The Stomach 

Bug Book:

What School Employees Need to Know
NEA Healthy Futures is a nonprofit organization that 

is affiliated with the National Education Association 

(NEA). Originally founded in 1987 as the National 

Education Association Health Information Network 

(NEA HIN), we provide health and wellness 

solutions,advocacy tools, and funding and resource 

opportunities for NEA members and the education 

community at large.

This project has been funded at least in part with funds 

from the USDA Food and Nutrition Service. The content 

of this publication does not necessarily reflect the views or 

policies of the Depart-ment, nor does mention of trade 

names, commercial products, or organizations imply 

endorsement by the U.S. Government.
Megan just threw up, 

and kids are calling 

for help. You rush to help her.

As a school employee, what do 

you need to know about stomach 

illnesses in order to protect yourself and others at school? What 

should be the first thing you 

do? This booklet will give you the

information you need to minimize 

health risks from fast-spreading 

stomach illnesses.

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This booklet explains what 

you—the school employee—

need to know about stomach illnesses at school. What are your 

responsibilities? How can you decrease 

the risks to yourself, your co-workers, 

and other students? How should you 

clean up? This booklet will answer 

these questions for you and provide you 

with tips to share with your co-workers, 

family, and the school community.

When Megan 

threw up, your first 

impulse was to rush 

to help her.

What should you 

have done next? Give 

Megan something 

to cover her mouth 

and remind her not to 

touch her face with 

her hands. Separate 

the other children 

and have them wash 

their hands. Don’t try 

to clean it up unless 

you have the correct 

supplies and use the 

techniques described 

in this booklet.

INTRODUCTION

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What is norovirus?

Norovirus is a very 

contagious stomach 

illness. People usually 

feel sick suddenly 

with no warning. 

They may have sudden, explosive vomiting, watery diarrhea, 

and stomach cramps. 

They can become ill 

within 12 to 48 hours 

after being exposed 

and can infect others 

for up to three days 

after recovery, or possibly longer. Although 

they feel really bad 

while they are sick, 

most people get better without treatment.

Norovirus causes over 

half the food-related 

illnesses each year, 

infecting an estimated 

21.5 million people.

When a stomach bug caused by norovirus 

strikes a child or an adult, it usually strikes 

fast. Symptoms include nausea, vomiting, 

diarrhea, and stomach cramps. 

When there are many people in a setting 

such as a school, illnesses can spread quickly. 

At any time school personnel may need to 

respond—whether in the classroom, on the 

playground or school bus, or in the clinic.

Types of stomach illnesses

Stomach illnesses can be viral, bacterial, 

or parasitic. Viral illnesses include those 

caused by norovirus and rotavirus. Bacterial 

illnesses include infections caused by Salmonella and E.coli or may result from ingesting 

toxins produced by bacteria. Parasitic illnesses 

include those caused by Giardia and Cryptosporidium. Norovirus is the most common cause 

of stomach illness. Many of the same protection and prevention methods for norovirus 

are effective for other types of illnesses.

People with norovirus spread the virus 

in their stool and vomit. People become 

infected in several ways including:

• eating or drinking contaminated food or

liquids 

• touching contaminated surfaces or objects

and then placing their hand in their mouth

• having direct contact with an infected person

Did you 

know?
Claude the custodian 

is always working, keeping the 

school clean and running. 

Whenever anything needs fixing or there’s an accident, 

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Claude is the one who takes 

care of it. He has the right supplies and knows the right way 

to clean up after someone 

vomits at school. He knows to 

put on protective clothing before he begins any cleanup. 

He always uses his gloves and 

disposable facemasks during 

the cleanup and works hard 

to make sure everyone stays 

healthy. He knows to use special cleanup procedures for 

carpet, curtains, and 

any other soft 

surfaces.

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TIP:

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When someone vomits, tiny particles can 

spread widely and land on surfaces as far as 25 

feet away. If someone touches these surfaces 

and accidentally ingests the particles, they can 

become sick. Treat all vomit and other body 

fluids as infectious material. The procedures 

described in this booklet should be used to 

cleanup after an incident. If bleach solution is 

used as a disinfectant, be sure to increase the 

ventilation in the cleanup area.

Prevent the Spread

You can decrease the chance of getting 

or spreading norovirus by following 

these steps:

Wash your hands with soap and water frequently. 

