Employee Illness in retail food facilities

Why is it important to have a written policy and effective training for employee illness?

The cost of an outbreak is reported to be between $6,330 and $2.6 million dollars depending on type of retail facility and the severity of the illness. 3 An outbreak is classified as 2 or more people.  However, most illnesses related to foodborne illness go unreported and facilities are never implicated.  The thought of “We will most likely not be caught” should not be your policy on preventing foodborne illness.

 64% of outbreaks are from retail restaurants, 48% of those are from sit-down type facilities.1   58% of outbreaks 2 are from at least one employee being ill.  Only 47% of facilities implicated in outbreaks had a written policy on employee illness.

A study4 conducted that interviewed 491 workers from 391 randomly selected restaurants revealed some very important information about employee and management behaviors as it relates to employee illness.   59% of the employees surveyed reported working a shift while ill.  Out of those 59%, 63% of managers were aware of the illness!  81% of the time it was the employee that notified the manager, yet the employee was still allowed to work.  The reasons for continuing to work was;

  • 43% No paid sick leave or sick leave policy
  • 32% Understaffed or no one to cover shift
  • 30% Symptoms did not feel bad or not contagious and
  • 30% Felt obligated or strong work ethic.

Some indicated more than one reason.   This indicates that employees, not managers, were making decisions about when to work.  To make matter worse, of the ill employees that continued to work less than one third washed hands more frequently.

An FDA study published in 2004 found food establishments were frequently out of compliance with the Food Code requirements for proper and adequate handwashing. In the study, the percent of food establishments observed to be out of compliance with handwashing requirements ranged from 34% in hospitals and a whopping 73% in full-service establishments.

In my experience providing third party inspections, when I observed improper handwashing and explained the proper process, many had little to no understanding of how and when they should wash hands or they stated they didn’t have time.

This creates a perfect storm for transferring pathogens from hands of an ill employee to the surface of food.

What illnesses and medical conditions should management and employees be aware of?

There are certain illnesses, exposure to certain illnesses, or even infections that employees must report to management or the Person in Charge (PIC). The PIC must know what the next action should be.  This could be restricting the employee from working around exposed food, excluding the employee from facility and possibly reporting the diagnosis, illness or exposure to the authorities.   There are certain pathogens that employees must be made aware of.  These are called the Big 6.  They are;

  • Norovirus,
  • Hepatitis A virus,
  • Shigella spp.,
  • Shiga toxin-producing Escherichia coli,
  • Typhoid fever (caused by Salmonella Typhi) or
  • Salmonella (nontyphoidal).

Employees also should be made aware that they need to report excessive sneezing, coughing, general nasal discharge, skin cuts, lesions or infections and a sore throat with a fever. Vomiting and or Diarrhea, regardless of frequency.  Jaundice that is less than 7 days old must be reported as well.  Management and Employees should also understand the risks associated with Staphylococcus Aureus.

The person in charge should be most concerned with the following symptoms of foodborne illness;

  • Vomiting
  • Diarrhea
  • Jaundice (yellow skin or eyes)
  • Sore throat with fever
  • Infected cuts and burns with pus on hands and wrists

How are pathogens transferred to food and surfaces?

Transmission can happen in a variety of ways.  Hand to food contact, Hand to surface to food, surface to hand to food.   Water and oils in fecal matter can assist in the transfer of pathogens found in the feces.

How can the PIC prevent the spread of illness causing pathogens from ill employees?

  • Provide employee illness training to all staff members.
  • Be observant and inquire if employees appear to be ill.
  • Management must be informed of the specific circumstances that must be reported and when employees should be restricted from working around exposed food and when they should be excluded from facility.Details are available in the FDA food code subpart 2-201.11-13.
  • PIC must provide on-going and job specific training to all staff. Training should include;How easily pathogens like Norovirus can be transmitted, proper handwashing, proper glove use, and a reminder of all illnesses that must be reported.
  • Food handlers should be trained to not use bare hands to touch Ready to Eat (RTE) foods.
  • Provide a culture where reporting illness and missing shifts does not threaten employee hours or job security.
  • Create a culture of good hand care and reward staff for good practices.
  • Provide adequate supplies for proper hand care and tools for touching RTE foods.

