Module 3 – Environmental Assessment
1Industry‐Foodborne Illness Investigation Training & Recall Response
Module 3
Environmental Assessment
Exercise
Industry-Foodborne Illness Investigation Training & Recall Response
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Module 3 - Learning Objectives
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• Identify the information used by a public health agency to evaluate a suspected foodborne illness outbreak
• Identify the contributing factors associatedwith foodborne illness
• Develop a food flow diagram and identify where contamination, pathogen survival and/orgrowth occurred
Module 3 – Environmental Assessment
2Industry‐Foodborne Illness Investigation Training & Recall Response
Sources of Foodborne Illness Outbreaks
Restaurants, markets
Potluck suppers
Home food preparation
Summer camps
Food processors
Farms
Oceans
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Why Collaborate?
• More efficient information gathering andresolution of outbreak
• Collaboration with all partiesmay prove the establishment wasNOT the cause of an illness
• Outbreak may be caused by aningredient and not apractice of the establishment
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Module 3 – Environmental Assessment
3Industry‐Foodborne Illness Investigation Training & Recall Response
It’s Your Right To Ask
Health agency can
• 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 providepatient names, personal info or health status
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Module Objective #1
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Identify the information used by a public health agency to evaluate a
suspected foodborne illness outbreak
Module 3 – Environmental Assessment
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Review Outbreak Information
• When illnesses occurred
• Incubation period
• Foods consumed
• Anecdotal information(observations, interviews)
• Lab results ofcases/patients, if any
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• Food facility information
• Existing regulatory records
• Menus, recipes, processes
• Causative agent information
• Mode of transmission
(how is it spreading)
Review Outbreak Information
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Module 3 – Environmental Assessment
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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
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Environmental Assessment
Food Preparation Review
• Identify foods and beverages offered
• Reconstruct past events - when and how food(s) wereproduced
• Examine risk factors and theorize why did this happen?
• Identify possible cause & effect
• Implement effective control actions
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Module 3 – Environmental Assessment
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Investigator Site Visit
1. Manager Interview
2. Facility walk through3. Assessment of food preparation
4. Develop food flow diagram
5. Sampling
6. Worker interviews
7. Collect records/
review documents
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1. Manager Interview
• Explain reason for the investigation
• Review health, hygiene, food safetypractices, past inspection reports
• Identify who worked with theimplicated food(s)
• Any food worker ill duringtime period of interest?
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5 & 6
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2. Facility Walk Through
• Observe critical operations
• Collect samples if available
• Verify who worked with
implicated foods
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3. Assessment of Food Prep
• How the same items are prepared today
• Attempt to reconstruct how they wereprepared during time period of interest
• Take measurements(time, temperature,product dimensions, quantity produced,locations)
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Module 3 – Environmental Assessment
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4. Develop Food Flow Diagram
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5. Collect Samples for Lab Testing
Environmental swabs
• Work surfaces, utensils
Employees
• Stool, nasal secretions
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Module 3 – Environmental Assessment
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Laboratory Testing
Food/Ingredients tested for:
• Disease causing agents(e.g., bacteria, viruses, toxin)
• Food characteristics(e.g., pH, water activity)
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6. Food Worker Interviews
• Establishes a timeline & reconstructs events
• Allows food worker and other employeesto tell their story
• Looking for unique circumstances, stressful situation infood operation
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Module 3 – Environmental Assessment
10Industry‐Foodborne Illness Investigation Training & Recall Response
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 eachemployee on incident date
• Employee Illness policy
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1, 3, 5, 10, recall forms
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
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Module 3 – Environmental Assessment
11Industry‐Foodborne Illness Investigation Training & Recall Response
Module Objective #2
Identify the contributing factors associatedwith foodborne illness
• Contamination (foods / surfaces)
• Survival (microorganism on foods / surfaces)
• Proliferation (rapid growth of bacteria )
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CDC -Top 5 Risk Factors Associatedwith Foodborne Illness
1. Improper hot/ cold holdingof TCS foods
2. Improper cookingtemperatures
3. Contaminated utensilsand equipment
4. Poor personal health andhygiene
5. Food from unsafe sources
Photos courtesy of Larry Pong
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Module 3 – Environmental Assessment
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Contamination
• Ingredients
• Hands
• Ill food workers
• Improper glove use
• Equipment, utensils
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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?
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Proliferation of Pathogen
Factors that encourage rapid growth
Time/temperature abuse
Low acidity
Moisture
Availability of oxygen
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Compile & Analyze Findings
Investigators will:
• Compile and interpret information gatheredfrom different sources(food operations assessment, illnesses, lab results)
• Identify risk factors at each step in food flow
• Determine what happened,what did not andwhat is still unknown
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Module 3 – Environmental Assessment
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Summary - Module 3
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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
Performs environmental assessment; helps implement control measures; serves as link to the food facility
Industry 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.
Module 3 Investigations Exercise‐ part 1
Preparation and
Food Flow Diagram
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Module 3 – Food Flow Exercise
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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.
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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.
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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)
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FOOD FLOW DIAGRAMS
BUFFET ITEMS (TCS/other foods)
Receive
Store
Prepare
Cook
Serve
Store
CAKES
Receive
Store
Prepare
Cook
Store
Transport
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Restaurant:
How do you communicate with your employees
about the situation?
Health Departments:
How do YOU want the establishment to initially assist you?
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
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