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