Less food poisoning associated with employee paid sick time?

I refer to parenting as hypocrisy disease.

And there’s been more than a few times when Amy has said to me, practice what you preach.

Like barfing and going to work.

People should not work when they are sick.

But in the world of food, people are going to lose their jobs if they don’t show up.

Hsuan et al. write in the American Journal of Preventative Medicine that:

Previous studies suggest an association between paid sick leave (PSL) and better population health, including fewer infectious and nosocomial gastrointestinal disease outbreaks. Yet few studies examine whether laws requiring employers to offer PSL demonstrate a similar association. This mixed-methods study examined whether laws requiring employers to provide PSL are associated with decreased foodborne illness rates, particularly laws that are more supportive of employees taking leave.


The four earliest PSL laws were classified by whether they were more or less supportive of employees taking leave. Jurisdictions with PSL were matched to comparison jurisdictions by population size and density. Using difference-in-differences, monthly foodborne illness rates (2000-2014) in implementation and comparison jurisdictions before and after the laws were effective were compared, stratifying by how supportive the laws were of employees taking leave, and then by disease. The empirical analysis was conducted from 2015-2017.


Foodborne illness rates declined after implementation of the PSL law in jurisdictions with laws more supportive of employees taking leave, but increased in jurisdictions with laws that are less supportive. In adjusted analyses, PSL laws that were more supportive of employees taking sick leave were associated with an adjusted 22% decrease in foodborne illness rates (p=0.005). These results are driven by campylobacteriosis.


Although the results suggest an association between more supportive PSL laws and decreased foodborne illness rates, they should be interpreted cautiously because the trend is driven by campylobacteriosis, which has low person-to-person transmission.

Association of paid sick leave laws with foodborne illness rates

Am J Prev Med. 2017 Sep 1. pii: S0749-3797(17)30359-8. doi: 10.1016/j.amepre.2017.06.029. [Epub ahead of print]

Hsuan C, Ryan-Ibarra S, DeBurgh K, Jacobson DM


Norovirus modeling: Stay at home after the barfing and pooping is gone

Duret et al. write in Risk Analysis:

We developed a quantitative risk assessment model using a discrete event framework to quantify and study the risk associated with norovirus transmission to consumers through food contaminated by infected food employees in a retail food setting.

This study focused on the impact of ill food workers experiencing symptoms of diarrhea and vomiting and potential control measures for the transmission of norovirus to foods.

The model examined the behavior of food employees regarding exclusion from work while ill and after symptom resolution and preventive measures limiting food contamination during preparation.

The mean numbers of infected customers estimated for 21 scenarios were compared to the estimate for a baseline scenario representing current practices. Results show that prevention strategies examined could not prevent norovirus transmission to food when a symptomatic employee was present in the food establishment. Compliance with exclusion from work of symptomatic food employees is thus critical, with an estimated range of 75–226% of the baseline mean for full to no compliance, respectively.

Results also suggest that efficient handwashing, handwashing frequency associated with gloving compliance, and elimination of contact between hands, faucets, and door handles in restrooms reduced the mean number of infected customers to 58%, 62%, and 75% of the baseline, respectively.

This study provides quantitative data to evaluate the relative efficacy of policy and practices at retail to reduce norovirus illnesses and provides new insights into the interactions and interplay of prevention strategies and compliance in reducing transmission of foodborne norovirus.

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, Vol. 37, No. 11, 2017

DOI: 10.1111/risa.12758

Duret et al.



Hotel Marshfield: Not a John Irving novel but familiar storyline with dozens sick from noro

On 4/19/2016, the Wood County Health Department (WCHD) notified the Wisconsin Division of Public Health (DPH), Communicable Diseases Epidemiology Section (CDES) of two ill individuals who had both attended a company (Company A) banquet event at the Hotel Marshfield in Marshfield, WI on 4/16/16.

hotel-new-hampshireOnset of gastrointestinal symptoms in these individuals began early morning 4/18/2016. Appetizers, snacks, and entrees served during the event were prepared by Hotel Marshfield staff. Cupcakes were purchased from Bakery A, and cookies were provided by Company B. Leftover entrees from the banquet were boxed up immediately after the event and donated to Organization A (12 boxed meals total) where some were eaten by staff and residents of that organization.

