Content Analysis of Vomit and Fecal Matter Clean-up Procedures to Prevent the Spread of Enteric Agents in Retail/Foodservice Operations

Introduction:  Noroviruses are the leading cause of acute gastroenteritis and foodborne disease, sickening 19 to 21 million Americans each year.  A concentrated source of norovirus particles is vomit and diarrhea, illustrating the importance of proper clean up.  Clean-up procedures are required in states that have adopted the 2013 Food and Drug Administration (FDA) Food Code.  However, compliance could be low, particularly among the 70% of establishments independently owned and operated suggesting the need for editable model procedures.

Purpose:  Our aim was to assess vomit/fecal matter clean-up procedures to determine clarity of presentation and alignment with the 2013 FDA Food Code.

Methods:  In July 2015 vomit/fecal matter clean-up procedures were located by (1) asking NoroCORE (Norovirus Collaborative for Outreach, Research, and Education) stakeholders for procedures used by their constituency groups and (2) conducting a Google Advanced Search of the World Wide Web using the terms: vomit AND fecal AND clean AND disinfect AND foodservice.  We then performed content analysis to assess clarity of presentation using the Centers for Disease Control and Prevention Clear Communication Index and to determine alignment with recommendations outlined in the 2013 FDA Food Code, Annex 3 2-501.11.

Results: A total of 40 artifacts were analyzed.  The mean clarity score was 6.9±2.7 (3 to 15) of 20 points; the mean alignment score was 6.4±1.9 (2.4 to 9.9) of 11 points.  Only three artifacts were classified as high clarity, high alignment. Most (24) were low clarity and high alignment.  

Significance: Vomit/fecal matter clean-up procedures must align with the FDA Food Code, the best evidence base to date, and be clearly presented, yet only three artifacts met these two conditions.  If we are to reduce the burden of illness attributed to noroviruses, existing clean-up procedures must be modified to improve their clarity and alignment.