashes (i.e., active vomiting, diarrhea).
that hands do not touch potentially contaminated environmental surfaces/items.
contaminated with feces or vomit. See the attached “Clean up and Disinfection for Norovirus” and “Cleaning and Disinfection
Instructions” for detailed guidance. Allow surfaces to remain wet with bleach solution for at least 5 minutes when disinfecting.
A bleach solution should be used for disinfection whenever possible. If bleach cannot be used, then a product from EPA List G
may be used, however these products may not be as effective as bleach, even with EPA approval.
objects that are frequently touched like sinks, faucets, showers, bath rails, toilets, handrails, door handles, phones, chairs, tables,
light switches, elevator buttons, and keyboards. See attached “Prevent the Spread of Norovirus” and “Cleaning and Disinfection Instructions”.
Hand sanitizer is ineffective for Norovirus
hands with soap and water whenever possible. Alcohol-based hand sanitizer may be used if hands are not visibly soiled. See
attached “Handwashing and Approved Disinfectants Effective Against Norovirus”.
not
adequately clean and disinfect equipment between uses. See the attached “Handwashing and Approved Disinfectants Effective
Against Norovirus”.
feeding meals) are ill with vomiting and/or diarrhea. Contact ACPHD at (510) 267-3250, to facilitate notification of the
Department of Environmental Health.
Assessing Outbreak Control Measures
consider the viral gastroenteritis outbreak resolved. If a pathogen other than norovirus is identified as the cause of the
outbreak, resolution of the outbreak will be determined in consultation with ACPHD on a case-by-case basis and will vary
depending on the pathogen identified.
A staff member from ACPHD will notify you when the outbreak investigation has concluded and you may discontinue sending
the daily line list.
Norovirus and other viruses that cause gastroenteritis can survive on surfaces and be shed in the stool for several weeks after
symptoms resolve, so it is important to practice good hand hygiene and environmental cleaning and disinfection even after
the outbreak resolves.
v.10.2025
Alameda County Public Health Department
Division of Communicable Disease Control and Prevention
Acute Communicable Disease Section
1100 San Leandro Blvd
San Leandro, CA 94577
Phone: (510) 267-3250 Fax: (510) 273-3744
Name of Facility: Today’s Date: No new illness to report today
Identification Illness Description Risk
Factors
Laboratory Test Illness Outcome
Name
Line List for Facilities
St
a
f
f
or
Re
s
i
d
e
n
t
(
S
/
R
)
Un
i
t
Ag
e
Se
x
On
s
e
t
da
t
e
of
sy
m
p
t
o
m
s
Da
t
e
of
la
s
t
sy
m
p
t
o
m
s
Di
a
r
r
h
e
a
x2
w/
I
24
hr
(Y
/
N
)
Bl
o
o
d
y
di
a
r
r
h
e
a
(Y
/
N
)
Vo
m
i
t
i
n
g
(Y
/
N
)
Na
u
s
e
a
(Y
/
N
)
Ab
d
o
m
i
n
a
l
cr
a
m
p
s
(Y
/
N
)
Fe
v
e
r
> 10
0
.
4
(Y
/
N
)
He
a
d
a
c
h
e
(Y
/
N
)
Ot
h
e
r
Pr
e
g
n
a
n
t
(Y
/
N
)
Im
m
u
n
e
Co
m
p
r
o
m
i
s
e
d
(Y
/
N
)
Sp
e
c
i
m
e
n
te
s
t
e
d
(Y
/
N
)
Sp
e
c
i
m
e
n
ty
p
e
STOOL SPECIMEN COLLECTION INSTRUCTIONS Dry Container
1.Remember where everything goes in the bag when you receive it. When you are done,they need to go back the same way you found them. The specimen container goes in
the ziplock pocket that gets zipped closed.
2. Remove the specimen container from the plastic bag when you are ready to collect stool.WRITE YOUR NAME, DOB, SEX AND COLLECTION DATE AND TIME ON THECONTAINER FIRST.
3. When you have a bowel movement, catch the stool in the disposable toilet hat provided.You can also stretch a loose piece of plastic wrap across the toilet bowl under the seat.Make sure the plastic wrap sags in the middle; don’t make it tight! The sample CANNOTbe scooped from the toilet.
