The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Division of Food and Drugs 305 South Street, Jamaica Plain, MA 02130-3597 (617) 983-6700 (617) 524-8062 - Fax

MITT ROMNEYGOVERNORKERRY HEALEYLIEUTENANT GOVERNORRONALD PRESTONSECRETARYCHRISTINE C. FERGUSONCOMMISSIONER

To: Local Boards of Health

From: Paul Tierney, Director

Date: March 15, 2004

Re: No Barehand Contact with Ready-to-Eat Foods

On March 1, 2004, the Department issued a Hepatitis A Surveillance Alert to local boards of health in response to the increased number of reported cases in Massachusetts. As stated in that alert, a major method of primary prevention of hepatitis A virus (HAV) is improved personal hygiene (hand hygiene). On March 12, 2004 the Department issued a press release announcing a case of hepatitis A in a Ludlow food employee. Immune globulin (IG) is currently being offered to patrons who ate cold or uncooked foods at the restaurant during the time range in which this employee was infectious.

Touching food with barehands may result in an imminent health hazard if a food employee, who is infected with a highly infectious pathogen such as hepatitis A, does not properly wash their hands and then handles a ready-to-eat food. Section .004(E) of MA regulation 105 CMR 590.000 prohibits the use of barehand contact with ready-to-eat food unless the establishment has a written food safety plan that addresses "alternative procedures" and more importantly, is effectively implementing their alternative plan. The Department's policy for approving such procedures is attached. The plan must address ready-to-eat food handling procedures, employee health and handwashing training, monitoring by management, procedures for corrective actions and verification procedures to ensure proper implementation. The majority of food establishments in Massachusetts are not approved to use barehands with ready-to-eat foods. Only 37 out of 238 boards of health reported approving one or more alternative barehand contact procedures with ready-to-eat foods in our 2002 board of health survey.

If a food establishment does not have a written plan or is not properly implementing their plan, preventive measures by the board of health must be initiated on-site. Preventive measures may include one or more of the following:

§ Immediately suspend barehand contact with ready-to-eat foods. § Implement use of disposable gloves, disposable papers or equipment such as spoons and tongs as physical barriers. § If the use of a physical barrier cannot be immediately implemented, suspend ready-to-eat operations until procedures are modified and food employees trained. § If a food establishment is implicated in a suspected foodborne illness outbreak, immediately suspend approved alternative procedures until the investigation is completed and safe food handling procedures verified.

In addition, the board of health should verify that food establishments with approved plans are properly implementing them during routine inspections. In regions where there is an increase in the number of reported cases of Hepatitis A, the Department recommends that the board of health temporarily suspend all approved alternative procedures for barehand contact with ready-to-eat food as an extra precaution.

If a food employee is diagnosed with hepatitis A, previously approved alternative procedures for barehand contact with ready-to-eat food must be suspended immediately. All ready-to-eat foods that are open and have been handled by food employees should be discarded and all food contact surfaces and equipment properly cleaned and sanitized. All of the other food employees in that facility must receive immune globulin (IG) within two weeks of exposure. If IG is not received within 2 weeks and the food employee does not provide documentation of HAV vaccination or documentation proving immunity to HAV by serologic test, she/he must be excluded from work for 28 days. The same exclusion criteria apply to any food employee "contact" of any confirmed case of hepatitis A. Contacts of a case should be monitored for 50 days (one incubation period) from the last date of exposure for symptoms compatible with hepatitis A.

If you need more information or have any questions relative to the enforcement of 105 CMR 590.000, please contact Food Safety Specialist, Priscilla Neves, at 617-983-6773 or Epidemiologist Frauke Argyros at 617-983-6757 in the MDPH Center for Environmental Health - Food Protection Program.