Food Handlers, Illness Reporting and Fitness to Work

Personal illness is an important food safety issue for anyone working with or around food. An infected person can spread harmful bacteria, viruses and other microorganisms to food, water, equipment, surfaces and other people, sometimes without realising it.

Food businesses must have effective procedures for reporting illness, excluding affected workers and deciding when it is safe for them to return to food-handling duties.

Legal Responsibilities for Food Handler Illness

Food safety law places responsibilities on both food business operators and people who work with food.

A person who is suffering from, or carrying, a disease that could be transmitted through food must not handle food or enter a food-handling area if there is a risk of directly or indirectly contaminating food.

This includes people affected by:

• Diarrhoea
• Vomiting
• Infected wounds
• Skin infections
• Sores
• An infected nose or throat
• Another illness that could be transmitted through food

Food handlers must report relevant illnesses and symptoms to their manager or supervisor immediately.

What Is a Food Handler?

A food handler is not limited to somebody who cooks or directly touches food. The term can include anyone whose work may bring them into contact with:

• Open or packaged food
• Food-contact surfaces
• Utensils and preparation equipment
• Food packaging
• Food-storage areas
• Cleaning equipment used in food areas

Kitchen assistants, waiting staff, cleaners, warehouse employees and other workers may therefore be treated as food handlers, depending on their duties.

Symptoms Food Handlers Must Report

Food handlers must tell management immediately if they experience:

• Diarrhoea
• Vomiting
• Stomach pain
• Nausea
• Fever
• Jaundice
• An infected wound or sore
• An infected skin condition
• An infected nose or throat
• Symptoms of another illness that may be transmitted through food

They should also report if someone living in their household has diarrhoea or vomiting, as this may indicate that the food handler has been exposed to an infectious illness.

How Illness Can Contaminate Food

When harmful bacteria or viruses infect the stomach or intestines, they may be present in vomit and faeces. This creates a serious contamination risk.

Infectious microorganisms can be transferred to:

• Hands
• Food
• Work surfaces
• Utensils and equipment
• Door handles and taps
• Toilets and washrooms
• Cleaning materials
• Other employees and customers

Ready-to-eat food is particularly vulnerable because it will not receive a further cooking treatment capable of destroying harmful microorganisms before it is eaten.

Infected Cuts, Wounds and Skin Conditions

Harmful bacteria may be present in infected wounds, sores and damaged skin. A food handler must report any:

• Infected cut
• Boil
• Septic finger
• Weeping skin condition
• Open sore
• Red, swollen or pus-containing wound

Minor cuts and grazes should be completely covered with a suitable brightly coloured waterproof dressing. Gloves may also be required, depending on the location of the injury and the food-handling task.

If an infected wound or skin condition cannot be contained safely, the person must not handle food or work in an area where contamination could occur.

Can People Spread Infection Without Symptoms?

People can sometimes carry and spread an infection without showing obvious symptoms.

This may happen because a person:

• Is in the early stages of an illness
• Has very mild symptoms
• Continues to carry microorganisms after feeling better
• Is an asymptomatic carrier

This is why effective handwashing and good personal hygiene are required at all times, not only when somebody feels unwell.

Viruses and Food Handling

Viruses do not multiply in food in the same way as bacteria, but they can survive on food, hands and surfaces and may cause illness when consumed.

Foodborne viruses can spread through:

• Contaminated hands
• Food handled after cooking
• Contaminated water
• Work surfaces and equipment
• Person-to-person contact
• Droplets released during vomiting

Norovirus is particularly infectious and can spread rapidly in enclosed environments such as restaurants, schools, hospitals, hotels and care homes.

Parasites and Protozoa

Some gastrointestinal illnesses are caused by parasites or protozoa. Although these infections are less common in the UK than many bacterial and viral illnesses, they may still spread through contaminated food, water or poor personal hygiene.

Anyone diagnosed with or suspected of having an infectious gastrointestinal illness should follow medical and public-health advice before returning to food-handling work.

The 48-Hour Exclusion Rule

Food handlers suffering from diarrhoea or vomiting must be excluded from working with or around open food.

They should normally remain excluded until they have been free from diarrhoea and vomiting for at least 48 hours after the symptoms have stopped naturally.

The 48-hour period begins after the final episode of vomiting or diarrhoea, not when the person first begins to feel better.

Why Is the 48-Hour Rule Important?

Harmful bacteria and viruses may still be present after symptoms have stopped. Returning to food handling too soon could contaminate food and cause an outbreak.

