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  • Controlling Viral Gastroenteritis In hotels and other accommodation providers

  • Controlling Viral Gastroenteritis in hotels and other accommodation providers


    About Public Health England

    Public Health England exists to protect and improve the nation’s health and wellbeing,

    and reduce health inequalities. We do this through world-leading science, knowledge

    and intelligence, advocacy, partnerships and the delivery of specialist public health

    services. We are an executive agency of the Department of Health and Social Care,

    and a distinct delivery organisation with operational autonomy. We provide

    government, local government, the NHS, Parliament, industry and the public with

    evidence-based professional, scientific and delivery expertise and support.

    Public Health England

    Wellington House

    133-155 Waterloo Road

    London SE1 8UG

    Tel: 020 7654 8000

    Twitter: @PHE_uk


    Prepared by: Public Health England South West.

    This is an update of a manual originally produced by Community Safety at Torbay


    For queries relating to this document, please contact:

    © Crown copyright 2019

    You may re-use this information (excluding logos) free of charge in any format or

    medium, under the terms of the Open Government Licence v3.0. To view this licence,

    visit OGL. Where we have identified any third party copyright information you will need

    to obtain permission from the copyright holders concerned.

    Published: March 2019

    PHE publications PHE supports the UN

    gateway number: GW-182 Sustainable Development Goals

  • Controlling Viral Gastroenteritis in hotels and other accommodation providers



    About Public Health England 2

    Executive summary 4

    Causes and symptoms 5

    Control of outbreaks 8

    Guest illness 12

    Staff illness 14

    Cleaning and disinfection 15

    Precautions for guests on arrival and departure 23

    Appendix 1 Flow chart for action to prepare for viral gastroenteritis outbreaks 25

    Appendix 2 Flow chart for action when a viral gastroenteritis out break occurs 26

    Appendix 3 Illness report form 27

    Appendix 4 Information for guests 28

    Appendix 5 Summary sheet 29

  • Controlling Viral Gastroenteritis in hotels and other accommodation providers


    Executive summary

    Outbreaks of viral gastroenteritis are particularly common in situations where large

    numbers of people live in close proximity eg hotels, hospitals, residential care homes

    and nursing homes. The virus causing most of these outbreaks is Norovirus.

    Norovirus infection can be extremely unpleasant and can severely disrupt a business

    trip or holiday not only for the sufferer but also for their travelling party. It can cause

    significant disruption to the running of a hotel as the infection can be easily spread if

    there is not a co-ordinated action plan in place to ensure the highest of hygienic

    standards are in place. It is possible through prompt action to control and minimise an


    This publication is an update of a manual originally produced by Community Safety at

    Torbay Council.

  • Controlling Viral Gastroenteritis in hotels and other accommodation providers


    Causes and symptoms

    What causes norovirus illness?

    Norovirus particles are microscopic. Norovirus only affects humans and infected

    individuals will excrete the virus in their stools and vomit. Affected persons will continue

    to excrete viruses for several days after symptoms have ceased and in some cases for

    up to 2-3 weeks.

    The virus enters the body via the mouth. This can happen by:

     eating food or drinking liquids contaminated with the virus

     touching surfaces or objects contaminated with the virus before putting fingers in


     being in contact with someone who is infected with the virus, eg sharing food with


    Norovirus and other viruses causing gastroenteritis can be found in the following


    1. Human cases - they may be a guest, member of staff or a visitor. They may be

    unaware they are infected, only becoming ill once they are in the hotel.

    2. In the environment after someone has vomited. For example on horizontal


    3. In food that has been handled by someone with symptoms.

    4. Live foods such as contaminated shellfish eg mussels, clams, oysters. All

    shellfish should be purchased from reputable suppliers and be correctly handled.

    It should be thoroughly cooked wherever possible.

    5. Sewage contaminated water has been implicated in outbreaks. Salad foods

    irrigated with waste water are a potential source of infection.

    Norovirus is resistant to some cleaning chemicals and may survive within the

    environment for several days.

  • Controlling Viral Gastroenteritis in hotels and other accommodation providers


    What are the symptoms of norovirus?

    Prompt recognition of an outbreak can save considerable time and effort in helping

    prevent the spread of the illness. Symptoms usually occur 24-48 hours after ingesting

    the virus and generally last between one and 3 days. Recovery is usually rapid


    The main symptoms are:

     vomiting - onset can be extremely sudden, and may be projectile resulting in

    widespread environmental contamination

     diarrhoea - this tends to be short-lived and less severe than with other causes of


     nausea, abdominal cramps, headache, muscle aches, chills and fever can also


     dehydration, especially in the elderly and very young, can occur through loss of body

    fluids and may need special medical treatment

     the stress caused may also be detrimental to persons with other underlying diseases

    or conditions

    All age groups can be affected, although spread is more rapid where large groups

    gather eg children attending children’s clubs or group activities at a hotel.

    Norovirus infection results in only short-term immunity against subsequent infection.

  • Controlling Viral Gastroenteritis in hotels and other accommodation providers


    How is it spread?

    Norovirus is predominantly spread from the vomit of a sick person and transmitted by

    the following routes:

    1. Droplets produced following violent projectile vomiting and profuse diarrhoea.

    This liberates an aerosol of viral particles into the air that spread readily to others

    in a wide area.

    2. Environmental contamination from both vomit and diarrhoea can occur with

    subsequent transfer of the virus onto the hands of guests and staff and then into

    their mouths.

    3. Poor hand washing after using the WC can leave hands contaminated and they

    can then contaminate anything they come into contact with such as food,

    surfaces etc. Therefore toilets and bathrooms are a major risk area for

    environmental contamination.

    4. Coming into contact with surfaces contaminated with viruses as described above.

    5. Eating food that has become contaminated by an infected person either directly

    or indirectly.

    Only a very small number of viral particles are needed to produce symptoms and this

    usually takes between 24 and 48 hours (average 36 hours) to take effect.

    A 30 ml bolus of vomit contains 30 000 000 viral particles and the particles can be

    spread up to 3 metres away. The infective dose is thought to be less than 100 particles.

  • Controlling Viral Gastroenteritis in hotels and other accommodation providers


    Control of outbreaks

    Action needed before an outbreak, develop an action plan.

    Do not wait for several cases of sickness and diarrhoea to occur before you put controls

    in place to prevent the spread of an outbreak.

    Be prepared!

    If an outbreak occurs swift and effective action is essential to prevent more people

    becoming exposed to Norovirus and to prevent an outbreak increasing in size. This is

    best achieved with some forward planning. A flow chart summary is available in

    Appendix 1.

    Train staff

    Train staff in the recognition of and procedures for dealing with an outbreak. All staff

    (including cleaners, chambermaids, night staff, waiting staff, coach drivers, etc) should

    be trained to immediately notify management of any instances of sickness or diarrhoea

    in private rooms and public areas, or about general comments made by residents or

    guests about feeling ill. In this way, you are likely to be aware of suspected cases at the

    earliest opportunity.

    Create an Outbreak Control Team

    This will consist of key personnel including Senior Managemen


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