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.