Environmental Assessment. Exercise

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Industry-Foodborne Illness Investigation Training & Recall Response Module 3 Environmental Assessment Exercise 1 Module 3 - Learning Objectives Identify the information used by a public health agency

1 Industry-Foodborne Illness Investigation Training & Recall Response Module 3 Environmental Assessment Exercise 1 Module 3 - Learning Objectives Identify the information used by a public health agency to evaluate a suspected foodborne illness outbreak Identify the contributing factors associated with foodborne illness Develop a food flow diagram and identify where contamination, pathogen survival and/or growth occurred 2 1

More efficient information gathering and resolution of outbreak Collaboration with all parties may

2 Sources of Foodborne Illness Outbreaks Restaurants, markets Potluck suppers Home food preparation Summer camps Food processors Farms Oceans 3 Why Collaborate? More efficient information gathering and resolution of outbreak Collaboration with all parties may prove the establishment was NOT the cause of an illness Outbreak may be caused by an ingredient and not a practice of the establishment 4 2

Health agency can It s Your Right To Ask inform you as to why they are there what they know so far keep you informed of their findings If not getting cooperation ask WHY ask for inspector s

3 Health agency can It s Your Right To Ask inform you as to why they are there what they know so far keep you informed of their findings If not getting cooperation ask WHY ask for inspector s supervisor contact information Health agencies cannot provide patient names, personal info or health status 5 Module Objective #1 Identify the information used by a public health agency to evaluate a suspected foodborne illness outbreak 6 3

Review Outbreak Information Food facility information Existing regulatory records Menus,

4 Review Outbreak Information When illnesses occurred Incubation period Foods consumed Anecdotal information (observations, interviews) Lab results of cases/patients, if any 7 Review Outbreak Information Food facility information Existing regulatory records Menus, recipes, processes Causative agent information Mode of transmission (how is it spreading) 8 4

Differences in Investigation Approaches IF NO single food item is implicated: Conduct general risk-based assessment using most up to date information

FOOD: Food Preparation Review is critical 9 Environmental Assessment Food Preparation Review Identify foods and beverages offered Reconstruct past events -

5 Differences in Investigation Approaches IF NO single food item is implicated: Conduct general risk-based assessment using most up to date information available Determine which samples epi and lab investigators are most interested in (food, clinical, environmental, water/ice) IF there is an IMPLICATED FOOD: Food Preparation Review is critical 9 Environmental Assessment Food Preparation Review Identify foods and beverages offered Reconstruct past events - when and how food(s) were produced Examine risk factors and theorize why did this happen? Identify possible cause & effect Implement effective control actions 10 5

Manager Interview Explain reason for the investigation Review health, hygiene, food safety practices, past

6 Investigator Site Visit 1. Manager Interview 2. Facility walk through 3. Assessment of food preparation 4. Develop food flow diagram 5. Sampling 6. Worker interviews 7. Collect records/ review documents 11 5 & 6 1. Manager Interview Explain reason for the investigation Review health, hygiene, food safety practices, past inspection reports Identify who worked with the implicated food(s) Any food worker ill during time period of interest? 12 6

Assessment of Food Prep How the same items are prepared today Attempt to reconstruct how

7 2. Facility Walk Through Observe critical operations Collect samples if available Verify who worked with implicated foods Assessment of Food Prep How the same items are prepared today Attempt to reconstruct how they were prepared during time period of interest Take measurements (time, temperature, product dimensions, quantity produced, locations) 14 7

8 12 4. Develop Food Flow Diagram Collect Samples for Lab Testing Environmental swabs Work surfaces, utensils Employees Stool, nasal secretions 16 8

Food Worker Interviews Establishes a timeline & reconstructs events Allows food worker and

9 Laboratory Testing Food/Ingredients tested for: Disease causing agents (e.g., bacteria, viruses, toxin) Food characteristics (e.g., ph, water activity) Food Worker Interviews Establishes a timeline & reconstructs events Allows food worker and other employees to tell their story Looking for unique circumstances, stressful situation in food operation 18 9

patrons served during outbreak Suppliers Job task assignments for each employee on incident date Employee Illness

10 1, 3, 5, 10, recall forms 7. Collect Records Invoices (for traceback) Employee work history Detailed menu/ related documents Total number of patrons served during outbreak Suppliers Job task assignments for each employee on incident date Employee Illness policy 19 Records & Other Information What SOPs or food safety systems are in place? HACCP Approved sources Personal hygiene Cleaning & sanitizing Time/temperature procedure Recipe formulations Training s 20 10

Associated with Foodborne Illness 1. Improper hot/ cold holding of TCS foods 2. Improper cooking temperatures 3.