Some diagnosed infections, including certain cases of Shiga toxin-producing E. coli, may require:

• A longer exclusion period
• Medical assessment
• Stool testing
• Approval from a health protection or environmental health professional

The standard 48-hour period may therefore not be sufficient for every illness.

When Symptoms May Have a Non-Infectious Cause

Vomiting, diarrhoea or abdominal symptoms do not always result from an infectious illness. Possible non-infectious causes include:

• Pregnancy-related sickness
• Side effects from medicines
• Medical treatments
• Crohn’s disease
• Ulcerative colitis
• Coeliac disease
• Food intolerances
• Other diagnosed medical conditions

However, food handlers must still report the symptoms immediately. They should not decide for themselves that an illness is non-infectious and continue handling food.

Management should assess the risk using the business’s fitness-to-work procedures and obtain medical or environmental health advice where necessary.

Single Episodes of Vomiting or Diarrhoea

A single episode may have a non-infectious explanation, but it could also be the first sign of an infectious illness.

The food handler must report the episode and stop working with open food while the circumstances are assessed. Relevant factors may include:

• Whether further symptoms develop
• Whether the person has a fever or stomach pain
• Whether somebody in their household is ill
• Whether there is a known outbreak
• Whether there is a confirmed non-infectious medical cause
• The type of food and customers involved

Where there is doubt, the illness should be treated as potentially infectious until appropriate advice confirms otherwise.

Alternative Duties for an Excluded Food Handler

An employee who is otherwise well enough to work may sometimes be moved temporarily to duties that do not present a food-contamination risk.

Possible alternative work may include:

• Administrative duties
• Telephone or computer-based work
• Training activities
• Work involving securely packaged goods
• Other duties away from open food and food-handling areas

Alternative duties are only appropriate when the risk of direct or indirect contamination can be controlled effectively. An ill employee should not be moved to another area where they could spread infection to colleagues or shared surfaces.

Assessing the Food Safety Risk

When deciding what action to take, managers should consider:

• The symptoms being reported
• The possible cause of the illness
• The person’s normal duties
• Whether they handle open or ready-to-eat food
• Whether the food will receive further cooking
• The likelihood of contaminating surfaces or equipment
• Whether vulnerable people will consume the food
• Whether other employees or household members are ill
• Any medical, public-health or environmental health advice

The risk is especially serious when food is being prepared for young children, older people, pregnant people or those with weakened immune systems.

Contractors, Visitors and Delivery Drivers

Fitness-to-work controls should not apply only to directly employed food handlers.

Businesses must also consider:

• Agency workers
• Cleaning contractors
• Maintenance engineers
• Pest-control technicians
• Delivery drivers
• Temporary workers
• Visitors entering food-handling areas

Anyone entering a food-handling area should follow the business’s personal hygiene and illness-reporting procedures.

Cleaning After an Ill Person Has Been at Work

If somebody has worked while suffering from a potentially infectious illness, all areas they may have contaminated must be cleaned and disinfected effectively.

Particular attention should be given to:

• Toilets and washrooms
• Flush handles
• Taps and washbasins
• Door handles
• Light switches
• Food-contact surfaces
• Equipment and utensils
• Shared telephones and keyboards
• Staff rooms and changing areas

Any food that may have been contaminated must be identified and disposed of safely. Cleaning staff should use appropriate protective equipment and follow the business’s procedures for dealing with vomit or diarrhoea.

Handwashing and Personal Hygiene

Food handlers must wash and dry their hands thoroughly:

• Before handling food
• Before touching food-contact surfaces
• After using the toilet
• After handling raw food
• After touching waste or bins
• After cleaning
• After blowing their nose
• After touching their face or hair
• After touching frequently handled objects

Alcohol hand gel must not be used as a substitute for washing hands properly with soap and water.

Returning to Food-Handling Work

Before allowing an employee to return to food handling, management should confirm that:

• The required exclusion period has ended
• The person has had no vomiting or diarrhoea for at least 48 hours
• Any infected wounds or skin conditions are controlled
• Any required medical or public-health clearance has been obtained
• The employee understands the necessary hygiene precautions
• There is no remaining risk of contaminating food

A fitness-to-work questionnaire can help the business assess and record whether it is safe for the employee to return.

Managing Food Handler Illness

Effective illness management requires:

• Clear reporting procedures
• Immediate action when symptoms are reported
• Appropriate exclusion from food handling
• Effective cleaning and disinfection
• Accurate records
• Suitable return-to-work checks
• Medical or environmental health advice when necessary

Excluding an ill food handler for a short period can prevent a much larger outbreak, protect customers and safeguard the reputation of the food business.