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Hand Hygiene, Infection Prevention and Food Safety Blog

Preventing Norovirus Outbreaks in Restaurants with Clean Hands

norovirus-restaurants.jpgCustomers never order a salad with a side of norovirus, but it’s a common pairing when food service employees don’t practice proper hand hygiene. In fact, according to the Centers for Disease Control and Prevention (CDC), 70 percent of reported norovirus outbreaks are caused by infected food workers contaminating food[1]. These outbreaks can be prevented by ensuring food service workers are educated on proper hand hygiene practices, avoid touching ready-to-eat foods before serving and stay home from work when they are sick.


Norovirus is highly contagious and can spread anywhere food is served, making people sick with vomiting and diarrhea. While sick, infected people shed billions of tiny viral particles and it only takes up to 18 to make another person sick[2]. The CDC reported that about 20 million people get sick from norovirus each year[3]. In addition to the risk of a norovirus outbreak, poor hand hygiene will lead to increased illness and can result in lost productivity, disruption in cost through employee absence, reduce employee efficiency and morale. It can even severely damage a restaurant’s reputation and brand image.


Implementing a hand hygiene routine, and maintaining it, is a daily challenge for any organization. Employers and facility managers are legally responsible to provide a safe, healthy and productive working environment. Hand hygiene is a vital asset in achieving that environment for both employees and customers.


Where Norovirus Hides


Norovirus is the leading cause of illness and outbreaks from contaminated food in the United States. According to the CDC, health departments reported 1,008 norovirus outbreaks from contaminated food between 2009 and 2012, most of which occurred in food service settings.


The CDC looked at foods that were commonly implicated in norovirus outbreaks. Leafy vegetables, fruits, and mollusks, such as oysters, were the most common single food categories implicated in these outbreaks. Of 324 outbreaks with a specific food item implicated, more than 90 percent were contaminated during final preparation.


Studies continued to find that 1 in 5 food service workers have reported working while sick with norovirus symptoms, and that food service workers practice proper hand washing only 1 of 4 times when they should[4]. There are numerous opportunities for norovirus to spread within food handling, which is why hand hygiene is ranked as such an important step in limiting outbreaks.


Maintaining Clean and Healthy Hands at Work


In order to reduce the risk of a norovirus outbreak within food service settings, employees must wash their hands frequently throughout the workday. Follow these steps to maintain a clean food service environment:




  • Wash hands properly and often. Apply a small amount of hand cleanser to dry hands. Rub hands vigorously together for at least 20 seconds. Scrub all surfaces, including the backs of hands, wrists, between the fingers, and under the fingernails for at least 20 seconds. Pay particular attention to the backs of hands and fingertips as these spots are frequently missed Rinse well and dry hands with a clean disposable towel to avoid risk of chapping or further risk of infection. Make sure to use a clean towel to turn off the faucet.


  • Use the right cleanser for the job. There is an ongoing misconception that a hand cleanser’s performance is measured by its ability to clean hands aggressively. In actuality, most cleansers far surpass the user’s actual requirements. Make sure to choose a sanitation product that takes into consideration the impact on the hands, yet is still effective for the job.


  • Keep cleansers easily accessible. The location of hand cleansers can help increase hand washing compliance. Place them where they are easy to find and enforce the importance of hand washing throughout the day, such as break rooms and serving stations.


  • Use gloves where required or necessary. It’s not always practical to use gloves when working. Nonetheless, gloves should be used whenever possible to ensure that cross-contamination is less of a risk.


Developing an effective hand washing technique is imperative to ensure hands are thoroughly clean. Perfecting proper hand washing skills is just as crucial for a restaurant’s success as providing excellent customer service and meals.


To limit norovirus outbreaks and other sicknesses within a facility, implement the following hand washing practices for all employees:



Finding the Right Cleanser


Once your team learns more about prevention, the next step is to pick the best-suited hand cleanser and dispensing system.


Washroom cleansers are great for publish restrooms and high-traffic facilities where effective, gentle cleansing is required for everyday dirt and grime. Most people are familiar with these types of cleansers, which can encourage hand washing compliance.


Antibacterial foam cleansers help protect from infection and prevent cross-contamination while also removing vegetable oil, animal fats, dirt and grime. This is an ideal option for restrooms and in food handling environments where employees can be exposed to foodborne pathogens.   


The appropriate cleansers should be available and accessible to workers at required areas, such as food processing area entrances, washrooms, and hand washing stations.


Emergency Hand Sanitizers

During a busy dinner rush, it’s not always easy for servers or chefs to drop their responsibilities and find soap and water and wash their hands. In this case, it is acceptable to use an alcohol-based broad spectrum hand sanitizer that contains at least 60 percent alcohol. Alcohol-based hand sanitizers used in food handling environments should be fragrance-free and ideally have an NSF E3* rating. Gel-based products can be sticky and leave gelling agent residues on the skin. Foam based products enjoy a higher consumer acceptance and do not leave an unpleasant or sticky residue on the skin.

According to the CDC, hand sanitizers with an alcohol concentration greater than 60 percent are very effective at killing germs and can reduce the number of microbes on a person's hands quickly. However, it’s important to note that hand sanitizers don't eliminate all bacteria and are not completely effective against norovirus. Washing hands with soap and water should always occur as soon as possible after using hand sanitizer.


Training Employees Is Key

Along with learning the new maze of restaurant tables and storage rooms, new employees should be trained on proper hand washing techniques and frequency during orientation. Show new workers where the sinks and sanitizing stations are and remind them when to wash their hands.


Employers can encourage good hand hygiene practice among all employees by providing easy-to-understand awareness materials such as posters and stickers for use in washrooms, food processing areas, and on mirrors and doors to remind employees of the importance of clean hands. Washroom services suppliers can also work with employers to create a hand washing campaign. Free downloadable posters are readily available from established suppliers to help promote hand hygiene.


Download Food Service Posters & Resources


Limiting norovirus outbreaks within restaurants and the food service industry can be achieved with a systemized approach to skin care. Educating employees, applying proper hygiene practices and providing the right soap and sanitizer options are the basic steps in adopting and maintaining a simple, yet cost-effective solution.


Klotz is technical product manager at Deb Group. He holds extensive experience in professional skin care products to prevent work-related occupational skin diseases.



[1] http://www.cdc.gov/vitalsigns/norovirus/index.html

[2] http://www.cdc.gov/norovirus/food-handlers/work-with-food.html

[3] http://www.cdc.gov/norovirus/trends-outbreaks.html

[4] http://www.cdc.gov/vitalsigns/norovirus/index.html


Additional content:

*NSF International certifies food related products and systems. Antibacterial hand soaps fall under the NSF standard E2 and hand sanitizers under the standard E3.  


About the Author


Andreas Klotz is Technical Product Manager at Deb Group, the world's largest leading away-from-home skin care company. He holds extensive experience in professional skin care products to prevent work related occupational skin diseases. After completing his Bachelor at University of Applied Sciences in Germany with a specialization in skin care and detergents, he worked in R&D and Marketing for Stoko in Europe for 17 years before he became a Sr. Marketing Manager with Stoko in the USA in 2012.


Stoko was acquired by Deb where Klotz manages marketing for the industrial segment focusing on solutions to ensure hands stay healthy at the work place.  You can contact Andreas on LinkedIN.

Topics: Cross-contamination Prevention - Food Industry, Norovirus, Food Safety

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