11 Module Objective #2 Identify the contributing factors associated with foodborne illness Contamination (foods / surfaces) Survival (microorganism on foods / surfaces) Proliferation (rapid growth of bacteria ) 21 CDC -Top 5 Risk Factors Associated with Foodborne Illness 1. Improper hot/ cold holding of TCS foods 2. Improper cooking temperatures 3. Contaminated utensils and equipment 4. Poor personal health and hygiene 5. Food from unsafe sources Photos courtesy of Larry Pong 22 11

spores, toxins Viruses and parasites Factors that inhibit survival Acidity,

12 Contamination Ingredients Hands Ill food workers Improper glove use Equipment, utensils 23 Survival Pathogen survives on contaminated surfaces, foods Bacteria: spores, toxins Viruses and parasites Factors that inhibit survival Acidity, salts, preservative, cooking, cleaning Does the disease agent survive the process? 24 12

information gathered from different sources (food operations assessment, illnesses, lab results)

13 Proliferation of Pathogen Factors that encourage rapid growth Time/temperature abuse Low acidity Moisture Availability of oxygen 25 Compile & Analyze Findings Investigators will: Compile and interpret information gathered from different sources (food operations assessment, illnesses, lab results) Identify risk factors at each step in food flow Determine what happened, what did not and what is still unknown 26 13

Summary - Module 3 Role Environmental Assessment Epidemiology Helps identify suspect facilities, agents and food vehicles; serves as link to medical community, ill people and controls Lab.

14 Summary - Module 3 Role Environmental Assessment Epidemiology Helps identify suspect facilities, agents and food vehicles; serves as link to medical community, ill people and controls Lab. Provides guidance on sampling techniques; performs analysis on clinical, environmental and food samples EH/Food Regulatory Industry Performs environmental assessment; helps implement control measures; serves as link to the food facility Works cooperatively with public health agency in an effort to stop outbreak, implement control measures to prevent further occurrence, may initiate independent third party involvement on behalf of company. 27 Module 3 Investigations Exercise part 1 Preparation and Food Flow Diagram 14

15 Module 3 Food Flow Exercise Background Information: You are the owner of G&G Supermarket and Deli, and have recently been notified by the Health Department about a number of illnesses associated with foods bought from your Market and Deli on the 14th. The business has been open for 50 years and never been implicated in an outbreak. Inspection scores have always been in the 80 s with few critical violations noted. The deli is run by Lucy Taylor and Mavis Edwards, both with food safety certifications. The company has a HACCP system, with reputable suppliers, and a recall plan in place. The products in question are still on site and all operations were suspended until an investigation is completed. The deli operates on a limited basis with occasional breakfast buffets. 2 The store has an illness policy for employees requiring sick employees to notify the Person in Charge and stay home with any gastrointestinal symptoms or contagious disease. The employees listed working on the 14th were Lucy Taylor, Mavis Edwards and Chet Wilkins, a part time maintenance worker who filled in during a rush when Mavis Edwards delivered some cakes. None of them have reported being sick as confirmed through time sheets. None of them have traveled. The self serve breakfast buffet consisted of scrambled eggs, bacon, sausage, hash browns and biscuits with ham and cheese. The temperature record entries (cooking and holding) for the day did not indicate any time or temperature violations on any of the products on the buffet. All equipment had been cleaned and sanitized before operations began. The employees do not know anything other than they were closed until further notice. 3 15

16 How should YOU prepare for the Health Department? 1. What foods do you consider to be the most suspect and what else is needed? 2. Draw a food flow diagram for these food(s) 3 FOOD FLOW DIAGRAMS BUFFET ITEMS (TCS/other foods) Receive Store Prepare Cook Serve Store CAKES Receive Store Prepare Cook Store Transport 3 16

3 Module 3 Exercise Summary Know what information to gather before Health Department arrives Understand where

17 Restaurant: How do you communicate with your employees about the situation? Health Departments: How do YOU want the establishment to initially assist you? 3 Module 3 Exercise Summary Know what information to gather before Health Department arrives Understand where potential issue may have arisen Food flow helps to identify critical control points Know how to assist the Health Department. Health Department can help solve and fix source of issue 3 17

18 Module 3 Review QUESTIONS? 35 18

4 OUTBREAK OF AN ENTERIC ILLNESS

4 OUTBREAK OF AN ENTERIC ILLNESS 4.1 Definition An outbreak of an enteric illness is defined as the occurrence of case(s) in a particular area and period of time, which is in excess of the expected number