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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

Vince Vince RadkeRadke, MPH, RS, CP, MPH, RS, CP--FS, DAAS, CPHFS, DAAS, CPH

SanitarianSanitarian

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

Atlanta, GAAtlanta, GA

2011 National Environmental Health Association2011 National Environmental Health Association

Annual Educational ConferenceAnnual Educational Conference

Columbus, OHColumbus, OH

Sunday, June 19, 2011Sunday, June 19, 2011

Food Safety Tools for Regulatory Professionals in the 21st century

National Center for Environmental Health

Division of Emergency and Environmental Health Services

CDC

The views, findings and conclusions in this presentation are those of the author and do not necessarily represent the official

position of the Centers for Disease Control and Prevention and the Department of Health and Human Services

Disclaimer

National Center for Environmental Health

Division of Emergency and Environmental Health Services

TOOLS

� Environmental Assessments

� Critical Thinking

� Contributing Factors

� Antecedents

� Surveillance

� National Voluntary Environmental Assessment Information System

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

Information Critical To Regulators

�� Food Vehicle IdentificationFood Vehicle Identification

�� Contributing Factors To OutbreakContributing Factors To Outbreak

�� Environmental Antecedents Environmental Antecedents

Medium(food, water,

Wastewater,Air, etc.)

EquipmentPeople

Process

Economics

Protective

Systempreventionunsuccessful

No

illnessprev

ention

success

ful

Adverse

Health Outcomes

Increasing

Severity of

illness

Outbreak

Exposure

Systems Approach to Investigating Systems Approach to Investigating

Disease OutbreaksDisease Outbreaks

Epidemiology

Lab(Identify

and/or

confirmAgent)

Environmental Antecedents

Medium(food, water,

Wastewater,Air, etc.)

Environmental

Health

AssessmentEquipmentPeople

Process

Economics

Protective

Systempreventionunsuccessful

No

illnessprev

ention

success

ful

Adverse

Health Outcomes

Increasing

Severity of

illness

Outbreak

Exposure

Using Environmental Assessments to Using Environmental Assessments to

Investigate Disease OutbreaksInvestigate Disease Outbreaks

Contributing

Factors

NVEAIS

Epidemiology

Lab(Identify

and/or

confirm

Agent)

NORS

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

ENVIRONMENTAL ASSESSMENTS:WHAT ARE THEY?

EnvironmentalEnvironmental

AssessmentAssessment

How the environment* can How the environment* can

contribute or did contribute to contribute or did contribute to

the introduction and or the introduction and or

transmission of agents that cause transmission of agents that cause

illnessillness.

*Everything external to the host, including *Everything external to the host, including

air, food, water, animals, plants, climate, etc., air, food, water, animals, plants, climate, etc.,

as well as people, social and built environmentsas well as people, social and built environments

Environmental Assessment

Routine

Regulatory

Inspections

Past Present Future

Physical Facility

Plan Review

HACCP Plan

Development

Foodborne Illness

Outbreak

Environmental

Assessment

Types of Environmental Assessments

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

Routine Regulatory Inspection

� Time frame context – present

� Focus – implementation of regulatory requirements

� May be framed by a HACCP or risk based inspection approach, but

may not be

� May be framed within a formal HACCP plan

� Question - What could cause the contamination of food

or the survival or growth of pathogens given the

present situation?

Plan Review / HACCP Plan Development

� Time frame context – future

� Focus – setting the stage for the future successful implementation of regulatory requirements

� Plan Review – establishing a physical environment to support the

successful implementation of regulatory requirements

� HACCP plan development – identifying hazards, control points,

critical limits (generally, regulatory requirements)

� Question – Given what we know today, what could

cause the contamination of food or the survival or

growth of pathogens given the expected future

situation?

