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