Gastro-enteritis
Outbreaks in Hotels
etc. – Essential
Information for
Managers
For information or advice, please contact New Forest Environmental
Health, 02380 285680
Introduction
The guidance is structured to enable managers to appreciate how
the virus can infect their staff and guests, and how they can take
positive steps to control the spread of illness. In addition, the
document shows how regulatory authorities work with the trade to
identify the source of an illness and to control an outbreak.
While documented guidance is useful as a training aid it is not the
ideal form of reference when an outbreak occurs and the final
section of this leaflet is, therefore, devoted to the preparation of a
contingency plan.
1. What is viral gastroenteritis:
Viral gastroenteritis is an illness caused by one of a group of
viruses known as Noroviruses. The virus can be ingested with fluid
or water, transferred by faecal soiling of surfaces or acquired from
infected individuals by droplet or aerosol transmission within the
atmosphere.
The illness occurs regularly in any resort or town and can affect
hotels, guesthouses and other residential establishments.
1.1 The Virus
Infection by Norovirus may result in illness of mainly diarrhoea and
vomiting, other symptoms include fever, abdominal pain, headache,
giddiness and flatulence! Effects vary according to the virulence of
the virus and an individual’s state of health. Only a very low
number of particles are necessary to cause illness. Exposure to
infection usually results in only a short-term immunity to the
particular SRSV involved.
1.2 How The Virus Arrives And Is Spread
Norovirus is usually introduced to a hotel environment by infected
individuals but can also be present on foodstuffs to cause a food
borne illness. Infected individuals shed virus particles when
breathing, coughing and sneezing but gross contamination arises
when minute droplets (aerosols) are liberated from vomit or faeces.
Virus-laden aerosols from vomit or diarrhoea can thus heavily
contaminate toilets and bathrooms.
Similarly, a single episode of vomiting in a public area or meeting
room can heavily contaminate the atmosphere. The survival time of
Norovirus in the atmosphere is not known, but it is believed that
dilution of number of virus particles may reduce the likelihood of
infection.
Infected individuals can spread the virus to other premises. Some
cases may not show any symptoms but can infect others, who in
turn may become very ill.
Food that has been contaminated with viruses shed by an infected
individual can then cause illness in consumers.
The predominant means of viral transmission is however believed
to be “person-to-person”. The illness can be contracted from an
atmosphere contaminated by an infective individual, or by hand-tomouth transfer of the virus from contaminated surfaces.
1.3 Illness And Its Effects
Sporadic cases are not usually reported or identified. The virus is
usually isolated when an outbreak is investigated.
Symptoms of the illness are sudden and can be severe. The
combination of symptoms is often unpleasant and exhausting for
the patient. Elderly or chronically ill people can suffer a stressful
period of illness.
The symptoms usually abate with 24 to 48 hours and there are no
lasting effects. As the symptoms are almost identical to those of
several food-borne diseases victims will invariably assume that they
are suffering form food poisoning. Indeed, the illness usually
affects a large number of people at the same time and this
resembles an outbreak of food poisoning.
The principle effect is not upon the victims but upon the business
where an outbreak has occurred. Media interest is heightened,
customer complaints are numerous and bad publicity is
engendered.
A planned and structured response is required to reduce the effects
upon both the victims and the business.
The Duty Manager who has reported an outbreak should be able to
contact a Senior Council Officer.
When there is good reason to believe that an outbreak of gastrointestinal illness has occurred in the hotel, the staff should be
briefed as they can then assist in gathering and disseminating
accurate information. Staff need to know why procedures have
changed and, without being briefed, they could feel threatened by
the on-going investigations.
2. Recognising An Outbreak
Sporadic cases of gastro intestinal illness are not usual and can
arise form changes of diet or various pathological causes. Potential
food borne incidents and Norovirus outbreaks are often recognised
because an usual number of people are ill at the same time and in
association with the same place.
2.2 Your Other Customers
Guests at the time of the cases being identified, and those who has
subsequently arrives, including delegates at seminars, receptions
and meetings may all be infected. Indeed anyone who uses the
hotel while the control procedures are in force may also contract the
illness.
