Foodborne viruses can be tough to prevent and mitigate. Some can’t be cultured, so they are difficult to analyze. Others aren’t affected even by strong disinfectants, so intervention is ineffective. In the past decade, an additional virus, hepatitis E, joined norovirus and hepatitis A as a top three concern for human food safety.

To tackle these challenging foodborne viruses that can cause serious human illnesses, the Food and Agriculture Organization of the United Nations and the World Health Organization (FAO/WHO) are holding a series of meetings focused on microbial risk. The first Joint FAO/WHO Meeting on Microbiological Risk Assessment (JEMRA) convened in September 2023 in Rome and focused on foodborne viruses of top concern for public health, analytical methods, and contamination indicators. The second meeting, which took place in February 2024 in Geneva, discussed prevention and intervention measures for these viruses. A third meeting is planned for later in 2024 and will focus on evaluating risk.

The final reports for the first two meetings are still in progress, with only summaries released so far. Experts involved in the meetings said significant advances have been made in the study of foodborne viruses; these have helped researchers understand the science of viral mitigation since the inaugural JEMRA meeting 16 years ago, a milestone event that was the first time the issue of viruses in foods was brought to international attention.

“We have improved norovirus surrogates and ways to study human norovirus, and we have better detection methods, like digital PCR,” says Kalmia Kniel, PhD, associate chair of the department of animal and food sciences at the University of Delaware in Newark. She adds that thermal treatments are often relied on to inactivate viruses, but there are promising non-thermal technologies being studied, including cold plasma, chlorine dioxide, and some chemical disinfectant combinations.

The Biggest Threats

Dr. Kniel chaired the 2023 meeting and was a member of the expert committee that reviewed recent scientific developments, data, and evidence associated with foodborne viruses. JEMRA will update and provide scientific advice to the Codex Committee on Food Hygiene, which requested the series of meetings. The Codex committee will use the information for its international recommendations and standards. The expert committee also considered trade implications of possible standards to ensure that food safety does not become a trade barrier.

In reviewing viruses associated with human foodborne illness, the expert committee identified human norovirus as the leading cause of viral foodborne illnesses, followed by hepatitis A and hepatitis E. The ranking considered the frequency of illness, the clinical severity of the disease, and the food most often linked to the virus; however, while hepatitis A and hepatitis E were ranked equally behind norovirus in terms of frequency, they were higher than norovirus in terms of clinical severity. The committee lacked sufficient data to rank other viruses, including rotavirus and sapovirus.

In terms of the foods most associated with the viruses as a potential public health threat, prepared food, frozen berries, and shellfish—in that order—are associated with norovirus. For hepatitis A, linked foods are shellfish, frozen berries, and prepared foods. Those two viruses are transmitted via contamination by feces exposure. For hepatitis E, a zoonotic virus, pork and wild game are associated, and the virus is transmitted from animal to human.

The committee considered only water used in food production, in processing, in preparation, or as an ingredient, not water intended only for drinking, in its assessments.

Viral foodborne disease has a substantial impact on morbidity and mortality globally, but surveillance data is sparse, and there is the potential for asymptomatic shedding, so it is difficult to craft prevention and control strategies.

Norovirus causes about 125 million cases of foodborne illness and 35,000 deaths worldwide annually, according to the committee’s summary, including severe outcomes such as hospitalization and death, especially in children younger than five years old, the elderly, and immunosuppressed people, who may shed the virus for extended periods. Hepatitis A causes about 14 million cases of foodborne illness and 28,000 deaths each year globally, but there are significant regional differences attributable to endemic prevalence, vaccine use, and international food trade. There are no global estimates for hepatitis E, which can damage the liver, the meeting summary said.

“The JEMRA committees discuss foodborne viruses in a global context,” Dr. Kniel said. “We need to keep in mind that our food system is global in nature, which means we need better surveillance of viruses in all countries in order to help each other.”

Dr. Kniel said that since the 2008 JEMRA report, international and national standard methods have been developed and validated to detect and quantify human norovirus and hepatitis A virus in foods. Methods released since that report include the International Standards Organization’s ISO-15216-1:2017 and ISO-15216-2-2019. These are used widely to detect norovirus and hepatitis A in leafy greens, soft fruits, and shellfish, and as a benchmark to validate new methods, the committee’s summary said. There is no ISO method for prepared foods. Methods to detect hepatitis E in meats are under development.

