Introduction

 

Norovirus, also known as the Winter vomiting bug, is a virus which affects the gut – it causes self-limiting, highly infectious gastroenteritis, which typically lasts for a day or two, but in some cases, can last up to a week. It is not a serious health issue in healthy people, but it can be very disruptive in schools due to its highly contagious nature.

This guidance document outlines the symptoms of Norovirus, alongside advice on what to do if staff or pupils within the school contract it.

Symptoms

Norovirus is highly contagious – it is particularly prevalent in schools and nurseries as the virus can survive for several days on surfaces or objects.

Symptoms can be a combination of any of the following:

  • Nausea
  • Vomiting
  • Abdominal pain
  • Diarrhoea

It is sometimes associated with a flu-like illness, e.g. aching joints and limbs.

Different types

 

Norovirus is the most common cause of stomach bugs in the UK, with at least 25 different strains known to affect humans. Each year, it’s estimated that between 600,000 and 1 million people in the UK catch Norovirus – because there are so many strands, we don’t develop immunity to it.

The virus is sometimes called the Winter vomiting bug as it’s more common during the Winter season; however, you can catch the virus at any time of the year.

How is it spread?

 

The virus is spread from the vomit or faeces of an affected person and may be transmitted to others in the following ways:

Droplets

  • Droplets are formed following vomiting which is often violent and projectile in nature, sometimes without warning
  • Diarrhoea is less of a risk for droplet spread if it is contained in the toilet

Environment

  • The environment becomes contaminated via the hands, or from the setting droplets of vomit. Droplets land on surfaces and are easily transferable via hands to mouth

Food

  • Eating food that has been contaminated by an infected person, either directly (droplets), or indirectly (contaminated hands), also poses a risk of infection

What you should do — staff

 

  • Inform the headteacher the moment you notice any symptoms
  • If symptoms commence during your working day, go home immediately – the risk of spreading is reduced considerably if contamination of the environment is reduced
  • If you have any of the above symptoms, do not come to work
  • Remain off work for 48 hours after the last symptom
  • Discuss whether you should submit a stool specimen with your GP
  • Specimens should be submitted via your GP only
  • Do not go to hospital, as this can risk spreading the infection further. Call NHS 111 to seek advice if the symptoms last longer than a few days, or visit nhs.uk/norovirus for more information
  • Movement of supply teachers and specialist staff between schools may need to be restricted
  • If possible, staff should supervise pupils whilst they wash their hands

What should you do — pupils

 

  • Pupils who become ill during the day should be sent home as soon as possible
  • If the pupil cannot go home, they should be kept away from other pupil if possible
  • Parents should be informed verbally that the pupil should remain off for at least 48 hours from the last symptom
  • Parents should consult with their GP on whether they should submit a stool specimen from their child

Treatment

 

To treat the symptoms of Norovirus, the NHS recommends the following for children, young people and adults (these should be communicated to all parents):

  • Ensure they drink plenty of water to avoid dehydration
  • Give them paracetamol for any fever, aches and pains
  • Ensure they get plenty of rest
  • If they feel like eating, give them easy to digest foods, such as bread or brown rice
  • Stay at home – there is nothing the GP can prescribe for sickness and diarrhoea, although your local chemist may be able to provide rehydration solutions
  • Contact your GP or call NHS 111 to seek advice if the symptoms last longer than a few days, or visit nhs.uk/norovirus for more information

Seek medical advice if your child:

  • Has passed six or more watery stools in the past 24 hours, or has vomited three times or more in the past 24 hours
  • Is less responsive, feverish, or has pale or mottled skin
  • Has symptoms of severe dehydration, such as persistent dizziness, only passing small amounts of urine, or reduced consciousness
  • Has bloody diarrhoea
  • Has a serious underlying condition, such as kidney disease, and has diarrhoea and vomiting
  • If the symptoms last longer than a few days

Prevention

 

Norovirus is extremely contagious and easily spread – you can catch it simply by touching a contaminated surface or object.

