TABLE 2.

Assessment criteria for norovirus-related food service provisions in state regulations

Provision	2013 Food Code	Assessment criteria for state regulation
Hand washing procedure	Food Code details a hand washing procedure for all food workers, including how to wash their hands and for how long, and nine specific instances before or after which employees should wash (Section 2–3).	Any provision requiring hand washing.
Prohibition of bare-hand contact	Food Code prohibits bare-hand contact with ready-to-eat (RTE) food, except in certain circumstances, such as when washing vegetables or when a kill step is involved (Section 3–301.11).	Any regulation prohibiting bare-hand contact with RTE foods; states that called for limitation or minimization of bare-hand contact were not considered as explicitly prohibiting contact.
Certified food protection manager (CFPM)	Provision requires that each establishment have at least one employee with supervisory or managerial duties who has been certified as a food protection manager by passing a test from an accredited program. Food Code also allows for the presence of a CFPM to fulfill a separate provision, which requires a person in charge to be able to demonstrate knowledge of food safety principles during an inspection or other request (Sections 2–102.12 and 2–102.20).	Provision requiring at least one CFPM per food establishment; states that did not require a CFPM but allowed a certification to fulfill knowledge requirements were not considered as explicitly requiring a CFPM.
24-h ill staff exclusion	Food Code recommends that food workers with diarrhea or vomiting be excluded until 24 h after resolution of symptoms. Exclusion means that affected employees do not report to work at all for the specified time. Food Code provides more stringent exclusion periods for employees with laboratory-confirmed norovirus infections, recommending exclusion for 24 h after symptom resolution and then restriction from certain food handling duties for another 24 h after the exclusion period. However, because laboratory confirmation of norovirus infection is rarely performed in sporadic cases due to lack of widely available routine clinical assays, this provision is often not applicable (Section 2–2).	Provision requiring employees with vomiting or diarrhea to be excluded for at least 24 h after symptom resolution. Provisions requiring medical clearance before returning to work were considered to meet this criterion. Provisions allowing either exclusion or restriction for employees with symptoms or not specifying a length of time for exclusion were not considered to meet this criterion. Because most ill workers will not be specifically diagnosed with laboratory-confirmed norovirus, we used adoption of the general vomiting and diarrhea exclusion period as the primary indicator of adopting ill staff exclusion guidelines and used this provision in our subsequent analyses. To descriptively assess differences in regulations, we also examined other exclusion criteria, including the norovirus-specific indicator.
Response plan for contamination events	Provision requires that food establishments have procedures in place for employees to follow during situations in which vomitus or fecal matter is expelled onto surfaces in the establishment. Although Food Code does not recommend specific procedures, it indicates that response plans should include actions that employees should take to prevent transmission of pathogens to other employees and patrons of the establishment (Section 2–501).	Any provision requiring a contamination event response plan.