The Cook With Diarrhoea and a Typhoid Contact
A cook at a Montego Bay hotel calls her supervisor on Monday morning. She has had diarrhoea since Sunday night - six loose stools - with mild cramps, but no fever, vomiting or jaundice. She feels well enough to work and is the only employee trained on the grill for a 200-cover banquet on Tuesday. She offers to wear gloves and work the back station. On Tuesday afternoon she mentions that her 6-year-old child was diagnosed with typhoid fever two days earlier and that her sister has similar diarrhoea. The supervisor wants to know whether the cook can work the banquet, what must be recorded, and what happens if a stool sample later grows Salmonella Typhi. The hotel has no written exclusion policy and the cook has not seen a doctor.
1. Can the cook work Tuesday's banquet? Give the decision and the reasoning, including whether gloves change the answer.
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No. A food handler with diarrhoea must be excluded from food handling, regardless of how well she feels. Diarrhoea is a symptom of a potentially communicable enteric infection, and the risk is not limited to direct hand-to-food contact: she may contaminate taps, door handles, cloths, utensils and surfaces. Gloves do not solve the problem. Gloves are easily torn, are worn across multiple tasks, and are often put on with unwashed hands; they can carry contamination from one surface to another. Gloves are a barrier for a clean task, not a substitute for exclusion during illness. The fact that she is the only grill-trained employee is an operational problem, not a public health exemption. The supervisor should remove her from food handling immediately, arrange cover, and refer her to a doctor and the parish health department. The household contact with typhoid raises the risk further.
2. The stool sample later grows Salmonella Typhi. What are the return-to-work requirements, and what must the hotel do in the meantime?
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Salmonella Typhi is a serious enteric pathogen, and a food handler with confirmed typhoid must not return to food handling until she is cleared by the medical officer of health. Clearance normally requires clinical recovery plus negative stool cultures taken after treatment, at intervals set by the public health authority; the exact number of samples should follow their instruction, not the hotel's. She may be an asymptomatic carrier, so feeling well is not enough. The hotel must keep her off all food-handling duties, including the back station, and must not let her enter the kitchen. It should provide the health department with the dates of her symptoms, the foods she handled and the people she worked with, and it should review the banquet exposure. The kitchen should be deep-cleaned and sanitised, and other handlers with diarrhoea should be interviewed. The hotel should also write an exclusion policy with paid sick leave or alternative duties.
3. What should the supervisor have recorded and reported on Monday, and to whom?
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On Monday the supervisor should have recorded the cook's name, job, symptoms, date and time of onset, duration, and the foods and surfaces she handled. The record should include that she had six loose stools and cramps, that she had not seen a doctor, and that she was excluded from food handling. The supervisor should also record who covered her duties and what cleaning was done. The matter should be reported to the parish health department and, where the establishment has one, to the environmental health officer. Reporting is not optional when a food handler has diarrhoea and there is a possible typhoid contact. The supervisor should not diagnose, but should report facts. A written log protects the business and helps the investigation. The absence of a policy does not excuse inaction; it is itself a finding the inspector will note.