Norovirus is the number one cause of foodborne disease outbreaks worldwide. It makes people sick causing nausea, stomach cramping, vomiting and diarrhea or “stomach flu” and leads to a lot of discomfort and even death, especially in vulnerable populations like children and the elderly. Elevated risk of infection is associated with certain foods that are served raw, like fruits and vegetables, contaminated ready-to-eat (RTE) foods, or improperly cooked Oysters from contaminated waters. According to the CDC, Norovirus is the leading cause of illness and outbreaks from contaminated foods in the United States, especially in retail foodservice settings like restaurants.

Some of the potential sources of Norovirus outbreaks in retail foodservice are as follows:

• Infected food handlers
• Infected non-food workers and guests
• Bare hands contact with RTE foods
• Contamination of food deliveries at source
• Improper cleaning and disposal of body fluids
• Training gap on sanitizer and disinfectant use
• Aerosolized vomitus around food and people
• Contaminated food contact and non-food contact surfaces
• Improper hand washing by food handlers
• Cross contamination from restrooms
• Cross contamination from high touch points in the back of the house

It is apparent from the statistics that Norovirus constitutes a major hazard to the retail foodservice industry. The good news, however, is that there are a lot of cost-effective strategies that can be implemented in a proactive manner to reduce its spread and impact on businesses, protect customers and the bottom line. Some of these preventive measures will be discussed here and in next week’s blog post.

Proper Hand Washing by Foodservice Workers

Proper hand washing is the most cost-effective method for preventing cross-contaminations including Norovirus in a retail foodservice environment. Hand wash sinks should be appropriately located to encourage compliance by both foodservice workers and guests. For example; the food code requires handling dry clean dishes with clean hands during the dish washing process. Thus, it makes a lot sense to install a hand wash sink in close proximity to an automated dishwasher. This will enhance hand washing compliance by Team Members before handling and stacking dry clean dishes. Adequate soap and hand sanitizers should be provided at all hand washing stations including restrooms. Whereas the use of hand sanitizers is not a replacement for proper hand washing with soap, there is evidence that hand sanitizers are effective against Norovirus. Proper hand washing remains the preferred option however, since the use of soap can indeed get rid of other cross contaminating organic matter and dirt. Incentive programs may be used to encourage frequent and proper hand washing by foodservice workers. More resources may be found at handwashingforlife.com to help foodservice establishments update their hand washing culture.

While enforcing proper hand washing among foodservice employees is desirable, it is also advisable to encourage hand washing among guests. Norovirus can be transmitted by infected guests to the foodservice establishment especially in buffet style restaurants where guests come in very close proximity with RTE foods. Facility design that encourages hand washing by guests was elegantly captured by the Florida based PDQ restaurant chain that installed a hand wash sink in their main dining room with a strong brand statement that “quality and clean go hand in hand”. The strategic location of a hand wash sink encourages hand washing by guests, especially among children in the full view of their parents, and with less cross contaminating contact surfaces as found in the restrooms.

Restroom Cleaning and Sanitation

Color coded cleaning and sanitizing tools are recommended for restrooms to prevent cross contamination. Tools will be dedicated for use in restrooms only and stored in a dedicated storage or closet to avoid accidental use in other areas of the foodservice establishment. The restroom can be the most important part of the restaurant with opportunities to prevent infections. Guests may also use the cleanliness of the restroom as a measure of food safety commitment by the retail food establishment (see my previous blog on “Clean Matters”). Thus, extra efforts are required to maintain and keep restrooms in a clean and sanitary condition all the time. Use of disinfectant grade chemicals for disinfecting restrooms, body fluids clean-up and high touch point areas is recommended. The alternative of preparing high concentration sanitizers is laborious and prone to mistakes by foodservice workers. In addition, such high concentrated sanitizers like 1000 – 5000 ppm chlorine-based sanitizer can be a safety concern to employees when used without PPEs. Frequent cleaning, disinfecting and replenishing of hand soap and sanitizers in the restroom are effective measures against restroom infections and cross contaminations including Norovirus.

Stay tuned for more preventative measures to be discussed in next week’s blog post…