Evaluating the Evidence-base of Outbreak Management and Clean-up Guidelines Available to Schools Experiencing Norovirus Outbreaks

Introduction:  An estimated 75% of absenteeism in schools is due to illness or injury, posing an educational impact on students and economic impact on families, and schools. It is estimated that norovirus causes nearly a quarter of school gastrointestinal outbreaks. Current materials provided to schools may not be effectively relaying accurate information. Public health officials and outbreak reports suggest that while evidence-based norovirus infection control guidelines specific to schools exist, the best management practices are not always used.

Purpose:  The project aim was to evaluate currently available norovirus management literature directed at schools for technical content and evaluate accuracy of the information. The project was carried out to provide insight into gaps in communication and evaluate the need for future development of materials based on the best available science.

Methods:  Artifacts, defined as publicly accessible online guidelines and instruction documents (n = 63), were found using online searches such as ‘school norovirus guidelines,’ and ‘school norovirus prevention and control.’ Content analysis was employed to evaluate document source and themes. Coders identified agreement with U.S. Centers for Disease Control and Prevention evidence-based best practices and captured erroneous recommendations (omission and commission).

Results:  There were inconsistencies and inaccuracies in the material and instructions provided to schools. Of the analyzed documents, 24% gave vague instructions void of specific compounds, PPE use or distance around a vomit event. Preventative cleaning was mentioned in 60% of documents; only 14% mentioned that commercially available, alcohol-based hand sanitizers are not effective. Twenty-four percent of documents said individuals could return after symptoms cleared; 30% did not mention absenteeism. 

Significance:  The results suggest a need for more evidence-based and more detailed materials targeted towards schools control and prevention methods. Targeted, clear instructions with varying formats may increase compliance and decrease the frequency and/or severity of norovirus outbreaks.