Business Continuity Plan, Prepare, Prevent Katherine MJ Swanson, PhD Vice 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

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

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.

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

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

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

Norovirus Example – Know The Enemy

US Top Confirmed Foodborne Outbreaks 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. Location of US outbreaks Source: CDC 2001 MMWR 50(RR-9):1-24 http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-factsheet.htm

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.

How is Norovirus Transmitted? Source: CDC 2001 MMWR 50(RR-9):1-24 http://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

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

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

How Long Does Norovirus Survive? Initial population >100,000,000 FCV particles/ ml Doubletree et al 1999. J. Hospital Infect 41:51-57 Estimated with Feline Calicivirus (FCV) <1 min - 212°F 5 min - 158°F 60 min - 133°F 99°F 68°F 39°F <1d 21-28d >56d Dry ~10d 14-21d >60d Liquid

Initial population >100,000,000 FCV particles/ ml

Doubletree et al 1999. J. Hospital Infect 41:51-57

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

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.

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 cleaning Source: MMWR 55(14):395-7 Sub Sandwiches – Michigan, 2005

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 cleaning

Cruise Outbreak 1988 Relationship between number of people using a communal bathroom and risk of illness Source: The Lancet; Oct. 21, 1989; pp 963 0 10 20 30 40 10 20 30 40 50 60 70 No. of Users per Toilet Attack Rate (%)

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

~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.

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.

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.

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)

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

Contains

Standard Procedures

Disinfectant

Gloves

Absorbent beads

Scoop

Bag

Mask

Shoe covers

Wipes

Apron

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

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.

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.com Links to WHO & CDC. Fact sheets on Public Health topics of concern.

www.ecolab.com

Links to WHO & CDC.

Fact sheets on Public Health topics of concern.