Clean up of Vomiting and Diarrhea

According to the CDC, Norovirus is the #1 cause of foodborne outbreaks in the United States.  Norovirus is extremely contagious.  The symptoms of Norovirus include vomiting and diarrhea, which if not cleaned properly, can further spread Norovirus to others.

Vomiting Larry Video

Clean-up

1. Remove vomit and/or stool immediately!
2. Block-off and clear individuals and pets from exposed area.
3. Put on personal protective equipment — disposable gloves, mask and plastic apron — to reduce your exposure to the virus.
4. Use disposable absorbent material (paper towels, kitty litter, baking soda or disposable cloths) to soak up visible vomit and/or stool.
5. Scrape up vomit and/or stool with paper plates or cardboard.
6. Dispose of soiled items/waste/gloves in a plastic trash bag.
7. Throw away food and packaging materials within a 25 foot circle of vomit or diarrhea.
8. Wash hands. Put on clean gloves. Take disposable cloths soaked in soapy water and wipe up remaining vomit and/or stool. Rinse surface well with clean cloths soaked in plain water.
9. Wipe area with dry paper towels and dispose of all soiled/items/waste in a plastic trash bag.
10. Isolate the contaminated area for two hours as norovirus particles can remain in the air for two hours after an incident.

DO NOT STOP HERE — your work is not done! The area needs to be decontaminated!

Decontaminate surfaces

To stop the spread of norovirus, the CDC (Centers for Disease Control) recommends using either chlorine unscented bleach or EPA (Environmental Protection Agency) registered antimicrobial products effective against norovirus. Product label must specify it is effective against norovirus available online or at restaurant supply stores. Examples include: Clorox© health care products and Comet Disinfecting Cleaner with Bleach.

1. Prepare a chlorine bleach solution. Use fresh unscented bleach within six months of opening. Look at table below to determine the concentration needed to disinfect the surface.
2. Clean and decontaminate soiled area and surrounding area in a 25-foot circle of infected area. The norovirus can be airborne, which means it can spread through the air. Decontamination could include multiple surfaces and areas.
3. Air dry for a minimum of five minutes.

Cleaning soiled, exposed surfaces

The table below (table 1) shows concentrations of bleach and water needed for soiled, exposed surfaces. Clean surfaces first using soap and water. Rinse with clean water and dry with disposable towels. Apply bleach solution for five minutes. Air dry.

Concentrations of bleach and water for soiled, exposed surfaces

Bleach (hypochlorite strength) Water amount Bleach amount Concentration PPM
5.25% Regular 1 gallon 1–2/3 cup ~5000
6 – 6.25% Ultra 1 gallon 1–1/2 cup ~5000
8.25% Concentrated 1 gallon 1 cup ~5000

Cleaning surfaces exposed within a 25-foot circle of soiled area

The table below (table 2) shows concentrations of bleach and water needed for cleaning surfaces exposed within a 25-foot circle of soiled area. These are areas such as handrails, tile floors, countertops, sinks, toilets, doorknobs and other commonly touched items. 

Clean surface using soap and water. Rinse with clean water and dry with disposable towels. Apply bleach solution for five minutes. Air dry.

Table 2. Concentrations of bleach and water for surfaces exposed within a 25 foot circle of soiled area

Bleach (hypochlorite strength) Water amount Bleach amount Concentration PPM
5.25% Regular 1 gallon 1/3 cup ~1000
6 – 6.25% Ultra 1 gallon 1/4 cup ~1000
8.25% Concentrated 1 gallon 2-1/2 tablespoons ~1000

Adapted from Norovirus Outbreak Response Guide. March 2016. Kentucky Public Health and How to clean up vomit and diarrhea, Olmsted County Public Health.

Clothing and linens

1. Remove visible vomit and/or stool from clothing/linen before washing.
2. Separate contaminated items from regular laundry.
3. Use detergent and a 1/2 cup of bleach to wash clothing and linens according to label directions.
4. If bleach cannot be used, use an oxygenated detergent according to label directions.
5. Wash contaminated items in a pre-wash cycle followed by a regular wash cycle using the hottest setting.
6. Dry using the hottest setting.

Carpet and furniture

Note: Using bleach could cause discoloration.

1. Don't vacuum area before cleaning as this will cause pathogens to become airborne and spread.
2. Apply kitty litter or baking soda to affected area.
3. Clean carpet or furniture using steam at 158 degrees F for five minutes or 212 F for one minute OR disinfect with an EPA (Environmental Protection Agency) registered antimicrobial products effective against norovirus.

Wash your hands

1. Remove personal protective equipment and dispose of in a plastic trash bag.
2. Put on a new set of disposable gloves and transport bag to a secure trash container.
3. Wash hands! This is a critical step in preventing the spread of the norovirus.
4. Use soap and warm running water.
5. Wash hands for at least 20 seconds.
6. Dry with paper towels.
7. Turn off faucet with paper towel to prevent re-contamination.

When can I produce food?

• Do not produce, package or distribute food for 72 hours after you or a household member no longer have symptoms of vomiting or diarrhea.
• The individual is infectious for up to 72 hours after symptoms subside and can contaminate food, drinks and equipment simply by touch.
• It can take 2 weeks to rid norovirus completely from the body. When you resume food production, wash hands well and often.
• Do not touch ready-to-eat food or food contact surfaces with bare hands.
• Use gloves, tongs or spatulas to create a barrier between your hands and the food.

Sources

Water Quality and Health Council. (2015). Clean-up and Disinfection for Norovirus.
Environmental Protection Agency. (2017). EPA’s Registered Antimicrobial Products effective against norovirus.
County of San Diego, Department of Environmental Health. (2013). Norovirus Infection Prevention and Control, Guidance Document. 
U.S. Centers for Disease Control and Prevention. How to Clean Up and Decontaminate After Someone Has Vomited.
Kentucky Public Health.  (2016). Norovirus Outbreak Response Guide.
Ecolab and Food Marketing Institute. (2010). Norovirus Information Guide.
Water Quality and Health Council. Norovirus Outbreak Response Guide. Bleach Dilutions.

Jena Heidmann, dietetic intern; Suzanne Driessen, Extension educator and Kathy Brandt, Extension educator