Sick restaurant and food-store workers were linked to four in 10 U.S. foodborne disease outbreaks in recent years, yet few establishments had comprehensive policies in place to prevent contamination, a government analysis found.
Food workers’ illnesses may have played a role in some 200 outbreaks from 2017 through 2019, according to the Centers for Disease Control and Prevention report. Ailing workers touching ready-to-eat food with bare hands alone was linked to 14% of cases. Other, unspecified types of contact by food workers suspected of harboring infections were linked to more than 100 cases.
Roughly one in six Americans gets a foodborne disease every year, according to CDC estimates, and restaurants have long been a major source of outbreaks. Foodborne illnesses are estimated to cause upwards of 100,000 U.S. hospitalizations and 3,000 deaths annually. Norovirus, a quickly spreading infection that causes diarrhea, vomiting and other gastric symptoms, accounts for the most outbreaks, followed by salmonella bacteria, according to CDC estimates.
Read More: What to Know About Norovirus
In the study, published Tuesday in CDC’s Morbidity and Mortality Weekly Report, most restaurants and food stores with outbreaks required employees to notify managers when they were ill and stopped sick employees from working. But less than a quarter had comprehensive policies for dealing with workers’ illnesses, the researchers found in interviews with managers.
Policies should specify that employees experiencing vomiting, diarrhea, jaundice, a sore throat with fever or a skin sore containing pus should report to their managers and be restricted from working, according to the U.S. Food and Drug Administration’s Food Code. Many policies specified vomiting or diarrhea as reportable symptoms, but jaundice—a sign of liver diseases such as foodborne hepatitis A—fevers and sores were addressed less often.
Written policies that address a wider range of suspicious symptoms would reduce outbreaks, researchers said. Regulatory requirements might also increase effectiveness, since officials would more closely inspect policies during inspections.
Improving employees’ benefits might also help prevent the spread of illnesses, the researchers said. Food workers have previously reported working when ill because of financial and perceived social pressures. Only about 44% of managers told the researchers that their restaurants provided paid sick leave to workers.
Restaurant managers should prepare staffing plans for when workers are absent and adopt “a food safety culture where absenteeism due to illness is not penalized,” the researchers concluded.
More Must-Reads from TIME
- Donald Trump Is TIME's 2024 Person of the Year
- Why We Chose Trump as Person of the Year
- Is Intermittent Fasting Good or Bad for You?
- The 100 Must-Read Books of 2024
- The 20 Best Christmas TV Episodes
- Column: If Optimism Feels Ridiculous Now, Try Hope
- The Future of Climate Action Is Trade Policy
- Merle Bombardieri Is Helping People Make the Baby Decision
Contact us at letters@time.com