The committee said infectivity assays are needed for wild-type viruses, as there still is no definitive way to tell infectious from noninfectious viruses using molecular amplification.

It recommended that countries consider building capacity to help with adopting and training in methods for detecting viruses in foods and the environment. “Appropriate global actions will help alleviate the anticipated increase in public health risk from viral foodborne illness arising from population growth, the climate crisis, and globalization of food supply chains,” the summary from the 2023 meeting said.

Prevention and Mitigation

Prevention is the preferred focus now, given the difficulty and expense of mitigating infected foods, says Lee-Ann Jaykus, PhD, rapporteur of the March 2024 meeting and a member of its expert committee. She says the viruses are not culturable organisms and cannot be grown in a lab like bacteria can, nor can they be culturally enriched. There is no host cell in a culture with which to propagate them. It’s necessary to concentrate and purify them from a sample and use reverse transcription polymerase chain reaction to detect the viruses. “We have standardized methods to detect these viruses in selected commodities, but they have some inherent disadvantages because of the limitations of not having a culture,” Dr. Jaykus says.

Limitations include the fact that even when a viral nucleic acid is detected, it doesn’t necessarily mean there is an infectious virus, she said. Real-time polymer chain reaction (RT-PCR) is a complicated method, and it is easy to lose viruses in the first steps, so it is not as sensitive as needed. “These are limitations not because the science is bad,” she says. “The science is the best it can be as it currently stands. There are limitations because we can’t grow these things.”

One focus of the second meeting was contamination routes for the virus to humans. Fecal matter and vomit from infected humans are the primary sources of contamination for norovirus and hepatitis A to get to humans through affected waters, food handlers carrying the viruses, and surfaces, because the viruses can live for weeks on surfaces, Dr. Jaykus says. The zoonotic hepatitis E virus is present in the meat, organs, tissues, and excretions of infected swine and game animals and gets transmitted through exposure.

Because the viruses persist in the environment for long periods and are resistant to many treatments, prevention is the key strategy to control foodborne viruses, Dr. Jaykus says. One example of prevention is reducing the viral load in shellfish by treating wastewater, but that requires infrastructure investment. Another is using production-related strategies to reduce contamination of fresh and frozen produce. Virus inactivation methods also are under investigation.

The committee recommended some directions for future research and development, including early identification of contamination hotspots using wastewater surveillance, for example, and technologies such as satellite imagery and hydrographic dye studies to predict virus dispersion. It also recommended using emerging scientific data to develop surface disinfectants and hand sanitizer formulations with greater efficacy against environmentally stable viruses. After all, hand sanitizers were effective in reducing transmission during the COVID-19 pandemic.

“Following up on the COVID-19 pandemic, it is critical that we launch surveillance studying the health of animals, humans, and the environment to identify important zoonotic viruses before the next pandemic,” says Dr. Kniel, who, like Dr. Jaykus, was surprised to see the hepatitis E virus added to the list of top foodborne virus concerns since the inaugural JEMRA meeting 16 years ago. “It is frustrating to continually talk about the need for better surveillance to better understand foodborne virus transmission and the attribution of disease to a specific virus.”

Table 1: Foodborne viruses and foods of highest public health concern

Source: FAO/WHO.

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Since the beginning of the COVID-19 pandemic, people around the world have eaten billions of meals and, despite significant rates of infection throughout food processing, handling, distribution, and retailing facilities, there appears to be no conclusive evidence that the disease has been transmitted from the source of infection via the food supply chain.

There has been considerable discussion in Japan about the connection between food and the potential risk of SARS-CoV-2 transmission through food and the potential implications for food safety. The context for this has been the Japanese media reporting on news that Chinese regulatory authorities have detected the virus on frozen food products and speculation that an employee infection cluster in a Japanese food factory was caused by food contact. Recent announcements from China seem to indicate that this mode of transmission may have contributed to the global pandemic. Because China is one of Japan’s closest neighbors and exports foods to the country, these allegations cannot be ignored.

