 Hello, my name is Julie Wagendorf. I work with the Department of Health with the Division of Food and Lodging. And today's webinar, Health and Hygiene, Best Practices When Handling Food for the Public, will be providing information that everyone can use to prevent spreading illness when handling food. This information is primarily gonna be focused on home-based food businesses that are not regulated by the Department of Health, yet who still will find the gold standard on best practices useful and important in their home businesses. Information in this presentation is based on the best practices of health and hygiene for food handlers recommended by the Centers for Disease Control and Prevention and the US Food and Drug Administration. And it is aimed at preventing ill food handlers from transmitting disease. The home-based businesses most commonly are referred to as the cottage foods industry. And so for those of you listening, if you're interested in starting a business in the cottage foods industry are already are, I have started that endeavor. You may be aware that there are some changes in this current legislative session. And although I don't have much of a update on any outcome, I'm assuming that by next week we'll have that information provided. And really it's just meant to provide some further clarification on some of the questions on what are allowed under the cottage food law. So we'll keep you informed. As we learn more. Moving on with today's presentation, I am going to advance the slide. And foodborne illnesses are caused by a variety of microorganisms or germs that can be acquired by consuming contaminated food or beverages, by contact with contaminated or recreational water like swimming pools and hot tubs can be transmitted by infected animals. And sometimes these animals don't show that they're sick. They're just spreading the germ that can cause illness in humans. And or contamination of microorganisms from the environment and infected people. So in today's webinar, we'll be focusing our discussion on mainly foodborne illnesses caused by the pathogens that are most frequently spread in food or beverages from infected food handlers. So we will be targeting the most common causes of foodborne illness as well as the proper hygienic best practices that can be put in place at the home business that will help prevent or reduce the likelihood of contaminating food. So the most common symptoms that spread foodborne illness are listed here on the slide. Vomit diarrhea, jaundice, sore throat with fever and infected wound or postular boils. This is a good presentation to give right after live so I apologize for some of the contents, but these are the symptoms that we are concerned about when it comes to handling food. And both vomit diarrhea I think are pretty well known about the common symptoms of foodborne illness, but sometimes it can be even more severe and the diarrhea can sometimes be bloody and it may be accompanied with fever or other severe complications that might include septicemia or an infection of the blood, which can lead to infection of other organism, organ in the body or kidney disease and kidney failure. So they really can be signs of severe disease. Jaundice is a common symptom of a virus called Hepatitis A. So we look for that symptom and targeting potential for Hepatitis A and that would be the yelling of the skin or the eyes. The sore throat and fever and infected wounds, those are symptoms caused by organisms such as deathlocacus aureus and streptococcus pyogenes, which can also be transmitted by food employees to consumers through contaminated food, and especially if you're dealing with a vulnerable population. And so we want to avoid handling food with any of those symptoms as well as any sneezing, coughing, having a runny nose, causing discharge from the eyes, nose or mouth. And those are all symptoms that should give an alert to the food handler when not to work with food. And also important to note that even these symptoms within your household members or family members, it's important to avoid handling food because they can be an indication that there's an infection or disease being spread throughout the household. And sometimes people don't show symptoms but are still infected and can still spread the illness. So even if you're feeling okay with someone else in your household, like your kiddos or maybe you're a caregiver for your parents, examples like that, even if those individuals are sick, you should avoid handling food. So this next slide breaks down what the FDA and CDC recommend as far as when these symptoms are present, when to completely avoid handling food, how long you should avoid handling food. Or in other words, when can you come back to work? And then in some situations, it may be okay to just be restricted to certain types of foods but not handling excessive food prep and ingredients. So we'll go through those symptoms again, the list of the most common symptoms related to foodborne illness. And again, with vomiting, diarrhea, or jaundice, whether it's you or someone in your household or a family member that you care for has any of those symptoms, it is highly recommended in our food code, our food laws require individuals with these symptoms to be excluded from handling food. And then the final column shows when you can come back to work. And so the recommendation would be 24 hours after your vomit stops or after the diarrhea stops. With jaundice, we want it to be within seven days. Or if a doctor says it's okay based on other testing. For sore throat and fever, if you're serving vulnerable populations, it's important to avoid handling food. But the general population, the recommendation is to at least limit that. So you could still serve pre-packaged items, things that are already prepared but not having to have been handled frequently by the food handler. And then when you're on antibiotics for 24 hours or when the doctor says it's okay, you can come back to work. And then if you have an infected wound or a postural boil that is, you can have