1. Firefly owner John Simmons poses at his restaurant at 3824 Paradise Road in Las Vegas on Monday Nov. 18, 2013. (Bill Hughes/Las Vegas Review-Journal)

3. January 17, 2012 Hickory, NC Catawba County Public Health received reports of illness after visiting the Harbor Inn Seafood Restaurant located in Hickory, North Carolina Eight staff members were identified who worked January 12–January 20 while experiencing gastrointestinal symptoms. 166 illnesses idenfied

4. What went wrong Norovirus is often called the “stomach bug” or “stomach flu.” Employees who continued to work with symptoms of diarrhea and/or vomiting will spread the virus.

5. What Went Wrong? Sick employees should not handle food Diarrhea – hands may have virus after bathroom use and improper hand washing Vomiting – virus particles may be spread to hands, clothes, and other surfaces

7. Learning Objectives Describe how and when to correctly wash hands Explain the symptoms, causes, and control methods for Norovirus and Hepatitis A List the correct procedure for cleaning an area where vomit is present List four important factors related to viruses

8. Key Terms Exclusion employees Norovirus Hepatitis A Jaundice Projectile vomiting

9. Viruses Only able to multiply in the cells of host Person to person contact Can’t grow in food (but can survive in food and infect someone else) Infected person to food Infected person to food contact surface Poor personal hygiene (fecal-oral route) Survives refrigeration and freezing

10. Norovirus Most common cause of gastroenteritis in U.S.

11. Norovirus Approximately 20 million illnesses 56,000 to 71,000 hospitalizations 570-800 deaths Most common cause of foodborne illness in U.S.

12. Facts about Norovirus Some norovirus infections occur without symptoms (asymptomatic) Infected people can shed large numbers of norovirus in feces and vomit Virus can persist on surfaces up to 6 weeks Some hand sanitizers are not effective at reducing norovirus on hands

13. Symptoms Vomiting (Projectile) Diarrhea Nausea Abdominal cramps

14. Foods Involved Ready to Eat Foods (contaminated by infected person) Produce (e.g. cut fruit, salads) Shellfish from contaminated water

15. Locations Nursing homes Daycare centers Schools Hotels Cruise Ships

16. Control 70% of norovirus outbreaks are caused by food handlers Monitor employees health Exclude employees with vomiting and diarrhea and confirmed Norovirus Personal hygiene (wash hands after bathroom) Rinse produce with potable water Clean and disinfect kitchen utensils and counters Clean and disinfect any area with vomit

17. http://www.wbtv.com/story/25217988/count y-manager-email-worker-at-charlotte

18. Hepatitis A Virus Symptoms: –Fever –Weakness –Nausea –Abdominal Pain –Jaundice Can take up to 50 days for symptoms to appear.

19. Foods Involved Ready to eat foods Shellfish harvested from contaminated waters Any food contaminated by employee Spread through fecal-oral transmission

20. Control Exclude employees with symptoms or confirmed Hepatitis Good personal hygiene (wash hands) –Wash hands after using the bathroom No bare hand contact with RTE foods Purchase shellfish from approved suppliers Cook shellfish properly Retain shellfish tag for 90 days

21. Proper Hand Washing

22. Hand washing Always use a hand wash sink –Must be at lease 1 designated hand sink and bathroom –Adequate flow and quality, at least 100 o F Wet hands and exposed parts of arms with warm water and soap Rub soap into hands and arms for 10-15 seconds Rinse hands and arms with warm water Whole process should take 20 seconds Dry hands and arms on disposable paper towel or electric dryer http://barfblog.com/2014/11/hand-dryers-even-the-fancy-ones-suck-new-study/

23. What is required at a hand washing sink Warm running water (100 o F) Soap Paper towels/hand dryer Trash can Reminder sign

24. When to Wash Hands Before: starting work, touching raw food or PHF/TCS food, touching ready- to-eat food, putting on new gloves During: food preparation as frequently as required to maintain clean hands and prevent cross-contamination Switching between raw and cooked food Switching between raw and ready –to-eat food

25. When to wash Hands (continued) After: handling raw food, using bathroom, coughing, sneezing, blowing nose, touching handkerchief, hair, face. Cleaning/sanitizing, removing garbage Changing protective gloves Break - eating, drinking, or smoking Touching money Any activity contaminates hands

27. Reporting Illness/Exclusion Employees must report to “person in charge” If diagnosed with illness due to : Salmonella, Shigella species, E.coli 0157:H7, Norovirus or Hepatitis A Have had a past illness from above or live in household where someone has had above Traveled within last 50 days to an area outside U.S. with an epidemic from above

28. Reporting Illness/Exclusion Employee has symptoms: diarrhea, fever, vomiting, jaundice, or sore throat with fever Employee has a boil (draining) or open infected wound Employee suspected of causing or being exposed to confirmed illness outbreak

29. Employees need to know the rules. Example form from Food Code

30. Restriction vs Exclusion employee Symptoms of sore throat and fever may exclude or restrict (assign non-food handling tasks) Covered open wounds or cuts Not allowed if serving highly susceptible population

31. Returning to work For mandatory reporting illnesses, need written clearance from a medical professional or health official. For symptoms only, must be symptom free for 24 hours. Check with health department for specifics

33. Cleaning Vomit Protective Clothing & Area –Use protective tools (disposable latex gloves, surgical mask and plastic apron, biohazard bag) –Virus can mist from vomiting can be spread up to 25 feet outside the visual area Sanitizers – concentration and time are important

34. Cleaning (continued) Cleaning procedure –Using protective equipment, carefully wipe up spill using paper towels and bag waste –Pour bleach (5,000ppm or 1:10 dilution) or other recommended disinfectant around the area and let it stay 4 minutes –Wipe up remaining solution, reclean and sanitize –Discard all disposal material in plastic bags double bagged (Biohazard bags)

35. What’s your view? How do you talk to employees about illness and staying home?

36. Case Study 166 people sick with severe nausea, vomiting, diarrhea. Norovirus was the cause. What happened Everyone ate at a seafood restaurant What they found

37. Case Study Employees were working when sick Not washing hands properly What went wrong Exclude sick employees Proper hand washing Clean up vomit properly Prevention

38. Activity: Proper Hand washing

39. Quiz A food handler must always wash his or her hands: a) Before starting work b) During food preparation as often as necessary to keep their hands clean and to prevent cross- contamination c) When switching between handling raw and ready-to- eat food d) All of the above

40. Quiz When washing hands, rub the soap into your hands and arms vigorously for at least: a)10 seconds b)15 seconds c)20 seconds d)30 seconds

41. Quiz Which fact about viruses is INCORRECT? a)Viruses feed off of food particles in contaminated foods and multiply b)Viruses need to infect a host to multiply c)Viruses can survive on hand contact surfaces for up to 6 weeks if not cleaned and sanitized d) It can take up to 50 days for Hep A symptoms to appear

42. Summary Norovirus and Hepatitis A Sick employees Hand washing Cleaning up after illness