Schools are common settings for spreading germs and illnesses, particularly during the cold winter months when people spend more time inside. While the flu and RSV (respiratory syncytial virus) seem to have peaked for this season, norovirus and other "stomach bugs" are wreaking havoc on K-12 schools. A few elementary schools have even been in the U.S. news recently with norovirus outbreaks, some even canceling school for a few days.
What is norovirus?
Norovirus is a highly contagious virus that causes vomiting and diarrhea. (While sometimes referred to as the "stomach flu," it is not caused by a flu virus.) It takes only a few virus particles to make someone sick, and a sick person sheds billions of particles of the virus in their vomit and feces, so it’s one of the more contagious illnesses that plague our schools.
How does norovirus spread at a school?
Most norovirus outbreaks are caused by person-to-person spread. So, either having direct contact with someone sick or touching contaminated surfaces and transferring those germs from your hands into your mouth when you eat or touch your face. Think of a sick student who does not wash their hands well. They can leave tiny norovirus particles on the surfaces they touch, including those shared surfaces like sink handles, doorknobs, handrails, water fountains, shared electronic devices, and cafeteria tables.
To become infected with norovirus, the germs must be ingested (swallowed.) So, while it's gross to think about, the illness spreads when particles of stool or vomit from an infected person make their way into another person's mouth!
Another way norovirus spreads is by consuming food or water that has been contaminated with the virus by an infected person, for example, during meal preparation. It's similar to the above, but now it's a sick staff member preparing food in the cafeteria, which is leaving the virus behind, this time on food or items touched during food consumption, like utensils and trays.
Schools are a common setting for norovirus outbreaks, given how close together students are for extended periods of time and the many shared surfaces there are, like those in cafeterias, school health clinics, and restrooms. Also, children are notoriously poor hand washers – plus they touch their faces frequently – a combination that norovirus could thrive in, given the opportunity.
A child vomiting in a classroom or other shared space can spread aerosolized norovirus particles more than 3 feet.1 A child with diarrhea in the bathroom spreads those particles around the restroom when they flush. In fact, norovirus can be found throughout restrooms, including on toilet seats and handles, door latches, and even sink handles.2 To make matters even worse, if kids don't wash their hands well, they will still have the virus stuck to their hands when they head back to class.
How can I tell if it's norovirus?
Vomiting and diarrhea are often symptoms of viral gastroenteritis – inflammation in the lining of your gastrointestinal tract – and are most often caused by norovirus, rotavirus, and adenovirus. Without a test, you won't know for sure which you have, but if your symptoms are primarily a sudden onset of vomiting and diarrhea, it's likely norovirus. They're all very contagious viruses with slightly different symptoms, but luckily the prevention methods for these viruses are the same.
How can I prevent norovirus at my school?
Frequently disinfecting high-touch surfaces in your school is essential.
- Clean surfaces first. In order for the surface disinfectant to work, the surface must be free of any dirt, crumbs, or other debris (including vomit) that may make it harder for the disinfectant to kill germs. To save time and money, look for products that offer 1-step cleaning and sanitization or disinfection. Another tip – avoid using a soiled rag that will spread dirt and germs.
- Use an EPA-approved disinfectant with short contact times. Norovirus can survive on surfaces for weeks,3 making it necessary to disinfect surfaces properly and frequently. Choosing an EPA-listed sanitizer or disinfectant will give you confidence that you are killing key germs. A product with a kill time of a minute or less will help increase staff compliance with enhanced disinfection protocols and, in turn, help reduce the risk of an outbreak within your facility. Plus, it saves your staff valuable time.
- Make sure your surface sanitizer and disinfectant are effective against norovirus. Most food-contact surface sanitizers on the market do not have a high degree of efficacy against norovirus. Be sure to examine the product's label to determine which pathogens it is effective against, and always follow the label use instructions. (To learn more about how important formulation is when it comes to product performance against norovirus, read this Q&A from North Carolina State University about new research.)
- Identify high-touch surfaces in your school and ensure they're in your cleaning plan. Make a list of surfaces that are very high touch – or get heavily soiled – and require cleaning and sanitization/disinfection multiple times per day versus those that can be cleaned and sanitized/disinfected daily or even weekly. With all the tasks that need doing every day, this takes the guesswork out – making knowing what to clean and when easy.
