The CDC will release a groundbreaking report this week showing that restaurant employees who work sick are the leading cause of foodborne illness outbreaks.

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The study goes into depth on 800 outbreaks that took place between 2017 and 2019, using health department data and interviews conducted with the restaurant managers. 

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Key Findings:

Employees who worked sick were linked to 41% of foodborne illness outbreaks with a known cause.

The researchers were only able to identify “contributing factors” (the closest the CDC will come to saying “a cause”) in about two thirds of cases. Of those cases, a whopping 41% involved an employee who worked in the restaurant while they were sick. 

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Very few restaurants involved in outbreaks had a sufficient written foodborne illness policy. 

Most restaurants had some sort of policy, though it wasn’t always written. Very few were comprehensive enough to cover all five key symptoms outlined in the Food Code: vomiting, diarrhea, lesion with pus, sore throat with fever, and jaundice. Even fewer explicitly stopped employees from working if they had any of those symptoms, or required employees to inform their managers if they felt sick.

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Most restaurants didn’t have paid sick leave. 

Employees cited loss of pay and perceived social pressure as the two most common reasons for working sick. Over half of the restaurants studied had no paid sick leave for employees. 

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Process impacts food safety. 

Cool is key - Over 1 in 5 outbreaks had issues with improper or slow cooling after cooking, or improper cold holding temperatures. 

Complexity matters - Outbreaks were more likely in restaurants with complicated prep processes that included cooking, cooling, and reheating. 

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Most restaurants involved in outbreaks had at least one critical violation on their last health inspection. 

Half of the restaurants studied had two or more critical violations on their most recent inspection. Restaurants with poor inspection results tend to have lax food safety protocols in general, which puts them at higher risk for an outbreak. These same critical violations are linked to the process issues around bacteria growth (cooling prepared food, holding temps, undercooking) and contamination (handwashing, glove use) that were a contributing factor in many of these outbreaks.

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What You Need To Take Away From This Report:

Don’t let employees work sick. 

• Contamination from a sick employee is the #1 threat in terms of foodborne illness outbreaks. 

Use a sick call program.

• ZHH offers a sick call program where your sick employees are asked about the five key symptoms and then text directly with a clinical professional who determines when it’s safe for them to return to work. 
• This helps take sick calls off a manager’s plate and drastically reduces your chances of employees working sick

Review & enforce your foodborne illness policy.

• ZHH can support your team with updating or writing a new sick call policy. We’ll make sure it hits all the key points that the CDC looks for in investigations like this one. 
• Focus on realistic ways to enforce your ill worker policy, like manager training and sick call programs. 
• Expect renewed focus from health departments on your foodborne illness policies.

Run a risk assessment of your restaurants (or update the one you have).

• Any restaurants with critical violations are at higher risk of an outbreak. Consider switching to daily wellness checks at those locations or doing additional training on key symptoms and your sick call policy or program. 
• Ensure effective temperature controls and consider ways to simplify processes in high-risk restaurants. 

Consider expanding paid sick leave. 

• If hourly employees don’t have access to paid time off when they're sick, consider expanding that benefit to reduce financial stress that causes employees to work sick.

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