The Chef with Diarrhoea
It is Friday evening at a 60-seat restaurant. The head chef, who prepares salads, desserts and cold garnishes, tells the manager he had diarrhoea at 6 a.m. and again at 9 a.m. He took two loperamide tablets and says he feels fine now; he has no fever, vomiting or stomach pain. Two other kitchen staff are on holiday, and 80 covers are booked for Saturday. The chef has worked at the restaurant for six years and is the only person who knows the dessert recipes. He says he will 'stay away from the salad' and work only on the grill, but the grill station is next to the cold prep area and staff share tongs and cloths. The manager is unsure whether to send him home, and the chef is worried about losing pay. A waitress has also just called in with vomiting and diarrhoea; she was at work yesterday.
1. Should the head chef be allowed to work? Explain the fitness-to-work decision.
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Exclude him from food handling. Diarrhoea is a symptom of a foodborne pathogen and can be spread by hands, cloths, tongs and surfaces. Loperamide does not make him safe; it slows the gut and can mask ongoing symptoms. Moving him to the grill is not enough because the grill is next to cold prep and equipment is shared, so cross-contamination remains likely.
Apply the 48-hour rule. A food handler with diarrhoea should be excluded from food handling and food-handling areas until 48 hours after the last episode. He should not prepare open food or clean food-contact surfaces. He should be advised to seek medical advice if symptoms are severe, bloody or persistent, or if a notifiable illness is suspected. Staff shortage and his knowledge of dessert recipes are commercial pressures, not food safety controls.
2. What should the manager do about the waitress and about cleaning and reporting?
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Exclude the waitress too. Vomiting and diarrhoea suggest a viral or bacterial infection, and norovirus spreads easily. She should stay away until 48 hours after her last symptoms. Because she was at work yesterday, clean and disinfect toilets, taps, door handles, staff areas and any surfaces she may have contaminated. Review handwashing and make sure staff do not share cloths between toilets and food areas.
Consider reporting. If two or more people are linked to the same illness, or a notifiable organism is suspected, report it to the local authority. Do not pressure staff to use anti-diarrhoeal medicine to return to work. Keep the chef's and waitress's information confidential and record the advice given.
3. When can each person return, and what records should be kept?
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Return criteria. Both should return only after 48 hours free of diarrhoea and vomiting. A return-to-work interview should confirm this and reinforce handwashing. If a doctor advises a longer exclusion, for example for E. coli O157 or Salmonella, follow that advice.
Records. Record the dates of symptoms, the last episode, when the person was excluded, the advice given, and the return date. Note any medical advice received. The records show that the business acted on fitness-to-work risks and help if an outbreak is investigated. The chef can return once the 48-hour criterion is met; the menu can be simplified temporarily rather than using an unsafe food handler.