it, that it can be covered. And if it's on your hands, it should be covered with like a tight fitted bandaid or dressing, covering, and then a glove should be worn over that. So as long as you can cover the affected area, you should be okay. And so just in summary, we want to say when it comes to the diseases that are most shown by symptoms with vomit diarrhea, really to make sure that you're waiting for that 24 hour time period to come back before you come back to work. And then keeping in mind that these are just symptoms. There's also diagnosed illnesses that the doctor's going to test for. And if you know what the pathogen is that's causing those symptoms, there most definitely will be additional restriction or exclusion requirements based on the pathogen. And there's over 40 known pathogens that can cause foodborne illness. Today we're going to only talk about six of them. And we're going to talk about the six that are most contagious and most common for spending foodborne illness from food handlers. So author nicknamed the big six. And I listed here on the slide for you to review the Centers for Disease Control and Prevention and the FDA cite these six pathogens. As being highly contagious and they can easily be transmitted by food workers and may cause severe illness. So these six foodborne pathogens include norovirus, the hepatitis A virus, salamonella typhi, sometimes nickname. You might have heard the story typhoid Mary is, is a kind of a typical story about. How this type of organism can be transmitted by someone over a long period of time. If you've heard about that story. Salamonella non typhoidal is just other salamonella species that are non typhi. And then we talk about the bacteria Shigella and also the bacteria Shigatoxin producing E. E. And if any of these big six are diagnosed by a physician, they are reportable to the health department. And there are restrictions and testing requirements before you can come back to work in a food business. And during a case investigation with the health department, a history of exposure to someone infected by a disease. And during a case investigation with the health department, a history of exposure to someone infected is also considered such as an ill family or household member. So part of that case definition, if any of those illnesses are diagnosed, that clinical information is reported by the physician or medical health care provider or laboratory. It's reported to the health department and the health department is required by law to investigate and follow up on these types of illnesses. So we look into the clinical information that's received as it is a reportable condition in North Dakota, the occupation of the infected person. And in this case, because we're focusing on food, we're really interested if the person may be a food handler. Also important is if the person works with small children or the elderly or as a caregiver, those types of things are important because we want to make sure that there's measures in place so the disease isn't spread further and public health interventions are taken. We ask about travel history, food and water history as far as what items have been purchased and consumed. And the last, usually we go back three days, sometimes back as far as seven days depending on what the suspected agent is or the diagnosed agent is. And then we also ask about large gatherings, public events that have been attended and figure out if there's any child care settings or school settings that need to be taken into consideration as well. So who is affected by food-borne illness? Really anyone in the general population is at risk for food board illness. But what we want to bring attention to are especially vulnerable populations and those would be people that are immunocompromised that have their immune system that's impaired by disease or medical treatment such as cancer, patients, HIV patients, pregnant women are considered a vulnerable population, preschool young children, preschool aged, the elderly, people who have underlying health conditions who are ill, and then also people confined to facilities that provide custodial care. So as we move forward these next couple of slides, we're going to focus on the most likely cause of illness resulting from food-borne or from ill food workers in the food is caused by a virus called norovirus. And I like to start with learning about norovirus because I feel that we can use that as a gold standard if you understand what and how norovirus is spread and how to prevent that from getting into food, then a lot of the same types of hygienic practices and employee health policies will protect from the other types of diseases as well. So just starting out with this virus, a lot of people consider or nickname this the stomach bug or the stomach flu. And although it has nothing to do or it's not similar at all to the virus called influenza that causes flu, which is an upper respiratory infection, it's just over time been given that nickname. So you might have heard many people call it the stomach flu, stomach bug, sometimes it's referred to as food poisoning, or it's a viral infection, and it causes more than 50% of our outbreaks. That's the statistic for both the nationwide food-borne outbreaks reported as well as the state of North Dakota. So our stats also reflect that and it causes more than 50%. The symptoms that you get from this virus is diarrhea, vomiting, nausea, stomach aches, stomach pain, and it usually lasts about 24 to 48 hours. So you hear people refer to it as the 24-hour flu bug, things like that. You can get sick multiple times in your lifetime. You won't have long-term immunity if you get sick with this virus, and most people can contract it up to five times in their lifetime. So a little bit more on this virus. We talked about how it's important to know if whether or not your family member, household members are suffering from any of these illnesses. About 30% of people infected with Norovirus are asymptomatic. So if you have something going around your household, you may not know that