Food safety conference

Norovirus thrives on poor hand hygiene

Failure of food handlers to wash their hands properly is a main way norovirus is spread

Poor personal hygiene, and specifically the failure of food handlers to wash their hands properly, has been identified as one of the main sources for spreading norovirus – winter vomiting bug – in catering establishments, according to new research published by the Food Standards Agency (FSA).

Workers failing to wash their hands properly was also identified as a serious failing in food manufacturing plants, according to Sterling Crew, head of technical at Kolak Snack Foods and vice president of the Institute of Food Science & Technology, speaking at Food Manufacture Group’s food safety conference last month in a presentation titled ‘Creating a strong food safety culture in your workplace'.

“Food culture has been cited more and more in food safety incidents,” said Crew, at the one-day conference sponsored by Checkit, Dycem, eurofins, Ishida, Pal International and Westgate Factory Dividers. “When people do root cause analysis, yes they will go through the technical and operational findings, but what more commonly comes up is a culture of a business that allowed it to happen.”

Crew said creating a good food safety culture in any food business should be the “number one priority”. “Safe behaviour creates safe food,” he added. But he warned, although it was very important, “training gives you a false sense of security” and what was more important was: “Would people do the right thing?”

He concluded: “Food safety culture happens when you are not there. That’s when you know whether you are doing a good job or a bad job.”

Stop norovirus from spreading

The FSA study, carried out by Ipsos MORI, aimed to help stop the norovirus from spreading, by understanding and improving food handler behaviours (see box story below right). It was based on a literature survey and in-depth interviews, surveys, and structured environmental and behavioural observations during visits to catering outlets.

Five strategies for controlling norovirus identified in the research

1. Personal hygiene
2. Food handling
3. Washing and cooking food
4. Surface and uniform cleaning
5. Fitness to work

Data analysis and behavioural theories were used to rank behaviours which risk spreading norovirus in relation to the control strategies, according to the strength of evidence that food handlers expressed these behaviours (see box at bottom of this story).

Norovirus is the most common cause of infectious gastrointestinal disease in the community. In 2014, the FSA estimated approximately 74,000 cases of foodborne norovirus infection in the UK. Norovirus has frequently been associated with outbreaks of illness linked to raw or lightly cooked shellfish, principally from oysters, as well as fresh produce, particularly soft fruit.

However, the introduction of norovirus into food by infected food handlers is thought to be a significant contributor to human infection. Reducing the incidence of norovirus is a key priority for the FSA.

In November 2015, the FSA funded this study to enhance its understanding of norovirus transmission in the catering sector in order to better understand the role of food handlers in this context.

Participants in the research often reported recognition or awareness of the term ‘norovirus’ but knowledge about it was typically very low. There was often either a lack of knowledge or confusion about what norovirus was, and how it was contracted and transmitted. At best, participants had some awareness of norovirus symptoms and how to mitigate norovirus transmission but there was little evidence that norovirus was a particularly big concern.

What was more surprising was the knowledge and skills gap in terms of the awareness, and application of, recommended behaviours comprising more generic hygiene practice, such as what constitutes effective hand-washing.

Environmental barriers

Environmental barriers were often identified both in terms of: characteristics of the setting (time scarcity, busyness, workload, and in the case of returning to work, money and pay); and the physical design and infrastructure of food handling environments.

Both frequent micro-behaviours (eg hand washing, glove use, surface cleaning) and less frequent behaviours (eg uniform cleaning and exclusion from work) were environmentally influenced.

Social influences were notable by their absence. For example, there was a lack of social pressure or expectation to engage in recommended behaviours (which might also be related to not knowing what was appropriate), as well as the assumption that recommended practice was already happening.

Strongest evidence for norovirus spread identified in the study
  • Inadequate hand washing 
  • Not washing hands before gloving 
  • Using bare hands when preparing food
  • Not regularly changing gloves
  • Food handlers instead of trained staff cleaning areas where people vomited 
  • Not washing uniforms correctly 
  • Returning to work too early after being ill

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