Guidelines for Parasitologic Screening of Food Handlers

Local health units typically require stool examinations for food handlers but commonly use Direct Fecal Smear (DFS).
DFS is inexpensive but lacks sensitivity, particularly for asymptomatic infections.
Studies show Formalin Ether/Ethyl Acetate Concentration Technique (FECT) is significantly more sensitive than DFS.
There is a need to update and improve parasitologic screening to better detect infections early.

No person may work in food establishments without a health certificate issued by the municipal/city health officer.
Health certificates require medical and physical exams, immunizations, and briefing by the local health office.
Certificates are renewed annually or as required and are non-transferable.
Persons with communicable diseases or symptoms such as diarrhea or respiratory infections are prohibited from food handling.

General: Enhance parasitologic screening of food handlers by local health units.
Specific:
- Mandate stool examination for food handlers applying for health certificates.
- Use FECT as the required stool examination method.
- Define examination frequency.
- Specify personnel qualifications, equipment, and procedures for FECT.

Clarifies key terms including DOH, DFS, Food, Food Establishment, Food Handler, FECT, Health Certificate, Local Health Authority, Local Health Unit, Medical Technologist, and Municipal/City Health Officer.

These guidelines apply to all municipal and city health offices involved in issuing health certificates to food handlers.

Mandatory stool examination for all food handlers applying for health certificates.
Use FECT as the standard stool examination method.
Food handlers must have stool exams at least once per year.

Requirements for FECT:

Personnel must be licensed Medical Technologists with specific training in parasitic diagnosis.
Facilities must have designated areas with adequate space, lighting, and ventilation.
Equipment includes clinical centrifuges and microscopes with appropriate power objectives.
Supplies include stool cups, formalin, ether or ethyl acetate, pipettes, gloves, and other laboratory materials.

Procedures:

Stool Collection: Food handlers must provide stool samples properly labeled and uncontaminated.
Transportation: Samples should be transported immediately or refrigerated but not frozen; use plastic bags.
Preservation: If delayed, mix stool samples with 10% formalin in a 1:3 ratio.
FECT Procedure:
- Mix feces with formalin suspension.
- Filter, add ether/ethyl acetate, and centrifuge.
- Decant layers leaving sediment.
- Prepare slides for microscopic examination.
- Examine systematically under microscope for parasites.

All prior rules or regulations inconsistent with these guidelines are repealed or amended accordingly.

The order takes effect 15 days after filing or upon publication/posting in the DOH Intranet.