1. Module 6: Personal Hygiene and Employee Health Part 1

2. Case Study

3. What Happened June 2014, Bentonville, AR
275 confirmed and probable cases of Shigella were reported among workers and visitors at a Walmart office
Illnesses thought to be associated with Salsarita’s in the office food court
One sick employee had taken leftover salsa home after a catered party

4. What They Found
Environmental health came in to inspect and noted several violations, including improper handwashing and glove use
Several employees reported diarrhea and other gastrointestinal symptoms prior to the outbreak but still worked
Environmental health concluded outbreak was probably caused by a sick food worker
With these violations and with the reports of illness there was a pretty clear tie between risky practice and disease
While the salsa sample was not enough test, epidemiologist still suspected that it, or another RTE food, was related to the outbreak

5. What do you think the food safety culture was like at the Salsarita’s?
Discussion
What do you think the food safety culture was like at the Salsarita’s?
Maybe people didn’t know the rules?
Maybe management didn’t care about the rules?

6. Learning Objectives
Understand symptoms, sources and control of Shigella and Staphylococcus aureus 
Describe good personal hygiene habits and how they can protect foods
Explain the difference between a restricted and excluded employee
List reasons for exclusion or restriction of employee and requirements for reinstatement
List five reportable illnesses and requirements for reinstatement

7. Shigella Sources and foods Transferred fecal-oral route
Infected food handler
Contaminated equipment, untreated water
Raw produce
RTE foods
Symptoms
Diarrhea (sometimes bloody), fever, abdominal pain, dehydration
Onset, 1-7 days
Shigella- often spread through cross-contamination and cross-contact - only infects primates (humans and monkeys). So it likely comes from an infected person, sometimes through water.
It’s a problem in day care because of all to dirty diapers and bathroom accidents.
Causes dysentery - Dysentery: Inflammation of the intestine, with pain, diarrhea, bloody stools, and often a fever above 101'F. The causes of dysentery include bacteria (such as Shigella), parasites and viruses. Dysentery can be fatal because it can cause severe dehydration. 

8. Science Olympiad ‘Disease Detectives’ all ate food provided by volunteers
Around 200 people got sick, 50 of them had to be taken in for medical attention
Staph is often an issue with personal hygiene and temperature abuse

9. Staphylococcus aureus
Source
Common in the environment
Lives in humans and animals
Present in nasal passages and throats
Hand or arm sores (especially pus)
Transmitted via cough or sneeze
Symptoms and onset time
Nausea, stomach cramps, vomiting, diarrhea
Symptoms start 1-7 hours after consumption
Last for a few hours to a day

10. Staphylococcus aureus
Characteristics
Produces a heat stable, fast acting toxin
Bacteria can be destroyed by proper cooking, toxin cannot
Foods associated
Animal foods
meat, poultry, egg, dairy
Salads
egg, tuna, chicken, potato, macaroni
Bakery products
cream-filled pastries, cream pies, chocolate éclairs
Any food product handled after cooking
What do these salads have in common? These salads all require preparing and mixing RTE and TCS foods. All the chopping and mixing, combined with any temp abuse creates a risky set up
Everyone wants to blame the mayo for problems with creamy salads. However, commercial mayo is acidified and won’t support pathogenic growth.
With this information, where do you think things went wrong with the Science Olympiad?

11. Key Terms Excluded employee - Can’t work in food establishment
Highly susceptible population – People more likely than other people in the general population to experience foodborne disease (YOPI)
Reinstated employee - Approved to work
Restricted employee - Can’t work with or around food

12. Personal Hygiene

13. Clothing and Hair Clothing Hair Bathe daily and wear deodorant.
Wear clean clothing. If possible, put your work clothes on when you arrive at work.
Wear a clean apron and remove it whenever you leave the kitchen.
Remove all jewelry while working. The only exception is a plain wedding band.
Hair
Hair shoulder length or longer should be pulled up
Wear a clean hat or other hair restraint
Why do you think these rules are in place?
You never know what could get on your or your clothes at home, so bathing and wearing clean clothes prevents bringing in contamination
A restaurant in South Carolina was involved in a foodborne disease investigation. They tested all the employees and food but didn’t find the cause. A week later the investigator saw a new employee and a kind of pungent smell. They asked, the new employee worked from time to time when they got busy. His full time job… drove a septic tank pump truck.
Have you seen people wear their aprons in the bathroom, or home at the end of a shift? Aprons protect your clothes, but also protect FROM your clothes
It is very hard to get detailed rings clean. Not only can jewelry fall out into food, they have the potential to transfer pathogens
Hair restraints help keep hair out of food and help prevent people from touching their faces/hair

14. Taste Testing Preventing contamination while tasting food is important
Food should not be tasted over pots, pans or serving containers.
Methods
Use a disposable utensil to taste a dish and take a step away to taste.
Place a tasting portion in a small dish and take a step away to taste
Do not reuse tasting utensils!
Have you seen a cooking show and the cook tastes with the stirring spoon and then dribbles back into the pot?
Tasting should be done so that there is no way for tasters to contaminate

15. Breaks and Personal Items
Employees should not eat, drink, chew gum or use tobacco in food preparation area
Drinks are allowed if in covered containers that prevent contamination
Personal items should be kept away from food preparation and storage areas
As the PIC, you should actively monitor employee behavior
Chewing while preparing food increases the chances of spitting into food
Drinks should be in covered containers, preferably with straws. This is so that liquid doesn’t spill out, and so that when the cup is picked up hands don’t touch a part that the mouth touches
As the manager, are you checking to make sure these rules are being followed?
Too many people in the kitchen can create a problem with flow of food (and people)

