Grocery stores are vital to the health and well-being of American citizens. The coronavirus epidemic has presented a unique set of challenges especially for the elderly and citizens of low socioeconomic status because of the barrier to technology that they face. State and local governments have issued ordinances requiring quarantining at home to reduce the spread of disease. Exceptions to these laws allow citizens to seek medical attention, medications, or groceries. Individuals that are unable to order groceries through online services place themselves at higher risk of becoming infected or infecting others with COVID-19. The grocery stores that have remained open to servicing the public can play a critical role in limiting the spread of disease. The aim of this article is to provide concise recommendations from CDC, FDA, and peer reviewed sources to reduce the spread of disease in grocery stores. Recommendations are tailored to employer actions which can reduce harm to customers and employees. The guidelines also provide sample flyers and brochures which employers can tailor to their specific needs to promote hygiene, social distancing, and personal protective equipment. Preserving grocery stores is a top priority for maintaining the health and well-being of the public. The provided recommendations may change due to national, state, and local ordinances; however, should be considered as a broad guidance for grocery stores wishing to safely serve customers during the COVID-19 pandemic.
Coronavirus; COVID-19; Disease prevention; Infectious disease
The food market and grocery store industry are the largest providers of food in the United States . Currently, there are no clear guidelines for grocery store employees to protect themselves during a pandemic. The coronavirus disease 2019 (COVID-19) pandemic has presented unique challenges for many industries to continue business and ensure employee safety. Grocery stores are in a challenging position during this pandemic due to their essential need and continuous contact with the public. To keep the workplace safe for both employees and customers guidelines need to be established to support both the employer and employees in this unprecedented time. The need to preserve the health and well-being of the grocery store employees is vital in continuing to keep society functioning by providing fresh food. In this guideline important actions are presented that can be taken by employees and the employer to reduce the transmission of COVID-19. To make sure this guideline is available to all workers at every educational level; an easy to understand brochure has been created to distribute amongst workers. As this situation is continuously changing it is likely that these recommendations will change based on emerging evidence.
Hygiene: Washing your hands should be done for at least 20 seconds with soap and warm water after being in a public, sneezing, coughing, blowing your nose, or touching another person. If soap and water are not available, an alcohol-based sanitizer that contains at least 60% alcohol is sufficient . Prior studies show that alcohol-based sanitizers are as effective as antimicrobial soap for the removal of several viruses . Proper hand hygiene methods have shown to reduce the spread of viruses in office-based environments, so practicing proper hand-hygiene is of upmost importance in a grocery store .
When sneezing or coughing it is important that the employees cover their mouth and nose with a tissue or their elbow rather than their hand . Employees should also be advised to avoid touching the face, eyes, ears, or nose until they have washed their hands . This reduces the possibility of transmitting the virus to others by touching objects.
Social distancing of at least 6-feet: Keeping adequate social distance between coworkers and customers should be the most important priority during work . Recommendations have been implemented by the CDC and the WHO to keep at least 6-feet of distance between each other. Therefore, a store should measure the amount of free square footage and allow no more than 1 person per 113 square feet. Workers should instruct their colleagues and customers about these measures and enforce them to the best of their ability.
Masks: Employees who have access to N95 masks should always wear them while they are at work. Cloth masks have shown worse efficacy when compared to N95 masks, but they have been recommended to curtail droplet transmission during times of mask shortage . Masks can be manufactured using cloth found around the home and should be thoroughly washed with soap and water after each use . Employees should make sure that the mask has a tight seal around their face to ensure that room air cannot enter around the facemask .
Gloves: Nitrile and latex gloves have been shown to stop viral particle transmission through the glove . Common gloves found in grocery stores are usually polyethylene and should not be worn with the intent to stop exposure to COVID-19 . If nitrile gloves are available, employees should wear them to limit skin contact with the virus. In the case that nitrile or latex gloves or not available previous studies demonstrate that vinyl gloves at lower levels of use there was no statistical difference in leakage . This study is critical given the need to reserve latex and nitrile gloves for healthcare workers in high use situations. Gloves should be changed before performing different work tasks to decrease cross contamination between work activities.
Inform the customers about the importance of social distancing and hand hygiene: If possible, a designated employee should be placed at the front of the store to manage store capacity, sanitation of store carts, and inform customers about 6 ft social distancing from other customers and employees. Disinfection of shopping carts can be done using CDC recommendations of a 5 tablespoons (1/3 cup) bleach per gallon of water . Flyers provided in the appendix can be provided to customers to advice about social distancing and reminders of hygiene. All employees should be well versed in these basic recommendations so that they can inform customers on the importance of preventing the spread of COVID-19.
Decontamination after work duties have concluded: Washing hands immediately following work duties for 20 seconds under warm water is advised to reduce risk of transmission of viral particles to the household. Workers should adequately disinfect their clothing upon returning home from work duties. If possible, workers should immediately use household detergents and water that is above 132.8°F to properly clean their clothing . It is also advised to thoroughly wash hands for at least 20 seconds upon returning home and after interacting with spoiled clothing . Proper hand hygiene and appropriately disinfecting work clothes can contribute to reducing the transmission of COVID-19.
Supplying adequate Personal Protective Equipment (PPE) to employees: Employers should work to secure quality PPE for employees to use while at work. Supplying adequate face masks, gloves and hand sanitizers should be a major concern for employers in keeping their employees and their customers safe while in the store.
Install barriers for cashiers: Installing plastic or glass shields to physically separate the cashier from the customer are already used in many restaurants to prevent contamination of food by customers. Installing a plastic shield at each cash register could stop transmission of COVID-19 from customers. These shields can be thin plastic curtains or glass barriers which cover face level. When possible a barrier of 6 ft should be put in place between cashiers and paying customers.
Provide paid sick leave: Providing paid sick leave allows employees who have symptoms of COVID-19 to stay at home and reduce the risk of spreading the virus to workers and customers. Employers should inform employees who have symptoms of COVID-19 to stay at home. Promotion of self-assessment tools from organizations such as the Mayo Clinic can promote employee health and safety .
Limiting customer contact with non-packaged ready-to-eat food: Although it is unknown whether COVID-19 can be transmitted by foodborne transmission the FDA advises the discontinuation of self-service food bars and salad bars . Recent evidence has shown that COVID-19 is stable on a variety of surfaces . This means that the virus can be present on a surface of utensils and can be transmitted by a person interacting with an infected item. Grocery stores should also consider limiting the interaction that customers can have with non-packaged, ready-to-eat food items such as produce. These customer interactions can be limited by a designated employee that retrieves the non-packaged ready-to-eat food items. The dedicated employee represents a critical control point in reducing community transmission of COVID-19. Reducing the number of customers touching food items may reduce the spread of COVID-19 in grocery stores.
Dedicated shopping hours for Immunocompromised and elderly individuals: Having dedicated shopping hours for elderly and immunocompromised individuals can greatly alleviate the burden of these individuals. Publicizing these hours through social media and company websites can help the grocery store to maximize the customers during this time.
The COVID-19 pandemic is requiring dedicated measures to be implemented by the grocery store and supermarket industry. Grocery stores should encourage openness and accountability from their employees. Creating a culture where employees feel comfortable policing others and themselves to prevent the spread of COVID-19. Maintaining the function of this industry is vital in supporting the United States populace during the COVID-19 pandemic. Carefully following the guidelines listed above may reduce the spread of COVID-19 amongst grocery store employees and customers.