Upon recognition of a suspected outbreak, Organization A was asked by WCHD to hold the leftover food in their refrigerator and not serve it to anyone. WCHD collected a list of food and drink items served at the banquet from both the Hotel Marshfield manager and the Employee Relations Officer for Company A. CDES began creation of an investigation questionnaire, as well as an online survey to collect food and hotel exposure information from attendees. WCHD began dissemination of stool kits to ill banquet attendees and Hotel Marshfield employees to submit for laboratory testing.

This investigation identified a foodborne outbreak of norovirus gastroenteritis associated with consuming food from a banquet event held at the Hotel Marshfield banquet facility in Marshfield, WI on 4/16/2016. The causative agent was Norovirus genogroup II.17B (Kawasaki). Confirmed and probable cases were identified among banquet attendees and employees of Hotel Marshfield.

Based on the epidemiologic, laboratory, and environmental evidence gathered during this outbreak, improper food handling by a Hotel Marshfield employee who was infected with norovirus is the most likely cause of this outbreak. Because specific food items were identified that were associated with higher risk of illness and all of these items were served on the same plate, this suggests the ill employee was a chef rather than a server or bartender. The challenge of being short-staffed in the banquet kitchen on the day of the banquet may have contributed to a breakdown in hand hygiene or glove use.

The pattern of illness onset dates and times in the epidemic curve supports the conclusion that exposure to the virus occurred at the same time among banquet attendees and hotel staff. This means that the virus was not introduced to the hotel by an ill banquet attendee. Although one banquet attendee reported becoming ill during the event, the epidemic curve indicates a point source exposure consistent with a foodborne outbreak, rather than the pattern of illnesses typically seen with person-to-person transmission from an ill attendee. Since ill attendees do not come in contact with kitchen staff, outbreaks where both food workers and attendees are ill at the same time generally indicate the food worker was the source, rather than a victim.

Additionally, the same strain of norovirus, norovirus GII.17B (Kawasaki) was isolated from both food workers and banquet attendees. The Kawasaki strain is a rare strain of norovirus only recently introduced to the United States in the last five years.7 In Wisconsin, it tends to be associated with foodborne outbreak settings rather than person-to-person transmission in the community; during 2015- 2016, 62.5% of the outbreaks caused by the Kawasaki strain in Wisconsin were foodborne.8 The rarity of the strain, its recovery from both employees (including Chef A) and attendees, and the fact that the same strain was identified in all norovirus positive specimens support the conclusion the illnesses were all acquired from a single source.

norovirus-qmraChef A reported illness onset at 1:45am on the night of the banquet (4/16/16) while the majority of other illnesses began in the evening of the next day. The length of Chef A’s incubation period (time between exposure and start of symptoms) was 7.75 hours, which is shorter than the range of 10‐50 hours observed during volunteer studies of norovirus infection where exact time of exposure is known,9,10 as well as the median incubation period length of 32.5 hours observed in this outbreak. Assuming the onset date and time of Chef A’s illness was accurately reported, this indicates Chef A was likely exposed to the virus 1-2 days prior to the banquet (not at the same time as banquet attendees and other staff). Although Chef A’s symptoms did not begin until after the banquet was over, shedding of norovirus in the stool of infected asymptomatic individuals has been documented11 and it was likely Chef A was shedding virus at the time he/she was preparing and plating the food for the banquet. Additionally, carriage and shedding of norovirus has been documented in individuals who never develop symptoms.12 It is also possible that an unidentified asymptomatic shedding employee could have served as a source of contamination during food prep, or that an ill employee did not accurately disclose his/her illness status and onset date/time.

While Front of House staff were involved in adding croutons to salads, none of these items were statistically associated with illness. Only items that were prepared and finished in the kitchen were statistically associated with illness, increasing the likelihood the contamination event occurred during banquet meal preparation. If a banquet server was the source, we would expect to see no statistically significant association with a specific food item because all types of entrée plates would be handled by the ill individual.