4.Use the tongue depressor in the bag to collect a small amount of stool. Place the stool in
the DRY container. CLOSE THE CONTAINER TIGHTLY. If there is no tonguedepressor, use a disposable plastic spoon to scoop the poop.
5. Put everything back into the plastic bag in the way it was when you got it (specimeninside the sealed ziplock bag).
6.Store the specimen in a COOL, DRY PLACE away from sunlight (like the garage,refrigerator, or closet). DO NOT PUT IN THE FREEZER.
7.Facility Staff only: Complete the Norovirus Outbreak Lab Submittal Form (2 pages)when all specimens have been collected and call the Acute Communicable DiseaseSection at (510) 267-3250 by noon to arrange for pick-up and delivery to the PublicHealth Lab.
v.10.2025
Number of cases who died:
Page 1 of 2
California Department of Public Health – Viral and Rickettsial Disease Laboratory NOROVIRUS OUTBREAK SPECIMEN SUBMITTAL FORM
Both sides of this submittal form must be completed and sent with the samples for Norovirus testing.
Name of institution:
Type of institution/setting (e.g. long term care facility, school, camp, restaurant, cruise ship, catered event, etc):
Number of residents/students/population-at-risk (current census):
Number of staff at-risk (current census):
Date of first case: / / Date of last case: / /
Suspected source: Food-borne Water-borne Person-to-person Imported/travel Unknown
If source identified, note any additional information available:
Total number of cases tested: Total number of laboratory-confirmed cases:
Tested for bacteria? Yes No Results:
Tested for ova and parasites? Yes No Results:
*Outbreaks of any disease are reportable under the Title 17, California Code of Regulations. Please communicate withyour local communicable disease control unit to ensure that any norovirus oubreaks are reported to the CaliforniaDepartment of Public Health Statistics and Surveillance Section.
Note that while vomitus may contain high norovirus titers, our PCR has only been validated to test stool samples.
Timing Ideally stool specimens should be obtained during the acute phase of illness (within 48-72 hours of diarrhea
onset) while the stools are still liquid or semisolid because the level of excretion is greatest then. The increased sensitivity of molecular assays (PCR) often allows the virus to be detected in stools collected up to 7-10 days after onset. For specimens collected late in the illness, the utility of viral diagnosis and interpretationof the test results should be discussed with laboratory personnel before tests are conducted.
Number of Samples
For meaningful laboratory results (see interpretation below) specimens from a minimum of four (4) and preferably more, up to a maximum of ten (10) ill persons should be obtained during the acute phase of illness. The greater the number of stool samples submitted (up to a maximum of 10), the more meaningful the test results.
Storage and
Transportation
Interpretation of Results
•A single stool sample will not be tested since neither a positive nor negative result will bemeaningful.
•Testing of asymptomatic cases is not encouraged without prior consultation.
Stool specimens should be kept refrigerated at 40C until they can be sent to the laboratory. Samples stored at this temperature can be kept for 2-3 weeks without compromising diagnostic yield. Samples should be frozen if they cannot be shipped to the laboratory within 3 weeks.
Note: norovirus PCR testing is intended for use primarily as laboratory support for epidemiological investigations. We recommend that the following interpretative guidelines be used to evaluate laboratory PCR results:
•POSITIVE - Norovirus can be considered to be the etiologic agent if norovirus nucleic acid isdetected in two (2) or more stools per outbreak.
•NEGATIVE - To be considered negative for Norovirus, at least four (4) or more acute stoolsamples (all collected with 7-10 days of onset of diarrhea) must be submitted and all must benegative for norovirus nucleic acid.
•INCONCLUSIVE – All other outcomes.