CRITICAL THINKING

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

Critical Thinking

Critical Thinking

FOODBORNE ILLNESS OUTBREAK ENVIRONMENTAL ASSESSMENTS

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

FoodborneFoodborne Illness Outbreak Illness Outbreak Environmental AssessmentsEnvironmental Assessments

� Describe how the environment contributes to the

introduction and/or transmission of agents that cause

illness

� Component of an outbreak investigation

� All aspects of the external environment can be listed as variables that,

in relation to transmission, are:

• neutral,

• conducive or

• protective.

� From this description contributing factors and environmental

antecedents to an outbreak can be determined.

� Is NOT an inspection

Objectives of Foodborne Illness Outbreak Environmental Assessment

� Identify contributing factors

� Identify environmental antecedents

� Generate recommendations for informed interventions

CONTRIBUTING FACTORS

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

Contributing Factor DefinitionContributing Factor Definition� The factors likely to be conducive to the contamination

and survival of the etiologic agent or suspected agent

and/or to its growth or proliferation.

� Contamination Factors (C1-15)

• Toxic substance part of the tissue , Contaminated raw product, Cross-

contamination of ingredients, Bare-hand contact by a food

handler/worker/preparer who is suspected to be infectious

� Proliferation Factors (P1-12)

• Improper cold holding due to malfunctioning refrigeration equipment,

Improper hot holding due to improper procedure or protocol, Prolonged

cold storage

� Survival Factors (S1-4)

• Insufficient time and/or temperature during cooking/heat processing,

Insufficient time and/or temperature during reheating

� Contributing factors are NOT code violations

ENVIRONMENTAL ANTECEDENTS

Environmental Antecedents DefinitionDefinition

� Root causes

� Supporting factor(s) to the contamination, survival or

increase of biological or chemical agents in food

� They may be related to

� People

� Equipment

� Process

� Food

� Economics

� Behavior

� Other circumstances

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

SURVEILLANCE

Foodborne Disease Surveillance

�� Disease Incidents (Outbreaks)Disease Incidents (Outbreaks)

�� CDCCDC’’s National Outbreak Reporting System (NORS) s National Outbreak Reporting System (NORS)

�� Laboratory Isolation Of PathogensLaboratory Isolation Of Pathogens

�� CDCCDC’’s s PulseNetPulseNet ProgramProgram

�� Sentinel Community StudiesSentinel Community Studies

�� CDCCDC’’s s FoodNetFoodNet ProgramProgram

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

NORS

PulseNet

FoodNet

?????????

Where Do Food Safety Programs Fit?

�� Hazard Surveillance Hazard Surveillance

�� Not established but some steps in that directionNot established but some steps in that direction

•• Routine InspectionsRoutine Inspections

•• State And Local BaselinesState And Local Baselines

•• FDA Contributing Factor BaselineFDA Contributing Factor Baseline

�� FoodborneFoodborne Disease Incident SurveillanceDisease Incident Surveillance

�� Environmental Assessment In Environmental Assessment In FoodborneFoodborne Outbreaks Outbreaks

Problems with Existing Contributing Factor Data Reported to NORS

�� Categories of contributing factor data is more complex Categories of contributing factor data is more complex than what is reportedthan what is reported

�� Data is incomplete or missingData is incomplete or missing

�� Unsure of the meaning of contributing factor data that Unsure of the meaning of contributing factor data that is reported is reported

�� Unclear how the contributing factors are determinedUnclear how the contributing factors are determined

�� No context for contributing factors that are reportedNo context for contributing factors that are reported

�� Factors may not be reflective of farm or processing Factors may not be reflective of farm or processing

environmentenvironment

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

The Public Health ChallengeThe Public Health Challenge

“…“…public health surveillance and outbreak public health surveillance and outbreak

investigation programs have evolved investigation programs have evolved

independently from food safety programs, and independently from food safety programs, and

current human health statistics address the current human health statistics address the

questions of communicable disease control questions of communicable disease control

officials better than the questions of food control officials better than the questions of food control

authorities.authorities.””