Results of the case-control study showed that individuals who consumed the New York strip steak (served with a red wine reduction), buttery garlic chive mashed potatoes, and glazed carrots were more than two times more likely to become ill than those who did not. These three items were plated together on the same plate. A significant statistical association with illness existed for each item individually and for all three items combined. No other food or beverage items were statistically associated with illness. The fact that all food items with a significant association with illness were cooked items (except the chopped parsley garnish and honey glaze) suggests that contamination occurred after the items were cooked. Foodborne norovirus outbreaks commonly involve food items that are handled and served raw, such as salads and fruit. The only raw ingredients on the steak plates reported by the establishment were chopped fresh parsley used as garnish and the honey squeezed onto the carrots after reheating. Since the chef stated that the same parsley was used as garnish for all three entrees, if the parsley was contaminated at its source (in the field), we would expect to see no statistically significant food item, since all entrees would have contained the same parsley. However, the fact that only the steak plate was statistically associated with illness suggests contamination by food worker during kitchen prep is more likely than contamination in the field. Contamination could have been introduced if parsley was chopped while wearing gloves, but then added to the steak plates by an ungloved hand. Alternatively, the parsley may have only been added to the steak plates. Also, contamination could have also been introduced if the honey squeeze bottle or bottle nozzle was contaminated with norovirus.

Although no additional illnesses were reported among attendees of subsequent banquets, one secondary case occurred in an employee, suggesting person-to-person transmission or transmission from contact with contaminated environmental surfaces also occurred among staff the day after the banquet. Chef A continued to work the next couple days while symptomatic with diarrhea and could have contaminated surfaces or transferred the virus via contact, serving as the source of infection for the secondary case identified among staff. Hotel employees with primary cases who became ill but did not consume banquet food may have been exposed to contaminated food during serving, table clearing, or cleaning, or to contaminated surfaces such as tables in kitchen prep areas, sinks, bathrooms, or door handles.

Several contributing factors were identified during this outbreak investigation, and multiple violations of Wisconsin Food Code which could contribute to the likelihood of an outbreak occurring were observed during the on-site assessments conducted by WCHD sanitarians. Bare-handed contact of ready-to-eat food items by food workers was observed multiple times during the same visit, suggesting that bare- handed contact occurs frequently during routine food prep activities at the facility. The facility did not have any formal written employee illness, hand washing, or glove use policies. Review of the employees’ work schedules in conjunction with their illness onset and resolution dates indicated that Chef A worked preparing food for more banquets at the facility while symptomatic with diarrhea, which violates Wisconsin Food Code. Additionally, hotel employee restrooms did not have functioning fans and are located near (approx. 15ft) food preparation areas. While the case-control study results point to contamination of specific food items as the source of illness during this outbreak, the close proximity of the employee bathrooms to prep areas could contribute to kitchen contamination and future outbreaks.


According to the CDC, while there is no vaccine to prevent norovirus infection, illness can be prevented through proper hand hygiene; washing fruits and vegetables and cooking seafood thoroughly before consuming; avoiding food preparation and caring for others when sick; cleansing and disinfecting contaminated surfaces; and carefully washing laundry.

Individuals who work in the food service industry should be aware of practices that can prevent the spread of noroviruses:

  • not preparing food for others when sick and for at least 48 hours after symptoms stop,
  • practicing proper hand hygiene,
  • rinsing fruits and vegetables and cooking shellfish,
  • regularly cleaning and sanitizing kitchen utensils, counters, and surfaces, and
  • carefully washing table linens, napkins, and other laundry.

It is particularly important for food establishment employees to inform their manager when they are ill and to not work while sick with gastroenteritis and for at least 48 hours following recovery. Complying with this recommendation means that employees need to be both aware of it and have the motivation and responsibility to comply with it.

The following recommendations were developed for Hotel Marshfield following the assessment conducted on 4/20 and 4/21/2016:

  • Review internal procedures regarding employee illness, glove use, and hand washing to ensure they are consistent with standard food safety regulations, and create written policies outlining these procedures.
  • Review and update sick leave policy for management and employees.
  • All personnel, including management, should undergo comprehensive food handling training that includes at a minimum: personal hygiene, proper use of disposable gloves, and employee illness policies to ensure complete understanding.

