Everyone Plays a P.A.R.T. –Norovirus Control in Child Care Facilities
Goals for Today
What is norovirus
Why it is a concern in child care settings
What the symptoms are
How it is transmitted
Describe norovirus control
◦ Prevention
◦ Assemble a Body Fluid Cleanup Kit
◦ Respond to an incident
◦ Total cleanup
Why is Norovirus a Concern?
• Leading cause of foodborne illnesses • More than 50% of all food-related outbreaks
• Survives at least a week on surfaces
• Very resistant to routine cleaning and sanitizers
Based on the CDC “Norovirus Illness: Key Facts” handout
Norovirus Symptoms
• Nausea
• Vomiting
• Diarrhea
• Abdominal cramps
• Onset – 1 to 2 days after exposure
• Duration - 1 to 3 days
Highly Contagious
• About 1 Trillion viral particles per gram of feces
• About 300 thousand virus particles in one projectile vomiting incident
• About 18 viral particles to make you sick
2013 FDA Food Code
Norovirus Transmission
In stool or vomit of
infected people
Transmission through– Person to person– Food – Water– Environmental
surfaces – Air
Food
Contact
Water
Surfaces
Other
Hall 2012 Preliminary CDC Data
Transmission by Air: 25 feet
Everyone Plays a P.A.R.T.
• Prevent through good personal hygiene
• Assemble a Body-Fluid Cleanup Kit
• Respond correctly to a vomiting incident
• Total cleanup after an incident
Prevent
Use frequent, appropriate handwashing
Prevent
Do not use bare hand contact with ready-to-eat foods
Prevent
• Vomiting
• Diarrhea
• Jaundice (yellowing)
• Sore throat with fever
• Cuts & infected wounds on the hands, wrists, or exposed portions of the arms.
• A current, recent or exposure to a foodborne illness
Report symptoms:
Prevent
• Exclude: to prevent a person from working as a foodservice employee in the foodservice operation or entering the foodservice operation as an employee.
• Restrict: to limit the activities of a foodservice employee so that the foodservice employee does not work with exposed food, clean equipment, utensils, linens, or single-service or single-use articles.
FDA “Three-Legged Stool”
FDA “three legged stool” for norovirus protection:
1. Effective handwashing
2. No bare hand contact with ready-to-eat foods
3. Employee health program
A Challenge….
• Identify the components of a Body Fluid Cleanup Kit - “Barf Bucket”
• Which components are for Personal Protection Equipment (PPE)?
• Which components are for cleaning?
ASSEMBLE the Barf Bucket
Norovirus Control
In Child Care Facilities
Items PPE Cleaning
Bucket and spray bottle
Disposable gown
Effective disinfectant*
Facemask with eye protection or goggles
Gloves
Paper towels
Plastic garbage bag
Sand or liquid spill absorbent material
Flat-edged scoop, small shovel or dustpan
Shoe covers
Assemble
Personal Protective Equipment
• Disposable, non-latex, medical grade gloves
• Disposable facemask (N95) with eye protection or goggles
• Disposable shoe covers
• Disposable gown/apron
Assemble
Cleaning Supplies
Sand, or liquid spill absorbent material Cat litter
Disposable flat-edge scoop, shovel, or dustpan
Bucket and spray bottle
Disposable paper towels
Liquid soap
Designated, disposable mop head (optional)
Plastic garbage bag & twist-ties (double bagging)
Assemble
Disinfectants
• EPA-registered effective against norovirus• http://www.epa.gov/oppad001/list_g_norovirus.pdf
• Virkon is an example
• Chlorine bleach (5.25% - 8.25% concentration)• 5000 parts per million =
• 1 cup bleach per 1 gallon of water (8.25%)
RESPOND to an INCIDENCE
Norovirus Control
in Child Care Facilities
Respond – What to do Immediately
• Stop all operations
• Require handwashing
• Consider discarding food
Respond
Dispose of exposed foods within 25 feet
Respond – Immediately cover the spill
Respond - Move children to a different room. Wash hands!(norovirus particles can spread 25 feet)
Get the “Barf Bucket” a.k.a. Body Fluid Clean Up Kit
Step 1: Post Signage
Step 2: Protect Yourself
Put on Personal Protective Equipment
Step 2: Protect Yourself
Personal Protective
Equipment (PPE)
Step 3: Pick Up
• If surface will not be harmed by disinfectant, spray paper towels and area with the disinfectant first.
