Key TakeawaysHuman factors, such as inadequate oversight, training, and food safety culture, are responsible for over half of all foodborne illness outbreaks in the United States.A lack of paid sick leave for food service workers is linked to a higher incidence of norovirus outbreaks, as sick employees may feel compelled to work.Establishing a strong food safety culture, through leadership commitment and ongoing training, is crucial for reducing foodborne illness outbreaks.

Key Takeaways

Human factors, such as inadequate oversight, training, and food safety culture, are responsible for over half of all foodborne illness outbreaks in the United States.A lack of paid sick leave for food service workers is linked to a higher incidence of norovirus outbreaks, as sick employees may feel compelled to work.Establishing a strong food safety culture, through leadership commitment and ongoing training, is crucial for reducing foodborne illness outbreaks.

Norovirus,Salmonella, and other foodborne illnesses infect millions of Americans every year. What’s the most common culprit behind these outbreaks? Humans.

Among the 393 foodborne illness outbreaks between 2017 to 2019, researchers found that restaurant employee-related issues—such as lack of oversight, training, and food safety culture—contributed to most of the outbreaks.Food workers suspected of being sick accounted for nearly a quarter of these outbreaks.

“They handle food, and that’s an important link in the public health and safety atmosphere of restaurants,” saidVictor DiRita, PhD, chair of the department of microbiology, genetics, and immunology at Michigan State University, who was not involved in the study.

Less than half of U.S. food service workers have paid sick leave, so they may feel obligated to clock in even if they feel unwell.

The study linked a lack of sick leave to 26.3% of norovirus outbreaks, the main type of foodborne illness in the U.S. This contagious virus, better known as the stomach flu, typically causes vomiting and diarrhea for one to three days.

“Norovirus, in particular, is highly infectious. People can carry it on their hands without being aware of it,” DiRita said.

In 2021, about 70% of foodborne illness outbreaks were attributed to restaurant settings, according to available data from the Centers for Disease Control and Prevention.

Providing better sick leave policies could help reduce some norovirus outbreaks. It also sends the right food safety cultural message, said Janet Buffer, MPH, RD, a food safety expert and senior institute manager at the Institute of Food Safety and Nutrition Security at George Washington University.“We don’t want sick people around the food, so if you’re sick, we’re willing to pay you not to come to work because it’s that important,” Buffer said.

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Offering paid sick leave is important, but restaurant managers must also emphasize a food safety culture in their day-to-day practices.

“Even when people have resolved the symptoms, they can still carry it and still excrete it for several weeks after they’ve been infected,” DiRita said.

This means restaurant employees could return to work while they’re still contagious.

Norovirus spreads through fecal-oral transmission, so if an infected food service worker doesn’t wash their hands properly or wipes their hands on their apron after using the restroom, they can potentially pass the virus to customers when handling food.

“If you see someone from the back of the house with their apron on in the bathroom, that would be a huge red flag for me, and I would not want to eat there,” Buffer said.

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How Can Restaurants Improve Food Safety Culture?

Even if signs remind employees to remove their aprons before entering the restroom and wash their hands before returning to work, food service workers may not always follow these practices.

“Food safety culture” is a term referring to the shared values, practices, and beliefs in a restaurant that promote proper food handling.Deficient food safety culture was identified in almost 60% of the reported causes of foodborne outbreaks in the study.

Leadership, management and employee commitment, and resources—such as plenty of soap and handwashing sinks—are key components of food safety culture, according to the Centers for Disease Control and Prevention.

“You’d want a manager, or even the owner, to come in and observe and monitor and make sure that they’re following the procedures and the policies that are written around food safety, such as hand washing, final cooking temperatures, and preventing cross-contamination,” Buffer said.

A 2023 study identified poor communication with leadership, short staffing, and a lack of equipment as the main barriers to food safety culture. To promote a good food safety culture, leadership should encourage regular two-way communication, offer engaged oversight and appreciation, and support ongoing training.

“It really does need to have a top-down approach,” she said.

Studies have shown that one-time food safety training is not enough to promote a strong food safety culture.Adequate, ongoing training could cut down on the instances of improperly used equipment and cross-contamination, helping to reduce the risk of spreading bacterial foodborne diseases.“If they don’t use it every day, or if it’s not reinforced, or if it’s not focused on, they’re going to forget some things,” Buffer said.