you're infectious because you may not have symptoms. Most people, the people that are most contagious do have symptoms, though. You can still shed the virus and spread it, but you are most contagious when you have symptoms of vomit and diarrhea, and that usually takes about 12 to 48 hours to kick in once you're exposed and then it lasts about one to three days. However, you can still shed that virus in your stool for up to two weeks after you feel better. So you can be contagious for a really long time even after you get better. And symptoms can be severe for young children and older adults. Both vomit and diarrhea can lead to dehydration and hospitalization, and it's important to prevent that dehydration by drinking plenty of water and seeking health care if symptoms don't subside. So we talk about Norovirus. We're going to use this as an example of other types of the microorganisms that we're focusing on for today's discussion. Most of them will spread by the fecal oral route. Norovirus is highly contagious, as are the other diseases that we're talking about today. And you can get in contact with some of these illnesses, by just touching surfaces or objects that are contaminated with the microorganism and then putting your hands in your mouth. And so frequently touched surfaces would be considered something like faucets in a bathroom, door handles, light switches, things that are frequently handled. And then direct physical contact with an infected person. So for an example, you could be changing a baby's diaper or something like that. You can be drinking or eating food that is contaminated with Norovirus. So if someone is sick and has used the restroom and then goes to handle food, that is how the virus gets into food and then that food is ingested by someone else and then they get sick. And then also through aerosolized vomit. So there are outbreak settings caused by Norovirus especially, where there's a public vomiting event or someone gets sick in a public setting and people several feet away have come down with the same virus just by the droplet spread on the force of getting sick in public, how it disperses through the air. Just a little idea, again, using Norovirus as an example, but keeping in mind that all these diagnosed illnesses are just as contagious and just for the interest of time, I'm focusing on the one that's most common. So how contagious is Norovirus? So just a very small amount is to use 18 viral particles of Norovirus on your food or your hands can make you sick. And so to put that into perspective, that means that the amount of virus particles that fit on the head of a pin would be enough to infect more than 1,000 people. And so the reason why I have the picture of a spoon with a fourth teaspoon is to give you an idea of how much or how much a gram would be and also know that millions of viral copies per gram are shed in feces of symptomatic infected people. So if you think about one gram of stool having millions of copies of viral particles or viruses and then only about eight of those are required to get someone sick, it just goes to show how very contagious this virus is and how it spreads so easily and quickly throughout the public and throughout the setting. And there are the millions of viral copies per gram of feces in symptomatic people with diarrhea. And if you ever wanted to know how much of a gram of feces would be, it'd be about a fourth teaspoon of sugar as an example. I didn't know what else to use. So let's talk about prevention strategies because none of us mean for or want anyone to become sick if we're handling food for our families, for the public, for our food business, whatever the situation might be. So let's talk about how we prevent this from happening. First and foremost, the most important thing is to avoid handling food. So we already kind of talked about that and one of the first couple of slides we had that table that showed when you need to avoid handling food and not to come back for 24 hours, that absolutely is important. And one of the reasons why is because these bacteria and viruses are so contagious that really just handwashing alone isn't probably enough to keep it at bay. The next most important thing is handwashing. And I'm not saying that that's not an important thing. It's just you can wash your hands all day long and it's just these viruses and bacteria are so contagious you're probably not going to get rid of it all. So it's just best to stay away from the food handling business during this time of illness. We'll talk about food contacts, surfaces and proper sanitation and cleaning and how to do that and what to use for sanitizers, how to check to see if you have the right sanitizing concentration that would be effective. And then again, coming back with the hands, eliminating bare hand contact with ready to eat foods, especially known with some of the viral types of illnesses that are spread. It's just important. So if you're going to be handling sandwiches or cutting or chopping a lettuce or doing something that you're going to serve to someone in the public and it's not going to get cooked anymore, they're going to just directly, it goes from your service and they're going to eat it, that's ready to eat and that's the most high risk food in this category. A little bit of information for you. Is the, there's a fact sheet that we have on our website, so that's ndhealth.gov slash food lodging. And it does give you some guidelines on how to clean up and disinfect, diarrheal and vomiting events. So if you do have people sick in your home or whatever studying you're in, these are guidelines on how to effectively clean those areas. And we do have some free download fact sheets that you can find and help you get rid of any situations that might have occurred. And then also, again, just to show on our website, we have additional information off to the right on employee health. So whether you're a food business or not or a cottage food business that requires regulation or not, these are good resources to use as best practice to make sure that