Furthermore, a recent increase in norovirus cases in Japan attributed to food has added to concerns about viral transmission via food. The norovirus season is generally observed from early autumn to mid-winter, but outbreaks have occurred in spring and summer. While norovirus and SARS-COV-2 are both viruses, they are very different in structure and in how they are affected in different environments. For example, alcohol does not adversely affect norovirus, but is effective for disinfection and as a countermeasure against COVID-19. It is imperative to understand the relationship between COVID-19 and food and to clarify how that coronavirus differs from norovirus.

Viruses usually remain viable and stable at cooler temperatures, even at a domestic refrigerator temperature of approximately 4℃. They are not inactivated, remaining viable for months. They do not lose their infectivity even at -70℃.

One report indicates that COVID-19 is able to maintain viability and will remain infective for between four and 21 days at 4℃. Therefore, it is not improbable to see reports that the virus was detected on frozen products. There are reports that COVID-19 has been isolated on chicken meat from Brazil and on shrimp from Ecuador.

Viral Infection from Food

There are two proposed routes for viral infection from food. In the first route, it is theorized that COVID-19 adheres to the surface of food, food containers, and packaging and is released through handling, allowing the virus to enter the body via the mucous membranes of the mouth, nose, and eyes. The second route involves COVID-19 that is present on or in food products that are consumed and the theory says this causes infection through the epithelial cells of the digestive tract and thereby proliferates. Neither of these routes have yet been verified.

Experiments with coronavirus attached to various materials in the laboratory have shown that the virus retains its infectivity on the surface of objects for quite some time. COVID-19

Reprinted from J Hosp Infect, vol. 104, Persistence
of coronaviruses on inanimate surfaces and their
inactivation with biocidal agents, pages 246-254.
Copyright 2020, with permission from Elsevier.

has been compared with the severe acute respiratory syndrome (SARS) virus that prevailed in 2002 and the Middle East respiratory syndrome (MERS) first reported in 2012, and it is thought that it will have a similar lifespan (see Table 1).

However, in reality, food does not appear to be a significant or likely path to infection with SARS-CoV-2. Experts at the World Health Organization have emphasized that China has sampled very large volumes of food packaging but found very few positive samples. In addition, there have been questions regarding the test methods employed by the Chinese researchers.

The theories about the consumption route to infection come with certain concerns. COVID-19 has an outer membrane called an envelope. It’s believed that the envelope makes it easier for the virus to attach to specific cells in the mucous membrane and multiply. However, the envelope is fragile when exposed to an acidic environment; therefore, the virus would lose its infectivity when exposed to stomach acids.

Norovirus has no envelope, and its protein is exposed. Normally, this protein has some resistance to acids. Therefore, even if food containing norovirus enters the mouth and is digested, it retains the ability to pass through the stomach acids and reach the small intestine, resulting in food poisoning. Stomach acid has a pH of about 2.

Envelope viruses are stable at pH 5-9 and have little resistance to an acidic environment, so even if the new coronavirus is eaten, the envelope will be broken and viral activity will be lost when it comes into contact with stomach gastric acid. So, contracting an infection through this route is not believed to be possible. It is reported that norovirus can tolerate a pH of 3, however, so if you eat foods high in norovirus, there is the potential that some of them will pass through your stomach acids and enter your small intestine. The end result is that norovirus can cause food poisoning, but that the new coronavirus does not.

Gastrointestinal issues such as diarrhea may affect people infected with the new coronavirus. It’s believed that this may occur after the new coronavirus has entered the lungs and spread through blood vessels, eventually reaching the digestive tract. This route has not been confirmed, however, and the WHO and the Japanese Ministry of Health, Labour and Welfare have not declared that infection by food does not occur.

It’s obviously quite confusing for the average person trying to understand the realities of viral infectivity. No one can say that the chances of both the first and second routes are zero, but the odds of food or food packaging being the cause of a COVID-19 infection are extremely low. Therefore, infection from food is regarded as highly unlikely and is considered even more unlikely if one looks at Japanese food factories. They typically have highly developed food hygiene processes and generally have a commitment to a food safety culture that minimizes the potential for foodborne infection.

The Difference Between COVID-19 and Norovirus

Recently, the norovirus infection rate has increased noticeably in Japan. Norovirus is different from the new coronavirus both in terms of viability in stomach acid and heat resistance. Generally, norovirus is inactivated by exposure to temperatures between 85℃ and 90℃ for more than 90 seconds. The new coronavirus is inactivated at 70℃. Furthermore, there are earlier significant differences in how the two viruses react to different chemicals used for disinfecting (see Table 2).