(ICMSF, 2006)(ICMSF, 2006)

NATIONAL VOLUNTARY ENVIRONMENTAL ASSESSMENT INFORMATION SYSTEM (NVEAIS)

CFP Recommendation

A food regulatory program has a systematic approach for the detection,

investigation, response, documentation, and analysis of alleged food-

related incidents that involve illness, injury, unintentional, or deliberate

food contamination.

Regulatory programs are encouraged to also participate in

the CDC National Voluntary Environmental Assessment

Information System (NVEAIS). NVEAIS is designed to provide

a more comprehensive approach to foodborne disease

outbreak investigation and response and will provide a data

source to measure the impact of food safety programs to

further research and understand foodborne illness causes

and prevention.

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

NVEAIS Rollout

� Piloting 2010

� System is open for review and comment by potential users

� 2011

� Foodborne Illness Outbreak Environmental Assessment Training to

aid in conducting environmental assessments during foodborne

illness outbreak investigations

� January 1, 2012

� NVEAIS opens nationally for data reporting

NVEAIS

� www.cdc.gov/nceh/ehs� Provides information about NVEAIS

� Registration information

� Information on how to use EHSNIS that houses NVEAIS

� Registering to use the NVEAIS

� Send and email to NVEAIS@cdc.gov

• First and Last Name

• E-mail address

• which will be used to deliver an automated message to begin the registration

process.

WHAT DOES ALL THIS MEAN?:

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

EXAMPLE

� What caused the outbreak? Campylobacter Jejuni (CJ) in the “cooked” chicken (EPI, LAB, ENV Assessment)

� Why was CJ in the “cooked" chicken? Insufficient temperature during cooking to kill CJ (Contributing

Factor)

� Why was there insufficient temperature during the

cooking process to kill CJ? The cook did not know the

temperature (Environmental Antecedent – People

variable)

Relationship of Environmental Antecedents Relationship of Environmental Antecedents

to Contributing Factorsto Contributing Factors

No sick leaveAfraid of reporting

No policy

No supervisionLack of knowledge

Hands not washed

No gloves used

PEOPLE

Lack of hand wash sinksLocation of hand wash sinks

Lack of supplies for hand wash sinksNo supervision

Not enough water available

Not enough gloves available

EQUIPMENT

Handling after kill step

No kill step

Multiple steps involving process

PROCESS

Minimum wage

Equipment costs

Glove costs

ECONOMICS

FOOD

Outbreak

Contamination at preparation step

Contributing

Factor A

Bare-hand contact by a food handler/worker/preparer who is suspected to be infectious

Contributing

Factor X

HOW CAN I USE IT?

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

Conclusions

� The environmental assessment in a foodborneoutbreak investigation is critical to understanding

contributing factors and potential antecedents to

foodborne illness, yet information regarding potential

antecedents is rarely captured.

� While current foodborne outbreak surveillance data

may identify working while ill or poor handwashing

practices as factors contributing to outbreaks

information on why these circumstances may have

existed is not collected or reported.

Conclusions(Cont.)

� A systematic collection, analysis, interpretation, and dissemination of environmental data from foodborne

disease outbreak investigations can support the

overall foodborne disease surveillance system in a

country, strengthening the ability of food control

authorities at all levels of government to formulate

food safety action and assess the effectiveness of these actions.

Your Role

� Lower the burden of foodborne illness

� Participate in understanding how and why foodborne

illness outbreaks are occurring

� Conduct environmental assessments during foodborne illness

outbreaks

� Enter environmental assessment data into NVEAIS

� Educate food managers and workers about how and why foodborne

illness occurs

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2011 NEHA AECFS1104 Food Safety Tools for Regulatory Professionals in the 21st Century

Vince Radke

vradke@cdc.gov

www.cdc.gov

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of

the Centers for Disease Control and Prevention.

Thank you

Questions

National Center for Environmental Health

Environmental Health Services Branch