Employee responsibilities and preventions

  • Reporting illnesses as required
  • Always, wash hands when required and using proper methods.
  • Report workers that are not reporting illness to PIC or are not properly washing hands.

It is important that the PIC be knowledgeable about employee illness, reporting, exclusion, and restricting of employees.  This is discussed briefly in the Food Manager Protection training (ServSafe).  Trained staff members must make sure the all staff are trained in employee illness as well.  If you would like assistance creating an employee illness training for your staff, please contact us.  We can provide decision trees, employee agreement forms and other training tools.

 

  1. https://www.cdc.gov/fdoss/pdf/2017_FoodBorneOutbreaks_508.pdf
  2. NORS and NEARS system, CDC
  3. https://www.qsrmagazine.com/outside-insights/tremendous-cost-foodborne-illnesses-and-what-do-about-it
  4. Carpenter, L. R., A. L. Green, D. M. Norton, R. Frick, M. TobinD’Angelo, D. W. Reimann, H. Blade, D.C. Nicholas, J. S. Egan, K. Everstine, L. G. Brown and B. Le. 2013 Food worker experience with and beliefs about working while ill. J. Food Prot. 76:2146-2154.

Easter Time Egg Questions

Easter is almost here!  What a fun time coloring and decorating hard-boiled eggs with friends and family.

Easter Eggs

But have you ever wondered about how to safely handle your hard-boiled eggs? Below are some of the top questions I get asked during the ServSafe Manager Training.

How can eggs make you sick?

The pathogen of concern is Salmonella.  Salmonella (nontyphoidal) is the number 2 pathogen that causes foodborne illness in the US and the number 1 that causes hospitalization and death.  The CDC estimates over 1 million illnesses a year.  79,000 of those come from of Salmonella Enteritidis which comes directly from improperly handled eggs.  People that are infected will usually become ill 12-72 hours after consuming the bacteria.  Symptoms include diarrhea, fever, abdominal cramps and vomiting.  People with weakened immune systems are at a greater risk.

How does Salmonella affect a regular shell egg?

The bacteria is carried in the fecal matter of the hen.  It can be introduced to the egg shell when the hen is laying the egg.  The bacteria can enter through the porous shell of the egg.  The Salmonella Enteritidis can also be introduced to the egg before the shell is formed in the intestinal track of the hen.

Why are raw eggs in some countries not refrigerated?

The production process is different in the US from European countries, because of this the USDA requires producers to wash and sanitize the egg before selling.  This creates an environment where air and bacteria can more easily pass through the shell. Therefore, temperature control is required.

Do hard-boiled eggs need to be refrigerated? 

The CDC, USDA, Egg Board and FDA consumer guidelines all agree after an egg is hard-boiled the surface even more porous.  The recommendation is that eggs be refrigerated at 40°F or below for no more than 7 days.  The only source of information that is different is the FDA food code for retail food establishments.  Raw shell eggs can be stored at 45°F or below.  Water cooled eggs must be stored at 41°F or below and as stated in Annex 3 Public Health Reason / Administrative guidelines 3-501.14, air cooled eggs are no longer a TCS food.

“Hard-boiled eggs with shell intact may be cooled in ambient air and are not considered to be a time/temperature control for safety food after cooling. Hard-boiled eggs may be cooled in drinking water but are considered to be a time/temperature control for safety food after cooling because pathogens, which may be present in the water, may pass through the egg shell during cooling”

Should you eat eggs that have been used for hiding?

Yes and No.  As long as the egg has not been left at room temperature for more than 2 hours and the egg is washed off before placing back in refrigeration you should be safe.  However, it would be safer to use other items like plastic reusable eggs for hiding.

Additional Resources:

https://www.fda.gov/downloads/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/UCM595140.pdf

https://www.foodsafety.gov/keep/charts/eggstorage.html

https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/egg-products-preparation/shell-eggs-from-farm-to-table/