School staff and parents can help prevent the spread of the virus by:

  • Washing hands frequently with household soap, and encouraging children to do the same – especially after going to the toilet, before eating and before handling food
  • Ensuring any infected child is not sharing things such as toys, food, blankets, etc.
  • Keeping any child with Norovirus symptoms home from school and away from other children where possible – children with the virus should also avoid contact with vulnerable adults, such as elderly relatives
  • Ensuring all children and adults are encouraged to cover their mouth and nose with a disposable tissue and to watch hands after using or disposing of tissues
  • Ensuring all spillages of faeces and vomit are cleaned up immediately, wearing personal protective equipment (PPE), such as disposable gloves and plastic aprons, and in line with the school’s Bodily Fluid Hygiene Policy.

 

Dealing with an outbreak at school

 

An outbreak is defined as such when an incident in which two or more people experiencing a similar illness are linked in time or place, or there is a greater than expected rate of infection compared with the usual background rate for the place and time where the outbreak as occurred.

Headteachers should contact their local health protection team (HPT) as soon as they suspect an outbreak to discuss the situation and agree if any actions are needed. Ensure the following information is available to hand to ensure the HPT can ascertain the size and nature of the outbreak:

  • Total numbers affected
  • Symptoms
  • Date(s) when symptoms started
  • Number of classes affected

If you suspect cases of infectious illness at your school, but are unsure if it is an outbreak, call your local HPT.

In the event that an outbreak of Norovirus occurs in school, and after the headteacher has informed the HPT, the below steps should be followed:

  • All environmental soiling should be cleaned up immediately
  • All staff who come into contact with any bodily fluids, such as vomit or faeces, should ensure they wear the appropriate PPE, such as gloves and aprons that can be disposed of immediately following use
  • Hands should be washed following any cleaning up of bodily fluids, after using the toilets, before eating, before handling or preparing food, and if there has been direct contact with someone who is infected
  • Warm water, soap and paper towels should be available in the toilet facilities
  • Communal play should be stopped until the outbreak has stopped
  • Arrange for toilets and facilities should be cleaned more often than normal in order to reduce the risk of transmission of the infection via environmental contamination, such as toilet seats, toilet flush and door handles
  • Any person who becomes ill during the day should be sent home as soon as possible and, if possible, kept away from others
  • The headteacher should be advised by the HPT to send out a letter informing parents of their responsibility with regards to infection control

During an outbreak, the HPT will contact the school regularly to collect information about new cases. You should ensure that all information is well-documented and that any incidents are recorded accordingly.

What’s next?

 

To maintain a high standard of care, it is important that all information relating to any incident in the school is retained. Our Pupil Accident Log book can be used to record any incidents that occur within the school – any cases of Norovirus should be recorded accordingly.

Our Infection Control Policy outlines the precautions that a school should take, and the procedures that should be in place, in order to prevent the spread of illness and infectious diseases within the school. Alongside this, our Ill Health and Infectious Disease Risk Assessment can be utilised to ensure all the possible risks concerning ill health and infectious disease are explored, and that the appropriate measures are put in place to mitigate those risks.

If any incidents occur at school, such as spillages of faeces or vomit, which require the use of cleaning products, then ensure our Control of Substances Hazardous to Health (COSHH) Risk Assessment is in place to mitigate any risks associated with using such products.

 

 

Bibliography

Health Protection Agency (2004) ‘Viral Gastroenteritis (Norovirus) Outbreak Guidance for Schools in Devon’

NHS (2015) ‘Norovirus’, <https://www.nhs.uk/conditions/norovirus/> [Accessed: 30 January 2018] 

NHS Choices and Food Standards Agency (2015) ‘Norovirus Schools Guide for early years professionals’

Public Health England (2017) ‘Health protection in schools and other childcare facilities’, chapter 3 and 4

 

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