Washing your hands is one of the most 

effective ways to keep disease from spreading. Drying your hands with a paper towel 

or hand dryer is also an important part of 

keeping your hands free of bugs that cause 

disease. Always make sure all hand washing 

sinks in your school building have adequate 

soap and hand drying supplies available.

Always wash and dry your hands after using 

the bathroom, changing diapers, or removing disposable gloves. Most importantly, 

wash your hands before eating or preparing 

food. Use hand sanitizers when soap and 

water are not available.

Did you 

know?

Hand washing 

works and should 

be used as the first 

option to protect 

against the spread 

of disease. Use 

hand sanitizer when 

soap and water 

are not available. 

Schools that started 

hand washing programs or installed 

hand sanitizers 

reduced illnesses 

and absences.

Treat any vomiting 

episode as if it is 

norovirus and follow 

special cleanup 

procedures.
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Follow correct procedures for cleanup. 

When someone vomits or has diarrhea, use 

the approved supplies and the techniques 

described in this booklet for cleanup.

Stay home when you are sick. 

Follow food safety rules. 

Safely prepare and store all foods. 

Clean: wash hands, surfaces, utensils, and 

food—especially fruits and vegetables—

very well.

Separate: keep raw foods and their juices 

away from cooked and ready-to-eat foods.

Cook: use a food thermometer and cook 

food to the right temperature.

Chill: refrigerate perishables and cooked 

foods quickly.

Do not prepare food when you are sick or 

for at least three days after the symptoms 

are gone.

Properly dispose of any food that an 

infected person may have prepared.

Cleanup Supplies

Treat all vomit and body fluids as infectious 

material. Norovirus spreads easily and resists 

many disinfectants. Have supply kits ready for 

immediate use. Only personnel equipped with 

the right supplies and using cleaning procedures described in this booklet should clean 

up when someone vomits or has diarrhea. 

Remember, “clean, 

separate, cook, chill” 

for food safety.

Handwashing:

Lather with soap and 

rub your hands vigorously under running 

water for at least 

15-20 seconds. Rinse 

hands and dry completely with a paper 

towel, then turn the 

water off using that 

towel.

TIP:

TIP:

TIP:

To prevent further 

spread of infection, 

the guidelines in this 

booklet should be

followed.
Nicole is a school 

nurse. She sees lots of kids 

because she works at many 

different sites during the day.

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She makes sure all of the kids 

get the right care when they 

come to the clinic. She 

also keeps in contact 

with the local health 

department and knows 

the signs of a stomach 

virus outbreak vs. one 

upset tummy.

She knows how to prevent 

the spread of illness and trains 

school employees to make 

sure they know also.

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Shannon the special 

education assistant 

works every day with 

children with special needs. 

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She helps many students who 

are severely disabled and 

have unique medical needs. 

Shannon knows a stomach illness is especially risky to these 

students and is careful not to 

expose them to sick students 

or adults. If one of these 

students, or any other 

student, or an adult gets sick 

at school, Shannon needs 

training to know what 

to do.

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Personal protective 

equipment

To keep from getting sick, use disposable 

face masks, non-absorbent gloves, and disposable gowns/aprons to clean up after an 

incident. Disposable gloves and gowns protect hands and clothing. Wear a disposable 

face mask because the virus can vaporize and 

become airborne during cleanup. Wear safety 

goggles when mixing all chemical solutions. 

Put on the disposable gown, face mask, 

safety goggles, and gloves before beginning 

to clean up.

Other supplies

Other supplies to have ready include plastic 

garbage bags, bleach or other disinfectants, 

disposable cloths or paper towels, buckets 

and mops. The non-disposable equipment designated for cleaning up after 

vomiting incidents should not be used 

for routine cleaning.

While wearing the equipment:

Keep hands away from face.

Do not touch any unnecessary surfaces. 

Change gloves when torn or dirty and discard gloves after each use.

Remember to wash your hands with soap 

and water and thoroughly dry your hands 

after you finish the cleanup.

TIP:

Each supply kit 

should include the 

following:

• Disposable gloves

• Disposable gown

• Disposable mask

• Safety goggles

• Plastic garbage bags

• Disposable cloths

• Disposable mop

• Bleach

• Bucket

For routine cleaning, 

don’t use the same 

cleaning equipment 

in the kitchen and 

the bathrooms. Have 

a separate kit for 

vomit cleanup that is 

not used for routine 

cleaning. 

TIP:
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Cleanup Techniques

When someone vomits, immediately clear 

the area. Have all individuals who were 

touched by vomit wash their hands and, 

when possible, change their clothes. 