Because the new coronavirus has an envelope, alcohol and surfactants, such as soap or detergent, that break the envelope work well. Of course, a sodium hypochlorite solution (made by diluting bleach at home) is also effective. On the other hand, because norovirus has no envelope, it’s actually quite strong against alcohol and surfactants in detergents or soaps. In other words, these do not work. Sodium hypochlorite solution must be used to disinfect norovirus.

Understanding the infection route of norovirus makes it easier to understand the countermeasures. Norovirus propagates in the human body but cannot multiply in food or on its surfaces. There are also contact infections through doors and toilets, and droplet infections. Therefore, as countermeasures against norovirus, food should be heated to inactivate the virus before eating, and an infected person should not handle food or cook. Wash hands thoroughly before doing anything with food, and disinfect with the appropriate chemicals.

Today, the real concerns with food poisoning come from pathogenic bacteria such as Campylobacter, Salmonella, and Listeria monocytogenes, not viruses.

Dr. Kubomura is president of Kubomura Food Advisory Consultants. Reach her at kubomura.food@gmail.com.

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Union Bay Seafood Ltd., headquartered in Richmond, British Columbia, Canada, has commenced a recall of three types of Pacific oysters after concerns over a link to the rise of a potential norovirus.

“The recall was triggered by findings by the Canadian Food Inspection Agency (CFIA) during its investigation into a foodborne illness outbreak,” says Marie-Pier Burelle, media relations officer for Health Canada.

The Union Bay products under the recall consist of:

• Pacific Oysters, Chef Creek Xsm in five-dozen containers with the code: Harvest location: BC 14-8, Landfile: 1402060, Lot: W20200211, Harvest date: 10 Feb. 2020
• Pacific Oysters, Cascadia Xsm in 5-dozen containers with the code: Harvest location: BC 14-8, Landfile: 1402060, Lot: W20200211, Harvest date: 10 Feb. 2020
• Pacific Oysters, Royal Miyagi Xsm in 5-dozen containers with the code: Harvest location: BC 14-8, Landfile: 1402060, Lot: W20200211, Harvest date: 10 Feb. 2020

The CFIA noted that these oysters have been sold in B.C., Alberta, and Manitoba, and may have been also distributed nationally throughout Canada. An investigation is still ongoing. “The CFIA is conducting a food safety investigation, which may lead to the recall of other products,” a spokesperson for the CFIA says. “If other high-risk products are recalled, the CFIA will notify the public through updated food recall warnings.”

The CFIA has verified that Union Bay is eradicating the recalled merchandise from the marketplace.

This marks the second Canadian company faced with a recall to oysters this year after investigations into reported illnesses associated with the norovirus. In February, Heriot Bay seafood company and Sawmill Bay Shellfish Co. Ltd., also recalled two brands of Pacific Oysters from the market.

Public health officials are advising retailers to check to see if they have the oysters on hand, and if so, to discard them immediately. Consumers who have already purchased the oysters can either return them to the place of purchase or discard them.

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The FDA is collecting samples of frozen berries from processors, distribution centers, warehouses, and retail locations throughout the year to test for hepatitis A virus and norovirus.

The sampling assignment began in November and is estimated to last approximately 18 months. FDA is collecting domestic samples of frozen berries. It is also collecting import samples from ports of entry, importer warehouses, or other storage facilities where foreign goods are cleared for entry into the country. The agency plans to collect and test 2,000 samples in all.

Some consumers use frozen berries as ingredients in foods without first cooking them, increasing their risk of exposure to harmful viruses, says FDA. The agency reported three hepatitis A virus outbreaks and one norovirus outbreak linked to frozen berries in the U.S. from 1997 to 2016.

Strawberries, raspberries, and blackberries are delicate and may become contaminated with bacteria or viruses if handled by an infected worker who does not use appropriate hand hygiene, or if exposed to contaminated agricultural water or a contaminated surface, like a harvesting tote. Freezing preserves berries but generally does not kill viruses, which can survive at low temperatures.

If FDA detects hepatitis A virus or norovirus in a sample, the agency will notify the firm of the finding(s) and work with the firm to take appropriate action. Upon detecting a positive test result, FDA may also take actions such as placing a firm on an import alert, overseeing a recall, or issuing public warnings.

