Business Continuity: Plan, Prepare, Prevent

© 2008 Ecolab Inc. All rights reserved.

Business Continuity

Plan, Prepare, Prevent

Katherine MJ Swanson, PhDVice President Food Safety

May 19, 2008

National Restaurant Association Show

Crisis Planning: Business Continuity Workshop

for Restaurateurs


Business Continuity

Different kinds of business disruptions One time event OR on-going disruptions Site specific OR regional OR national OR global disruptions Impacts employees OR customers OR both Perceived OR real Etc….

Planning, preparation, and prevention are essential to minimize disruption


Example –

Perceived issue Is the poultry safe for

consumption?

Real issues Will poultry be available? Will people be coming to

restaurants? How can transmission be

minimized? Etc.

Avian Influenza versus Pandemic Influenza


Business Continuity

Planning is essential! Identify potential risks Plan for the worst Leverage your industry and supplier resources Include your team Use available tools


Plan, Prepare & Prevent

Plan a scheme or method of acting, doing, proceeding, making, etc.,

developed in advance

Prepare to put in proper condition or readiness

Prevent to keep from occurring; avert; hinder

Definitions from Dictionary.com


Norovirus Example – Know The Enemy


US Top Confirmed Foodborne Outbreaks

0

50

100

150

200

250

300

350

1992 1997 2002 2007

# O

utb

reak

s R

epo

rted

Camplyobacter

E. coli

Salmonella

Norovirus

Norovirus emerging as leading problem

Source: CDC 2006 MMWR 55(SS10):1-34; CDC 2000 MMWR 49(SS1)1-64; and CDC Outbreak Surveillance Data http://www.cdc.gov/foodborneoutbreaks/outbreak_data.htm


Why is Norovirus a Concern?

The virus is difficult to kill.

If not controlled, it can spread rapidly in a large population.

Health departments can institute mandatory closures.

Outbreaks can lead to negative publicity.

School13%

Other18%

Vacation10%

Restaurant or catered42%

Nursing Homes23%

Location of US outbreaks

Source: CDC 2001 MMWR 50(RR-9):1-24http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-factsheet.htm


How is Norovirus Transmitted?

Unknown24%

Foodborne57%

Person-to-person16%

Waterborne3%

Source: CDC 2001 MMWR 50(RR-9):1-24http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-factsheet.htm

USA


What is the Source of Norovirus?

Feces or vomit of an infected person Infectious dose < 10 viral particles One vomiting incident may aerosolize 100

billion viral particles.

Spreads : Directly from person to person Through unwashed hands Via ingestion of contaminated food or water Through contact with contaminated surfaces

An infected person may be contagious for 2 weeks after recovery

People can contract norovirus and become ill more than once


How is Norovirus Inactivated?

Difficult to inactivate Persists in chlorinated drinking

water

Persists in the environment Survives freezing and refrigeration Requires high temperature to

inactivate Survives in acidic environments

Source: Doultree, et. al. 1999. J. Hosp. Infection 41:51-57


How Long Does Norovirus Survive?

39°F 68°F 99°F 133°F 158°F 212°F

Dry >56d 21-28d <1d - - -

Liquid >60d 14-21d ~10d 60 min 5 min <1 min

Initial population >100,000,000 FCV particles/ mlDoubletree et al 1999. J. Hospital Infect 41:51-57

Estimated with Feline Calicivirus (FCV)


Norovirus –Learn from the Past


Airborne Outbreak

126 people attended a dinner at a large hotel.

During the meal, a woman vomited onto a polished wooden floor.

It was immediately cleaned with a mop and disinfectant.

THE MEAL CONTINUED.

Within 48 hours, 52 people reported norovirus symptoms.

1998 Dinner Party Outbreak

Source - Marks. 2000. Epidemiol. Infect. 124:481-487


Layout Plan of Restaurant

Source - Marks. 2000. Epidemiol. Infect. 124:481-487


Foodborne Outbreak

Employee returned to work the day norovirus symptoms ended

Same employee sliced lettuce Lettuce food prep sink also used

for handwashing

170 people ill 3 different lunch events Restaurant closed twice for

cleaningSource: MMWR 55(14):395-7

Sub Sandwiches – Michigan, 2005


Cruise Outbreak 1988

Relationship between number of people using a communal bathroom and risk of illness

0

10

20

30

40

10 20 30 40 50 60 70

No. of Users per Toilet

Att

ack

Rat

e (%

)

Source: The Lancet; Oct. 21, 1989; pp 963


Hurricane Katrina Evacuees in Houston Astrodome – 2005

~1200 of ~24,000 total evacuees (18%) had symptoms of acute diarrhea and/or vomiting.

Less-than-ideal conditions probably contributed to outbreak. Crowding Insufficient sanitation in bathrooms Lack of an adequate number of handwashing facilities Delays in cleaning and decontaminating soiled areas and bedding

Initial isolation procedures were difficult to maintain over time because they separated family members already traumatized by displacement, grief and personal loss.

Source – MMWR 54(40):1016-1018


Norovirus –Plan, Prepare, Prevent


Risk Reduction Plan

Review current cleaning, hygiene and personnel plans.

Do not permit infected workers in the establishment:

For at least 3 days after recovery Per FDA Food Code

Have a hand hygiene plan in place.

Hands should be washed frequently.

Discard food that may have been contaminated by an ill person.


Tips for Being Prepared

Have appropriate spill kits and other products on hand.

Have personal protective equipment (PPE) on hand.

Audit your products and procedures.

Consult with your local health department to find out what action will be required in the event of an incident or outbreak.

Post handwashing signage and procedures.


Antimicrobial Regulatory Status

Sanitizers Food contact surface sanitizers at EPA registered sanitizer concentrations

typically not effective against norovirus

Disinfectants EPA accepted a feline calicivirus (FCV) as a surrogate for norovirus in 2005 Products passing the FCV protocol can have EPA registered label claims

against norovirus

Hand care products There are no anti-viral claims available for hand care products, as they are

not recognized by the FDA (CDER)


Spill Kits Are Useful

Contains Standard Procedures Disinfectant Gloves Absorbent beads Scoop Bag Mask Shoe covers Wipes Apron

Be prepared, prevent spread


Prevention

Risk reduction and remediation considerations :

LEVEL GREEN: Standard procedures – maintaining hygiene when norovirus poses no direct threat

LEVEL YELLOW: Risk reduction – a heightened defensive response to an outbreak in your area/industry

LEVEL RED: Remediation – a focused response to an outbreak in your facility, designed to break the chain of infection or illness

INCIDENT CLEAN-UP – How to clean an incident of vomitus or stool contamination


What Can You Do?

Review procedures based on levels of risk, as well as incident clean-up.

Have appropriate products on hand. Check expiration dates where applicable.

Reinforce proper cleaning, sanitation and hygiene procedures with your employees.


Additional Resources

www.ecolab.comLinks to WHO & CDC.Fact sheets on Public Health topics of concern.

Business Continuity: Plan, Prepare, Prevent

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