"In this outbreak, vomiting by a line cook at the work station might have contributed to transmission … Because of the open physical layout of the restaurant, no barrier impeded airborne spread of the virus from the kitchen to the main dining area."

Or so concludes the U.S. Centers for Disease Control in its write-up of a Jan. 2006 norovirus outbreak in Michigan (it was a Carrabba’s Italian Grill in Lansing, Mich.) in which "at least 364 restaurant patrons became ill with gastroenteritis after dining at a restaurant where employees had reported to work while ill."

At the time of the outbreak, a food service employee in Lansing wrote that, "What happened at Carrabba’s could occur at any of our local eateries. Not because their kitchens are not clean, not because they don’t follow all of the safety standards, but because sick employees report to work. There is an internal peer pressure to report to work even when you are ill, not to mention that a day without pay can be crucial for some families."

As I wrote in Feb. 2006,

The industry spokesthingies may say that sick employees should not work, but the reality is, no work, no pay. So, for the food industry, tell your sick employees to stay at home, and perhaps even provide incentives, like allowing for a couple of sick days. The cost of a few workers abusing the system pales in comparison to the lawsuits and lost business.

Following the outbreak, the Barry-Eaton District Health Department (where Lansing, MI, is located) issued four recommendations (based on previously published guidelines) for infection control and environmental decontamination after any vomiting incident in a food-service establishment (what to do after someone barfs):

• Any exposed food or single-service articles (e.g., drinking straws, takeout containers, and paper napkins) should be discarded, and all surface areas within at least a 25-foot radius of the vomiting site should be disinfected with a bleach solution;

• ill employees should be excluded from work for at least 72 hours after symptoms subside, and employees returning after a gastrointestinal illness should be restricted from handling kitchenware or ready-to-eat food for an additional 72 hours;

• because thorough disinfection might be necessary, partial or complete closure of the food establishment should be considered after a vomiting incident

• restrooms used during or after a vomiting incident should be closed immediately until they are disinfected properly with bleach solution.