Instructions for Submitting Stool Samples
Page 2 of 2
California Department of Public Health – Viral and Rickettsial Disease Laboratory NOROVIRUS OUTBREAK SPECIMEN SUBMITTAL FORM
(Norovirus is the new genus name for “Norwalk-like” viruses and is a member of the Caliciviridae family of viruses)
USE A SEPARATE FORM FOR EACH OUTBREAK
Sharon Messenger, PhD, Acting Chief California Department of Public Health Viral and Rickettsial Disease Laboratory 850 Marina Bay Parkway, Richmond, CA 94804 Phone (510) 307-8585 Fax (510) 307-8599
Rev. 12/07/2011
Summary of Norovirus PCR Results
DETECTED
Name of Facility
Report Date
Clean-up and Disinfection forNorovirus (“Stomach Bug”)
THESE DIRECTIONS SHOULD BE USED TO RESPOND TO ANY VOMITING OR DIARRHEA ACCIDENT
1 Clean up
a. Remove vomit or diarrhea right away!•Wearing protective clothing, such as disposable gloves, apron and/or mask, wipe up vomit or diarrhea with paper towels• Use kitty litter, baking soda or other absorbent material on carpets and upholstery to absorb liquid; do not vacuum material: pick up using paper towels• Dispose of paper towel/waste in a plastic trash bag or biohazard bagb. Use soapy water to wash surfaces that contacted vomit or diarrhea and all nearbyhigh-touch surfaces, such as door knobs and toilet handlesc. Rinse thoroughly with plain waterd. Wipe dry with paper towels
DON’T STOP HERE: GERMS CAN REMAIN ON SURFACES EVEN AFTER CLEANING!
2 Disinfect surfaces by applying a chlorine bleach solution
a. Prepare a chlorine bleach solution
b. Air dry surfaces unlikely to have food or mouth contact
or…
c.Rinse all surfaces intended for food or mouth contact with plain water before use
3 Wash your hands thoroughly with soap and water
Steam cleaning may be preferable for carpets and upholstery. Chlorine bleach could permanently stain these.
• Remove and wash all clothing or fabric that may have touched vomit or diarrhea
• Machine wash these items with detergent, hot water and bleach if recommended, choosing the longest wash cycle
• Machine dry
Note: Anything that has been in contact with vomit and diarrhea should be discarded or disinfected.
Make bleach solutions fresh daily; keep out of reach of children; never mix bleach solution with other cleaners
Facts about Norovirus
Norovirus is the leading cause of outbreaks of diarrhea and vomiting in the US, and it spreads quickly.
Norovirus spreads by contact with an infected person or by touching a contaminated surface or eating contaminated food or drinking contaminated water. Norovirus particles can even float through the air and then settle on surfaces, spreading contamination
Norovirus particles are extremely small and billions of them are in the stool and vomit of infected people.
Any vomit or diarrhea may contain norovirus and should be treated as though it does.
People can transfer norovirus to others for at least three days after being sick.
Hand sanitizers may not be effective against norovirus
IF CLOTHING OR OTHER FABRICS ARE AFFECTED...
disinfect-for-health.org
NEHA
waterandhealth.org americanchemistry.comco.somerset.nj.us/health neha.org
For more information on norovirus prevention, please see http://www.cdc.gov/norovirus/preventing-infection.html.Scientific experts from the U.S. Centers for Disease Control and Prevention (CDC) helped to develop this poster.
+1 1GALLON
IF POROUS SURFACES ARE AFFECTED…e.g., wooden floors or unsealed concrete or natural stone surfaces
CONCENTRATION ~5000 ppm
GALLON WATER
1 2/3
CUPS BLEACH
1CUP
2/3CUP
+1 1GALLON1/3CUP
1/3CUP BLEACH
IF HARD SURFACES ARE AFFECTED…
e.g., non-porous surfaces, vinyl, ceramic tile, sealed counter-tops, sinks, toilets
CONCENTRATION ~1000 ppm
GALLON WATER
waterandhealth.org americanchemistry.com neha.org co.somerset.nj.us/health
Limpiezay desinfección para losnorovirus(“gripeestomacal”)
ESTAS INDICACIONES DEBEN USARSE PARA REACCIONAR ANTE CUALQUIER ACCIDENTE DE VÓMITO O DIARREA.
Nota: Todo aquello que haya estado en contacto con el vómito o ladiarrea debe descartarse o desinfectarse.
Limpie
a.Retire de inmediato el vómito o la diarrea.
• Use ropa protectora, como guantes desechables, delantal o máscara, limpie el vómito o la diarreacon toallas de papel.• Use sepiolita, bicarbonato de sodio u otro material absorbente en las alfombras y los tapizados a fin de absorber el líquido; no aspire el material: recójalo con toallas de papel.• Deseche las toallas de papel o los residuos en una bolsa de plástico para basura o en una bolsapara material biológico peligroso.b.Use agua con jabón para lavar las superficies que estuvieron en contacto con el vómito o ladiarrea y todas las superficies cercanas de contacto más frecuente, tales como las perillas de las puertas y las manijas de los sanitarios.
c.Enjuague cuidadosamente el piso solo con agua.
d.Seque frotando la superficie con toallas de papel.
