Supermarkets

Contents:
ARTICLE: "NOROVIRUS THREAT ..."
HACCP IN THE SUPERMARKET
MEAT ROOM SANITATION
PAPER PROFITS



ARTICLE:
NOROVIRUS THREAT SPURS NEW FOCUS ON SANITATION, SICK-LEAVE POLICIES
Strict rules may help prevent costly outbreaks of stomach 'bug'

DELTA TOWNSHIP, MICH. -- At a Carrabba's Italian Grill here in the Lansing, Mich., area during a weekend in January, at least one employee came to work with a stomach "bug" that in turn made nearly 500 people violently ill and caused a steep drop in the restaurant's sales.

The virus that caused the outbreak among the restaurant's guests and employees was not one of the more widely known pathogens that operators lose sleep over, such as salmonella, E. coli or hepatitis A. It was a class of infectious microbes that is far more common: the norovirus.

The recent Lansing incident was a wake-up call for the 205-unit Carrabba's chain, owned by Tampa, Fla.-based Outback Steakhouse Inc. Other restaurateurs and health officials also say the increasing number of norovirus outbreaks should prompt all foodservice operators to review sanitation practices with employees and implement stricter sickleave policies.

Thought to be the culprit responsible for at least half of all gastrointestinal illness in the United States -- an estimated 23 million cases each year -- noroviruses are highly contagious and typically cause a one- to two-day bout of severe nausea, vomiting and diarrhea, as well as abdominal cramps, fever and muscle aches. In some cases victims are hospitalized.

Sometimes called the Norwalk or Norwalk-like virus, the pathogen has been linked in news reports of outbreaks on cruise ships, in nursing homes and in schools. However, the U.S. Centers for Disease Control and Prevention, or CDC, in Atlanta estimates that far more norovirus outbreaks over the past decade have been associated with restaurants, and even in other settings food handlers most often are implicated. To address the situation, the U.S. Food and Drug Administration for the first time included in its model 2005 Food Code norovirus as an illness that must be reported to employers.

Of 348 outbreaks reported to the CDC between 1996 and 2000, an estimated 39 percent were linked to restaurants, the most common setting. By contrast, cruise ships and other vacation settings accounted for only 10 percent of those outbreaks.

In 2004, the most recent year for which data are available, 251 reported outbreaks of foodborne illnesses across the country involving nearly 10,000 victims were thought to be viral. Almost all were classified as norovirus related, and 93 were norovirus outbreaks tied to restaurants, according to CDC statistics.

While foodborne illness from bacterial and other causes is declining because of better refrigeration and food-supply controls, CDC officials say norovirus outbreaks are on the rise, in part because Americans are eating in restaurants more often.

In some cases, food is contaminated at the source -- raw oysters and fresh produce are common vehicles for infection. But typically noroviruses walk in a restaurant's front door, carried either by sick employees or guests.

Health officials nationwide say the foodservice industry is ill-prepared to deal with the problem, even though a norovirus outbreak can have a devastating effect.

In the Carrabba's case, Eric Pessell, director of environmental health for the Barry-Eaton District Health Department, which includes Lansing, said the wave of illness there likely began after a sick restaurant employee vomited in the unit.

"This is happening more frequently than we as regulators know and more than the industry is aware," Pessell said.

What most operators don't realize, he said, is that vomiting can cause the norovirus to become airborne, landing on surfaces up to 15 feet away.

Commonly used restaurant sanitizers, such as quaternary ammonium chloride solutions, are ineffective against the virus. The CDC recommends a high concentration of bleach, said Pessell, who added that personnel should be trained on how to use such solutions safely.

If someone gets sick in a restaurant, operators should consider closing the restaurant immediately before gross contamination occurs, Pessell said.

In the Carrabba's case, he said, "that's the only thing, in our opinion, that would have stopped it." Carrabba's never closed the unit. The problem, said Steve Shlemon, the brand's president and chief executive, is that it typically takes 24 to 48 hours after exposure to such viruses for people to fall ill.

When complaints of illness started trickling into the local health department and Carrabba's was found as the common link, officials first suspected contaminated food, but tests proved negative. Norovirus was identified after a firm used by the chain for health-crisis management tested employees' stool. By then, hundreds of people were probably already exposed.

"It was a learning moment for everyone in the company," Shlemon said. "We're in this business and we're not 100-percent educated about this virus, and the public is even less educated. They immediately think there's something wrong with the restaurant."

No one was seriously injured, but Shlemon said the company's insurance services paid an estimated $100,000 in compensation to victims for lost work and medical bills.

A handful of victims who declined to settle have filed lawsuits or say they plan to do so, he said.