The FDA will post the sampling results on its FY 19-20 Frozen Berries Assignment page on a quarterly basis and will publish an analytical report once the assignment is complete.

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(Editor’s Note: This is an online-only article attributed to the February/March 2018 issue.)

In November of 2015, the North Carolina Division of Public Health was notified that approximately 44 people attending a company Thanksgiving lunch became ill with moderate to serious intestinal disease and diarrhea. Within hours of the notification, the department set up a website asking lunch attendees—those sick and those that did not get sick—what food and drink they consumed at the event.

Of the 80 people asked to complete the survey, 73 percent did so. Of those who reported they got sick, the following was revealed:

• Most became ill within 13 hours of the lunch;
• 93 percent said they experienced moderate to severe diarrhea;
• 91 percent reported abdominal pain; of these, most reported vomiting; and
• Nearly half of the people that became sick had eaten turkey and stuffing, which were served together.

It was becoming clear to public health officials that this was a classic case of norovirus. The virus normally comes on quickly with precisely these types of symptoms, often the result of eating specific food. Follow-up tests of those that became ill proved this to be the case. They then turned their focus to the commercial caterer that prepared the lunch.

The caterer had a “permitted” kitchen that has passed inspection by public health officials, but this time the meal was cooked in the home of the caterer. Once the meal was prepared, it was delivered to the party setting by car in stages—with the turkey and stuffing left unattended in warming pans or at ambient temperatures for up to eight hours before serving.

Health officials blamed the outbreak squarely on the caterer for not following proper safety procedures: using an “unpermitted” kitchen, leaving food unattended for a prolonged period, and for failure to monitor the temperature of the food products before consumption. All of these contributed to the growth of pathogens that can cause norovirus.

But that’s not the end of the story. Many of the people experienced vomiting while they were sick. Over the next 24 to 48 hours, almost as many family members of those that became ill at the lunch also came down with norovirus. While it was clear the commercial caterer was responsible for the original outbreak, why did so many family members also become sick?

A Closer Look at Norovirus

Before answering this question, let’s review some of the statistics regarding norovirus in the U.S. According to the CDC, some of the key facts include:

• There are about 20 million cases of norovirus each year in the U.S., with most of them happening on land, not on cruise ships (which is where many people assume the majority of norovirus cases occur);
• Norovirus contributes to approximately 70,000 hospitalizations each year and about 800 deaths;
• While people can get norovirus at any time of the year, it is most common in the winter;
• Most outbreaks occur in food service settings like restaurants; and
• Unlike other types of airborne pathogens that may die within hours after landing on a surface, norovirus pathogens can live up to two weeks.

But here is another important fact about norovirus. While it can spread through close personal contact with an infected person or the fecal-oral route similar to other illnesses, it is very often spread when someone vomits. This is why norovirus is commonly referred to as “the vomiting disease.” The vomiting is often forceful, called “aerosolized vomit” that can land on surfaces as much as 25 feet away.

If someone touches the droplets of this aerosolized vomit on a counter, a door handle, or a light switch, and then swallows it, there is a very good chance they will come down with the disease. This explains why so many family members at the Thanksgiving lunch later became ill.

Norovirus Spill Kits

It is very likely that few if any of the people that became ill at the Thanksgiving lunch were aware of how norovirus can spread to others. In addition, they likely were not aware of what cleaning protocols are necessary to help mitigate the spread of the disease.

But those in the food service industry must know these facts and most importantly, they must know what steps to take when a vomiting incident occurs, whether it happens in a restaurant, a food court, or in a commercial kitchen by a staff member.

To explain the steps, let’s say there is a vomiting incident in a restaurant kitchen. The first and most important thing kitchen managers and administrators must know is that they must always assume the cause is norovirus. Since the disease can spread so fast to so many people, there is no other choice but to make this assumption.

The second thing we must know is not to grab a mop to clean up the incident. This is often the first inclination, but mopping the floor will just spread pathogens over the floor, walls, and other surfaces, as well as release pathogens into the air, allowing it to spread to other surfaces.

Third, the most efficient way to clean up a vomit incident is to use a spill cleanup kit. The spill kit should include all of the protective gear necessary to address the situation and, very importantly, protect the health of those handling the cleanup operation.