NO SE DETENGA AQUÍ: los gérmenes pueden permanecer en las superficies incluso después de haberlas limpiado.
Desinfecte las superficies aplicando una solución de blanqueador con cloro
Para el caso de lasalfombras y lostapizados, es posible que se prefiera la limpieza al vapor. El blanqueador con cloro podría dejarles manchas permanentes.
a.Prepare una solución de blanqueador con cloro.
Prepare una solución de blanqueador nueva cada día. Manténgala fuera del alcance de los niños. Nunca
mezcle la solución de blanqueador con otros limpiadores.
Datos sobre los norovirus
Los norovirus constituyen la causa principal de los brotes de diarrea y vómitos en Estados Unidos y se propagan con rapidez.
Los norovirus se contagian al estar en contacto con una persona infectada, al tocar una superficie contaminada, al consumir alimentos contaminados o al beber agua contaminada. Las partículas de los norovirus incluso pueden encontrarse suspendidas en el aire y luego establecerse en las superficies, expandiendo la contaminación.
Las partículas de los norovirus son extremadamente pequeñas y miles de millones de ellas se encuentran en las heces o en el vómito de las personas infectadas.
Cualquier vómito o diarrea puede contener norovirus y debe tratarse como si así fuera.
Las personas pueden contagiar los norovirus a otras durante al menos tres días después de haber estado enfermas.
b.Ventile las superficies secas que probablemente no tengan contacto con la comida o la boca. O…c.Enjuague solo con aguatodas lassuperficies destinadas aestaren contactocon la comida y la boca antesdeluso.
Lávese minuciosamente las manos con agua y jabón
Es posible que los desinfectantes para las manos no sean eficaces para combatir los norovirus. disinfect-for-health.org
Por ejemplo, pisos de madera o de cemento húmedo,
2/3 TAZA DE BLANQUEADOR
1
GALÓN DE AGUA
1 GALÓN
Concentración: ~5000 ppm
SI SE AFECTARON LA ROPA U OTRAS TELAS...
Quite y lave toda la ropa o las telas que pueden haberestado en contacto con vómito o diarrea.
Lave a máquina estos elementos con detergente, agua caliente y blanqueador, si fueserecomendado, y elija siempre el ciclo de lavado más largo.
Seque a máquina.
SI SE AFECTARON SUPERFICIES DURAS… or ejemplo, superficies no porosas, vinilo, mosaicos
TAZA DE BLANQUEADOR + GALÓN DE AGUA
1 GALÓN
Concentración: ~1000 ppm
Expertos científicos de los Centros para el Control y la Prevención de Enfermedades (Centers for Disease Control and Prevention, CDC) de Estados Unidos ayudaron a crear este póster. Para obtener más información sobre la prevención de los norovirus, consulte http://www.cdc.gov/norovirus/preventing-infection.html.
NEHA
waterandhealth.org americanchemistry.com neha.org co.somerset.nj.us/health
disinfect-for-health.org
HelpPreventtheSpreadof Norovirus(“StomachBug”)
IF NOROVIRUS IS AFFECTING YOUR COMMUNITY, HERE ARE SOME
ACTIONS YOU CAN TAKE TO HELP PREVENT FURTHER ILLNESS
Clean up surfaces
a.Clean frequently touched surfaces with soapy water
b.Rinse thoroughly with plain water
c.Wipe dry with paper towels
d.Dispose of paper towels
DON’T STOP HERE: GERMS CAN REMAIN ON SURFACES EVEN AFTER CLEANING!
Disinfect surfaces
a.Prepare and apply a chlorine bleach solution
Make bleach solutions fresh daily; keep out of reach of children; never mix bleach solutionwith other cleaners
b.Air dry surfaces unlikely to have food or mouth contact
or…
c.Rinse all surfaces intended for food or mouth contact
with plain water before use
Washyour hands thoroughly with soap and water
Hand sanitizers may not be effective against norovirus
Factsabout Norovirus
Norovirus is the leading cause
of outbreaks of diarrhea and vomiting in the US, and it spreads quickly.