16. Hands are the biggest vehicle of cross-contamination
Best practices for hand hygiene include: 
Keeping fingernails clean and cut short.
Not wearing nail polish.
Not wearing false nails.
Covering cuts and sores on hands with a bandage.
Washing your hands frequently and properly will also prevent contamination 
Preventing bare hand contact
More on handwashing and BHC in the next module

17. Cuts and Wounds
Staphylococcus aureus bacteria is naturally present on our skin, around the mouth and nose.
Open cuts, wounds and lesions/boils are problematic
Wash hands properly and frequently
No bare hand contact
Exclude employees with uncovered wounds on hands or arms
Cover open wounds with appropriate bandages and gloves

18. Reporting Illness and Injury

19. Reporting Illness
Sick employees can very easily contaminate food and spread illness to other people.
Employees must report the following to the Person in Charge:
Sore throat with fever
Infected cuts, wounds or lesions containing pus on the hand, wrist or other exposed body part
Persistent sneezing, coughing or runny nose that causes discharges from the eyes, nose or mouth
Diarrhea
Vomiting
Jaundice (yellowing of the skin and eyes)

20. Employee Restriction vs. Exclusion
Restricted employee – can’t work with or around food
Excluded employee – can’t work in establishment
The presence of some symptoms require restriction, while others require exclusion

21. Restricted From Work
If an employee presents with the following they must be restricted:
Sore throat with fever
Infected cuts, wounds or lesions containing pus on the hand, wrist or other exposed body part
Persistent sneezing, coughing or runny nose that causes discharges from the eyes, nose or mouth
Employee can be in the establishment but should not come in contact with food or clean food contact surfaces
This could mean giving them jobs such as cleaning bathrooms or taking out trash.

22. Reinstating Cuts and Wounds
According to the FDA Food Code 2013, reinstate restricted employee if skin, infected cut or lesion is covered with:
Impermeable cover (finger cot, waterproof bandage) and single use glove if it is on hand, finger, or wrist
An impermeable cover on the arm
Dry, durable, tight fitting bandage on body

23. Excluded From Work Employee has following symptoms: Diarrhea Vomiting
Jaundice
Sore throat and fever*
Symptoms from noninfectious conditions do not apply (e.g., pregnancy, gastrointestinal syndromes, medications, etc.)
*restricted if in normal establishment, excluded if in establishment that serves highly susceptible population

24. HENSS Reportable Illnesses
Employees must be excluded if diagnosed with:
Hepatitis A virus
Shiga-toxin producing E.coli (STEC)
Norovirus
Salmonella species (Typhoidal and nontyphoidal)
Shigella species
HENSS
HENSS can be used as an acronym for the exclusion diseases
These may show up on the exam. It isn’t necessary to know all the disease details about them, but know that diagnoses with these illnesses require exclusion

25. Reportable Illnesses Employees must also be excluded if:
Have had a recent illness from or lives in household with someone who has a reportable illness
Traveled within last 50 days to an area outside U.S. with an epidemic from a reportable illness
Employee suspected of causing or being exposed to confirmed illness outbreak
PIC must report jaundice and/or diagnoses of these 5 illnesses to the regulatory authority

26. Returning to Work Reinstated employee – approved to work
Required reporting illnesses:
Need written clearance from a health practitioner
Symptoms only:
Must be symptom free for 24 hours
Check with health department for specifics

27. Summary RESTRICT EXCLUDE REINSTATE Sore throat and fever*
RESTRICT
Sore throat and fever*
Open, infected cut/wound/boil
Persistent sneezing, coughing or runny nose with discharge
EXCLUDE
Vomiting
Diarrhea
Jaundice
Confirmed diagnosis of: Hepatitis A, STEC, Norovirus, Salmonella species (typhoidal and non-typhoidal), Shigella species
REINSTATE
Properly covered cut/wound/boil
Symptom-free for 24 hours
Confirmed cased of required reported illnesses require a doctor’s note

28. Employees Need To Know The Rules Example form from Food Code Appendix 7
Build in employee health policies so that workers are all on the same page and know what’s expected

29. How do you talk to employees about staying home when sick?
Discussion
How do you talk to employees about staying home when sick?

30. Case Study What Happened What They Found
275 were sick with Shigellosis
Restaurant had several critical violations
Employees reported illness

31. Case Study What Went Wrong Prevention Proper personal hygiene
Sick employees shouldn’t have worked
Hand hygiene violations
Proper personal hygiene
Exclusion when ill

32. Quiz
You see that the food handler you assigned to prepare the salad has a small cut on their hand. You should:
Have them start preparing the salad anyway
Move them to the meat slicing area
Send them to see the doctor, then home for the day
Have them put on a watertight bandage over the cut and wear gloves
Answer: d)

33. Quiz
You see that the food handler you assigned to prepare the salad has a small cut on their hand. You should:
Have them start preparing the salad anyway
Move them to the meat slicing area
Send them to see the doctor, then home for the day
Have them put on a watertight bandage over the cut and wear gloves
Answer: d)

34. Quiz
When an individual is made sick by a toxin present in the food, it is called:
Toxin mediated infection
Foodborne infection
Foodborne intoxication
None of these
Answer: c)

35. Quiz
When an individual is made sick by a toxin present in the food, it is called:
Toxin mediated infection
Foodborne infection
Foodborne intoxication
None of these
Answer: c)

36. Review Personal hygiene
Best practice for clothing, hair, hands and tasting
Approved coverings for infected cuts and wounds
Restriction, exclusion and reinstatement for employees
Required reporting illnesses