Preventing Norovirus is in Hands of Food Workers

Compliance

The FDA produces a document known as the Food Code that recommends best practices for safety in the food industry, including hand hygiene, according to Lee-Ann Jakus, a Food Science professor at North Carolina State University. “A huge issue in this country is compliance. You can tell people you should wash your hands this way for this amount of time, with soap and water, and you need to do it after you use the bathroom, but you have no way of ensuring people are actually doing that.”­

The CDC recommends washing hands frequently with soap and warm water for at least 20 seconds, particularly after using the restroom. Also, workers should use utensils and single-use disposable gloves to avoid touching RTE foods with their bare hands. Kitchen surfaces and objects should be sanitized with a product approved by the EPA for use against norovirus. Fruits and vegetables should be carefully washed and shellfish should be cooked to at least 140 degrees.

Hand hygiene in food service is well below 100 percent in observational studies, according to Hall. In one study, it was only performed in about 20 percent of cases. “Clearly there’s room to improve in hand hygiene compliance,” says Hall.

There are some measures known to improve compliance. Training and certification of kitchen managers in food safety can improve compliance and decrease incidence of norovirus outbreak, Hall says.

However, perfect hand hygiene is difficult in a fast-paced food service environment. “There are so many instances in the chain where you have to wash your hands in a busy food service establishment—it becomes overwhelming,” says Jaykus. “It adds a level of complexity. This particular workforce in many instances is not as highly skilled as other workforces.”

Sick Time

Another intervention possibly even more powerful than hand hygiene is sick time.

One of the other major findings of the CDC report was that people shed virus in their fecal material before they show symptoms, and for most of the time after they show symptoms. Although it’s difficult to identify workers who are shedding virus, but not yet sick, excluding workers who are ill is an obvious way to minimize norovirus outbreaks.

Food service workers often don’t have paid sick time, and so are reporting to work when actively sick and contagious. In addition to handwashing, the food industry can prevent outbreaks by encouraging workers to stay home when ill.

Although norovirus is a clear and persistent problem in the food industry, there are not many options for intervening and preventing outbreaks. The CDC findings that fresh produce, mollusks, and RTE foods are most likely to be contaminated, and that food handlers are a significant source of outbreaks offer guidance as to where to focus prevention efforts. The CDC also advocated development and validation of more advanced analytic methods, particularly those capable of correlating virus levels with infection risk. More study is also needed on the role of food handlers, particularly those that are asymptomatic.

The CDC also advocates for better surveillance by public health agencies and development of vaccines. In the meantime, hand hygiene is potentially the most powerful front-line tool for controlling norovirus outbreaks. Increasing hand hygiene awareness and compliance can stop outbreaks at the source, whether that source is the farm or the point of service, since all human norovirus requires a human vector, and it requires little investment beyond time spent on training and awareness.

Shaffer is a freelance writer based in Ann Arbor, Mich. Reach her at [email protected].