Prepare bleach disinfectant solution

Put on safety goggles before mixing bleach 

solution. Prepare 5000 parts per million 

(ppm) chlorine bleach solution by adding 

8 1

/3 cups of standard household (5.25%) 

bleach to 5 gallons of water. This is a very 

strong bleach solution that should only be 

used in a well ventilated area.

Other disinfectants may also be effective 

against norovirus. The Environmental 

Protection Agency (EPA) keeps a list of 

registered disinfectants on its website.

Basic Cleanup Procedures

1. Personnel should put on a disposable 

face mask, nonabsorbent gloves, and gown/

apron. Follow the directions for putting on 

personal protective equipment. 

2. Use paper towels or disposable cloths to 

clean up the soiled materials and liquid.

3. Place used towels or cloths into a

garbage bag.

4. Use paper towels to wipe the area clean 

with detergent and water.

How to put on 

personal protective 

equipment

• Put on the gown,

making sure it covers

from neck to knees

and from shoulder

to the end of the

wrists. Gown wraps

around the back.

• Put on the face

mask, fit snugly to

face and below chin.

• Put on safety goggles

to cover eyes.

• Put on gloves and

extend to cover

wrists of gown.

How to mix disinfecting bleach 

solution:

Put on safety goggles 

before mixing bleach 

solution. 

To make a bleach 

solution for disinfecting 

(5000 ppm), mix 8 1

/3

cups bleach with 5 

gallons of water. 

Use disinfecting 

bleach solution in a 

well ventilated area.

TIP:

TIP:
Ben the bus driver takes

care to keep the children safe 

on the bus. Along with driving 

the school bus safely, he 

cleans the bus regularly.

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 He is often the first school employee to see a child who looks 

ill. He notices if children aren’t 

coming to school. If a student 

vomits on the bus, Ben needs 

to know what to do to protect 

himself and the other students.

He needs to have at least a disposable face mask, disposable 

gloves, and paper towels. The bus 

driver should disinfect the bus as 

soon as possible 

after an incident 

occurs. 

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5. Cover the site with clean paper towels 

and soak with the bleach solution. Disinfect 

with bleach solution for at least five minutes. 

6. Place all soiled paper towels and disposable cleaning items in garbage bag.

7. Clean and disinfect any tools or other 

nondisposable items used in the cleanup 

with bleach solution.

8. Remove disposable gloves, gown/apron, and 

face mask carefully and place in garbage bag. 

9. Seal the garbage bag before placing it in trash.

10. Wash hands and face immediately.

Cleanup technique for 

carpets, curtains, upholstery 

and other soft surfaces

Carpets, curtains, and other soft surfaces 

require special handling to prevent any part 

of the virus from becoming airborne. 

1. Trained personnel should put on a disposable face mask, nonabsorbent gloves, 

and gown/apron. Follow the directions for 

putting on personal protective equipment. 

2. Cover the vomit using disposable, absorbent materials such as paper towels. 

3. Carefully place the soiled paper towels in 

a plastic bag to minimize the chance of any 

particles becoming airborne.

4. Disinfect carpets with a chemical 

How to remove 

personal protective

equipment

• Take the outside of

one glove with the

other gloved hand

and peel off.

• Hold removed glove

in gloved hand.

• Slide fingers of

ungloved hand under

remaining glove at

wrist.

• Peel second glove off

over first glove and

put in garbage bag.

• Undo ties of gown

without touching

front and sleeves.

• Pull gown away from

neck and shoulders,

touching only inside

of gown.

•Turn gown inside out

and roll into bundle.

• Remove mask by

touching only ties

or elastic and remove 

without touching the

front of soiled areas.

• Wash hands carefully 

with soap and water.

TIP:

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disinfectant and steam clean for a minimum 

of five minutes at a temperature of 170°F 

or for one minute at 212°F.

Handle soiled laundry gently: Do not shake. 

Wash with hot water and dry on the hot 

setting. Wash soiled laundry separately from 

other laundry.

Kitchen and Cafeteria 

Cleanup

Kitchen and cafeteria areas require extra 

care when someone vomits in those areas. 

In the kitchen, consider any exposed area 

within 25 feet of the vomit contaminated.

1. Everyone within the area should immediately wash their hands.

2. Discard any exposed or uncovered food. 

3. Cover the vomit immediately with paper 

towels or disposable cloths and soak with 

bleach or disinfectant.

