The Employee
Connection
Employee Health and Hygiene
Colleen Zenk, MS, CDM, CFPP, CFM
Presented to MN ANFP
2015 Fall State Conference
St. Cloud, MN
October 22, 2015
Education Outcomes Today
 Objectives
 Increase knowledge of the foodborne pathogens most likely
to be transmitted by employees in a foodservice operation
 Demonstrate the need for managing employee illness in a
food operation and the requirements for reporting
 Discuss policies and procedures for the avoidance of bare
hand contact with ready-to-eat foods
 Discuss the effectiveness of hand antiseptic use in a
foodservice operation
 Develop a cleanup and response plan per 2013 Food Code
for a Norovirus event
ANFP Minnesota State Meeting | St. Cloud | 2015
2
FDA Risk Factor Non-Compliance
Personal Hygiene
 Proper and adequate handwashing
 Hospitals - 35.6%
 Nursing Homes - 34.4%
 Hand-washing facilities
convenient and accessible
 Hospitals - 23.3%
 Nursing Homes - 12.9%
 Good hygienic practices
 Hospitals - 13.3%
 Nursing Homes - 12.1%
Source: FDA Report on the Occurrence of Foodborne Illness
Risk Factors in Selected Institutional Foodservice,
Restaurant, and Retail Food Store Facility Types (2009);
ANFP Minnesota State Meeting | St. Cloud | 2015
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FDA Risk Factor Non-Compliance
Personal Hygiene
 Prevention of contamination
by hands
 Hospitals - 9.0%
 Nursing Homes - 12.5%
 Hand-washing cleanser and
drying devices in place
 Hospitals - 4.4%
 Nursing Homes - 8.6%
ANFP Minnesota State Meeting | St. Cloud | 2015
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Pathogens of Concern
 Bacteria
 Usually live/multiply in food, on surfaces
 Can be managed/prevented by
 Procuring food from approved sources
 Time and Temperature control
 Cleaning and sanitizing
 Viruses
 Need a host to survive (person)
 Usually transmitted by infected food handler
 Can be managed by
 Procuring food from safe sources (water, seafood)
 Proper employee health and hygiene
ANFP Minnesota State Meeting | St. Cloud | 2015
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The “Big Six” Pathogens
Reportable Foodborne Illness


2-20
Bacteria
o
Shigella spp.
o
Salmonella Typhi
o
Nontyphoidal Salmonella (NTS) – added in
2013 food code
o
Shiga toxin-producing Escherichia coli
(STEC), also known as E. coli
Viruses
o
Hepatitis A
o
Norovirus
How Food Handlers Can
Contaminate Food
Food handlers can contaminate
food when they:
 Have a foodborne illness
 Have wounds that contain a
pathogen
 Sneeze or cough
 Have contact with a person who is
sick
 Touch anything that may contaminate
their hands and don’t wash them
 Have symptoms such as diarrhea,
vomiting, or jaundice—a yellowing of
the eyes or skin
Bare-Hand Contact with
Ready-to-Eat Food
 Food Code 3-301.11 – Preventing Contamination from
Hands
 Food employees shall wash their hands as specified under 2 301-12
 Food employees may not contact ready-to-eat food with their
bare hands and shall use suitable utensils such as deli
tissue, spatulas, tongs, single-use gloves, or dispensing
equipment
 Food employees shall minimize bare hand and arm contact
with exposed food that is not eaten in ready-to-eat form
 3-801-11 – Highly Susceptible Populations
 Food employees may not contact ready-to-eat foods
ANFP Minnesota State Meeting | St. Cloud | 2015
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Ready-to-Eat Food
Ready-to-eat (RTE) food is food that
can be eaten without further:
 Preparation
 Washing
 Cooking
Ready-to-eat (RTE) food includes:
 Cooked food
 Washed fruit and vegetables
 Deli meat
 Bakery items
 Sugar, spices, and seasonings
1-11
Bare-Hand Contact with Ready-to-Eat
Food (Changed 2013)
Bare-hand contact with ready-to-eat food may be
acceptable if
 The food is an ingredient in a dish that does not
contain raw meat, seafood, or poultry and the dish
will be cooked to at least 145ºF (63ºC) (cheese to
pizza dough)
 The food is an ingredient in a dish containing raw
meat, seafood, or poultry and the dish will be
cooked to the required minimum internal
temperature of the raw items(s)
 NEVER handle ready-to-eat food with bare hands
when you primarily serve a high-risk population
Infected Wounds or Cuts
 Must be covered to prevent pathogens
from contaminating food and food-contact
surfaces
 How a wound is covered depends on
where it is located:
 Cover wounds on the hand or wrist with
an impermeable cover, (i.e. bandage or
finger cot) and then a single-use glove
 Cover wounds on the arm with an
impermeable cover, such as a bandage
 Cover wounds on other parts of the body
with a dry, tight-fitting bandage
Single-Use Gloves
 Should be used when handling
ready-to-eat food
 Except when washing produce
 Except when handling ready-to-eat
ingredients for a dish that will be
cooked
 Must NEVER be used in place
of handwashing
 Must NEVER be washed and
reused
 Must fit correctly
How to Use Gloves
 Wash and dry hands before putting
gloves on when starting a new task
 Select the correct glove size
 Hold gloves by the edge when
putting them on
 Once gloves are on, check for rips
or tears
 NEVER blow into gloves
 NEVER roll gloves to make them
easier to put on
Hand Antiseptics
 Hand antiseptics:
 Liquids or gels used to lower the
number of pathogens on skin
 Must comply with the CFR and
FDA standards
 Should be used only after
handwashing
 Must NEVER be used in place of
handwashing
 Should be allowed to dry before
touching food or equipment
3-9
MDH Fact Sheet
on Sanitizer Use
Use of Hand Sanitizers (Antiseptics)
• Must be FDA
Approved
• Don’t kill
viruses
• Effective
against some
bacteria
• Current
controversy
regarding
ingredients
Handling Staff Illnesses
If the food handler has at least one of these
symptoms
● Vomiting
● Diarrhea
Exclude the food handler
from the operation
● Before returning to work, food handlers who
vomited or had diarrhea must meet one of these
requirements
o
Have had no symptoms for at least 24 hours
o
Have a written release from a medical
practitioner
Handling Staff Illnesses
If the food handler has a sore
throat with a fever