Norovirus spreads by contact with an infected person or by touching a contaminated surface or eating
contaminated food or drinking
contaminated water. Norovirus particlescan even float through the air and then settle on surfaces,
spreading contamination
Norovirus particles are extremely
small and billions of them are in
the stool and vomit of infected people.
Any vomit or diarrhea may contain
norovirus and should be treated as though it does.
People can transfer norovirus to others for at least three days after
being sick.
1
Scientific experts from the U.S. Centers for Disease Control and Prevention (CDC) helped to develop thisposter. Formoreinformation on norovirusprevention,pleaseseehttp://www.cdc.gov/norovirus/preventing-infection.html.
NEHA
waterandhealth.org americanchemistry.com neha.org co.somerset.nj.us/health
disinfect-for-health.org
Ayude a prevenir la propagación de los norovirus (“gripe estomacal”)
SI LOS NOROVIRUS ESTÁN AFECTANDO SU COMUNIDAD, AQUÍ LE PRESENTAMOS ALGUNAS MEDIDAS QUE PUEDE TOMAR PARA AYUDAR A PREVENIR ENFERMEDADES FUTURAS.
Limpie las superficies
a.Limpie las superficies de contacto más frecuente con agua
y jabón.
b.Enjuague cuidadosamente el piso solo con agua.
c.Seque frotando la superficie con toallas de papel.
d.Deseche las toallas de papel.
NO SE DETENGA AQUÍ: los gérmenes pueden permanecer en las
superficies incluso después de haberlas limpiado.
Desinfecte las superficies
Prepare una solución deblanqueador nueva cada día. Manténgala fuera del alcance delos niños. Nunca mezcle la solución deblanqueador con otros limpiadores.
a.Prepare y aplique una solución de blanqueador con cloro.
b.Ventile las superficies secas que probablemente no tengan
contacto con la comida o la boca.O…
Datos sobre los norovirus
Los norovirus constituyen la causa principal de los brotes de diarrea y vómitos en Estados Unidos y se propagan con rapidez.
Los norovirus se contagian al estar en contacto con una persona infectada, al tocar una superficie contaminada, al consumir alimentos contaminados o al beber agua contaminada. Las partículas de los norovirus incluso pueden encontrarse suspendidas en el aire y luego establecerse en las superficies, expandiendo la contaminación.
Las partículas de los norovirus son
extremadamente pequeñas y miles
de millones de ellas se encuentran
en las heces o en el vómito de las
personas infectadas.
Cualquier vómito o diarrea puede contener norovirus y debetratarse como si así fuera.
Las personas pueden contagiar los norovirus a otras durante al menos tres días después de haber estado enfermas.
estar en contacto con la comida y la boca antes del uso.
Lávese minuciosamente las manos con agua y jabón
Es posible que los desinfectantes para las manos no sean eficaces para combatir los norovirus.
(Centers for Disease Control and Prevention, CDC) de Estados Unidos ayudaron a crear este póster. Para obtener más
NEHA
Cleaning and Disinfection Instructions
Items needed: disposable gloves, masks, gowns, eye protection, shoe covers, soap, water and regular5.25%household bleach.
Making a bleach solution
1.Make fresh bleach solution each day in a well-ventilated area. Throw out unused solution at the end of each day.
2.Use an unopened or recently opened bottle of bleach. Bottles of bleach that have been opened more than 30 days are not as
effective at killing germs.
3.For general cleaning and disinfection as well as disinfecting hard, non-porous surfaces after contamination with vomit/feces,use a 1000 ppm bleach solution (1/3 cup of 5.25% bleach mixed with 1 gallon water).
4.For disinfection of porous surfaces (wooden floors, unsealed concrete, natural stone surfaces) after contamination withvomit/feces, use a 5000 ppm bleach solution (1 and 2/3 cups of 5.25% bleach mixed with 1 gallon of water).
5.Do not mix bleach with any other chemicals.
Cleaning up stool and vomit and disinfecting the area
6.Wear gloves, gown, eye protection, shoe covers, and a mask when cleaning up vomit or stool.
