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March 7th, 2014

by Total Food Service

Norovirus


Evaluating your risk and developing a proactive plan to address it. by Wyman Philbrook


I originally was planning on writing about a different topic this month but the headlines in the news and the discourse that I have heard from the industry, regulatory and public sectors indicated this subject would be timely. Over the last few weeks there have been news stories on large scale outbreaks that have affected a large resort (200 people), 2 large ships from the same cruise line (600 & 189 people respectively ) and multiple educational & healthcare institutions. When you are discussing numbers of victims in the 100s from diverse locations, everyone sits up and takes notice. As a foodservice manager, what should you know about this viral illness and how you can address it in your overall food safety plan? Let’s first discuss what it is and the conditions it needs to survive and spread

Basic Facts about Norovirus

The virus was first identified in an outbreak at a school located in Norwalk, Ohio during the 60s (it is still referred to as Norwalk or Norwalk-like virus and encompasses multiple strains in the category). Its main sources are contaminated water, water filtering shellfish, contaminated fruits & vegetables and infected individuals. It is the number one cause of food-borne illnesses (approximately half of all cases). It is second only to the common cold in reported cases. The virus is highly resistant to normal disinfectant strength levels, can survive under refrigerated temperatures and even in a reasonably high acid environment. Like all viruses, it needs a host to grow in and replicate but can survive outside of the host. Norovirus has not been successfully grown under lab conditions so it is difficult to determine its survival under normal cooking temperatures. Only a small dose is required to infect an individual and once they are exposed an individual will show the following symptoms of gastroenteritis within 24-48 hours (can be as early as 12 hours):

  • Cramping
  • Projectile vomit
  • Diarrhea
  • Headaches
  • Low-grade fever, chills, muscle aches & weakness may also occur

These symptoms will last for 24-60 hours and positive results of a stool sample will confirm its presence.  There is no drug treatment or vaccine for the virus and it needs to run its course. Symptoms tend to come on quickly and are severe initially.

Typical Methods of Transmission

As stated above, an individual can become infected by consuming contaminated water or food product. An infected person can pass on the virus to the surface of a consumable product or on to a contact surface, where it survives but does not grow. Improper hand washing after using the toilet, the spray from or physical contact with vomit are the ways an infected person can pass the virus on. As stated, viruses need a host to grow but will survive outside of one. The virus can then pass to multiple surfaces once that original contaminated area is touched. Environments with large populations that are more or less closed i.e. healthcare, cruise ships & educational facilities will have high numbers of individuals coming in contact with certain areas/surfaces. Such as:

  • Handrails- stairs & escalators
  • Doorknobs & door handles
  • Utensils, glassware & china on self-serve stations
  • Condiments- stations & on tables
  • Tables, counters & bar surfaces
  • Chair backs
  • Trays & tray slides
  • Elevator buttons
  • Restrooms
  • Cashiers & money

*An important fact to note is that many high-volume facilities have alcohol-based sanitizer dispensers available for employees and customer. Hand sanitizers are a supplement and not a replacement for proper hand washing procedures so this should be conveyed at the dispenser location or through training.

Food Safety Systems

Foodservice operators should implement the following in their overall food safety plan to address the main issues that contribute to an outbreak:

Education & Training Program - Ensure employees are aware of Norovirus symptoms and transmission methods. An exclusionary agreement that outlines reportable symptoms should be reviewed and signed by the employee annually and kept on file. Exclude from the food establishment and notify the regulatory agency if an employee is confirmed with Norovirus. The manager will request medical clearance before allowing the employee to return to work.

Cleaning & Sanitizing SOP – Employees should know and follow procedures and cleaning schedules for equipment and contact surfaces. Have procedures outlining the cleaning after an incident of vomiting.

Employee Hygiene Policy – Employees should practice good hygiene especially with hand washing, uniforms and proper glove use.

Approved Vendor Program – Insure vendors are inspected by regulatory agencies and achieve satisfactory results. Establish recall procedures & communication with all vendors.

Food-borne Illness Program – Establish a questionnaire to use and document any notifications by customers of illness after eating in your food establishment. Management should follow-up and track incidents for patterns. Notify the regulatory agency if an outbreak is suspected.

Risk Assessment for Viruses – Review and document all high contact surfaces in your facility and establish a response to sanitize or change a potential procedure if Norovirus is suspected i.e. discontinue all self-service.

Handling a Norovirus Outbreak 

When you learn or are notified that a confirmed outbreak implicates your food establishment or facility, you need to react quickly. First steps you will take are to limit transmission of the virus and prepare for a visit from your local regulatory inspector. Having conducted a risk-assessment & developed the suggested programs for your food safety plan will make your initial steps easier to accomplish.

Step 1- Address all contact surfaces that may spread a virus.
Step 2 – (for the inspector)

  • Have all invoices for all food deliveries pulled for review
  • Have a list of all employees who missed work for illness for the previous 2 weeks 
  • Show verification of sanitizing- both chemical & by heat (final rinse temperature for dishwasher)
  • Demonstrate employee knowledge of Norovirus & exclusionary policy
  • Provide both visual & interactive proof of employee knowledge on proper hand washing and glove use

I was the director for food safety & sanitation at a major east coast university and our residence dining facility was implicated in the outbreak since a large number of students that tested positive for Norovirus had eaten in the facility. We were able to take all of the referenced steps and the regulatory & school officials were able to determine that our actions were appropriate and that food & kitchen employees had not been the likely source. (The investigation pointed at a communal restroom on a residence floor as the probable source site). 

When a food facility has been confirmed as the source like the recent cruise ships and the resort, management must relay the information to individuals who may have been exposed as quickly as possible and conduct a deep cleaning and sanitizing procedure throughout the premises. Provide the regulatory officials with full cooperation regarding their requests and seek their guidance. A single designated individual should be the contact with all media so that the company is providing a single focused message.

The key conclusions and facts of this column are that Norovirus strains are highly communicable and due to its survivability on foods and contact surfaces very hard to contain when allowed into your food establishment. Using this information can help you prepare for, prevent and contain possible Norovirus outbreaks in your facility. The less you are able to control its access and its capability to spread, the higher the number of infected individuals it will produce. Any number of confirmed cases is bad for the health of your customers & employees, your sales and your reputation. Being proactive regarding the causes and effects of an outbreak reduces your risks.
In the coming months we will be addressing Cross-Contamination, Cross-Contact, Cleaning & Sanitizing and anything else regarding food safety that become major news stories.

Philbrook Food & Beverage Consulting & Training specializes in preparing food service establishments to address all food safety issues by assisting with the development of programs, staff & facilities. We offer customized on-site and public training in HACCP, Food Safety, Integrated Pest Management and a variety of retail and wholesale food & beverage requirements. Check out our class schedules and contact info at philbrookconsulting.com for more information.

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