Restrict the food handler from working
with or around food

Exclude the food handler from the
operation if you primarily serve a highrisk population

A written release from a medical
practitioner is required before returning
to work
Handling Staff Illnesses
If the food handler has
jaundice
● Report the food handler to the
regulatory authority
● Exclude food handlers from the
operation if they have had
jaundice for 7 days or less
● Food handlers must have a
written release from a medical
practitioner and approval from
the regulatory authority before
returning to work
Handling Staff Illnesses
If the food handler is vomiting or has
diarrhea and has been diagnosed with an
illness caused by one of these pathogens.
●
●
●
●
●
●
Hepatitis A
Norovirus
Shigella spp.
Salmonella Typhi
Non-typhoidal Salmonella
Shiga toxin-producing E. coli
Then exclude the food handler from the
operation

Work with the food handler’s medical practitioner
and/or the local regulatory authority to decide
when the person can go back to work
Illness Reporting
 Do not prepare food for others while you
are sick and for 2 -3 days after you
recover.
 Minnesota Food Code requires that
workers be symptom free for 24 hours
before returning to work
 Require that manager be notified if
norovirus symptoms are present
 Keep an illness log to record similar
worker symptoms.
 Keep sick workers out of the food
preparation areas – must exclude sick
workers from food preparation
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Employee Illness Log
21
Preventing
Norovirus in
Foodservice
Operations
Norovirus
 Virus – one of the pathogen
groups that cause
foodborne illness
 Leading cause of illness
from contaminated food in
the US – accounts for
about 50% of all illnesses
related to food.
 Highly contagious – less
than 20 particles can cause
illness
What is norovirus?
 Members of a group of viruses called caliciviruses.
 Also called viral gastroenteritis, or food poisoning.
 Causes inflammation of the stomach and intestines.
 Leading cause of foodborne illness outbreaks in
Minnesota.
 Often mistakenly referred to as the “stomach flu“
 Not related to the flu (influenza), which is a
respiratory illness caused by influenza virus.
 Has many strains
Norovirus basics
Each year in the US, Norovirus causes
Leading cause of gastroenteritis in children in the US
Confirmed Foodborne Outbreaks by
Etiology, Minnesota,1999-2013 (n=752)
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Transmission
 Food
 Infected employees
 Contamination at source (oysters)
 Person-to-person
 Direct fecal-oral (poop – even a
tiny amount – on fingers)
 Vomitus
 Indirect via fomites (contaminated
objects)
 Water
 Drinking water (wells)
 Recreational
Norovirus transmission
Norovirus can transfer from contaminated fingers,
sequentially to 7 different environmental surfaces.
(Barker, Vipond, Bloomfield 2004)
Secondary transfer to 4 more surfaces
Trends and outbreaks
 Healthcare facilities
including nursing homes and
hospitals are the most
commonly reported places
for norovirus outbreaks
 Nearly 2/3 of all outbreaks in the
US occur in long-term care
facilities
 Also occur in restaurants,
cruise ships, schools,
banquet halls, summer
camps, and churches
Transmission & contagion
 You are most contagious
 When you are sick with the
norovirus illness and
 During the first 3 days after
you recover from the illness
 You become infected with
norovirus by accidentally
getting stool or vomit from
infected people in your
mouth. How does this
happen?
Becoming infected with norovirus
 Eating food or drinking liquids that are contaminated
with norovirus
 Touching surfaces or objects contaminated with
norovirus and then putting fingers in your moth or
 Having contact with someone who is infected with
norovirus
 Caring for someone who is sick
 Sharing food or utensils with
someone who is sick
 Spreads quickly in closed places
where lots of people either live,
work or play together
Symptoms
 Most common symptoms
 Diarrhea
 Vomiting
 Nausea
 Stomach Cramps
 Less common
 Low grade fever
 Chills
 Headache
 Muscle Aches
 Fatigue
 Can lead to dehydration, hospitalization and even death
Prevention & Treatment
 No Vaccine and No Treatment
 Caused by a virus – antibiotics
are ineffective
 Practice proper hand hygiene
 Wash carefully with soap and
water
 After using the toilet – and
changing diapers
 Before eating, preparing and
handling food
Preventing Norovirus Transmission
 Handwashing with soap and
water is the single most
effective way to prevent the
spread of bacteria and
viruses--the major causes of
foodborne illness.
 Norovirus is the leading cause
of foodborne outbreaks, often
in foodservice settings. Hand
sanitizers do not kill norovirus.
Prevention – Produce Handling
 Wash fruits and vegetables before preparing them and
before eating or serving to others
 Store fresh cut and newly prepped product in washed and
sanitized containers with production dates clearly indicated
on the container



