Hundreds of the foodborne illness outbreaks reported in the U.S. each year can be traced to one cause, according to the CDC: food workers who come to work sick. Ill employees have been implicated in foodborne illness outbreaks caused by at least 14 different germs.

The CDC states the obvious: many of these outbreaks could be prevented simply by making sure that food workers don’t work while they are sick. But how to do that?

If you have these symptoms...

To prevent food workers from making their customers sick, the Food and Drug Administration’s (FDA) Food Code, which provides the basis for state and local food codes, recommends that food workers with foodborne illness symptoms such as vomiting and diarrhea don’t work. The Food Code also recommends that food workers report specific symptoms and diagnoses to their managers so the manager can determine if the food worker should not work.

But not all state and local food codes include FDA’s sick worker rules. In fact, 19 states have not adopted these rules. And some food workers work while sick even when their states or localities do have those rules. Indeed, 20% of food workers say they worked at least one shift with vomiting or diarrhea in the past year.

Why do workers work when sick?

CDC’s research indicates that several factors influence whether food workers work while sick.

• Restaurant staffing: Food workers are more likely to say they worked while sick if their restaurant has a lot of customers, if their restaurant does not have on-call workers, and if they have concerns about leaving co-workers short-staffed. This suggests workers are more likely to work while sick if their absence would have negative impacts on remaining staff and on restaurant operations.
• Concern about negative consequences of missing work: Almost half of workers say they worked while sick because they wouldn’t get paid if they didn’t work; only 15% of food workers say they get paid sick leave. Food workers also have concerns about losing their jobs if they miss work—workers who feared job loss if they missed work were more likely to say they worked while sick.
• Management policies and practices: Workers are more likely to say they worked while sick if their restaurant does not require them to tell their managers if they are sick. Most managers and workers say that decisions about whether workers work while sick are made by workers rather than by managers.

The CDC's wish list

CDC’s findings suggest several approaches the restaurant industry could use that may be effective in preventing workers from working while sick:

• Ensuring restaurants are adequately staffed and there is a staffing plan for when sick workers need to be absent from work.
• Ensuring food workers will be paid and will not lose their jobs if they are absent from work because they are sick.
• Ensuring that food workers tell managers when they are sick and that managers are involved in decisions about whether sick workers can work.

State and local health departments might also be able to reduce the number of workers that work while sick by taking steps to align their food codes with FDA’s latest Food Code guidelines on sick workers, including

• Preventing workers sick with foodborne illness symptoms such as vomiting or diarrhea from working.
• Requiring workers to tell managers when they are sick.
• Requiring managers to make decisions about whether sick workers can work.

Health departments could also educate and work with the restaurant industry on these guidelines and enforce them where they are in place.

Preventing sick workers from working is critical to reducing foodborne illnesses and outbreaks. The restaurant industry and state and local health departments have a number of tools they can use to accomplish this.

Quick Links

CDC’s findings and recommendations on restaurant food safety topics such as sick food workers: www.cdc.gov/nceh/ehs/ehsnet/plain_language/index.htm.

CDC Prevention Status Reports showing state adoption of key Food Code provisions (including sick workers): www.cdc.gov/psr/index.html.

FDA educational materials on worker health: www.fda.gov/foodemployeetraining.

FDA Food Code: www.fda.gov/downloads/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/UCM374510.pdf.

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