Managerial practices regarding workers working while ill

Environmental Antecedents of Foodborne Illness Outbreaks, United States, 2017-2019

Foodborne outbreak investigations often provide data for public health officials to determine how the environment contributed to the outbreak and on how to prevent future outbreaks. State and local health departments are responsible for investigating foodborne illness outbreaks in their jurisdictions and reporting the data to national-level surveillance systems, including information from the environmental assessment. This assessment is designed to describe how the environment contributed to the outbreak and identifies factors that contributed to the outbreak and environmental antecedents to the outbreak. Environmental antecedents, also referred to as root causes, are specific reasons that allow biological or chemical agents to contaminate, survive, or grow in food. From 2017 to 2019, 24 jurisdictions reported 1,430 antecedents from 393 outbreaks to the National Environmental Assessment Reporting System. The most reported antecedents were lack of oversight of employees/enforcement of policies (89.1%), lack of training of employees on specific processes (74.0%), and lack of a food safety culture/attitude towards food safety (57.5%). These findings highlight the critical role that employees play in restaurant food safety and are heavily influenced by restaurant management, who can exercise active managerial control to manage these antecedents. Identifying antecedents during investigations is essential for understanding the outbreak's root cause and implementing sustainable corrective actions to stop the immediate outbreak and future outbreaks.

Usefulness and Limitations of PFGE Diagnosis and Nucleotide Sequencing Method in the Analysis of Food Poisoning Pathogens Found in Cooking Employees

In the case of a food poisoning outbreak, it is essential to understand the relationship between cooking workers and food poisoning. Many biological diagnostic methods have recently been developed to detect food poisoning pathogens. Among these diagnostic tools, this study presents PCR-based pulsed-field gel electrophoresis and nucleotide sequencing diagnostic analysis results for diagnosing food poisoning outbreaks associated with cooking employees in Chungcheongnam-do, Republic of Korea. Pulsed-field gel electrophoresis was useful in identifying the food poisoning outbreaks caused by Staphylococcus aureus and Enteropathogenic Escherichia coli. In the case of Norovirus, nucleotide sequencing was used to identify the relationship between cooking workers and the food poisoning outbreak. However, it is difficult to determine whether cooking employees directly caused the food poisoning outbreaks based on these molecular biological diagnostic results alone. A system is needed to integrate epidemiological and diagnostic information to identify a direct correlation between the food poisoning outbreak and cooking employees.

Exploring U.S. Food System Workers' Intentions to Work While Ill during the Early COVID-19 Pandemic: A National Survey

With "stay at home" orders in effect during early COVID-19, many United States (U.S.) food system workers attended in-person work to maintain national food supply chain operations. Anecdotally, many encountered barriers to staying home despite symptomatic COVID-19 illness. We conducted a national, cross-sectional, online survey between 31 July and 2 October 2020 among 2535 respondents. Using multivariable regression and free-text analyses, we investigated factors associated with workers' intentions to attend work while ill (i.e., presenteeism intentions) during the early COVID-19 pandemic. Overall, 8.8% of respondents intended to attend work with COVID-19 disease symptoms. Almost half (41.1%) reported low or very low household food security. Workers reporting a higher workplace safety climate score were half as likely to report presenteeism intentions (adjusted odds ratio [aOR] 0.52, 95% confidence interval (CI) 0.37, 0.75) relative to those reporting lower scores. Workers reporting low (aOR 2.06, 95% CI 1.35, 3.13) or very low (aOR 2.31, 95% CI 1.50, 3.13) household food security levels had twice the odds of reporting presenteeism intentions relative to those reporting high/marginal food security. Workplace culture and safety climate could enable employees to feel like they can take leave when sick during a pandemic, which is critical to maintaining individual and workplace health. We stress the need for strategies which address vulnerabilities and empower food workers to make health-protective decisions.

Evaluation of the Impact of Compliance with Mitigation Strategies and Frequency of Restaurant Surface Cleaning and Sanitizing on Control of Norovirus Transmission from Ill Food Employees Using an Existing Quantitative Risk Assessment Model