7.Immediately use disposable absorbent material such as paper towels to clean up visible vomit and stool. Put soiledabsorbent material into a plastic trash bag right away.
8.After cleaning up visible vomit and feces, use soap and water to wash and rinse the area, including the area within a 10-to-
25-foot radius of where the vomiting or diarrhea incident occurred. Wipe dry with a paper towel and immediately dispose of all waste in a plastic trash bag or biohazard bag.9.Spray the affected area, including the area withing a 10-to-25 foot radius, with a fresh bleach solution and allow the
area to remain wet for at least 5 minutes. Allow to air dry or rinse the area with clean water for food contact surfaces.
10.Use cleaning materials that can be thrown away after each use, if possible. If not, change bleach solution, mop head, orany other cleaning materials after each clean up. Do not use the same cleaning materials for different areas or floors.
11.Remove and dispose of PPE then wash hands immediately with soap and water.
General cleaning and disinfection of high-touch, non-porous (hard) surfaces
12.Clean the area with soap and water.
13.Spray the area with a fresh bleach solution and allow surface to remain wet for at least 5 minutes.
14.Allow to air dry or rinse the area with clean water for food contact surfaces.
Cleaning and disinfecting soft furnishings that can’t be bleached
15.Carefully remove vomit or feces using absorbent materials and dispose of all waste in a plastic trash bag or biohazard bag.
16.Steam clean the area at a temperature of 158°F for five minutes or 212°F for one minute. To minimize the aerosolization of
viral particles, do not vacuum.
Cleaning linens, clothing, and other machine-washable items
17.Wear gloves, gown, eye protection, shoe covers, and a mask when cleaning up linens contaminated with vomit or feces.
18.Linens dirty with vomit or feces should be double bagged and washed with detergent and hot water separate from other
linens; use bleach if possible. Dry separately at a temperature of greater than 170°F. If item can’t be cleaned, throw it away.
19.Remove and dispose of PPE then wash hands immediately with soap and water.
Frequency of cleaning and disinfection
20.During an outbreak, clean and disinfect the affected unit at least 2 times per 8-hour shift. Pay special attention to
bathrooms, sinks, faucets, showers, bath rails, toilets, handrails, door handles, phones, chairs, tables, light switches,
elevator buttons, keyboards, and other surfaces that are frequently touched.
Note: For staff who work at other facilities, remember to change your uniform and, if possible, shoes before working at a
different location.
v.10.2025
Handwashing and Approved Disinfectants Effective Against Norovirus
Handwashing Instructions
Hand sanitizers are not effective against Norovirus.
Handwashing is the best way to prevent spread. The proper way to wash your hands is as follows:
•Wet your hands with clean running water and apply soap. Use warm water if it is available.
•Rub hands together to make a lather and scrub all surfaces, making sure to clean between fingers and under
fingernails.
•Continue rubbing hands for 20 seconds, or about the time it takes to sing the "ABC's"
•Rinse hands well under running water.
•Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet.
If soap and water are not available, alcohol-based hand sanitizer may be used if hands are not visibly soiled.
See CDC’s handwashing website for additional information.
Environmental Disinfection
All areas must be cleaned/removed of visible soil and debris prior to disinfection to ensure maximum
effectiveness.
When cleaning up body fluids, wear a gown, disposable gloves, eye protection, shoe covers, and a mask that
covers the mouth and nose. For other general cleaning wear disposable gloves.
Always discard used PPE in a plastic trash bag after removal. Immediately after removing gloves, thoroughly wash
hands with soap and water. If soap and water are not available, alcohol-based hand sanitizer may be used if
hands are not visibly soiled.
1)A fresh chlorine bleach solution is the disinfectant of choice. See the Cleaning and Disinfection
Instructions for guidance on preparing a bleach solution. Allow surfaces to remain wet for at least
5 minutes then allow to air dry or rinse the area with clean water for food contact surfaces. If
bleach cannot be used, then a product from EPA List G may be used, however these products
may not be as effective as bleach, even with EPA approval.
2)Steam cleaning with a temperature of 158°F for five minutes or 212°F for one minute can be used on
items that cannot be subjected to chemical disinfectants.
* If unable to use bleach, contact the Alameda County Department of Public Health’s Communicable Disease
Control Section at (510) 267-3250.
v.10.2025