you're following all the prevention strategies that are known to be effective in preventing foodborne illnesses. So we talked about reporting some of these diseases to the health department, how that works. I just wanted to show you quickly a schematic as an example so we might get a call from whatever the situation might be. This example is a wedding over the weekends. And then once our disease control epidemiologists get information, we collect information from the guest list, we get emails, phone numbers, we find out what food was served, what products were consumed, we get those lists, and then we go through and collect information about the people that got sick and what foods they ate compared to the people who didn't get sick and what foods they ate. And we use statistical tools to find what correlations there are to determine if there's any statistical significance on certain items that might have been implicated as the cause of an outbreak. All right, so part two of the presentation is hygienic practices. And so these again, they're based on the standards of our food code that we use in the regulated industry and should be considered as the gold standard or best practices, whether your industry is regulated or not. They're just really important for you to know about so you can prevent any inadvertent illnesses from happening while handling food. So the first thing is we look at a food business, we look at the management and the personnel. So we look at the person who's in charge and make sure that that person realizes that they're responsible to be knowledgeable about how foodborne illness is spread and how to prevent that. How to train their staff, if there is staff or train yourself if you're your only staff and then also how to and when to restrict ill food workers. So you might be just worried about yourself, your family members or maybe you have employees. All that would be the responsibility of the manager, the person in charge. Most important aside from avoiding handling food when you're sick would be proper hand hygiene. So hand washing goes a really long way and there's a lot that we look at in our code, our food code to make sure that hand washing is the number one intervention used while handling. And one of the things we look at is when to wash. So you want to wash your hands after you handle any raw food or after you might handle dirty dishes or doing chores around the house or doing chores around the yard. Pretty much anything, even if you kind of itch your face or mess with your hair, you know, anytime that you take and handle something that isn't part of that food process, you want to make sure that you wash your hands. How to wash. There's the five easy steps and there's a schematic here that you want to wash your hands with warm running water, soap, scrub well for 20 seconds, rinse that and use a disposable paper towel or dryer to get your hands clean. And then where to wash is the hand sink availability. So in the food code, we require that there's a designated hand sink. And so for any home business, I would also urge while you're in the production, while you're in production to designate the sink for hand washing and stage your work area. So you have access to hand washing at all times at the operation. And I might take time logistically, because in a regulated or an industry setting, that's why our hand washing sinks are required to be designated for hand washing only. So they're not obstructed with food or dirty dishes or things thawing. They're always available to wash your hands. It always has hope. It always has paper towels and it's never skipped because it's not available to us. So hand washing is super important. The next couple items are just additional best practices for hygiene. If you're going to be tasting food while you're making it, make sure that you do it in such a way that's not cross-contaminating it, your food. During times of production, you want to make sure that other people are already in the kitchen eating or that you're not snacking while you're in production. If you, please, you know, stay healthy and hydrated. But if you need something to drink, it's recommended that you have a closed container with a straw so you don't accidentally contaminate or tip over the glass or anything like that. And also, you can't, we wouldn't want anyway, the use of tobacco products while food is being prepared. Hair should be restrained. Some folks use hair nets. That's fine. Even just a hat or a cap with hair tied back is fine. Clothes and personal cleanliness is important. And then just separating food production times from other chores or on the yard. If you do farming, feeding animals, and also separate from pets if you have pets in the house. So we have cleaning policies and practices. And part of those are how frequent you clean. And then keeping in mind too, that if you're going to be cleaning food, contact surfaces, the water needs to be from a portable water source and properly plumbed and the waste management system should also be properly plumbed. So those things we're just assuming are understood. The manual dishwashing procedure required for industry in a commercial setting is a four step process. That's to wash, sanitize and air dry. And that's if you're using a chemical sanitizer. So first you're washing with the soap and detergent with warm water. And prior to that, depending on your operation, you might need to scrape the food and pre-rinse. So all the food is scraped off. And then you wash with warm water and soap. And then you need to rinse that soap off before the sanitizing step. Because the detergent if mixed with the sanitizer could deactivate that sanitizer. So the rinse step is to make sure that you could get detergent off before you sanitize. Sanitizing is highly recommended for home businesses. It will get rid of up to 99.9% of the undesirable microorganisms that could be contaminated on utensils or dishware. So although it wouldn't be required to use the same manual dishwashing procedure as commercial establishments are, it definitely is a best