Being Proactive to Stop the Spread of Norovirus - the Importance of Excluding Sick Food Handlers

Chip Manuel, Ph.D.


By Chip Manuel, Ph.D.

Food Safety Science Advisor

Norovirus Outbreaks—A Consistent Concern

Norovirus is the leading cause of foodborne illness in the United States. It causes 58 percent of all foodborne illness each year, which amounts to approximately $2 billion in costs, mainly due to lost productivity and healthcare costs.1

The majority of those foodborne norovirus outbreaks occur each year in restaurant settings.

So why does norovirus continue to cause outbreaks in restaurants? A major reason is because infected food handlers come to work when sick.

Infected individuals who show signs of norovirus illness can easily spread the virus in their vomit and diarrhea. Individuals infected with the virus can shed up to a billion virus particles in their feces every time they use the bathroom.2 However, it only takes less than 100 virus particles to get someone sick, 3 so you can easily see why it is so important to exclude sick food handlers from coming to work when they are symptomatic and actively shedding the virus.

Sick Food Handlers

A recent study published by researchers from the United States Food and Drug Administration shows just how important it is to exclude infected handlers from preparing food in order to stop the spread of norovirus in a restaurant. 4 Using a mathematical modeling approach, researchers evaluated the effectiveness of various strategies (e.g., handwashing, disinfecting touch surfaces, employee exclusion, etc.) at controlling norovirus in a restaurant.

The study found keeping sick food handlers out of work was the single most effective strategy at controlling the spread of norovirus.

The effects sick workers have in infecting others are staggering. In instances where an infected food handler came to work, the number of guests who caught norovirus from the restaurant rose by over 200 percent!

The impact of an infected food handler on spreading norovirus is so strong that other prevention strategies – like handwashing or surface disinfection – cannot prevent guests from becoming ill if an infected food handler is present.

3 Steps Towards Preventing the Transmission of Norovirus.

So what can a food establishment do to help stop the spread of norovirus by infected food handlers?

1. Adopt a sick leave policy

Employees may feel pressured to come to work while sick. Alleviate that pressure. Employees are afraid they will be reprimanded, or even worse, lose their job if they do not report to work.

Consider adopting a policy that encourages employees to stay home when showing norovirus symptoms. The health policy should be specific for your establishment and include key contacts for your local regulatory authority, as well as how they will be consulted during a situation where a food handler reports to work while ill.

2. Adhere to recommended guidelines for exclusion and restriction in your sick leave policy

The FDA Food Code recommends excluding food handlers from working while having symptoms of norovirus (vomiting and diarrhea). 5 Additionally, sick employees should continue to be excluded from work 24 to 48 hours (48 hours is preferred) after symptoms have resolved.

Because individuals may continue to shed the virus after recovery, consider restricting food handlers to non-food related duties for up to 48 hours after returning to work.

3. Continue to follow best practices for control of norovirus

While keeping sick food handlers from coming to work is an important practice for preventing norovirus outbreaks, it is only one piece of the puzzle.

Practicing hand hygiene properly and frequently should always be taught and emphasized in establishments. Because guests themselves can be a source of norovirus, especially if they come into your establishment while sick, routine disinfection of high touch areas (especially within restrooms) using products with a fast kill time for norovirus is also encouraged. Consider products like PURELL® Foodservice Surface Sanitizer as part of your cleaning routine. The spray is formulated for food-contact surfaces and can kill norovirus in 30 seconds.

Finally, ensure your establishment has a plan to deal with vomit or cleanup events. Consider assembling a kit with the necessary personal protective equipment, tools, and disinfectant and cleaning chemicals necessary to deal with the spill.

Never Give Norovirus the Chance to Clock-In

Norovirus is a constant frustration and a continuous point of concern amongst food safety experts. While more data and findings around this virus are shared, restaurants need to find ways to proactively stop the spread of norovirus. That includes excluding ill food handlers. When we can stop the norovirus from clocking in at the start of the shift, everyone can feel more confident in the steps taken to avoid the transmission of it throughout the day.

1. https://www.cdc.gov/norovirus/trends-outbreaks/burden-US.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fnorovirus%2Fphp%2Fillness-outbreaks.html
2. Atmar, R. D., et al. Norwalk Virus Shedding after Experimental Human Infection. Journal of Emerging Infectious Diseases 14(10): 1553–1557, Oct. 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2609865/
3. https://www.cdc.gov/norovirus/downloads/keyfacts.pdf
4. Duret, S., et al. Quantitative Risk Assessment of Norovirus Transmission in Food Establishments: Evaluating the Impact of Intervention Strategies and Food Employee Behavior on the Risk Associated with Norovirus in Foods. Risk Analysis 37(11): 2080–2106, Nov. 2017. https://www.ncbi.nlm.nih.gov/pubmed/28247943
5. https://www.fda.gov/food/fda-food-code/food-code-2017

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