What to do with Sick Food Handlers? Michelle Malavet, MSA, HO, REHS Foodborne Disease Surveillance Coordinator NJDOH, Communicable Disease Service

Transcription

1 What to do with Sick Food Handlers? Michelle Malavet, MSA, HO, REHS Foodborne Disease Surveillance Coordinator NJDOH, Communicable Disease Service

2 Health Officer Authority May prohibit a person infected with a communicable disease which may be transmitted through food from working with food May prohibit a household contact of an infected person from working with food May require a person who is employed in a food establishment who is suspected of being infected with a communicable disease that may be transmitted though food, to submit specimens to ascertain whether or not the person is infected May prohibit sale or distribution of food prepared by a person who is ill or infected with a communicable disease which may be transmitted through food NJAC 8: , 1.12, 1.13

3 Who is a Food Handler? Cook? Waitress? Bus staff? Bartender? Dishwasher? Daycare worker? Healthcare professional (Nursing Aide, Home Health Aide)?

4 FDA Definition Food employee means an individual working with unpackaged food, food equipment or utensils, or food-contact surfaces

5 Determining Who is a Food Handler Interview cases reported in your jurisdiction and ask about high-risk activities including food handling. If case is a food handler obtain information where they work. If establishment is in your jurisdiction, exclude case according to recommendations. If establishment is not in your jurisdiction, contact local health department where establishment is located.

6 QUESTION! How long should a foodhandler with diarrhea (cause unknown) be excluded from work? 1. No exclusion as long as he washes his hands hours after diarrhea started hours after diarrhea ended 4. 7 days after diarrhea started 5. Until he has a negative stool test

7 General Rules Food handlers with: vomiting or diarrhea (non-diagnosed): exclude from food handling duties until 24 hours after symptoms resolve or medical documentation that symptoms are from a noninfectious condition. jaundice: exclude from food handling duties until medical documentation that they are free from Hepatitis A or > 14 days has passed since onset of jaundice. open infected wounds, lesions: exclude until affected area properly covered with non-permeable dressing. diagnosed with one of the Big Six : follow recommendations.

8 The Big Six Typhoid Fever (Salmonella Typhi) Salmonellosis (non-typhoidal) Shigellosis Shiga toxin-producing E. coli Hepatitis A Norovirus

9 Typhoid Fever (Salmonella Typhi) Causative agent: Salmonella Typhi Food handlers diagnosed with typhoid Fever should not work with food until they have obtained 3 consecutive negative stool specimens taken no less than 48 hours apart and at least 48 hours after cessation of antibiotic treatment. All contacts of a Typhoid Fever case that are food handlers should be handled the same as a case. Approximately 5% of cases become chronic carriers.

10 Salmonellosis Causative agent: Salmonella sp. Food handlers diagnosed with salmonellosis should not work with food until they have obtained 2 consecutive negative stool specimens taken no less than 24 hours apart and at least 48 hours after cessation of antibiotic treatment. All symptomatic contacts of a case that are food handlers should be handled the same as a case.

11 Shigellosis Causative agent: Shigella sp. Food handlers diagnosed with shigellosis should not work with food until they have obtained 2 consecutive negative stool specimens taken no less than 24 hours apart and at least 48 hours after cessation of antibiotic treatment. All symptomatic contacts of a case that are food handlers should be handled the same as a case.

12 QUESTION! You investigate a case of shigellosis and determine that he works at a restaurant in your jurisdiction. What should you do? 1. Don t worry about it - it s only shigellosis 2. Exclude the case from food handling until 2 negative stools taken 24 hours apart and 48 hours after cessation of antibiotic treatment 3. Make sure the food establishment is aware of exclusion requirements 4. Document all steps taken including negative stool specimens in CDRSS 5. Answers 2,3, and 4.

13 Shiga Toxin-producing E. coli (STEC) Food handlers diagnosed with STEC should not work with food until they have obtained 2 consecutive negative stool specimens taken no less than 24 hours apart and at least 48 hours after cessation of antibiotic treatment All symptomatic contacts of a case that are food handlers should be handled the same as a case

14 QUESTION! A daycare worker in your jurisdiction is diagnosed with STEC. What should you do? 1. Exclude the case from any food handling duties at the daycare until he obtains two consecutive negative stools taken at least 24 hours apart and 48 hours after the cessation of antibiotic treatment. 2. Put an add in the local paper warning parents not to send kids to the daycare. 3. Urge the daycare to send a letter home to all parents telling them that someone at the daycare has STEC. 4. Make sure that daycare worker never works in your town again! 5. All of the above

15 Hepatitis A (HAV) Food handlers diagnosed with acute hepatitis A infection must be excluded from work for at least 14 days from the onset of any symptoms that are compatible with hepatitis A. Persons with HAV are most infectious two weeks prior to onset of symptoms until one week after onset of symptoms (use onset of jaundice or elevated enzymes).

16 Hepatitis A- Determining Who Gets Post-exposure Prophylaxis (PEP) If a food handler receives a diagnosis of Hepatitis A, post-exposure prophylaxis (PEP) should be administered to other food handlers at the same establishment within two weeks of their last exposure unless they can prove immunity. If they do not receive PEP and cannot prove immunity, they should be excluded for 28 days.

17 Hepatitis A- Determining Who Gets Post-exposure Prophylaxis (PEP) Administration of PEP to patrons should be considered if: during the time when the food handler was likely to be infectious, the food handler both directly handled uncooked foods or foods after cooking and had diarrhea or poor hygienic practices, and patrons can be identified and treated within 2 weeks of exposure. consideration should be given to patrons that have repeated exposures. NOTE: Contact NJDOH staff to report HAV cases that are identified as food handlers. Consult with NJDOH staff on appropriate administration of PEP

18 QUESTION! A food handler that works at a local restaurant in your jurisdiction is diagnosed with Hepatitis A. What should you do? 1. Go on vacation 2. Determine the infectious period and whether the case worked during that time-frame 3. Assess food handling duties including hygiene practices 4. Consult with CDS to determine if prophylaxis is warranted for patrons, co-workers, contacts 5. Answers 2-4

19 Norovirus CDC estimates that infected food handlers cause ~70% foodborne outbreaks associated with Norovirus. Food handlers diagnosed with Norovirus should not work with food until they have been symptom-free for 48 hours. In an outbreak situation, food handlers with suspect Norovirus should not work with food until they have been symptom-free for hours.

20 Questions?