practice. And then after the sanitizer donk, you let that air dry and that gives contact time for the sanitizer to work. We'll talk about some sanitizers that are effective. You want to make sure that you're using a sanitizer that is EPA approved for food contact surfaces. But you can use bleach, and you can buy this bleach at a restaurant supply store or just in any big box store. If you use bleach that you buy at a Walmart or Target or Kmart type setting, you want to make sure that the label specifically says that you can follow instructions in making it for sanitizing and that it's okay to use on food contact surfaces such as dishes, cutting boards, baby bottles. And so I gave the example of that label in this slide. What the EPA requires is that you use an approved sanitizer for food contact surfaces, and that is approved by following the label instructions. So if you're using a chemical that doesn't have instructions on the label for what you want to use it for, then it's not EPA approved. So that's why the recommendation is, is make sure the bleach specifically says how to make that sanitizing concentration that it's okay to use on food contact surfaces. Typically, if you have a bleach that's added with a fragrance, those are not going to be approved for food contact surfaces. You won't find that on the label. You'll see it more for like toilets and kitchen floors and things like that, but they won't have that dishware. So that's really important. The other important thing is using test strips. So you want to target about 100 parts per million. And even following the label instructions, you want to make sure that you have that test strip. If you use too much chemical, you could be introducing a chemical contaminant into the food. And if you don't use enough, then it's not an effective sanitizer. So highly recommended that you get the test strip that comes with the sanitizer that you use. You can also find these at restaurant supply stores. Quaternary ammonium is another type of sanitizer. It takes different test strips. It's not the same as chlorine. It's a different type of sanitizer, but is also approved for food contact surfaces. So I wanted to mention that as well. The cleaning frequency. You want to make sure that everything's clean. You want to make sure that everything's clean before use. And if it's something that you're operating a long time throughout the day, you want to, you want to make sure it's cleaned every four hours. So if you're going to be operating for an eight hour day, using the same utensils in place, you don't want to stop and break after four hours. Otherwise have doubles, have double sets of tons or spatulas or things that you use. You can just after four hours, replace it with the new clean set. So that would be the best practice for proper cleaning and cleaning frequency. So I have contact information for the health department, our microbiology laboratory, our food and lodging division, and our division of disease control. We all three work very closely together when we investigate food burn illness and food burn illness outbreaks. We also work together closely through educational outreach and trying to prevent outbreaks from happening. And so if you do have any questions, please feel free to call any of our divisions and we'd be happy to help answer any of your questions. And my contact information as well is provided. And with that, I am willing and happy to answer any questions that anyone might have. All right, thanks Julie so much for that great presentation, very thorough presentation. Go ahead and type your questions into the chat now and I'll share those with Julie. Lucinda has maybe a comment here. She says, I sanitize cell phones one times a week to decrease the chance of transmitting illnesses. Purse cell phones are no loud in my kitchen, hand wash when entering house after shopping, et cetera. My family thinks I'm silly. Are those good practices? Julie, what do you think of Lucinda's comment? Lucinda, I think it's a great practice and something that is especially in this time, so many people have smartphones that they kind of depend on and we're getting recipes off our smartphones. It really can transfer and have transient bacteria on them. So especially if you need to have your smartphone available in the production area if you're operating a food business, I would recommend trying to kind of keep that out of the food contact surface and the handling part of it. But it's not going to hurt at all to wipe it down with a sanitizer. And I think it's great that you do. But as far as the purses too, there's so many times we put the purse on the floor. Think about how many times you set your purse on the floor. Then you come home and you set it on the table. I sanitize the bottom of my purse all the time. So you're not alone. Thanks, Julie, and thanks for the comment, Lucinda. If anyone else has questions, go ahead and please type them in the chat right now. Say, Julie, on the slide where you were showing the sanitizing practices, I noticed that there was a warning there about mixing bleach and ammonia. And I'm not sure if you've commented on that. I might have missed it. But can you talk about that a little bit? Yeah, I can. That's a safety warning on any bleach item and just warning that those two chemicals fumes from those two chemicals when cleaning could be harmful to health. So you'd find that safety warning on any bleach container to not use it in proximity with an ammonia. Thanks. Okay. I don't see anyone typing in the chat and I don't see any other questions. I hope I'm not missing them. So Julie, thank you so much for the presentation and for joining us for Field Before today. You're very welcome. Thanks for the opportunity. Thanks everyone for attending and attending throughout the series. Like I said, this is the last Field Before of the season. Please look for that link to the survey. I'll also be adding the link to Julie's presentation and the certificate of completion to the website in just a few minutes. Thanks, everyone. Have an awesome, awesome day.