If your staff note an unusual number of guests showing gastrointestinal symptoms they should know that management must be
informed. A responsible manager should determine how many
individuals are affected, when the illness commenced, what
symptoms were involved and the name of anyone removed to
hospital.
It is important that guests who are due to arrive during the control
period are aware of the potential hazard and be in a position to
determine the risk.
Although the law requires any medical practitioner attending a
patient to notify the Council of any case or suspected case of food
poisoning it is prudent for the hotelier also to notify any case to the
Council.
2.1 Notification
Notification by a hotelier is appropriate if a number of guests are
suffering from gastro-intestinal illness, if previous guests have
contacted the hotel alleging similar symptoms, or if a food handler
or other members of staff report sick.
To notify a suspected or potential outbreak please telephone the
Food Team on 02380 285680.
Information should be given to prospective guests in sufficient time
to enable a change of plan. Best practice appears to be to contact
prospective guests by telephone with operators working to a
prepared briefing not that is then reinforced by a letter confirming
the information given in the telephone call.
Experience has shown that hospital admission will occur if guests
with coronary conditions or debilitating diseases are infected. It is
therefore important that prospective guests who are suffering from a
serious medical condition, which could be exacerbated by viral
gastro enteritis, should stay away.
An effective customer relations package is the best way to address
potential complaints of litigation or allegations of misleading guests
for reason of profit
The package should be part of your contingency plan.
3. Controlling The Outbreak
3.1 The Role Of The Environmental Health Officers And The
Outbreak Control Team
Any report of an outbreak of gastroenteritis in a hotel will receive a
prompt response. The initial response will be a brief telephone
interview which is intended to identify the salient facts. If the
notification appears to be justified an Environmental Health Officer
will visit the hotel.
The hotel management team should follow a contingency plan.
Salient information should be communicated to staff, guests and the
media on a planned basis and the responsibilities for such briefings
should be identified in the contingency plan.
Management are responsible for ensuring that the control measures
specified in the contingency plan are brought into force and
maintained until the episode is over.
Departmental managers will have a crucial role in ensuring that the
investigators promptly receive any information they may require.
The investigation procedure is as follows:
a) The Environmental Health Officer will visit to obtain information
regarding victims and menus, to deliver specimen kits, to interview
a representative number of cases, to obtain details of staff
absences, to ascertain that precautions are being taken and to
advise on additional measures and any deficiencies noted.
b) The Environmental Health Officer will notify the Public Health
Laboratory (PHL) and the Consultant in Communicable Disease
Control (CCDC).
c) A Tentative diagnosis will be made by the Consultant in
Communicable Disease Control and the Director of the Public
Health Laboratory.
d) Specimens will be collected and be delivered to the laboratory for
analysis.
e) The situation will be monitored daily and further precautions
instituted should they appear to be necessary.
f) When the laboratory results are received and the casual
organism has been identified, specific advice will be prepared and
any further control measures introduced where appropriate.
3.2 The Role Of Hotel Management
When an outbreak of gastro intestinal disease occurs it is inevitable
that uninformed commentators will unfairly assume that the cause is
a food poisoning agent and that the hotel’s catering staff are
responsible. Until laboratory findings are available the investigation
team will form a tentative diagnosis based upon enquiries made in
the hotel. Necessarily these enquiries will centre upon food
handling and preparation. Indeed, the investigators will tend to treat
any outbreak of gastroenteritis as suspected food poisoning until
the contrary is proved!
It is recommended that catering staff, particularly the chefs, are
regularly reminded that they are not seen as the cause of illness
and that the investigation may in fact be the best means if
establishing that they are operating in an exemplary manner.
3.3 The Role Of Company Management
Controlling an outbreak requires additional staff, resources and
commitment. It is essential that a contingency plan of action has
been approved at the highest level in the organization and will not
subsequently be overruled at the whim of, for example, a Director.
Clear lines of communication and responsibilities should be detailed
in the contingency plan.
