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Food Protection Connection: Does Employee Health and Hygiene Make a Difference?

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(reprinted from Dietary Manager, September 2010)

Unfortunately, according to the Centers for Disease Control and Prevention (CDC), more than 76 million people experience foodborne illness; 300,000 are hospitalized; and 5,000 die each year from these unprejudiced germs. One of the most important control methods to reduce these numbers is for every food facility to have very strict food employee health and hygiene programs in place. This spring, FDA’s Center for Food Safety and Applied nutrition (CFSAn) published the “Employee Health and Personal Hygiene Handbook,” the purpose of which is to encourage practices and behaviors that can help prevent food employees from spreading bacteria and viruses to food. The sad facts are that poor employee practices can create
a plethora of problems for a food facility, including food-borne illness outbreaks.

The “big five” highly infectious pathogens identified by the CDC and FDA are norovirus, Hepatitis A Virus, Salmonella Typhi, Shigella spp., and Escherichia coli (E. coli) 0157:H7 (and other Shiga toxin-producing E. coli). The goal in the food industry is to control these pathogens. There must be proper management in order to assure this control. Proper management involves ensuring that the food employee does not work when ill; that they have good personal hygiene; and that good food safety practices, including no bare hand contact with ready-to-eat foods, are enforced. Proper management should include food safety education and constant reinforcement of that information. Too many times an employee is hired and, as a part of that hiring, is required to sit and watch videos and read manuals about their jobs and food safety. They rarely hear anything resembling the words “food safety” again, unless the facility flunks their inspection or someone gets sick. Food safety and personal hygiene are topics that need to be constantly reiterated. Remember, you are changing years and years of possibly bad food safety habits learned at home.

When encountering a sick employee many managers are reluctant to tell them to stay at home, and those that do are often faced with employees who insist on coming to work regardless, because many food industry workers will not get compensated for a day off work or they do not take the advice seriously. not working when you are ill is a statement that most managers cringe at having to tell their employees. There will always be those employees who take advantage of the rules.

Managers should be aware that there are options for ill em­ployees other than full exclusion from the establishment, although that may be necessary. FDA has set forth in the Food Code parameters for making decisions on whether to restrict or exclude an employee from working when ill. Just because an employee has the sniffles does not mean they cannot come to work. Managers just need to be more attentive to what duties that employee will perform those days.

Although these practices work for the general populations, the rules for making a determination in a highly susceptible population (HSP) facility are much more stringent. A highly susceptible person is more likely to experience a severe case of foodborne illness because they are: immunocompromised, pre-school age, an older adult, sick or confined to facilities that provide custodial care. If a facility is set up to serve a HSP—such as a hospital, senior center, daycare, or nursing home—the rules for HSP should be followed. These populations are much more likely to get ill from a foodborne pathogen at a lower dose and experience a much more severe case, so every effort must be made to closely monitor food facilities serving a HSP. To simplify when to exclude or restrict employees, refer to the decision trees and tables that are available in this new FDA handbook as well as the 2009 FDA Food Code. When in doubt, contact your local regulatory agency for guidance. They would much rather guide you in making a determination than to be investigating a foodborne illness outbreak.

Once we have people working in our food facilities that are healthy, we need to assure that good personal hygiene is being enforced. Personal hygiene goes beyond having clean uniforms, hair restraint, and not smoking or eating when working. Proper handwashing is the most critical aspect of personal hygiene. First, employees need to understand why good hand hygiene is important. you need to have the buy-in or you will never have compliance. The employee also needs to know where to wash, when to wash, and how to wash. This is often overlooked in the fast and furious pace of many food facilities. We just assume people know this information and practice it well. Management needs to continually be reinforcing good habits for handwashing. FDA suggests in their handbook several ways of having effective handwashing in a food facility: Make food employees aware of media coverage on local and national foodborne illness outbreaks; create opportunities to remind employees each week; emphasize hand-washing at the
beginning of each shift; use a buddy system for support and reminders; and finally, utilize training and incentive programs. Make hand-washing a priority. Motivate the employee. Make it convenient.

Thus far we have discussed having healthy employees with clean hands, but are their hands really clean enough not to contaminate food? CDC and FDA both report that when hands are heavily contaminated, even an effective hand-washing may not be enough to prevent the transmission of transient pathogens from the hands to ready-to-eat (RTE) foods. There must be one more barrier: no bare hand contact with RTE foods. This is not a glove rule. As a matter of fact, sometimes gloves create a false sense of security to the food employee who begins to forget that gloves are for protecting the food and not themselves. If gloves are used, care should be taken by managers to ensure every employee utilizes the gloves properly. Bare hand contact can also be accomplished by use of spatulas, tongs, dispensing papers, or other suitable utensils. Food employees need to be educated on what is a RTE food. Many times employees will tell us they had no idea that the toast or lemon wedge was a RTE food. Employees need to be made aware of which foods in their assigned duty areas are considered RTE; don’t assume they know.

Concurrent use of the three interventions; a strict employee health policy, good hand hygiene practices and no bare hand contact with RTE food, are the keys to success for warding off those nasty foodborne illness pathogens, but only if taught and constantly reinforced. The FDA Handbook provides easy references to forms and tables that food facilities and the public health community may find useful when training staff and addressing employee health and hygiene issues.

There are millions of cases of foodborne illness each year according to the CDC, and most were preventable. Proper cooking and processing of foods can destroy most pathogens and we certainly need controls over these processes, but consider this: go further back in the process and try not to contaminate the food in the first place by educating the employee and his role in cross-contamination and spread of pathogens. Start with good employee health and hygiene. This is the one time when nagging and doing as mother said is very important: ‘If you are sick go to bed,’ ‘Wash those hands— with soap,’ and ‘Don’t touch that food!’

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Resources

www.cdc.gov

www.fda.gov. This handbook and its resources are available for download or hard copy orders.

by Melissa Vaccaro, MS, CHO
Melissa Vaccaro, MS, CHO is a Food Program Specialist for the PA Department of Agriculture and an Executive Board Member for the Central Atlantic States Association of Food and Drug Officials (CASA). Contact her at mvaccaro@state.pa.us.