For instance, it should include a disposable apron and gown, shoe covers, up to three pairs of vinyl gloves, a combination mask/face shield, trash bags and ties (preferably colored yellow, which indicates a warning or caution), disposable towels, and an absorbent spill pad approximately 12 inches by 12 inches.*

The Actual Cleaning Steps

Now that you know what to do, what not to do, and what you need, here are some of the critical steps in the cleanup procedure:

• Make sure everyone has left the immediate area;
• Put on the protective gear;
• Spread the absorbent pad over the spill and allow it to be absorbed into the pad;
• Scrape or scoop up any vomit not absorbed by the pad—some kits will include the necessary tools for this;
• Use disposable towels to wipe clean all surfaces and place all items and towels in one of the disposable bags as they are used;
• Clean all soiled areas using a pH-neutral cleaner; then apply a disinfectant to the same areas (this is a two-step process to ensure the disinfectant works most effectively);
• Carefully remove and dispose of all protective gear in trash liners with the gloves being the last thing placed in the bag;
• Close the bag securely with a twist tie and place in an outside dumpster; and
• Wash hands thoroughly.

While this may look like an involved process, it actually can move along very quickly and safely if those handling the cleanup procedure know what they need to do and how to do it. A quality spill cleanup kit will include cleanup instructions, but they should only be used as a reference or guide should a question come up in the cleanup process.

In a commercial kitchen, it is advised that cleaning staff has proper training on the cleanup procedures. Very often, an astute distributor can provide this training at no cost, which helps protect the health of your staff and all those served food from your kitchen.

Sharek is category manager of facility-employee safety at DayMark Safety Systems. Reach him at esharek@cmcgp.com.

*Spill kits can vary as to what items are included. To protect health, it is best to select a kit that includes all the crucial items necessary to remove and neutralize the effects of vomit or bodily spill incident.

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Testing has confirmed norovirus in a customer who ate at the Virginia Chipotle Mexican Grill Inc. restaurant that was briefly closed earlier this week following multiple reports of diners falling ill, a county health department official said on Thursday.

Shares of the burrito chain, which has been under a microscope since it was linked to a string of food safety lapses in 2015, were down 2.7 percent at $362.75 at midday on Thursday.

Chipotle has worked to win back customers and rebuild the reputation of the once-high flying chain, whose stock traded well above $700 before it was connected to E. coli, Salmonella, and norovirus outbreaks in 2015.

Stool sample tests from the diner who ate at the Chipotle in Sterling, Virginia, late last week were positive for norovirus, said Victor Avitto, environmental health supervisor for the Loudoun County Public Health Department, which has jurisdiction over the restaurant on Tripleseven Road in Sterling.

Chipotle closed the restaurant on Monday and reopened it on Wednesday, following a deep cleaning. News of the outbreak came after diners reported symptoms on iwaspoisoned.com, a crowd-sourced website.

Chipotle expected the confirmation, since the symptoms described by customers of the Sterling restaurant were consistent with norovirus, spokesman Chris Arnold said.

Norovirus is the number one cause of illness from contaminated food in the U.S., resulting in an estimated 19 million to 21 million illnesses annually, according to the CDC. It is highly contagious and can spread from person to person, as well as through food prepared by an infected person. Symptoms include cramping, nausea, vomiting, and diarrhea.

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If food service and retail employees don’t practice proper hand hygiene, they could be serving a side of norovirus with their customers’ orders. Norovirus outbreaks from contaminated food in food service settings are often linked to infected food workers, according to CDC report. These outbreaks can be prevented by educating workers about proper hand hygiene on the job and making sure they stay home when they are sick.

Norovirus is highly contagious and can spread anywhere food is served, making people sick with vomiting and diarrhea. According to the CDC, about 20 million people get sick from norovirus each year. In addition to the risk of a norovirus outbreak, poor hand hygiene will lead to increased illness and can result in:

• Disruption cost and lost productivity through employee absence from work;
• Reduced employee efficiency through illness at work and lower employee morale; and
• Damage to a business’ reputation.

For any organization, implementing and maintaining an appropriate hand hygiene routine is a daily challenge. Employers and facility managers have a legal responsibility to ensure that they provide a safe working environment for their employees—addressing hand hygiene is a vital asset.

Common Norovirus Carriers

According to the CDC, health departments reported 1,008 norovirus outbreaks from contaminated food between 2009 and 2012, most of which occurred in food service settings, such as restaurants, catering, or banquet facilities.