ABSTRACT

Reduction of foodborne illness caused by norovirus (NoV) continues to be a focus for the food safety community. Using a previously published quantitative risk assessment model, we evaluated more than 60 scenarios examining the impact of implementation of and compliance with risk management strategies identified in the U.S. Food and Drug Administration Food Code for (a) surface cleaning and sanitizing, (b) hand hygiene, (c) exclusion, or (d) restriction of ill employees. Implementation of and compliance with hand hygiene and ill food employee exclusion strategies had the largest impact on the predicted number of highly contaminated food servings and associated consumer illnesses. In scenarios in which gloves were always worn and hand washing compliance was 90%, the model estimated reductions in the number of highly contaminated food servings and ill consumers to 39 and 43% of baseline estimates (i.e., typical practice), respectively. Reductions were smaller when gloves were never worn. Hand washing compliance after using the restroom strongly impacted predicted numbers of highly contaminated servings and consumer illnesses. Ten percent compliance with removing or excluding ill food employees was predicted to increase the number of highly contaminated food servings and ill consumers to 221 and 213% of baseline estimates, respectively. Ninety-four percent compliance with exclusion of ill food employees was predicted to decrease these numbers to 69 and 71% of baseline estimates, respectively. Surface cleaning in food establishments had a relatively small impact on these measures. Restriction of food employees (removed from contact with food and food contact equipment and utensils) was not effective for reducing NoV illness unless this restriction included additional provisions. The results from this study can help risk managers prioritize mitigation strategies and their implementation for controlling the transmission of NoV and subsequent consumer foodborne illness.

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Risk factors associated with respiratory infectious disease-related presenteeism: a rapid review

BACKGROUND

Workplace transmission is a significant contributor to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks. Previous studies have found that infectious illness presenteeism could contribute to outbreaks in occupational settings and identified multiple occupational and organisational risk factors. Amid the COVID-19 pandemic, it is imperative to investigate presenteeism particularly in relation to respiratory infectious disease (RID). Hence, this rapid review aims to determine the prevalence of RID-related presenteeism, including COVID-19, and examines the reported reasons and associated risk factors.

METHODS

The review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search approach and focused on studies published in English and Chinese. Database searches included MEDLINE, EMBASE, Web of Science, China Knowledge Resource Integrated Database (CNKI) and preprint databases MedRxiv and BioRxiv.

RESULTS

The search yielded 54 studies, of which four investigated COVID-19-related presenteeism. Prevalence of work presenteeism ranged from 14.1 to 55% for confirmed RID, and 6.6 to 100% for those working with suspected or subclinical RID. The included studies demonstrated that RID-related presenteeism is associated with occupation, sick pay policy, age, gender, health behaviour and perception, vaccination, peer pressure and organisational factors such as presenteeism culture.

CONCLUSIONS

This review demonstrates that presenteeism or non-adherence to isolation guidance is a real concern and can contribute to workplace transmissions and outbreaks. Policies which would support workers financially and improve productivity, should include a range of effective non-pharmaceutical inventions such as workplace testing, promoting occupational health services, reviewing pay and bonus schemes and clear messaging to encourage workers to stay at home when ill. Future research should focus on the more vulnerable and precarious occupational groups, and their inter-relationships, to develop comprehensive intervention programs to reduce RID-related presenteeism.

Olive Garden's Expansion Of Paid Sick Leave During COVID-19 Reduced The Share Of Employees Working While Sick

The COVID-19 pandemic has focused public and policy attention on the acute lack of paid sick leave for service-sector workers in the United States. The lack of paid sick leave is potentially a threat not only to workers' well-being but also to public health. However, the literature on the effects of paid sick leave in the US is surprisingly limited, in large part because instances of paid sick leave expansion are relatively uncommon. We exploit the fact that large firms in the US were not required to expand paid sick leave during the COVID-19 pandemic but that one casual dining restaurant in particular, Olive Garden, faced intense public pressure to do so. We drew on data collected from 2017 through fall 2020 from 10,306 food service-sector workers in the US by the Shift Project, which include employer identifiers. Using a difference-in-differences design, we found strong evidence of an increase in paid sick leave coverage among Olive Garden workers, as well as evidence that this expansion reduced the incidence of working while sick among front-line food service workers.

Assessing Employee Health Policies for Reporting and Excluding Ill Food Employees in Restaurants within the United States

ABSTRACT

Preventing ill food employees from spreading pathogens to food and food contact surfaces remains an important objective of retail food safety policy in the United States. Since 2005, the U.S. Food and Drug Administration (FDA) has recommended food establishments implement employee health policies that include requirements for the exclusion or restriction of ill food employees and reporting, to the person in charge, symptoms or diagnosis of certain diseases transmitted by food. However, the incorporation of this recommendation has not been widely studied. The purpose of this exploratory study was to assess the presence and prevalence of employee health policies at fast-food and full-service restaurants in the United States. More than 50% of fast-food and full-service restaurants were found to have nonexistent employee health policies for each of the five recommended components specified in the FDA Food Code. Results showed 17.41% of fast-food restaurants and 12.88% of full-service restaurants had all five recommended components. Moreover, most restaurants with all five recommended employee health policy components were part of a multiple-unit operation and were found to have more developed food safety management systems than restaurants with none of the recommended components. Further attention and research into the impediments associated with developing and implementing employee health policies in restaurants is warranted.

