Module 6: Personal Hygiene and Employee Health Part 1

Case Study

What Happened June 2014, Bentonville, AR 275 confirmed and probable cases of Shigella were reported among workers and visitors at a Walmart office Illnesses thought to be associated with Salsarita’s in the office food court One sick employee had taken leftover salsa home after a catered party

What They Found Environmental health came in to inspect and noted several violations, including improper handwashing and glove use Several employees reported diarrhea and other gastrointestinal symptoms prior to the outbreak but still worked Environmental health concluded outbreak was probably caused by a sick food worker With these violations and with the reports of illness there was a pretty clear tie between risky practice and disease While the salsa sample was not enough test, epidemiologist still suspected that it, or another RTE food, was related to the outbreak

What do you think the food safety culture was like at the Salsarita’s? Discussion What do you think the food safety culture was like at the Salsarita’s? Maybe people didn’t know the rules? Maybe management didn’t care about the rules?

Learning Objectives Understand symptoms, sources and control of Shigella and Staphylococcus aureus  Describe good personal hygiene habits and how they can protect foods Explain the difference between a restricted and excluded employee List reasons for exclusion or restriction of employee and requirements for reinstatement List five reportable illnesses and requirements for reinstatement

Shigella Sources and foods Transferred fecal-oral route Infected food handler Contaminated equipment, untreated water Raw produce RTE foods Symptoms Diarrhea (sometimes bloody), fever, abdominal pain, dehydration Onset, 1-7 days Shigella- often spread through cross-contamination and cross-contact - only infects primates (humans and monkeys). So it likely comes from an infected person, sometimes through water. It’s a problem in day care because of all to dirty diapers and bathroom accidents. Causes dysentery - Dysentery: Inflammation of the intestine, with pain, diarrhea, bloody stools, and often a fever above 101'F. The causes of dysentery include bacteria (such as Shigella), parasites and viruses. Dysentery can be fatal because it can cause severe dehydration. 

Science Olympiad ‘Disease Detectives’ all ate food provided by volunteers Around 200 people got sick, 50 of them had to be taken in for medical attention Staph is often an issue with personal hygiene and temperature abuse

Staphylococcus aureus Source Common in the environment Lives in humans and animals Present in nasal passages and throats Hand or arm sores (especially pus) Transmitted via cough or sneeze Symptoms and onset time Nausea, stomach cramps, vomiting, diarrhea Symptoms start 1-7 hours after consumption Last for a few hours to a day

Staphylococcus aureus Characteristics Produces a heat stable, fast acting toxin Bacteria can be destroyed by proper cooking, toxin cannot Foods associated Animal foods meat, poultry, egg, dairy Salads egg, tuna, chicken, potato, macaroni Bakery products cream-filled pastries, cream pies, chocolate éclairs Any food product handled after cooking What do these salads have in common? These salads all require preparing and mixing RTE and TCS foods. All the chopping and mixing, combined with any temp abuse creates a risky set up Everyone wants to blame the mayo for problems with creamy salads. However, commercial mayo is acidified and won’t support pathogenic growth. With this information, where do you think things went wrong with the Science Olympiad?

Key Terms Excluded employee - Can’t work in food establishment Highly susceptible population – People more likely than other people in the general population to experience foodborne disease (YOPI) Reinstated employee - Approved to work Restricted employee - Can’t work with or around food

Personal Hygiene

Clothing and Hair Clothing Hair Bathe daily and wear deodorant. Wear clean clothing. If possible, put your work clothes on when you arrive at work. Wear a clean apron and remove it whenever you leave the kitchen. Remove all jewelry while working. The only exception is a plain wedding band. Hair Hair shoulder length or longer should be pulled up Wear a clean hat or other hair restraint Why do you think these rules are in place? You never know what could get on your or your clothes at home, so bathing and wearing clean clothes prevents bringing in contamination A restaurant in South Carolina was involved in a foodborne disease investigation. They tested all the employees and food but didn’t find the cause. A week later the investigator saw a new employee and a kind of pungent smell. They asked, the new employee worked from time to time when they got busy. His full time job… drove a septic tank pump truck. Have you seen people wear their aprons in the bathroom, or home at the end of a shift? Aprons protect your clothes, but also protect FROM your clothes It is very hard to get detailed rings clean. Not only can jewelry fall out into food, they have the potential to transfer pathogens Hair restraints help keep hair out of food and help prevent people from touching their faces/hair

Taste Testing Preventing contamination while tasting food is important Food should not be tasted over pots, pans or serving containers. Methods Use a disposable utensil to taste a dish and take a step away to taste. Place a tasting portion in a small dish and take a step away to taste Do not reuse tasting utensils! Have you seen a cooking show and the cook tastes with the stirring spoon and then dribbles back into the pot? Tasting should be done so that there is no way for tasters to contaminate

Breaks and Personal Items Employees should not eat, drink, chew gum or use tobacco in food preparation area Drinks are allowed if in covered containers that prevent contamination Personal items should be kept away from food preparation and storage areas As the PIC, you should actively monitor employee behavior Chewing while preparing food increases the chances of spitting into food Drinks should be in covered containers, preferably with straws. This is so that liquid doesn’t spill out, and so that when the cup is picked up hands don’t touch a part that the mouth touches As the manager, are you checking to make sure these rules are being followed? Too many people in the kitchen can create a problem with flow of food (and people)

