Break the Chain of Outbreaks

Public restrooms and home bathrooms are the dominant sources of virus, and the primary transmission route is fecal-hand-oral. Today’s restaurateurs risk their livelihoods with anything less than an all-out aggressive attack. The port-of-entry to restaurants for norovirus and hepatitis A is split between the back door and the front door. The battleground covers nearly the whole footprint of the food service establishment. Interventions are needed at key viral intersections, with special attention given to the primary onsite viral harbor, the restroom.

Through the back door enters the ill employee and, through the front, the ill customer. Between these two doors are shared spaces we call the Xchange, where pathogens are regularly traded in patterns of unplanned contact and contamination (see Figure 1, p. 44).

Employees with symptoms can be screened out using the ill employee policy. Those without symptoms, the asymptomatic carriers, cannot be identified. They are free to work, prepare and serve all the foods handled by their healthy counterparts. The ready-to-eat (RTE) category of food becomes a particularly high risk one.

Thoroughly Assess Risk

Keeping pathogens in the restroom and off the menu—and the owners out of court—starts with a thorough assessment of the risks and the current barriers intended to keep the virus from intersecting with the food flow. Perform an in-depth review of cleaning methods and the frequency of restroom protocols carried out both by staff and contracted services. Hand hygiene and surface cleanliness are critical interventions in the restrooms, the kitchen, and the entire customer-service area.

The virus is clearly the primary predator on a long list of pathogens putting restaurants at risk. Most viruses start with invisible particles of fecal matter. For years the focus has been on bacteria and the kitchen’s food-sourced pathogens. But viruses are much smaller, generally more virulent, and harder to control than bacteria. As the enemy changes, so must hand washing standards and practices.

Operators are responding by specifying more integrated designs, with fewer access and transfer points and easier-to-clean surfaces. It is not surprising when you look at the overwhelming statistics on norovirus and hepatitis A that we see hand washing as the focus. The Centers for Disease Control and Prevention (CDC) point out that “hand washing is the single most important means of preventing the spread of infection.”

Poor hand hygiene is the virus’ best friend. It’s all about escape, survival, and the recurring fecal-hand-oral cycle. Hands are the documented bridge for the migrating virus, but holes in the operator’s hand hygiene intervention system are often just as invisible as the determined enemy. A well-disciplined third party audit can help discover risks otherwise masked by the rush of the daily routine.

The Back Door Virus

The ill employee policy is the first line of defense at the back door. Employers have made major strides in improving implementation of sick worker exclusion policies. A rigorous, aggressive, and highly visible hand washing program is the required backup response to deal with asymptomatic workers. A vaccine program, which has been used effectively in Las Vegas, can take the hepatitis A virus off the table and should be considered, especially when operating or building in endemic areas.

Creating systems has been a hallmark of restaurant progress. A system integrates all the detail into daily actions. While systems provide a basis for control and continuous improvement, they have eluded the area of hand washing. Most operators boast of their hand washing training, beaming at the question of certified managers, but go silent when asked about their hand washing system. Without a system, what do quality assurance and third-party auditors monitor? Where is the customary documentation for management review? What are the standards?