- Don't forget the back-of-house in the cafeteria. Remember to focus frequent sanitization where food is prepared or surfaces that are in contact with raw ingredients/foods. Use no-rinse surface sanitizer for these areas. Remember the hard-to-reach spaces where dirt and germs can thrive. Make sure you clean all the nooks and crannies of your kitchen and dining area regularly, including closets/walk-in coolers, storage areas, and counter or table-top edges and undersides.
- Choose products that limit student and staff exposure to harsh fumes by selecting products rated by the U.S. Environmental Protection Agency (EPA) as category IV (very low toxicity). Norovirus is hard to kill, but that does not mean you need to bring in harsh chemicals that compromise indoor air quality. (Watch out for higher toxicity products that have precautionary statements like "Caution" or "causes eye irritation," instructs to "wash hands thoroughly after use," or require the use of gloves during use.)
- Respond swiftly to a vomit incident. Norovirus can spread quickly, contaminating many areas of your facility. Quickly clear the room of students/staff and have them wash their hands well. Ensure staff use disposable gloves and other appropriate PPE to clean up the vomit. First, remove the vomit using paper towels and disposable tools (do not vacuum). Then, clean the impacted surface and surrounding surfaces. Finally, disinfect those surfaces, making sure to follow the contact time for norovirus listed in the instructions. (Cleaning removes visible dirt/debris while disinfecting kills germs.)
What happens if there is a norovirus outbreak?
A fast response is essential when it comes to a potential norovirus outbreak, so schools should have a plan in place before an outbreak. Ask your local public health agency for guidance on how to prepare. An outbreak should be suspected when two or more students (and/or staff) in a classroom have vomiting and diarrhea within one to two days. If your school nurse is concerned that norovirus is causing illness in your school, contact your local health department. (Note that some states may require potential norovirus outbreaks to be reported to your local health department.)
Outbreak response may include tracking potential cases through a log, coordinating testing with your local public health department, educating staff/students/parents on symptoms and preventive measures, posting notices of a potential outbreak, and implementing facility-wide control measures, like restricting sick students from school until at least 48 hours after symptoms resolve, canceling group activities, limiting visitors, deep-cleaning bathrooms and frequently touched surfaces, and reinforcing strict handwashing. Generally, outbreaks may be considered resolved within four days with no new illnesses. However, work with your local health department to determine when the outbreak is over.
For more information on norovirus, visit the CDC norovirus page and check with your local or state public health agency. For helpful resources on surface disinfection, including posters and best practices, visit the PURELL® Brand K-12 Well-Being Center.
Read some of my other GOJO blogs for more helpful information on preventing illness outbreaks in your school:
Worry-free and effective solutions are available:
- PURELL® Surface Sanitizers, Disinfectants, and Wipes are EPA-registered, safe for most hard surfaces (spray is also safe on soft surfaces), and quickly kill 99.9% of viruses and bacteria, including norovirus (spray kills in 30 seconds), the flu virus (spray kills in 30 seconds), and human coronavirus (spray kills COVID-19 in 10 seconds). They earned the EPA's lowest allowable toxicity rating (Category IV), so they don't contain harsh chemicals or fumes and don't require gloves, handwashing, or rinsing after use – even on food-contact surfaces. PURELL® surface sprays are certified for the EPA's Design for the Environment (DfE) as part of the EPA's Safer Choice program.
- PURELL® Body Fluid Spill Kits are single-use response kits that equip employees to respond to accidents and spills involving body fluids like vomit, blood, and diarrhea. Contains PURELL Foodservice Surface Sanitizer (8 fl oz); PURELL SINGLES® Hand Sanitizer; OSHAKits.com Absorbent Blend with Deodorizer; heavy-duty handheld scraper and dustpan; head-to-toe personal protection kit (hairnet, gown with thumb loops, gloves, shoe covers, eye shield and mask); three medical-grade absorbent towels; two large black trash bags with ties; and bilingual instruction guide with step-by-step images.
PURELL® surface sanitizers and disinfectants are U.S. EPA-registered and approved to kill norovirus on hard surfaces. Our goal is to provide products that are the best in the market, and towards that goal we conducted additional efficacy studies outside of the U.S. EPA requirements which demonstrated the efficacy of PURELL® surface spray products against human norovirus when used in realistic situations in accordance with label directions.4
Want to learn more about why schools are choosing PURELL® products? Our experts want to help; click here to schedule a meeting or find a distributor now.