Consider installing negative pressure ceiling fans in employee restrooms to minimize movement of aerosolized particles into the kitchen, or, discontinue use of the employee restrooms in the kitchen area.

As a result of these recommendations, the hotel has reviewed their procedures for reporting illness, glove use, and hand washing with all staff. The sick leave policy has been reviewed with all staff, and the fact that all staff that earn paid time off (sick leave) has been reinforced. The WCHD conducted an onsite food safety training at Hotel Marshfield that discussed personal hygiene, glove use, and employee illness, as well as other risk factors for foodborne illness. The information provided during the training presentation and via brochures has been incorporated into the hotel’s employee training program.

The employee restroom fans were verified operational (low-flow, constant-on fans) and the employee restroom doors have had spring hinges installed to self-close and keep closed. Ready-to-use spray bottles of bleach solution have been added as an additional option for sanitizing in the kitchen.

Norovirus Outbreak Associated with a Banquet at Hotel Marshfield


Wood County Health Department ,  Wisconsin Division of Public Health Bureau of Communicable Diseases


Disclosure and sick leave: Colorado lawmaker wants restaurants to post notice if workers are not given five paid sick days

A Colorado lawmaker is proposing a “Scarlet Letter” of sorts for statewide restaurants.

Disclosure_Still2_SnapseedState Sen. Jessie Ulibarri, D-Westminster, wants to require restaurant owners to have to post a notice on their door if they do not give their employees five paid sick days.

“If employees are not offered paid time off when they’re sick, then we, as the public, should know,” said Ulibarri. “If we know there’s dairy in our food or gluten in our food, we should know if there’s influenza in our food.”

He said his bill is not in response to the recent Chipotle health scare, but rather a few workers in his House district who have said they’ve had to decide between working sick and getting paid or staying home and risk their bills and their jobs.

“When there’s an economic incentive to show up to work sick, it can endanger the health of all of us,” said Ulibarri. “I’ve followed this issue and received some information from the Colorado Department of Public Health and Environment, which indicated in fact, most of the major food outbreaks are due to sick employees, not listeria or E.coli.”

Denver7 checked with CDPHE and was told that about half of all food-borne outbreaks are caused by Norovirus and not by E.coli, Listeria or other bacterial infections.

“It’s very easy for illness to be spread through a worker who’s ill,” said Brian Hlavacek, Environment Health Director for Tri-County Health Department, which covers Adams, Arapahoe and Douglas Counties. “Certainly it’s a problem that sometimes workers often work while ill.”

Heston are you listening? Every worker needs a time-off cushion for illness

Laura Otolski of Takoma Park, Maryland, writes that as a registered dietitian-nutritionist, my work has focused on not only what to eat, but also on how to keep food safe to eat. This has included seven years at a D.C.-based organization that provides home-delivered meals to people living with HIV/AIDS, cancer and other life-challenging conditions.

vomitMy department there monitored food safety, which involved thorough inspections of the kitchen twice a week, and regular reviews of proper hygiene procedures with both new and longtime volunteers. Both staff and volunteers knew not to work in the kitchen when they were ill, in order to prevent contamination.

These practices are absolutely necessary when you are feeding people with compromised immune systems. Indeed, such rules should be in place in any food service establishment.

Two factors made successful infection control more likely at that organization.

First, the kitchen staff were provided with paid sick leave, and, second, the volunteers were not under financial pressure to come in when they were not feeling well. No one was worried about losing a day’s pay, or their job.

All employees need to have that kind of security. Workers need to be able to stay home when they are ill, and keep infectious diseases out of the workplace. Everyone gets sick, so everyone should have the opportunity to earn sick days.

Protect those who protect our food

Jacob E. Gersen and Benjamin I. Sachs, professors at Harvard Law School, write in the N.Y. Times that every year, 5.5 million people are sickened by norovirus, a highly contagious gastrointestinal bug. According to the Centers for Disease Control and Prevention, norovirus is the leading cause of food-borne illness in the United States and is spread primarily by “infected food workers.” Last year cooks, waiters and other workers were involved in about 70 percent of the outbreaks.

public.healthThis is just one example of the critical role that food workers play in our nation’s economic and public health systems. And yet, while we often tailor employment rules for work that has a special impact on the public, the law has yet to recognize food workers as a distinct class — an approach that harms consumers, the economy and the workers themselves.