4. Dispose of soiled paper towels in a plastic 

garbage bag. Do not reuse towels, sponges 

or cloths that were used for cleanup. 

5. Clean the area with soap and water.

6. Disinfect with a 5000 ppm bleach solution 

with at least five minutes of contact time and 

have the area well ventilated.

7. Rinse the area with clear water.

TIP:

Do not vacuum, 

shake, or otherwise 

disturb vomit on 

carpets, curtains, or 

other soft surfaces. 

Follow the special 

procedures for these 

surfaces outlined in 

this booklet.

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Fran the food service 

worker serves wholesome

food to help keep kids healthy. 

She knows how important it is 

to wash her hands after 

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using the bathroom and to wear 

gloves while serving food. 

She needs training to know that 

she should stop handling food at 

the first sign she feels sick. She 

needs to know that she should not 

prepare any food if she has been 

sick to her stomach or has had 

diarrhea for at least three days 

afterward. She also needs to be 

able to stay home until she is completely well. Her medical provider 

or the health department may have specific guidance about 

returning to work.

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Sue the school secretary

knows everything that is going 

on in school. Sue sees the daily 

attendance list and knows 

when absences are up. 

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She is the first to receive a 

call if someone gets sick at 

school. She often fills in to 

help a sick child when the 

school nurse or clinic assistant 

is not there. She knows how to 

contact the nurse, health department, and school board. 

She has templates of letters 

ready so she can send them 

out quickly to keep the staff, 

school board, and parents informed. She needs the proper 

training and tools so she can 

respond to questions.

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If there is any 

question whether 

the illness has been 

transmitted by food, 

check with the health 

department for special procedures.

Mixing bleach 

solution for food 

contact areas:

To make a 200 ppm 

bleach solution for 

sanitizing food contact surfaces, mix 1

/3

cup bleach with five 

gallons of water.

8. Sanitize all food contact surfaces within 

25 feet by wiping down food contact surfaces with a 200 ppm bleach solution (1

/3 cup 

standard household [5.25%] bleach mixed 

with five gallons of water) or other sanitizer 

safe for food contact surfaces and approved 

against norovirus.

Cleaning 

“High-Touch” Areas

“High-touch” areas are places that people 

touch often with their hands. During a norovirus outbreak, take extra care to clean hightouch areas. These include tables, chairs, lockers, 

counters, door handles, push plates, railings, 

elevator buttons, telephones, and all areas of 

the bathrooms. These areas need frequent 

routine cleaning, especially during an outbreak 

of norovirus.

Use disposable wipes and clean only one 

surface per wipe. Sanitize high-touch areas 

of bathrooms often. Be sure to keep soap 

and paper towel dispensers filled.

Start Process To Inform 

Staff And Community

One person, often the school nurse or principal, should serve as the contact person 

for the school. This person ensures that 

information is correct and consistent. 

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TIP:

TIP:
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As soon as you suspect an outbreak, contact 

the local or state health department. Any 

unusual increase in the number of students 

and staff absent due to vomiting or diarrheal illness indicates a possible outbreak.

Work with the health department to gather 

any information needed. This information 

might include:

• number of ill students and staff

• symptoms and dates of illness onset

• total number of students and staff in the school

• absentee rates from previous years

• list of any special events such as field trips

in the two weeks before the illness

• school lunch menus for the last two weeks

News of an outbreak will travel through the 

school and into the community quickly. Right 

away, the contact person should make sure 

that all staff members have the facts they 

need in order to keep rumors from spreading. 

Remind sick staff members to go home and 

stay home until they are free of symptoms 

for at least three days (there is a contagious 

period even after symptoms are gone). If the 

staff member received medical care, their 

medical provider or the health department 

may give guidance for returning to work. Always stress ways to prevent further spread of 

the illness, especially through hand washing.

Prepare a letter to go home with students or 

start the school-wide notification process. 

TIP:

Good policies and 

procedures help with 

prevention. Having a 

policy in place before 

you need it makes the 

response simpler.

Clean all “HighTouch” areas often 

during any outbreak 

of illness.

TIP:

Remember, one of the 

best ways to prevent 

the spread of disease 

is to carefully wash 

your hands often with 

soap and water.

TIP:
Ted is a classroom 

teacher. He works all day

with the students in his class 

and usually knows when “something is going around.” When a 

child gets sick and vomits, Ted 

and other teachers are often 

the first ones to respond. With 

classes full of students, 

teachers 

need to 

know how 

to help one 

student while 

keeping 

others safe. 

