Routine stool cultures not needed for food servers

Question: We are revising our new hire policy. Is there any information you could provide regarding the need for obtaining stool cultures from food workers prior to employment?

Answer: Routine stool culturing of asymptomatic food service workers (FSWs) before or during employment is not recommended and lacks scientific validity.¹ Although state laws maintain authority and jurisdiction over this practice and some states still may require "screening" stool cultures of FSWs, the practice is to be discouraged.

Monitoring the health of FSWs obviously is important, and many states used to require pre-employment and sometimes annual stool cultures. However, the practice has never proven to be useful or cost-effective, and can even fail to define a chronic carrier due to intermittent excretion. Furthermore, the practice may be counterproductive by implying a false sense of security and inappropriately conveying the impression of enhanced food safety.

A more appropriate approach to promote food safety is to encourage a high degree of education to food service workers regarding personal hygiene and early notification of appropriate personnel regarding the presence of acute intestinal diseases or skin infections.

— Question answered by Patrick Joseph, MD, Chief of Epidemiology, San Ramon (CA) Regional Medical Center

Reference

1. Cruickshank JG, Humphrey TJ. The carrier food-handler and non-typhoid salmonellosis. Epidemiol Infect 1987; 98:223.

(Editor’s note: Readers should send infection control questions for this section to: Editor, Hospital Infection Control, P.O. Box 740056, Atlanta, GA 30374.)