Sick restaurant workers provide a particularly vivid example of the kind of legal reform that’s needed. Until recently, very few restaurant workers had the legal right to paid sick time, which meant that many of them went to work very ill (last week voters in Massachusetts and three cities passed paid-sick-leave laws). Federal law can fix this problem by requiring employers to provide their workers with paid time off.

But restaurant workers aren’t the only ones who need special treatment. All food workers are on the front lines of the vast food-production industry, and regularly witness dangerous breaches in safety procedures.

Take farm workers who witness the processing of infected (or “downer”) cows — an illegal but, unfortunately, not uncommon practice that risks spreading a host of diseases to humans. Or workers in poultry-processing facilities, where safety and hygiene regulations are flouted, thus increasing the risk of salmonella, which every year results in more than one million illnesses, more than 350 deaths and over $3 billion in health care and lost productivity costs. Unless we offer specific legal protection for all food workers who come forward to expose such practices — something the law does not do now — we all are at risk.

We should also adjust many of our standard workplace rules to take account of the special nature of food production. To avoid the transmission of bovine spongiform encephalopathy, which causes mad cow disease, workers involved in the processing of beef must fully and carefully remove the dorsal root ganglion, a part of the spinal nerve, from all cattle that are 30 months old or older. That’s because these dorsal root ganglia can contain the infective agent behind B.S.E.

public_restroom_rulesThis is high-stakes stuff, and we should make absolutely sure that the workers responsible for doing it aren’t too worn out, or working too fast, to do it right. That means rethinking rules about line speeds, paid break time, union-organizing protections, vacations and, of course, training requirements. The same is true for agriculture workers who are ultimately responsible for making sure that we don’t get salmonella, or for workers in supermarkets who monitor refrigeration protocols.

The basic problem is, neither state nor federal law today recognizes “food work” or “food workers” as legal categories. The Food Safety Modernization Act, which President Obama signed in 2011, gave whistle-blower protections to some food workers, but not to those who work in critical areas like beef and poultry. At the same time, many states have so-called ag-gag laws, which criminalize audio and video recording of agricultural production facilities, making it harder for certain food workers to blow the whistle. In any case, none of these laws recognize food work and food workers as distinct, comprehensive legal categories.

Once federal law recognizes food workers as a distinct legal category, it could then regulate food work and offer distinct protections to food workers. Such a move would not be entirely unprecedented in the law: We already treat nuclear workers, airline pilots and truck drivers differently because of the special nature of their work.

When it comes to food workers, some of the new protections would extend to everyone in the industry: Whistle-blower protections, for example, should be available to all food workers who report on practices related to food safety. Other protections might be more relevant to some food workers than others: Paid break and vacation time along with maximum hours, for example, seem potentially more critical in slaughterhouses than in restaurants, while paid sick leave might be more relevant in restaurants than in slaughterhouses.

Food workers are distinct from other workers in ways that are critical to food safety and public health, and they ought to be protected by the law in new ways. Otherwise, we run the risk that workers — charged with producing our food — will be unable to protect public safety.


Duh: Sick days for restaurant workers?

WWBT NBC 12 reports that the U.S.Centers for Disease Control recently reported that one in five restaurant workers admitted to working while they had symptoms for the highly contagious Norovirus.

That’s one of the reasons labor groups have been protesting, demanding paid sick days for restaurant workers. Most restaurants do not offer paid sick leave to employees.

The CDC also reports that 70 percent of Norovirus cases are caused by food handlers.

The Virginia Department of Health Director of Food & General Environmental Services, Julie Henderson, explained how the Norovirus can be spread by food handlers.  “The virus gets on their hand and can be transferred to the food.”

 VDH prohibits sick restaurant employees from working with food. “Restaurant workers are required to report if they have nausea, diarrhea, any symptoms associated with Norovirus, to report it to the person in charge,” Henderson said.

Henderson believes a high level of compliance has helped Virginia attain a lower rate of Norovirus spread by food handlers.