Teachers need 

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Teachers need training and 

a kit with gloves and paper 

towels. They need to know to 

remove all students from the 

area and to call for someone 

trained in cleanup.

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Jennie the paraeducator

is everywhere, helping in the classroom, on the playground, on field 

trips, and in the lunchroom to 

make sure the day runs smoothly. 

Jennie seems to keep an eye on 

all the kids at once and sees right 

away if a child is sick. 

Jennie needs to 

have a supply 

kit nearby and 

training to know 

what to do when 

a student throws 

up at school. 

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Remember Megan, 

the student who 

threw up? 

After you had her cover 

her mouth, you directed 

the other students 

away and carefully 

covered the vomit with 

paper towels without 

touching it. What 

should you do now?

• Call to have the

trained custodian 

come and clean up.

• Wash your hands 

thoroughly and have 

all the students 

wash their hands.

• Notify the school

office.

TIP:

Have templates of 

letters for parents 

ready so they can go 

out quickly.

TIP: Include in the letter a reminder that anyone 

with vomiting or diarrhea symptoms should 

stay home until the symptoms are completely 

gone. If indicated, also include in the letter any 

changes in the food service and restrictions on 

food sharing until the illness is contained.

Conclusion

When a student vomits at school, there is no 

way to know immediately if it is an isolated 

incident or the beginning of a norovirus 

outbreak. Stomach illnesses spread quickly in 

a school environment. When a student or an 

adult vomits or has diarrhea at school, small 

particles can spread widely, contaminate 

multiple surfaces, and infect others. 

To be safe, treat any incident as if it is 

norovirus and follow the proper procedures 

listed in this booklet.

To prevent the illness from spreading, school 

personnel need to know what to do to protect themselves and the students in their care.

Personnel responsible for cleanup should 

be able to follow the procedures outlined 

in this booklet. Staff members who are ill 

need to be able to stay home until all symptoms of illness are gone.

Ask your local NEA affiliate president, UniServ 

director or building representative for help in 

advocating for workplace policies, contract 

language, education and training. Effective 

organizing strategies include building coalitions, 
30

forming health and safety committees, and negotiating contract language and district policies.

Acknowledgements

Special thanks to our reviewers:

aron J. hall, DVM, MSph, 

Centers for Disease Control and Prevention

Shirley B. Bohm, rS, Mph, 

U.S. Food and Drug Administration

Mary Cartagena, rehS, 

U.S. Food and Drug Administration

Wendy Fanaselle, MS, rS, DaaS, 

U.S. Food and Drug Administration

Glenda r. lewis, MSph, 

U.S. Food and Drug Administration

Veronica S. Moore, MS, rS, 

U.S. Food and Drug Administration

laurie B. Williams, 

U.S. Food and Drug Administration 

Organize! Health and 

safety issues such as 

preventing the spread 

of nororvirus affect 

everyone in a school, 

making it an ideal 

organizing issue for a 

local association.
Production Coordinator: Jamila Boddie

Author: Margaret Miller Volpe

Illustrations: Dominic Cappello

Graphic Design: Rachel Boothe

Copy Editor: Cindy Brockwell
Phone: 202.822.7570

Fax: 202.822.7775

www.neahealthyfutures.org

Resources

Organizing around health and safety issues

www.neahealthyfutures.org/organizing 

The U.S. Environmental Protection Agency provides a list of 

registered disinfectants on its website:

www.epa.gov/oppad001/list_g_norovirus.pdf.

National School Boards Association 703.838.6722 

www.nsba.org/MainMenu/SchoolHealth/SelectedNSBA 

Publications/FoodSafety.aspx

CDC Norovirus fact sheets

Includes Q&A, fact sheet, and special information for food 

handlers. 

www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm

U.S. Food and Drug Administration Retail Food Protection: 

Employee Health and Personal Hygiene Handbook.

www.fda.gov/Food/FoodSafety/RetailFoodProtection/IndustryandRegulatoryAssistanceandTrainingResources/ucm113827.htm

Conference for Food Protection Emergency Action Plan for 

Retail Food Establishments: 

www.foodprotect.org/media/guide/EmergencyActionPlanfor 

RetailFoodEstablishments2008.pdf

National Park Service, Public Health Program Norovirus - 

Response and Cleanup: 

www.nps.gov/public_health/inter/info/factsheets/ 

fs_noro_r&c.htm