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Restaurant Policies and Practices Related to Norovirus Outbreak Size and Duration

ABSTRACT

Norovirus is the leading cause of foodborne illness outbreaks in the United States, and restaurants are the most common setting of foodborne norovirus outbreaks. Therefore, prevention and control of restaurant-related foodborne norovirus outbreaks is critical to lowering the burden of foodborne illness in the United States. Data for 124 norovirus outbreaks and outbreak restaurants were obtained from Centers for Disease Control and Prevention surveillance systems and analyzed to identify relationships between restaurant characteristics and outbreak size and duration. Findings showed that restaurant characteristics, policies, and practices were linked with both outbreak size and outbreak duration. Compared with their counterparts, restaurants that had smaller outbreaks had the following characteristics: managers received food safety certification, managers and workers received food safety training, food workers wore gloves, and restaurants had cleaning policies. In addition, restaurants that provided food safety training to managers, served food items requiring less complex food preparation, and had fewer managers had shorter outbreaks compared with their counterparts. These findings suggest that restaurant characteristics play a role in norovirus outbreak prevention and intervention; therefore, implementing food safety training, policies, and practices likely reduces norovirus transmission, leading to smaller or shorter outbreaks.

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Environmental Health Practice Challenges and Research Needs for U.S. Health Departments

BACKGROUND

Environmental health (EH) professionals, one of the largest segments of the public health workforce, are responsible for delivery of essential environmental public health services. The challenges facing these professionals and research needs to improve EH practice are not fully understood, but 26% of EH professionals working in health departments of the United States plan to retire in 5 y, while only 6% of public health students are currently pursuing EH concentrations.

OBJECTIVES

A groundbreaking initiative was recently launched to understand EH practice in health departments of the United States. This commentary article aims to identify priority EH practice challenges and related research needs for health departments.

METHODS

A horizon scanning approach was conducted in which challenges facing EH professionals were provided by 1,736 respondents working at health departments who responded to a web-based survey fielded in November 2017. Thematic analyses of the responses and determining the frequency at which respondents reported specific issues and opportunities identified primary EH topic areas. These topic areas and related issues informed focus group discussions at an in-person workshop held in Anaheim, California. The purpose of the in-person workshop was to engage each of the topic areas and issues, through facilitated focus groups, leading to the formation of four to five related problem statements for each EH topic.

DISCUSSION

EH professionals are strategically positioned to diagnose, intervene, and prevent public health threats. Focus group engagement resulted in 29 priority problem statements partitioned among 6 EH topic areas: a) drinking water quality, b) wastewater management, c) healthy homes, d) food safety, e) vectors and public health pests, and f) emerging issues. This commentary article identifies priority challenges and related research needs to catalyze effective delivery of essential environmental public health services for common EH program areas in health departments. An unprecedented initiative to revitalize EH practice with timely and strategic recommendations for student and professional training, nontraditional partnerships, and basic and translational research activities is recommended. https://doi.org/10.1289/EHP5161.

Explaining the food safety behaviours of food handlers using theories of behaviour change: a systematic review

Theories of behaviour change can explain the factors affecting food handlers' use of food safety practices. A systematic review was conducted on this topic to identify which theories have been applied in this area and to determine which theories are the most consistent predictors of food handlers' behaviours. Standard systematic review procedures were followed: comprehensive search strategy; relevance screening of abstracts; article characterization; data extraction; risk-of-bias assessment; and descriptive analysis. Among 19 relevant studies, the most commonly investigated theories were the Theory of Planned Behaviour (n = 9 studies) and Health Belief Model (n = 5). All investigated theories were useful to explain food handlers' behavioural intentions and behaviours related to food safety across different settings, and could serve as useful frameworks for future research and practice. However, there was wide variability in the predictive ability of the theories and their specific constructs, indicating theories should be adapted to the local context of application.

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

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.

Epidemiology of restaurant-associated foodborne disease outbreaks, United States, 1998-2013

Although contamination of food can occur at any point from farm to table, restaurant food workers are a common source of foodborne illness. We describe the characteristics of restaurant-associated foodborne disease outbreaks and explore the role of food workers by analysing outbreaks associated with restaurants from 1998 to 2013 reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System. We identified 9788 restaurant-associated outbreaks. The median annual number of outbreaks was 620 (interquartile range 618-629). In 3072 outbreaks with a single confirmed aetiology reported, norovirus caused the largest number of outbreaks (1425, 46%). Of outbreaks with a single food reported and a confirmed aetiology, fish (254 outbreaks, 34%) was most commonly implicated, and these outbreaks were commonly caused by scombroid toxin (219 outbreaks, 86% of fish outbreaks). Most outbreaks (79%) occurred at sit-down establishments. The most commonly reported contributing factors were those related to food handling and preparation practices in the restaurant (2955 outbreaks, 61%). Food workers contributed to 2415 (25%) outbreaks. Knowledge of the foods, aetiologies, and contributing factors that result in foodborne disease restaurant outbreaks can help guide efforts to prevent foodborne illness.