PART VII - ADDITIONAL INVESTIGATIONS

Water and ice samples obtained from the cafeteria on March 12 were negative for fecal

coliforms. Stool cultures and rectal swabs from the 23 foodhandlers were negative for bacteria.

The staff member who initially refused to be interviewed worked primarily at the deli bar.

When she finally agreed to be interviewed on March 23, she reported slicing ham on March 9,

for use at the deli bar during lunch and dinner that day, and lunch the following day. She also

prepared and served sandwiches for these same meals. She reported that she had worn gloves

while slicing the ham and while serving sandwiches at the deli bar. She denied any

gastrointestinal illness during the outbreak period but reported that her infant had been sick with

watery diarrhea since March 7, two days before she prepared items for the implicated meals.

Because the foodhandler wore gloves during food preparation and serving, she did not feel that

handwashing was an important activity.

Of the 18 fresh stool specimens sent on ill students to CDC, 9 (50%) had evidence of Norwalklike virus (NLV) by RT-PCR. Of the four deli foods available from the implicated meals, only

the ham sample, from Ma rch 9, was positive by RT-PCR for the presence of NLV RNA. NLV

was also detected by RT-PCR in a stool sample from the ill infant of the foodhandler who

prepared the deli sandwiches on March 9. The sequence of the amplified product was identical

to those products from the ill students and the deli ham.

Question 22: Do you think the evidence implicates the foodhandler as the source of the

outbreak? Explain.

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PART VIII - CONTROL

Spring break at the university ended on March 23. The chief of the campus food service called

TDH to find out what must be done to reopen the deli bar.

Question 23: Which of the following actions would you recommend? What are the pros and

cons of each?

A) throw away all leftover deli bar foods and ingredients

B) clean and disinfect all equipment and surfaces in the deli bar

C) require all foodhandlers to submit a stool specimen before allowing them to return to

work

D) educate foodhandlers on proper foodhandling procedures including handwashing and

appropriate hot-holding and cold-holding temperatures

E) develop a sick foodhandlers policy

Question 24: Who might you consult in developing actions/policies for the campus food service

to prevent a recurrence of this problem in the future? Why?