Most fast-food workers donít wash hands properly, FDA official says

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The Rock Island County Health Department has provided more than 5,325 doses of protection against hepatitis A in the past nine days.

About 100 people showed up Tuesday for the final free public clinic at which the department administered either the hepatitis A vaccine or a drug called immune globulin. The inoculations were free to anyone who visited the McDonald's restaurant at 400 W. 1st St., Milan, Ill., during July 13-14.

The food-borne illness has affected about 25 people to date.

Fifteen of the victims are from Rock Island County, and all of them ate at the Milan McDonald's, health department spokeswoman Theresa Foes said.

The disease has also affected five people from Mercer County, Ill., two from Scott County, Iowa, and residents of Henry, Warren and Woodford counties in Illinois.

The signs are ubiquitous in restaurant restrooms: "Employees must wash hands before returning to work."

But a federal government scientist who co-authored a study on the subject says more than half of all employees in the fast-food industry fail to wash their hands properly or use gloves when working.

"There's a disconnect between what we want to see and what is actually implemented," said William Burkhardt, a food virologist and microbiologist with the U.S. Food and Drug Administration, or FDA.

Burkhardt, of Dolphin Island, Ala., helped author a cleanliness and hand-washing study that was also sponsored by the U.S. Department of Health and Human Services.

That said, there are tens of thousands of fast-food establishments around America, and incidents such as a recent hepatitis A outbreak in the Quad-City region happen very infrequently.

"I only know of a few documented cases like this," Burkhardt said.

Some 25 people in the Quad-City region have a confirmed case of hepatitis A. Most of the cases, if not all, are connected to a McDonald's restaurant at

400 W. 1st St., Milan, Ill., where two employees were diagnosed with the disease that has flu-like symptoms. Eleven of the Quad-City region cases required hospitalization.

The Rock Island County Health Department just concluded on Tuesday a series of clinics at which at least 5,324 people were inoculated against the disease. All of them visited the McDonald's in question during early or mid-July.

Meanwhile, the Rock Island County Sheriff's Department is investigating why there was a delay in reporting to public health officials four hepatitis A cases handled by Trinity Regional Health System in late June and early July. Trinity officials said Friday that human error was to blame for the delay. The sheriff's department investigation is expected to be complete before the end of the week.

It can happen anywhere

Even restaurateurs who are vigilant about cleanliness can have problems with food-borne illnesses, even though it happens rarely, said Doni DeNucci, a spokeswoman for the Iowa Restaurant Association in Des Moines.

DeNucci, who has worked for the association for 14 years, said she can think of only two instances in which restaurants were affected by a severe food-borne disease outbreak.

One of them occurred four years ago when a fine dining establishment in Des Moines was found to be the cause of a norovirus outbreak. A salad preparer, who had recently completed a food-safety course, came to work one day when he "felt poorly but not real sick," she said. He completed his shift at the restaurant, and a number of patrons subsequently got sick with norovirus, a gastrointestinal illness commonly known as the stomach flu.

Restaurateurs need to be highly interested in food safety since good, safely prepared food is the source of their livelihood. But "sometimes, these things just happen," DeNucci said.

Norovirus, hepatitis A and E. coli, another gastrointestinal infection, are the most common food-borne illnesses involving restaurants, Burkhardt said. Norovirus, like hepatitis A, is spread by fecal matter on food products that are then ingested by unaware patrons. However, the hepatitis A symptoms might not show up for 10-14 days while those with norovirus know much more quickly, in as little as 12 hours after ingestion.

Easy to transmit

Those who ingest the hepatitis A virus need only a few particles to eventually become ill, according to the microbiologist. "Oftentimes, a hundred million of these viral particles are present in a gram of fecal material," he said.

Even a small piece of fecal matter on a person's hand can transmit the germs, especially to salads, uncooked food items or in ice. The virus is killed during proper cooking.

Best practices for preventing the spread of such illnesses are to order employees to do frequent hand-washing with warm water and soap, and the wearing of gloves.

Burkhardt is a proponent of gloves being used by food handlers. "These are relatively inexpensive," he said. However, the gloves must be discarded if they become dirty by performing a non-food task such as working at a cash register.

Turnover, vigilance

Fast-food restaurant owners and managers in particular must be vigilant about enforcing cleanliness rules among their workforce because the industry has so much turnover, Burkhardt said.

Most restaurants in Iowa have their managers and employees go through food-safety training, DeNucci said, and the practice is mandatory in Illinois.

"It's an industry with such a high turnover rate it's our goal to have all employees trained in a short course on food safety measures," she added. Many restaurants, including fast-food chains such as McDonald's, have their employees go through a training program called ServSafe.

In Illinois, managers must complete the Food Managers Certification Program, said Paul Guse, the environmental health director for Rock Island County. "Illinois is considered a leader in food safety training," he added.

Both states use outreach programs, such as the Iowa State University Extension, to do the actual training. Courses in the Quad-Cities are available at both Scott Community College and Black Hawk College, Guse said.

Dr. Patricia Quinlisk, epidemiologist and medical director of the Iowa Department of Public Health, cited the Quad-City area hepatitis A outbreak in a July 24 advisory: "Hepatitis A is endemic in Iowa," she said. "Infections can occur in Iowans without a significant travel history or known exposure to another case."

The state has had an average of 26 hepatitis A cases each of the last three years, and 16 have been reported in Iowa so far during 2009.





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