Article brought to you by the Association’s Clinic Division

As in the rest of the world, the debate continues in South Africa amongst health professionals and public health authorities on the relative merits, costs and benefits of health surveillance of food handling personnel by means of routine medical examinations. Some enforce it through legislation, which makes it compulsory, while others do not require it at all. This situation is not in the best interest of all concerned and the Department of Health has decided to issue the following guidelines in this regard.

“Food Handler” means “Persons who in the course of their normal routine work come into contact with uncovered food not intended for their personal use.”

Strategy for Health Surveillance of Food Handlers

The following principles should be applied as part of a strategy:

- management commitment;

- education and training;

- health interviews;

- reporting illness to management;

- applying basic food handling practices; and

- applying basic personal hygiene practices

These principles can only succeed in promoting a high standard of safe food handling if applied and accepted in an open and trusting manner by all the parties concerned, namely, employers and employees. Mutual understanding and trust between management and food handling employees form the basis of a safe food handling strategy.

Management Commitment

The hygiene of food is the responsibility of management and can at no point be delegated to food handlers. Management commitment to the following is essential:

A programme of optimum hygiene covering all aspects of food handling. Vigilant and competent supervision in this respect is vital.

Open discussion and reporting of hygiene problems by employees and quick response with corrective measures.

Reassurance that food handlers will not suffer loss of pay or their jobs if they report symptoms such as diarrhoea or infected skin lesions.

Employment of technical experts to advise on hygiene.

Creating optimum hygiene conditions and practices and the regular upgrading thereof.

Implementation of quality control programmes.

Responding to consumer complaints regarding hygiene in a professional and responsible manner.

Implementation of an occupational health programme for improving working conditions and increasing product reliability.

Mutual trust should be developed amongst employees in order to support each other to maintain maximum hygiene levels. To create this, food handlers should be empowered to be part of the evaluation process regarding hygiene standards.

Education and Training

The following aspects are important:

Health authorities must accept that the education and training of food handlers are also part of their responsibility and should ensure that appropriate programmes receive their attention;

Education and training of food handlers are vital elements of food safety programmes.

Practical and functional educational methods and aids should be used. Language and other cultural factors should be taken into account.

All employees must know and understand the basic principles of food safety and their own responsibility in this respect.

Managers must be aware that employees who have gastroenteritis or open skin lesions must stay away from work or be prohibited from handling food while symptoms persist.

Food handlers should receive instruction in food safety and personal hygiene and should be required to undergo a test of their knowledge of the subject. 

Refresher courses should be given periodically.

Particular attention should be given to the need to report illness by food handlers as soon as it occurs.

Education programmes must take literacy and educational standards of food handlers into consideration.

Education and training programmes to be conducted by properly trained personnel;

Education and training programmes must also be extended to management, cleaners and other personnel involved with food handling.

Reporting Illness to Management

Managers should encourage employees to report to their supervisors whenever they have diarrhoea, sore throat, fever, a cold or open skin lesions, or are jaundiced. Discretion should then be used as to whether or not these persons should be subjected to certain restrictions or suspended from food handling duties. Management should have a general knowledge of food borne diseases and the symptoms thereof to ensure that food handlers suffering from it can be identified early. Management must thus be aware that employees who have for example gastroenteritis or open pus producing lesions (ear, teeth/gums, lungs, skin, etc.) must stay away from work or be relocated with tasks that do no involve the handling of food. Questions often arise which medical conditions normally disqualify a person temporarily from food handling as well as what length of exclusion from work after illness must be applied. It must be kept in mind that health standards are applied in a practical way, so as not to exclude a person from work unnecessarily, while maintaining the safety of other employees and food.

The following conditions disqualify a person temporarily from food handling:

Infection of the eyes or eyelids.

Inflammation and/or discharge from ears.

Oral sepsis;

Staphylococcal conditions e.g. recurrent boils or open sores; or

Recent history of gastrointestinal infection.

The following rule with regard to the length of exclusion from work after specific illnesses should be applied. (Return to work in these cases should, however, only take place after consultation with and consent of a medical doctor):

Hepatitis A: six weeks from onset of jaundice.

Salmonella food poisoning, cholera, dysentery and typhoid and

Paratyphoid: three consecutive negative stool specimens taken 48 hours apart.

Parasite worms and other parasitic conditions: until successfully treated.

Staphylococcal and streptococcal: until successfully treated.

All other gastrointestinal illnesses (bacterial or viral): until symptom free: and

Tuberculosis: seven days from onset of effective treatment.

These measures are aimed at protecting co-workers as well as the public from becoming infected through direct contact with an infected food handler or by means of contaminated food handled by such a person. The transmission of diseases such as TB, STD’s and AIDS is practically of very little consequence with regard to the handling of food, but steps taken should be aimed mainly at protecting co-workers and clientéle from becoming infected.

Compiled by: Senzeni Ngcobo

REFERENCE

Health surveillance and management procedures for food handling personnel.

World Health Organisation (WHO), Geneva, 1989