Never mix prepped or fresh cut
product from different production
dates
Wash produce in “running water”
(3-301.15)
Wash your hands continually with
soap and water.
Seafood
 Cook oysters and other
shellfish thoroughly before
eating or serving them
 Noroviruses are fairly resistant
and can survive temperatures
that are often used to steam
cook shellfish
 Use reputable suppliers for
all shellfish
Food Code update
 2-501.11 Clean-up of Vomiting and
Diarrheal Events.
 A FOOD ESTABLISHMENT shall have
procedures for EMPLOYEES to follow
when responding to vomiting or
diarrheal events that involve the
discharge of vomitus or fecal matter
onto surfaces in the FOOD
ESTABLISHMENT.
 The procedures shall address the
specific actions EMPLOYEES must take
to minimize the spread of
contamination and the exposure of
EMPLOYEES , consumers, FOOD , and
surfaces to vomitus or fecal matter. Pf
Cleaning up – preventing spread
 Use protective tools when cleaning up
vomit, including disposable latex gloves, a
disposable surgical or procedure mask, and
apron.
 Norovirus can be aerosolized in vomit and
may be spread up to 25 feet outside
visually affected areas.
 Chlorine bleach can inactivate norovirus;
 Quaternary ammonia (quats) are not
recommended because they aren't effective.
 A 5,000 ppm (25 tablespoons 5.25% bleach
per gallon of water) bleach solution should
be applied to soiled areas for at least 4
minutes.
Clean up procedures
 When cleaning up vomit:
 Carefully wipe the spill, avoiding further spread, with
paper towels and bag the residues;
 Pour bleach solution or other disinfectant intended to kill
pathogens on and around the area;
 Let solution act for at least 4 minutes;
 Wipe the remaining solution and re-clean and sanitize
the area as per normal, non-vomit event procedures;
 All disposable material should be discarded in plastic
bags;
 Non-disposable material should be bleached and airdried; and, double-bag and tie up plastic garbage bags
and discard.
Laundry
 Immediately remove and wash
clothing or linens that may be
contaminated with vomit or feces
 Handle soiled items carefully
without agitating them
 Wear rubber or disposable gloves
while handling soiled items
 Wash your hands afterwards
 Wash the items with detergent at
the maximum available cycle
length and machine dry them
Managing a Personal Hygiene Program
Focus on the following:
 Creating personal hygiene
policies
 Training food handlers on
personal hygiene policies and
retraining them regularly
 Modeling correct behavior at
all times
 Supervising food safety
practices
 Revising personal hygiene
policies when laws or science
change
Colleen Zenk,
MS, CDM, CFPP, CFM
612-834-5723
[email protected]