“I know our latest statistics from 2012 show we had out of 250 outbreaks. Seventeen of them were associated with Norovirus and direct food contact from food handlers, said Henderson.

But Norovirus is one of several illnesses that can be spread.  There are colds, the flu, Salmonella, E. Coli, Shigella, and Hepatitis A, to name a few. 
NBC12 – Richmond, VA News

Restaurant workers bring risk when sick on the job

In the absence of paid sick days and health insurance, many food service workers show up sick.

restaurant_food_crap_garbage_10Sonia Cohen has worked in the fast food business for the last 10 years. Cohen said even missing one day of work hurts her family budget. And she’s not alone.

According to the Centers for Disease Control, 1 in 5 restaurant workers admits having reported to work while sick with diarrhea and vomiting, which are the two main symptoms of Norovirus.

Health inspectors and restaurant owners both watch for these symptoms.

“Always our inspections are a snapshot in time. We may walk in and someone may have a cold. That’s not a reportable symptom,” said Paula Cox, Health Educator with the Guilford County Department of Public Health.

The North Carolina Food Code spells out specific illnesses and symptoms that restaurant employees cannot bring with them to work. And restaurant owners are responsible for drafting and enforcing employee health policies to make sure employees don’t get patrons sick.

“There is not a customer in the world that wants to sit at a table that is being waited on by a sick person. There is not a customer in the world that wants to have food from a kitchen with sick employees,” said Eric Porter, owner of the Porterhouse Bar and Grill in Greensboro.

Fancy food ain’t safe food – NZ edition

As New York City somewhat quietly enacted its first paid sick leave law on April 1, wedding guests and eight serving staff at the exclusive Northern Club in Auckland, New Zealand fell sick in a suspected norovirus outbreak.

The wedding was held at the club in Princes St, central Auckland, on Saturday, March 29. People began to fall ill two days later.
norovirus-2Dr Hoskins said the club had alerted the Auckland Regional Public Health Service.

He said the service’s investigation was still in progress, and he did not know last night how many of the 100 guests had become ill.

Contact details had been obtained for 77 guests, of whom 44 had been interviewed.

Club’s president Tenby Powell (no relation) said that although the health service’s investigation had not yet identified the source of the outbreak, “we are very confident it’s got nothing to do with the Northern Club’s food handling processes”.

The eight affected employees were serving staff – “they serve plates” – and none of the food preparation staff had been affected.


Sick food workers a recipe for outbreaks

Denver Broncos kicker Matt Prater was sent home before practice for a third consecutive day because of a suspected Norovirus infection — in part, for him to recover and in part to prevent any other players from getting sick.

It’s a model that could well serve the food sector.

Mike Hughlett of the Star Tribune reports the spread that caterers served at two prep sports banquets last month betrayed no hint of what lurked matt.praterwithin.

Athletes from the Totino-Grace football team and the Fridley girls swim team dined on roast beef and rotisserie chicken at the prestigious Edinburgh USA country club.

The next day, the meal bit back. Students called in sick for school, parents couldn’t go to work.

They’d been hit by norovirus, the leading cause of foodborne illness. The likely culprit? Sick food service workers.

Since at least 2006, the Minnesota Health Department has concluded that sick workers were the likely or suspected cause of over 72 percent of all norovirus cases on average each year. “It’s one of the biggest problems in food safety, and arguably the biggest,” said Kirk Smith, head of the state Health Department’s foodborne disease investigation unit.

Restaurants and food service operators are supposed to have strong practices to keep ill employees out of the kitchen. But sometimes, policies aren’t adequate or properly communicated to workers, who vomitoften have an economic incentive to work because otherwise they won’t get paid.

“For these policies, it’s one thing to have them, and another thing to implement them,” said Jason Newby, Brooklyn Park’s code enforcement and public health manager. “At the end of the day, it starts with the manager. But the staff needs to tell management when they are sick, too.”

They often don’t. In a study published last month in the Journal of Food Protection, almost 60 percent of food service workers surveyed — including some in Minnesota — said they had worked while ill, mostly without management’s knowledge. Twenty percent of those worked at least once while vomiting or experiencing diarrhea.