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Abstract
Foodservice establishments are a significant source of foodborne disease outbreaks in the United States and transmission of pathogens from sick food workers is a substantial contributing factor. In an effort to reduce the likelihood that pathogens are transmitted from infected food workers to patrons, the U.S. Food and Drug Administration (FDA) Food Code has specific recommendations regarding sick foodservice employees that consider the degree of risk an infected food worker poses. In 2007, Georgia implemented food safety regulations that are closely aligned with the 2005 FDA Food Code which includes specific criteria for monitoring and enforcing employee health policies. Thus, foodservice establishments in this state are required to have employee health policies in place and management is expected to prevent infectious employees from handling food. This dissertation explores the factors that influence the feasibility of enforcing and determining compliance of FDA employee health recommendations that are theoretically sound but appear particularly challenging to enforce. Three studies were conducted and focused on: 1) quantifying the compliance status of foodservice establishments in Georgia specific to employee health controls, 2) investigating the attitudes, beliefs, and practices of Environmental Health Specialists (EHS) regarding how compliance of employee health policies is evaluated during inspections and, 3) describing the personal and external factors that influence a managers ability to enforce these policies effectively. Findings from this dissertation indicated that the majority of foodservice establishments in Georgia have employee health policies in place but determination of compliance with these policies may not be performed accurately during food safety inspections. Qualitative analyses suggested that EHS may lack the understanding and/or resources necessary to provide an accurate assessment of proper use of restriction and exclusion and foodservice managers may overestimate their ability to determine if an employee is working while ill. The findings of this dissertation provide information that can be used to help design more feasible intervention strategies and performance measures to help protect consumers from illnesses transmitted by infectious foodservice employees.