The CDC also looked at foods that were commonly implicated in norovirus outbreaks. Of 324 outbreaks with a specific food item implicated, more than 90 percent were contaminated during final preparation (such as making a sandwich with raw and already cooked ingredients) and 75 percent were foods eaten raw. Leafy vegetables, fruits, and mollusks, such as oysters, were the most common single food categories implicated in these outbreaks.

Best Practices for Clean and Healthy Hands

Wash hands properly and often. Apply a small amount of hand cleanser to dry hands. Rub hands vigorously together for at least 20 seconds. Scrub all surfaces, including the backs of hands, wrists, between the fingers, and under the fingernails. Rinse well and dry hands with a clean or disposable towel. Make sure to use a clean towel to turn off the faucet.

Use the right cleanser for the job. There is an ongoing misconception that a hand cleanser’s performance is measured by its ability to clean hands aggressively. In actuality, most cleansers far surpass the user’s actual requirements. Make sure to choose a sanitation product that takes into consideration the impact on the hands, yet is still effective for the job.

Keep cleansers accessible. The location of hand cleansers can help increase handwashing compliance. Place them where they are easy to find and enforce the importance of handwashing throughout the day.

Use gloves where required or necessary. It’s not always practical to use gloves when working. Nonetheless, gloves should be used whenever possible to ensure that cross-contamination is less of a risk.

Once your team learns more about prevention, pick the best-suited hand cleanser and dispensing system. Table 1 (click on to enlarge) provides a quick reference guide to keep employees clean and compliant.

The appropriate products should be available and accessible to workers where and when they are required, such as food processing area entrances, washrooms, and handwashing stations.

Developing a good handwashing technique is imperative to ensure hands are thoroughly clean. Pay particular attention to the backs of the hands and fingertips as these spots are frequently missed. To limit sickness and absenteeism in the workplace, implement the following handwashing steps:

1. Rub palm to palm;
2. Rub palm over back of hand, fingers interlaced;
3. Palm to palm, fingers interlaced;
4. Fingers interlocked into palms;
5. Rotational rubbing of thumb clasped into palm; and
6. Rotational rubbing of clasped fingers into palm.

Workers should rub theirs hands together for at least 20 seconds; the length of humming the “Happy Birthday” song from beginning to end twice. Skin should always be properly dried to avoid risk of chapping, particularly during the winter months. Clean towels should be available at all times—dirty towels mean exposing the skin to more dirt and the risk of infection. Ideally, single issue disposable towels should be used as communal towels can lead to contamination.

Hand Sanitizers Come in Handy

When it’s not convenient to use soap and water or when soap and water are not available, it is acceptable to use an alcohol-based broad spectrum hand sanitizer that contains at least 60 percent alcohol. According to the CDC, hand sanitizers with an alcohol concentration greater than 60 percent are very effective at killing germs and can reduce the number of microbes on a person’s hands quickly. However, it’s important to note that hand sanitizers don’t eliminate all bacteria. Washing your hands with soap and water is more effective against specific types of germs, especially norovirus. Alcohol-based hand sanitizers used in food handling environments should be fragrance-free and ideally have an NSF E3 rating (NSF International certifies food-related products and systems, hand sanitizers fall under the NSF standard E3). Gel-based products can be sticky and leave gelling agent residues on the skin. Foam based products enjoy a higher consumer acceptance and do not leave an unpleasant or sticky residue on the skin.

Training is Key

New employees should be trained on proper handwashing techniques and frequency during orientation. Show new workers where the sinks and sanitizing stations are and remind them when to wash their hands.

Employers can encourage good hand hygiene practice among all employees by providing easy-to-understand awareness materials such as posters and stickers for use in washrooms, food processing areas, and on mirrors and doors to remind employees of the importance of clean hands.

Employers can also work with their washroom services supplier to create a communications campaign to educate employees on this necessity. Free downloadable posters are readily available from established suppliers to help promote good hand hygiene practices.

A systemized approach to skin care combined with programs to educate employees about their skin allow employers to provide a simple yet cost-effective solution to help all employees adopt these proper practices.

Klotz is technical product manager at Deb Group. He holds extensive experience in professional skin care products to prevent work-related occupational skin diseases. Reach him at andreas.klotz@degroup.com.

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