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What This Means For You

8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Holst MM, Salinas S, Tellier WT, Wittry BC.Environmental antecedents of foodborne illness outbreaks, United States, 2017-2019.J Food Prot. 2024;87(7):100293. doi:10.1016/j.jfp.2024.100293Center for American Progress.The sate of paid sick time in the U.S. in 2024.Centers for Disease Control and Prevention.About norovirus.Centers for Disease Control and Prevention.National outbreak reporting system.Centers for Disease Control and Prevention.Food safety culture.DiPrete L, Garza T, Spinrad M.Focus groups among retail food establishment staff and management reveal obstacles and promoters of good food safety culture.Food Humanit. 2023;1:880-886. doi:10.1016/j.foohum.2023.07.022McFarland P, Checinska Sielaff A, Rasco B, Smith S.Efficacy of food safety training in commercial food service.J Food Sci. 2019;84(6):1239-1246. doi:10.1111/1750-3841.14628U.S. Department of Agriculture.Food safety education month: preventing cross-contamination.

8 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Holst MM, Salinas S, Tellier WT, Wittry BC.Environmental antecedents of foodborne illness outbreaks, United States, 2017-2019.J Food Prot. 2024;87(7):100293. doi:10.1016/j.jfp.2024.100293Center for American Progress.The sate of paid sick time in the U.S. in 2024.Centers for Disease Control and Prevention.About norovirus.Centers for Disease Control and Prevention.National outbreak reporting system.Centers for Disease Control and Prevention.Food safety culture.DiPrete L, Garza T, Spinrad M.Focus groups among retail food establishment staff and management reveal obstacles and promoters of good food safety culture.Food Humanit. 2023;1:880-886. doi:10.1016/j.foohum.2023.07.022McFarland P, Checinska Sielaff A, Rasco B, Smith S.Efficacy of food safety training in commercial food service.J Food Sci. 2019;84(6):1239-1246. doi:10.1111/1750-3841.14628U.S. Department of Agriculture.Food safety education month: preventing cross-contamination.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Holst MM, Salinas S, Tellier WT, Wittry BC.Environmental antecedents of foodborne illness outbreaks, United States, 2017-2019.J Food Prot. 2024;87(7):100293. doi:10.1016/j.jfp.2024.100293Center for American Progress.The sate of paid sick time in the U.S. in 2024.Centers for Disease Control and Prevention.About norovirus.Centers for Disease Control and Prevention.National outbreak reporting system.Centers for Disease Control and Prevention.Food safety culture.DiPrete L, Garza T, Spinrad M.Focus groups among retail food establishment staff and management reveal obstacles and promoters of good food safety culture.Food Humanit. 2023;1:880-886. doi:10.1016/j.foohum.2023.07.022McFarland P, Checinska Sielaff A, Rasco B, Smith S.Efficacy of food safety training in commercial food service.J Food Sci. 2019;84(6):1239-1246. doi:10.1111/1750-3841.14628U.S. Department of Agriculture.Food safety education month: preventing cross-contamination.

Holst MM, Salinas S, Tellier WT, Wittry BC.Environmental antecedents of foodborne illness outbreaks, United States, 2017-2019.J Food Prot. 2024;87(7):100293. doi:10.1016/j.jfp.2024.100293

Center for American Progress.The sate of paid sick time in the U.S. in 2024.

Centers for Disease Control and Prevention.About norovirus.

Centers for Disease Control and Prevention.National outbreak reporting system.

Centers for Disease Control and Prevention.Food safety culture.

DiPrete L, Garza T, Spinrad M.Focus groups among retail food establishment staff and management reveal obstacles and promoters of good food safety culture.Food Humanit. 2023;1:880-886. doi:10.1016/j.foohum.2023.07.022

McFarland P, Checinska Sielaff A, Rasco B, Smith S.Efficacy of food safety training in commercial food service.J Food Sci. 2019;84(6):1239-1246. doi:10.1111/1750-3841.14628

U.S. Department of Agriculture.Food safety education month: preventing cross-contamination.

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