While having food safety policies that include hand washing, use of gloves and sanitation of surfaces is critical in combating norovirus outbreaks at restaurants, implementing a food safety management system that oversees and documents those policies is the best course of action.

Norovirus experts detailed best practices for restaurants today during an online panel, “Restaurant Policies and Practices Related to Norovirus Outbreak Size and Duration,” at the 2021 Food Safety Summit.

Lee Ann Jaykus, William Neal Reynolds Distinguished Professor in the Department of Food, Bioprocessing and Nutrition Sciences at North Carolina State University, said norovirus has been referred to as the “perfect foodborne pathogen” because of its sanitizer resistance, evolution of strains and ability to infect someone even when small numbers of the virus particles are present.

Although norovirus doesn’t grow in foods like some other pathogens, it is able to remain stable in environments for weeks and possibly months, said Jaykus, scientific director of the Food Virology Collaborative (NoroCORE), a five-year project at the U.S. Department of Agriculture’s National Institute of Food and Agriculture.

Anita Kambhampati, an epidemiologist for the Center for Disease Control and Prevention’s National Center for Immunization and Respiratory Disease, said norovirus is the leading cause of foodborne illness outbreaks and overall cases in the U.S. From 2009-12, nearly half of those outbreaks were from norovirus, she said.

Research on foodborne norovirus outbreaks from 2009-15 showed that 76 percent of the cases with a known contributing factor implicated food workers as a source of the virus, and bare hands in contact with ready-to-eat foods transmitted the virus in more than half of those cases.

Kambhampati said following the Food and Drug Administration’s Food Code model and guidelines from the CDC have been shown to greatly reduce norovirus cases.

Five recommendations for foodservice operators have been shown to reduce norovirus transmission,  she said. Those are:

• Hand washing requirements
• Preventing bare-hand contact with RTE foods
• Keeping employees who have vomiting and diarrhea out of the workplace (regardless if they’ve tested positive for norovirus)
• Employing a certified food protection manager
• Having a response plan for contamination events.

Kambhampati also said employee and manager training has been linked to a reduction in the number of norovirus cases in outbreaks.

Glenda Lewis, director of the Retail Food Protection staff in FDA’s Center for Food Safety and Applied Nutrition, said states have adopted varying degrees of the FDA’s Food Code. She said the agency’s goal is full adoption in every state, which “establishes really practical science-based guidance for mitigating risk factors that are known to cause foodborne illness.”

“It’s an important part of strengthening the national food safety system,” Lewis said.

Guideline compliance and behavior change is key, said Lewis, who highlighted results of a 2017 review of food safety management systems at foodservice establishments and how they affected norovirus outbreaks. Again, removing ill employees from restaurants was found to be a significant step in reducing the size of the outbreak, she said, and having a strong food safety management system leads to better compliance.

Hal King, president and CEO of Public Health Innovations LLC, said the science is clear: to reduce the number of people who become ill from norovirus, restaurants must have specific food safety controls defined.

King and other panelists touched on lower norovirus numbers in 2020, and the COVID-19 pandemic’s likely contribution to the dro in cases, with social distancing and shutdown or curtailed business at restaurants. Panelists said the issue needs to be studied more, and King said there’s a case to be made that some of the pandemic safety procedures could be helpful in limiting norovirus cases in the future.

That includes temperature and wellness screening before employee shifts, and using hand sanitizers and personal protective equipment.

But those steps are just one part of an overall food safety plan at a restaurant, King said, and protocols must be set for everything from food cooking temperatures to proper cleaning procedures.

“You really can’t manage food safety if you don’t know that controls are in place on a daily basis,” he said. “So you need a food safety management system in place that your manager can check every day.”