• Proceed with cleaning up spill after the disinfectant has remained on the surface for the allotted contact time.
Step 3: Continued
Cover and remove the waste; re-glove.
Step 3: Continued
Re-glove
Consider Re-gloving between Pick Up and
Cleaning.
Step 4: Clean the Area.
Step 4. Total Cleanup
• Wash
• Rinse
Step 4: Cleaning within 25 ft
Clean the affected area
Step 4: Continue cleaning all surfaces (remember norovirus can spread 25 feet.)
Put all items from clean up in garbage bag(s)
Step 5: Mixing the Disinfectant
Bleach Solution (5000 ppm)
(8.25% Sodium
Hypochlorite)
4 T. bleach
1 quart water
Contact time: 5
minutes
Step 5: Disinfecting the Area
Mix, then spray fresh disinfectant to saturate the waste & adjacent 25 foot area-– Include food contact surfaces
Step 5: Disinfect continued
Disinfect high-touch surfaces
Step 5: Continued
Rinse if it is a
Food Surface
Step 5: Fabric Surfaces
Disinfect cloth surfaces
- Steam cleaning for Upholstery and Carpets
- Other non-bleach disinfectants are available
Step 5: Disinfect continued
Disinfect non-disposable tools
Step 5: Continued
Remove Personal Protective Equipment
Step 5: Continued
Double bag and dispose of waste in outdoor
receptacle.
Step 6: Wash Hands
Step 7: Reopening Area
Wait
2 hours Before
reopening the area.
Barf Bucket Video
Everyone Plays a P.A.R.T.
• Prevent through good personal hygiene
• Assemble a Body-Fluid Cleanup Kit
• Respond correctly to a vomiting incident
• Total cleanup after an incident
After the Incident
• Restock the Barf Bucket
• Keep a record of staff and child absences• Child Care Absence and Illness Log (Best Practice)
• Norovirus is a reportable disease
• Provide information to staff and parents• Keep Me Home Poster
• Norovirus Illness: Key Facts
After the Incidence
• Review the event and discuss ways to improve
• Body Blood Cleanup Policy (Best Practice)
• Sample Health Contract (American Academy of Pediatrics Best Practice)
Knowledge Challenge
• Post Test
• Norovirus “Barf Bucket” Pledge Agreement
Resources from ICN
www.theicn.org/norovirus
• 18 –Minute Video
• Online courses
• Tool kit• Standard operating procedures
• Fact sheets
• Mini posters
• Employee Health & Personal Hygiene • http://www.theicn.org/ResourceOverview.aspx?ID=430
Resources
• The Stomach Bug Book
• Available online at http://www.fns.usda.gov/fns/safety/pdf/stomach_bug_book.pdf
• Hardcopies available from NEA http://www.neahin.org/HINPrograms/ order.html
Resources
Lincoln Lancaster County Health Department
Barf Bucket info:
• http://lincoln.ne.gov/city/health/environ/CEH/CCResources.htm
AcknowledgementsResources and materials were developed and modified from the following Agencies:
• Institute of Child Nutrition
http://www.theicn.org/ResourceOverview.aspx?ID=399
• Lincoln Lancaster County Health Department
• Nebraska State Department of Education Nutrition Services – Child Nutrition Program
• FDA and CDC• 2013 Food Code
http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm374275.htm
• www.cdc.gov/norovirus
• University of Nebraska Extension