It’s estimated that the average person will get norovirus five times during their lifetime. Globally, there are 685 million cases of norovirus each year, with approximately 20 million of those cases occurring in the United States. Norovirus is the number one foodborne illness – and the leading cause of foodborne illness outbreaks – in the United States.

Norovirus is a huge threat within the hospitality industry. According to the Centers for Disease Control and Prevention, the majority of norovirus outbreaks occur in foodservice settings, and 70 percent of infected workers cause 70 percent of those outbreaks. Several recent studies indicate that people work in foodservice industry jobs even when they’re sick.

Infected food workers often cause – and spread – norovirus outbreaks, typically because they’ve touched ready-to-eat foods, such as raw fruits and vegetables, with their germ-infested bare hands before serving them. Or they touch other items that have been contaminated, such as cell phones, utensils, doorknobs, etc., and spread the disease to others through this contact. Often, stool or vomit particles have caused the contamination. An individual only needs to ingest few of those particles, as few as 18 is enough, to get sick.

Additionally, norovirus outbreaks can occur from foods, such as oysters, fruits, and vegetables, which were contaminated at their source. It’s important to note that any raw or cooked food can get contaminated with norovirus.

In the past year, there were multiple norovirus outbreaks at restaurants, on cruise ships, at schools, and even at the Republican National Convention. Last December, dozens of students at Boston College contracted norovirus, according to the city’s health commission. Officials believe the Boston outbreak was linked to a Chipotle restaurant near campus. Charlotte-Mecklenburg school was closed in February due to a norovirus outbreak. In July, norovirus struck the Republican National Convention when an infected individual made the trip from California to Ohio and spread the disease throughout the close quarters of the convention. Even the Disney Cruise Line‘s Wonder ship suffered a norovirus outbreak this year after a nearly perfect CDC inspection score. It can happen anywhere, so foodservice professionals must remain vigilant about constantly and consistently implementing food safety protocols.

Food safety is a critical issue for the entire foodservice industry, including restaurants, schools, colleges, contract services, convenience stores, hotels, manufacturing and production facilities, medical facilities, retirement homes, retail locations, etc. Bottom line – if you grow, sell, serve, or make food in any capacity, you must be vigilant about food safety. Training employees and following proper protocols are essential to keep consumers safe.

Ongoing employee training and food safety education are important. Be sure that all employees understand food safety basics such as don’t cross-contaminate, clean and sanitize, wash hands properly and regularly, etc.  The Food Code is updated every four years with supplemental updates in between. This means employees must stay up to date on potential changes to food service policies and procedures.

While a certified food safety training program is essential, it’s only one piece of a strong food safety environment. A food safety culture must be created from the top down. Corporate executives should be seen washing their hands when they visit their facilities, not just in the restrooms but in the kitchens as well.  Everyone – including the leadership team – should be following proper food safety protocols, and modeling the importance of this behavior. The bottom line is don’t just talk the talk, walk the walk.

As I conduct food safety inspections nationwide, I’m amazed at the number of cell phones I find lying about kitchens and food prep areas. Statistically speaking, 1 in 6 cell phones have traces of poop on them – which is more bacteria than the flush handle of a toilet! So as an employee is prepping salads while simultaneously texting their BFF, the salad ingredients are becoming contaminated with whatever is on their cell phone. YUCK!

While there are policies that state that everyone must wash their hands after using the restroom – and that cell phones are not to be used in food prep areas – people break these rules all the time.  The average person doesn’t realize how easy it is to spread norovirus and may get complacent about the rules. When employees take their cell phones into the bathroom and either hold them while using the facilities or put them down on the dirty bathroom floor while they “go,” the phone can easily get contaminated with traces of feces or vomit, which can be spread to foods and other surfaces.

The example I frequently use in food safety classes to demonstrate how norovirus spreads through the workplace: everyone at work is healthy and then someone comes down with “the stomach flu” aka vomiting and diarrhea. Before you know it, everyone in the workplace is vomiting and has diarrhea because that person either didn’t wash their hands after using the restroom or didn’t wash them properly.

All of the team members touch the same door handles, telephones, calculators, cash drawers, etc., spreading the germs throughout the facility. This virus spreads widely and rapidly, so one person’s poor hygiene can make everyone else sick.  I can tell you firsthand that contracting norovirus is one of the most miserable experiences ever! No one wants to spend time in the bathroom with explosive diarrhea and projectile vomiting, I can assure you.

The best way to prevent norovirus is through proper hygiene. Wash your hands with soap and warm water, then use single use towels to dry them — especially after using the restroom, and always before eating, preparing, or handling food. Noroviruses can be found in your stool even before you start feeling sick, and the virus can stay in your stool for two weeks, or more, after you feel better.

There’s no substitute for good old-fashioned handwashing. Case in point: the CDC and FDA have opposed the antiviral claims on hand sanitizer products due to concern around the physical presence of soil during some norovirus outbreaks.  For this reason, hand sanitizer should only be used as an additional precaution, just like wearing single use gloves. Employees should be instructed to properly wash their hands with soap and water at regular intervals, before touching food, after using the restroom, between glove changes, etc.

Typically, we think of norovirus as being an illness that involves vomiting and diarrhea, and in most cases this is true. However, in some situations, the ramifications are much more severe. A norovirus infection can become quite serious in children, the elderly and immune-compromised individuals. Sometimes severe dehydration, malnutrition, and even death can result from a norovirus infection.

If someone in the foodservice industry is diagnosed with norovirus in the U.S., it must be reported to the local regulatory authority and the required protocols must be taken. The 2013 FDA Food Code states that food employees that are “symptomatic with vomiting or diarrhea or symptomatic with vomiting or diarrhea and diagnosed with an infection from norovirus” shall be excluded from working in a food establishment – period. The exception to this is when the symptoms are from a noninfectious condition. And, food employees that are diagnosed with an infection from norovirus and asymptomatic must be “excluded from food establishments that serve a highly susceptible population.”

Establishments that do not serve a highly susceptible population may restrict the food employee’s activities so that there is no risk of transmitting the disease through food, and the employee does not work with exposed food, clean equipment, utensils, linens, or unwrapped single-service or single-use articles.

If a team member has been excluded or restricted from work, according to the 2013 FDA Food Code, they may not return to their regular food service duties until they receive approval from the regulatory authority and provide written medical documentation from a health practitioner to the person in charge, stating that the food service employee is free of a norovirus infection.

Chipotle’s food safety crisis is fading from memories, but their troubles are far from over.  The Department of Justice (DOJ) has launched an investigation into Chipotle’s 2015 norovirus outbreak, and the restaurant chain is facing more negative repercussions from that incident.

Everyone in the food service industry should be taking all precautions to avoid foodborne illnesses.  Whether you grow, manufacture, sell, prepare or otherwise handle food that’s consumed by the public, you have an obligation to make certain that food is safe. Period.

Foodborne illness outbreaks can sicken (or kill) your customers, and can cause irrevocable damage to your company’s reputation.  As if those repercussions weren’t bad enough, the stakes for your business are even higher: foodborne illnesses are resulting in criminal investigations, tremendous fines, and even prison time for corporate executives.  Food safety is a very serious issue, and you should treat it as such.

About the author: Francine L. Shaw is president of Food Safety Training Solutions Inc., which offers a roster of services, including food safety training, food safety inspections, norovirus policies for employees, norovirus clean-up procedures, responsible alcohol service training, and more. Francine has been featured as a food safety expert in numerous media outlets, including the Dr. Oz Show, the Huffington Post and Food Management Magazine.

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