Outbreaks Where Food Workers Have Been Implicated in the Spread of Foodborne Disease. Part 3. Factors Contributing to Outbreaks and Description of Outbreak Categories

Abstract

In this article, the third in a series of several reviewing the role of food workers in 816 foodborne outbreaks, factors contributing to outbreaks and descriptions of different categories of worker involvement are discussed. All the outbreaks had worker involvement of some kind, and the majority of food workers were infected. The most frequently reported factor associated with the involvement of the infected worker was bare hand contact with the food followed by failure to properly wash hands, inadequate cleaning of processing or preparation equipment or utensils, cross-contamination of ready-to-eat foods by contaminated raw ingredients, and (for bacterial pathogens) temperature abuse. Many of the workers were asymptomatic shedders or had infected family members and/or used improper hygienic practices. Outbreaks were sorted into categories based on how many workers were implicated, the origin of the infective agent (outbreak setting or off site), the degree of certainty that the worker(s) were the cause or were victims, whether or not the workers denied illness, the ability of the agent to grow in the food, whether only the workers and not the patrons were ill, and whether patrons were more responsible for their illnesses than were the workers. The most frequent scenarios were (i) a single worker causing an outbreak by directly infecting patrons; (ii) an infected worker fecally contaminating foods that were then temperature abused, leading to an outbreak; and (iii) multiple workers linked to an outbreak but with no clear initiating source. Multi-ingredient foods with limited descriptions were most frequently implicated and usually were served in restaurants or hotels, at schools, and at catered events. Identified contaminated ready-to-eat foods included produce, baked goods, beverages, and meat and poultry items. In some situations, it was not clear whether some of the workers were the cause or the victims of the outbreak. However, in other situations there may have been an underestimation of the role of the worker. For instance, workers sometimes denied infection or illness for a variety of reasons, but subsequent investigation provided evidence of infection.

Foodborne bacterial pathogens recovered from contaminated shawarma meat in northern Jordan

“…Meat could be contaminated from cutting boards [17]; other ingredients could be contaminated from the hands of food handlers [18]. Furthermore, seasoning sauces and mayonnaise used in sandwich dressing could also be contaminated.…”

Assessment of Hygienic Practices and Microbiological Quality of Food in an Institutional Food Service Establishment

“…Also, the serving utensils were carelessly kept on the bare floor of the serving area at the time of serving, and back into the ready-to-eat food when the need arises without washing. Similarly, several risk factors related to the food service environment contribute to occurrence of foodborne illness: poor personal hygiene, inadequate sanitization of surfaces or equipment, cross contamination of prepared food with contaminated ingredients and inadequate temperature control [73,74]. Food handling personnel play important role in ensuring food safety throughout the chain of food production, processing, storage and preparation.…”

Assessment of the Knowledge, Attitude and Practice Towards Food Poisoning of Food Handlers in Some Egyptian Worksites

“…Food handlers may also shed food borne pathogens as E.coli and non typhoidal salmonella during the infectiousness period or during the recovery period of a gastrointestinal sickness (Adams and Moss, 2008). Todd et al (2007) formed a workgroup and analyzed 816 food borne outbreaks where food workers have been implicated in the spread of food borne diseases. In their last publication, they found that the most frequently reported food worker errors were handling of food by a person either actively infected by or carrying a pathogen bare-hand contact with food, failure to properly wash hands when necessary, insufficient cleaning of processing or preparation equipment or kitchen tools.…”