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Employee Illness in retail food facilities

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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.

You think the last place you ate made you sick? Here is what to do.

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Social media can be an excellent source to share information.  But when bad information is shared it can unfairly harm a business’s reputation.

I often see posts where someone claims that they became sick or got food poisoning from a restaurant.   The problem is most often you did not get sick from the last thing you ate.  It just may have been your bodies “tipping point” of when the vomiting and or diarrhea starts.

Take a look at this chart, it lists the top 6 pathogens as identified by the CDC1.  I have included estimated number of cases, transmission, incubation period, duration and symptoms.  Although this is just a quick overview of these pathogens it will help you see that each pathogen is different from each other.  Remember there are approximately 40 pathogens that can cause illness in humans.

 

Pathogen Mean estimated number of cases each year. How do humans typically get sick. Onset or incubation period before symptoms appear Duration of your illness Symptoms
Norovirus 20 million Ready to eat foods or by drinking contaminated beverages.  Touching a surface and putting your hand in your mouth could also be a source.  Only a few cells are necessary to cause illness. 12-48 hours 1-3 days Diarrhea, vomiting, nausea, stomach pains.  Sometimes fever and body aches
Campylobacter 1.3 million Most illnesses likely occur due to eating raw or undercooked poultry, or to eating something that touched it. Some are due to contaminated water, contact with animals, or drinking raw (unpasteurized) milk.

Only a small number of cells is needed to cause illness.  A single drop of poultry juice can contain enough cells!

 2-5 days 1 week Diarrhea (often bloody), fever, cramping, nausea, vomiting
Salmonella 1.2 million Can be found in many foods, including sprouts and other vegetables, eggs, chicken, pork, fruits, and even processed foods, such as nut butters, frozen pot pies, chicken nuggets, and stuffed chicken entrees. 12-72 hours 4-7 days Diarrhea, fever, cramps
Clostridium Perfringens 1 million Beef, poultry, gravies, and dried or pre-cooked foods.  Especially those left out for too long during cooling. 6-24 hours 24 hours Diarrhea, cramping, usually there is no fever or vomiting
Shigella 500,000 Found in human feces, so any contact with feces from a person that had shigella can become contaminated very easily, even weeks after they are better.  This transmission could happen when changing a sick baby’s diaper, during sex or eating foods that person touched without proper hand-washing.   It only takes a small number of cells to cause illness. 1-2 days 5-7 days Diarrhea, fever, stomach cramping
Staphylococcus Aureus (Staph) 300,000 Ready to eat foods that require refrigeration that have been handled by someone that is a carrier of Staph.  25% of healthy adults are carriers in their nose or infected cuts.  Contaminated food is left at unsafe temperatures for too long.  Cooking will typically kill the bacteria but sometimes a toxin is formed and those cannot be destroyed. 30 minutes – 6 hours 1 day Nausea, vomiting, cramps, most have diarrhea but not always.

As you look at the data, you see that the only pathogen that causes illness right after eating is Staph.  There are 300,000 estimated cases a year.  That is still a large number of people getting sick from improper handling of food, but statistically you are more likely to be ill from another pathogen.

What does this mean?

Do NOT immediately blame the last place you ate and publicly shame them.   I am in no way dismissing your illness and how bad you felt.  But making false accusations can be very harmful to someone already in a grueling business.

What should you do?

First and foremost, take care of yourself.  If you experience symptoms of foodborne illness, such as diarrhea or vomiting, drink plenty of fluids to prevent dehydration.

Then report the illness, doing so helps alert the health department of a possible outbreak.

They will likely do an investigation including asking you what your exact symptoms are and what foods you ate in at least the last 7 days.  They may also ask you go to the doctors to be tested.  A doctor is the only sure way that your illness can be diagnosed.

If you don’t feel it is necessary to make a report here is the recommendations from the CDC2 of when you should seek medical attention:

  • High fever (temperature over 101.5°F, measured orally)
  • Blood in stools
  • Frequent vomiting that prevents keeping liquids down (which can lead to dehydration)
  • Signs of dehydration, including a marked decrease in urination, a very dry mouth and throat, or feeling dizzy when standing up.
  • Diarrhea that lasts more than 3 days

But remember, unless you have the illness diagnosed, understand the incubation period, think of what you ate that is typically associated with that illness during that time period and make a report, please do not blame a restaurant for your illness.  Remember, the illness could have come from your own home.  Be informed. Be smart.

 

  1. gov/foodborneburden/pdfs/scallan-estimated-illnesses-foodborne-pathogens.pdf
  2. gov/foodsafety/symptoms.html