Same-store sales at the unit dropped between 20 percent and 40 percent in the week following the incident, which was widely reported in the local media -- though unit sales are recovering and the rest of the chain was not affected, Shlemon said.

The company also published a full-page ad offering a public apology in the local paper. And brand protection services firm Steritech, based in San Diego, was brought in for four days of intensive training with employees on every detail of foodborne illness prevention, from hand washing to temperature control.

Shlemon said every Carrabba's unit now has several "vomit cleanup kits," in addition to the blood cleanup kits put in place several years ago.

Key in prevention, he added, is rethinking sick-leave policies.

Like most foodservice operators, Carrabba's doesn't offer paid sick leave. But, since the incident, the chain's managers now ask any employee who calls in sick about specific symptoms, such as vomiting or diarrhea. If they report such symptoms, they are excluded from work for 72 hours.

Managers are given discretion to determine whether the sick employee will be paid for time lost.

If they have really been sick, they'll probably get paid, Shlemon said. But probably not "if there's a big concert that night," and managers suspect abuse of the practice, he added.

Still, Shlemon conceded that workers worried about losing pay might not always tell the truth about their symptoms.

In the 2005 Food Code, the FDA addresses norovirus for the first time as an illness that employees must report to managers, who must then report to the local regulatory agency -- but only when the norovirus is specifically diagnosed and workers without health insurance are considered unlikely to visit a doctor.

The code outlines when and how long employees should be excluded from work under certain circumstances, generally 24 to 48 hours after symptoms have cleared. But as of December, only Mississippi and Puerto Rico had adopted the 2005 version of the code, according to the FDA.

Attorneys who specialize in foodborne illness complaints, however, contend that established sick-leave policies could offer restaurants some protection in the event of a lawsuit.

Dave Babcock, an attorney with Marler Clark, a Seattle-based law firm that represented plaintiffs in the 1993 E. coli outbreak at Jack in the Box, pointed to a 1996 norovirus outbreak at the Reno Hilton in Nevada. In that case, a jury awarded six victims punitive damages of $25 million, in part because the casino did not have a sick-leave policy.

That case is pending on appeal. Marler Clark also is representing a victim in the Carrabba's incident and plaintiffs in several other norovirus cases. One involves an outbreak at a Blimpie in Grand Rapids, Mich., which reportedly left 125 sickened.

The law firm settled for an undisclosed sum on behalf of six victims of a norovirus outbreak linked to Si Casa Flores restaurant in Grants Pass, Ore., in January 2005. In that case 32 people reportedly fell ill.

The firm also is suing on behalf of 125 individual clients who became sick after a norovirus outbreak in 2004 at the Flamingo Hotel in Las Vegas, in which an estimated 1,200 to 1,300 people fell ill. Class-action status was denied in that case.

That outbreak was thought to be caused by a sick conventioneer who vomited in the facility and consequently sickened several hundred hotel workers, who inadvertently spread the virus, Babcock said.

Such cases emphasize the importance of hand washing and other basic sanitation practices, attorneys say, especially given that victims of such outbreaks can shed the virus in their stool for up to two weeks after they feel better.

That means restaurants should ensure specific food-safety policies are enforced, said Drew Falkenstein, an attorney with Marler Clark who is involved in the Carrabba's lawsuit.

Even if a guest contaminates a surface at a restaurant, he said, "that virus is not going to get from a customer's hands to another customer's food without some breakdown in restaurant policies."

Lack of understanding about how the virus works has put some restaurants out of business.

In November 2002, a Chuck-ARama buffet chain based in Salt Lake City was hit by the virus, which health officials said likely came from restaurant employees who came to work sick. In that case, 250 illnesses were reported to the health department, though officials estimate the number of victims probably topped 800.

At the time, the health department closed the Chuck-A-Rama unit for cleaning, but, after the restaurant reopened, another round of illnesses was reported.

"One of the hard things was learning what it takes to take care of this virus," said Ron Lund, environmental health supervisor for the Salt Lake Valley Health Department. In retrospect, the relapse could have been caused by improper cleaning -- or that employees lied about being sick.

When the unit closed for a second time, the operator decided to shut down permanently, Lund said. Calls to Chuck-A-Rama's Salt Lake City headquarters were not returned by presstime.

Before the Carrabba's case hit Lansing, Pessell of the health department there said he had read and heard very little about noroviruses. Now advisories are being developed on the state and local levels to better educate restaurant operators.

"We visit restaurants only twice each year, but it's only when something like this happens -- and when people are being open and honest about it -- that we find what really goes on," Pessell said. "We need to bridge that gap. Are we regulators or are we partners in this?"


Reproduced courtesy of Nation's Restaurant News under license NRN - 2006100346576