Food Handlers

Educate all food handlers about the importance of handwashing before, during and after food preparation, refrigerate prepared foods in small containers, thoroughly cook all food products derived from animal sources, avoid recontamination within the kitchen after cooking is complete, and maintain a sanitary kitchen and protect foods against rodent and insect contamination.

Food handlers with vomiting or diarrhea should be excluded until asymptomatic for at least 24 hours. Individuals with questionable hygiene may return to work when symptoms resolve, but should be reassigned to other duties (non-food handling) until they can be trained and are likely to follow proper hygienic measures. Refer to the Missouri Food Code for additional information regarding individuals working in food establishments.

Health Care Workers

Health care workers (HCWs) should be excluded from care of patients until after the diarrhea has ceased for 24 hours. HCWs who are asymptomatic need not be excluded from work if proper personal hygiene measures, including hand hygiene, are maintained.2

Schools

Exclude symptomatic children and teachers from schools until diarrhea stops. Stress proper handwashing.

Child Care

Increased surveillance within the child care facility to identify others with diarrheal illness is important. Child care staff with diarrhea should be excluded from the facility until after the diarrhea has ceased for 24 hours. Infants and children in diapers with diarrhea should be excluded from the facility until after the diarrhea has ceased for 24 hours or may be cared for in a separate protected area until diarrhea has subsided. Antibiotic treatment (e.g., azithromycin or erythromycin) may further limit the potential for transmission.2

• Emphasize handwashing to all staff and children because good hand hygiene is the best preventive measure. Supervised handwashing after visiting the bathroom and before eating is essential for all children. Waterless hand sanitizers may also be helpful in addition to washing hands with soap and warm water.
• Employees handling food in child care settings should follow the criteria listed above in the Missouri Food Code.
• Staff that prepare food should not change diapers or assist children in using the toilet.
• If a child in diapers has campylobacteriosis, everyone who changes the child’s diapers should be sure the diapers are disposed of properly in a closed-lid garbage can and should wash their hands and the child’s hands carefully with soap and warm water immediately after changing the diaper. After use, the diaper changing area should be wiped down with a disinfectant such as diluted household bleach, Lysol or bactericidal wipes.
• Other surfaces and objects should be decontaminated regularly and on a daily basis during an outbreak of campylobacteriosis.
• If several cases occur in a child care center, the local public health agency should coordinate efforts to improve handwashing among the staff, children, and their families. Contact the District Epidemiologists, who will notify the Section for Child Care Regulation for an Environmental Public Health Specialist to perform an assessment of the child care facility. The inspection should include emphasis on the items listed in “Day Care Establishment Inspection Related to Enteric Infection” (CD-8).
• Access to shared water-play areas and dirty diapers should be eliminated.

To prevent the spread of infection, efforts should be made to avoid the transfer of children to other child care centers. Closure of affected child care centers may lead to placement of infected children in other centers (with subsequent transmission in those centers) and is counterproductive.