Viral Gastroenteritis (Norovirus) Outbreak Guidance
In the event of a suspected outbreak at a school:
- The Head Teacher or Deputy should inform the Health Protection Unit (HPU) Tel: 01823 287817 and the local Education Authority.
- The HPU will notify the Local Authority Environmental Health Officer, The Hospital Microbiology Department and Local GP’s as appropriate.
- The School must ensure that there is adequate Personal Protective Equipment, e.g. gloves and plastic aprons that can be disposed of immediately following use if cleaning up spillages of vomit or diarrhoea
- Wash hands on removal of gloves and if hands are soiled
- Ensure environmental soiling is cleaned up immediately
- Toilet and facilities must be cleaned more often to reduce the risk of transmission of the infection via environmental contamination e.g. toilet seats/ levers switches and door handles etc.
Safe use of products
The current guidance on cleaning up spills and the recommendation from the HPU is detergent and water followed by a standard hypochlorite (0.1%) solution to disinfect (e.g. Milton diluted as detailed by the manufacturer). There are differing opinions on what are the best products to use, however it is important that whatever product is used contains 0.1% hypochlorite (bleach). The chosen product must be able to deal with viruses.
All chemicals should be handled and stored in accordance with manufacturer’s instructions and product safety data sheets. These can be obtained free from the product manufacturer. COSHH Assessments need to be carried out for products used. Any staff who handle chemical cleaners should be given instruction on their safe use. These instructions should include first aid measures required in the event of accidental ingestion, inhalation or contact with skin or eyes. Contractors should be aware of the COSHH Regulations. All chemicals used on the premises should be stored in a cool, dry and well ventilated place (room/cabinet) that is lockable; out of reach of children/visitors/the public; in their original containers. Expiry dates should be routinely checked.
It is important when using bleach (hypochlorite) in particular that the COSHH regulation and manufacturers instructions are adhered to. Gloves should always be used when handling bleach. Any contact with skin, eyes and mouth should be avoided and bleach should not be used on urine spillages, carpeted, metal or wooden surfaces. Bleach should always be used in a well ventilated room/area.
It is essential that the correct type of cleaning agent, in the correct concentration is used for the type of decontamination/cleaning required, as per manufacturers instructions. Manufactured detergent/disinfection product containers with spray nozzles should ideally be purchased for easy use. Commercial brands are advocated over ‘home-made’ squeeze bottles or containers with spray nozzles which can readily become contaminated during the ‘topping up’ process.
If the latter are used they must be clearly labelled with safety instructions and hazard warnings that appear on the original container and fresh solutions should be used daily. These spray bottles should also be washed and dried daily.
The cleaning, removal and disposal of body fluids
Spillages of diarrhoea and vomit should always be attended to as quickly as possible.
Step 1Contain the spillage, if needs be, by placing disposable wipes orpaper
towels around it and use gel granules, (such as ‘Sanitaire Emergency Clean up’) The granules must not be used on urine spillages (urine and granules create a strong vapour) .
Step 2Always assess the risk of carrying out the required task before you begin.
Step 3Isolate the area, e.g., with warning cones if at all possible.
Step 4Make sure that all the protective clothing and equipment you require is
available (disposable gloves – non latex and plastic aprons)
Step 5Put on the protective clothing.
Step 6Remove the bulk of the contamination with paper towels. The area should be cleaned thoroughly with detergent and water, using disposable cloths. The area should be then wiped over using standard hypochlorite solution. Ensure adequate ventilation when using hypochlorite solutions.
Step 7Put all disposable items into a plastic bag, consider double bagging if bags are flimsy, tie and dispose.
Step 8Contaminated items such as books and drawings must be disposed of. Items such as cushions/curtains/clothing that can be washed in a washing machine can be washed at the temperature stated on the label. It is important that the washing machine is able to go through a whole cycle.And the clothes are then dried thoroughly. Staff must wear Apron and gloves whilst handling contaminated items .
Step 9All re-usable items must be thoroughly cleaned, disinfected and dried before being returned to the correct storage area. The cleaning of such equipment must be carried out in the cleaning equipment sink and never any where else
Step 10Thoroughly wash your hands on removal of gloves with soap and dry well.
Step 11Remove safety cones when the area is dry.
Step 12Report any shortfalls in the protective clothing or equipment used for dealing with body fluids to the person responsible for maintaining stock levels.
The disinfectant solution (hypochlorite / Milton etc) should always be freshly prepared and then discarded (in the cleaners sink) when you have finished– the solution made up may become deactivated after 24hrs.
If the spillage has taken place on a carpet, thoroughly clean the affected area using disinfectant or carpet shampoo (but not hypochlorite). If possible use a steam cleaner, if appropriate; or a carpet extraction machine.
It is important that all visible soiling is physically removed prior to disinfection.
Once the outbreak is over then a thorough environmental clean should take place.
Staff must work together to enable the final clean to be performed in a safe,
timely manner. Good communication between the HPU, School and cleaning
agency (if involved) etc. is essential.
Prior to cleaning ensure:
- Areas to be cleaned are emptied of as many of the children’s personal
belonging’s as possible e.g. lunch boxes are taken home, gym kit,
coats etc.
- It is the responsibility of the school to ensure soiling (i.e. vomit or diarrhoea) is cleaned up in a timely manner to reduce the risk of further transmission.
Process of cleaning:
Removal of vomit
Use gel granules, (such as ‘Sanitaire’ Emergency Clean up)
Dispose of any vomit and impregnated articles such as books etc as hazardous waste (Use the bags that are used for sanitary waste contract arrangements) I
Articles that can be washed follow Step 8
General areas / Hard surfaces
Cleaning staff must have heightened awareness of cleaning during this potential outbreak. Toilets areas must be cleaned more frequently during this time, paying particular attention to:
- Door edges
- Door handles/levers
- Light switches
It is important to ensure that there is adequate pump action soap and paper towels. Bars of soap and towels should never be used in the school environment.
Hard surfaces such as:
- Table tops where dust and debris can collect
- Underside of tables (hands grip the rim when standing up)
- Back of chairs
- Floors
Should be damp dusted with detergent and water and then a standardhypochlorite solution, or appropriate locally agreed product. This ensures thatdust and possible virus particles are wiped away. If necessary and ondiscussion with the HPU; curtains can be steam-cleaned insitu unless there are mitigating circumstances and they need to be taken down and washed.
Carpets if soiled should be steam cleaned or at least shampooed,(hypochlorite solution should not be used on carpet or softfurnishings as it may damage the fabric. Please check the manufacturer’s advice on the product for more information).
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