3.4 Methods Of Control
The principal methods of control are the safe sourcing and
preparation of food and water, exclusion or quarantine of cases and
rapid cleaning of contaminated areas. Staff should receive
appropriate training to ensure that they appreciate what they must
do and more importantly, why they are doing it!
The following notes identify known problems and a sensible way to
address them:
1. Diarrhoea or vomiting among staff:
(a)
(b)
(c)
(d)
Send affected person home.
Tell them not to return for at least 72 hours after
they have recovered. (Recovery is being able to eat
without nausea, no vomiting for 24 hours and a
formed stool)
Pass details to Environmental Health Officer as soon
as possible.
Disinfect any area where the person has vomited
and/or any toilet facilities they have used.
as is practicable, to isolate the affected guest by
providing “exclusive” service.
3. Cleaning:
It is vital that physical evidence of illness is promptly and thoroughly
removed by trained personnel who have access without delay to the
correct materials.
The contingency plan should provide for a number of members of
staff to be available on a shift basis to clean up evidence of illness.
It is inappropriate for these people to be employed on any duties
other than cleaning potentially infected areas during an outbreak.
The cost of a 24-hour cleaning hit squad is minimal in comparison
to the trade that will be lost as a result of outbreak publicity!
Separate equipment and material should be used by the “hit squad”
and the recommended cleaning methods are:
a) Hard Surfaces:
Wipe clean with paper wipers
Place soiled wipers in plastic sack
Wipe inward to restrict soiling
Wash with a detergent solution mixed in a
bucket and disposable wiper
Wash with disinfectant solution
Ventilate room to maximum possible extent
and leave to air dry
b) Fabric and
soft surfaces:
If possible remove in bags for laundering if
fixed in position then treat as hard surface
2. Diarrhoea or vomiting among guests:
(a)
Inform them what is going on and that an
Environmental Health Officer will be calling to see
them.
(b)
If any guests are removed to hospital ensure that the
Environmental Health Officer is aware of their
removal so that the hospital Control of Infection staff
can be warned and can take appropriate
precautions.
Try to persuade ill guests to stay in their room, select
a chambermaid(s) to work exclusively on the rooms
of ill guests and provide regular cleaning to that area
throughout the day. Use the same individual to
deliver room service. The objective must be, so far
(c)
N.B. Need to saturate with detergent and
disinfectant and dry by physical means prior
to ventilating area.
The use of heat as a source of cleaning
energy is recommended and a temperature
of 60ºC is recommended. The use of wash
and extract vacuum equipment is
recommended.
4. Failure To Comply
Officers will make every attempt to assist you in complying with this
legal requirement. However, the Government has been given
instructions that where compliance is not being achieved formal
action must be considered by Local Authorities.
Initially this will involve the Officer using a written warning
accompanied by an agreed deadline for completion. Failure to
undertake the specified works may lead to the service of an
Improvement Notice to secure compliance again accompanied by a
deadline for completion. Failure to comply with the notice is a
criminal offence. Flagrant beaches of the law may also result in a
business facing legal proceedings, although these instances are
rare.
5. Written Records And Your Defence
Although in law you do not have to provide written documents (e.g.
a hazard analysis) or monitoring records, it is difficult to show that
you are meeting the requirement of the Food Safety (General Food
Hygiene) Regulations 1995, Regulation 4 (3)(a) to (e) without
written documents or records.
If your food business is charged with an offence under the Food
Safety Act 1990 (e.g. foreign body contamination of food), the Act
provides a legal defence if you can show you exercised all “due
diligence” to prevent the offence occurring.
To use this defence you would have to prove that you took all
reasonable precautions to ensure the food you produce is safe to
eat. You could do this by showing you have controls in place which
would prevent the problem occurring and that you can show that
these controls were operating at the time of the offence. In practice
this could be demonstrated by your having undertaken a hazard
analysis and providing records of the monitoring you carry out.
6. Finally
Please remember that this document and the hazard analysis
information contained in it have been produced to give you advice
on complying with the law. The information does not form a
complete list but indicates the areas that your hazard analysis must
seek to identify to enable effective control measures to be
implemented.
Your business may have its own particular hazards and problems.
The law requires that you identify these and implement effective
controls.