Hands are the biggest vehicle of cross-contamination Best practices for hand hygiene include:  Keeping fingernails clean and cut short. Not wearing nail polish. Not wearing false nails. Covering cuts and sores on hands with a bandage. Washing your hands frequently and properly will also prevent contamination  Preventing bare hand contact More on handwashing and BHC in the next module

Cuts and Wounds Staphylococcus aureus bacteria is naturally present on our skin, around the mouth and nose. Open cuts, wounds and lesions/boils are problematic Wash hands properly and frequently No bare hand contact Exclude employees with uncovered wounds on hands or arms Cover open wounds with appropriate bandages and gloves

Reporting Illness and Injury

Reporting Illness Sick employees can very easily contaminate food and spread illness to other people. Employees must report the following to the Person in Charge: Sore throat with fever Infected cuts, wounds or lesions containing pus on the hand, wrist or other exposed body part Persistent sneezing, coughing or runny nose that causes discharges from the eyes, nose or mouth Diarrhea Vomiting Jaundice (yellowing of the skin and eyes)

Employee Restriction vs. Exclusion Restricted employee – can’t work with or around food Excluded employee – can’t work in establishment The presence of some symptoms require restriction, while others require exclusion

Restricted From Work If an employee presents with the following they must be restricted: Sore throat with fever Infected cuts, wounds or lesions containing pus on the hand, wrist or other exposed body part Persistent sneezing, coughing or runny nose that causes discharges from the eyes, nose or mouth Employee can be in the establishment but should not come in contact with food or clean food contact surfaces This could mean giving them jobs such as cleaning bathrooms or taking out trash.

Reinstating Cuts and Wounds According to the FDA Food Code 2013, reinstate restricted employee if skin, infected cut or lesion is covered with: Impermeable cover (finger cot, waterproof bandage) and single use glove if it is on hand, finger, or wrist An impermeable cover on the arm Dry, durable, tight fitting bandage on body

Excluded From Work Employee has following symptoms: Diarrhea Vomiting Jaundice Sore throat and fever* Symptoms from noninfectious conditions do not apply (e.g., pregnancy, gastrointestinal syndromes, medications, etc.) *restricted if in normal establishment, excluded if in establishment that serves highly susceptible population

HENSS Reportable Illnesses Employees must be excluded if diagnosed with: Hepatitis A virus Shiga-toxin producing E.coli (STEC) Norovirus Salmonella species (Typhoidal and nontyphoidal) Shigella species HENSS HENSS can be used as an acronym for the exclusion diseases These may show up on the exam. It isn’t necessary to know all the disease details about them, but know that diagnoses with these illnesses require exclusion

Reportable Illnesses Employees must also be excluded if: Have had a recent illness from or lives in household with someone who has a reportable illness Traveled within last 50 days to an area outside U.S. with an epidemic from a reportable illness Employee suspected of causing or being exposed to confirmed illness outbreak PIC must report jaundice and/or diagnoses of these 5 illnesses to the regulatory authority

Returning to Work Reinstated employee – approved to work Required reporting illnesses: Need written clearance from a health practitioner Symptoms only: Must be symptom free for 24 hours Check with health department for specifics

Summary RESTRICT EXCLUDE REINSTATE Sore throat and fever*   RESTRICT Sore throat and fever* Open, infected cut/wound/boil Persistent sneezing, coughing or runny nose with discharge EXCLUDE Vomiting Diarrhea Jaundice Confirmed diagnosis of: Hepatitis A, STEC, Norovirus, Salmonella species (typhoidal and non-typhoidal), Shigella species REINSTATE Properly covered cut/wound/boil Symptom-free for 24 hours Confirmed cased of required reported illnesses require a doctor’s note

Employees Need To Know The Rules Example form from Food Code Appendix 7 Build in employee health policies so that workers are all on the same page and know what’s expected

How do you talk to employees about staying home when sick? Discussion How do you talk to employees about staying home when sick?

Case Study What Happened What They Found 275 were sick with Shigellosis Restaurant had several critical violations Employees reported illness

Case Study What Went Wrong Prevention Proper personal hygiene Sick employees shouldn’t have worked Hand hygiene violations Proper personal hygiene Exclusion when ill

Quiz You see that the food handler you assigned to prepare the salad has a small cut on their hand. You should: Have them start preparing the salad anyway Move them to the meat slicing area Send them to see the doctor, then home for the day Have them put on a watertight bandage over the cut and wear gloves Answer: d)

Quiz You see that the food handler you assigned to prepare the salad has a small cut on their hand. You should: Have them start preparing the salad anyway Move them to the meat slicing area Send them to see the doctor, then home for the day Have them put on a watertight bandage over the cut and wear gloves Answer: d)

Quiz When an individual is made sick by a toxin present in the food, it is called: Toxin mediated infection Foodborne infection Foodborne intoxication None of these Answer: c)

Quiz When an individual is made sick by a toxin present in the food, it is called: Toxin mediated infection Foodborne infection Foodborne intoxication None of these Answer: c)

Review Personal hygiene Best practice for clothing, hair, hands and tasting Approved coverings for infected cuts and wounds Restriction, exclusion and reinstatement for employees Required reporting illnesses