Module 3: Environmental Assessment · Module 3: Environmental Assessment Bureau of Environmental Services Food, Milk, and Lodging Division Epidemiology Division Bureau of Clinical
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Module 3: Environmental Module 3: Environmental AssessmentAssessment
Bureau of Environmental ServicesFood, Milk, and Lodging Division
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
Module Learning Objectives Module Learning Objectives g jg jFoundational Knowledge ReviewDescribe Differences & Priorities BetweenDescribe Differences & Priorities Between Process I, II, and III FoodsDescribe Environmental AssessmentDescribe Environmental Assessment ObjectivesDescribe Basic Steps of EnvironmentalDescribe Basic Steps of Environmental AssessmentConstruct a Well Documented Environmental ReportPerform Group Exercise
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services2
Various Sources of FBO Various Sources of FBO Various Sources of FBO Various Sources of FBO
RestaurantsGrocery store delis Church potluck suppersChurch potluck suppersSummer campsFood processorsFarmsTrucks
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services3
Know the Agent to TargetKnow the Agent to TargetI ti ti & C t l MI ti ti & C t l MInvestigation & Control MeasuresInvestigation & Control Measures
Contributing Factors toHAZARD
Contributing Factors to Investigate During Field Visit
Spore-FormersPreformed Toxins
Cooling, Re-Heating, Hot Holding,Bare Hand Contact Room Temp StoragePreformed Toxins
(i.e. Clost perf, B cereus, staph)Bare Hand Contact, Room Temp Storage, Cold Holding
Viral Infections (i e norovirus)
Ill Food Worker, Bare Hand Contact, Handwashing Contaminated Raw Product(i.e. norovirus) Handwashing, Contaminated Raw Product
Bacterial Infections Ill Food Worker, Bare Hand Contact, Handwashing, Contaminated Raw Product, Cross Contamination, CookingCross Contamination, Cooking
Parasitic Infections Contaminated Raw Product and Source
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
See IAFP manual for details on specific diseases 4
Contributing FactorsContributing FactorsggAssociated with FBOAssociated with FBO
Improper holding temperatures
Unsafe sourcePoor personal
Inadequate cooking
phygieneCross
Contaminated equipment
contamination
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services5
Food Safety Management Food Safety Management y gy gSystems: The PrerequisitesSystems: The Prerequisites
E l H lthEmployee HealthPersonal Hygiene ProgramTime Temperature ManagementCleaning and Sanitizing of FoodCleaning and Sanitizing of Food Contact SurfacesCross Contamination PreventionCross Contamination PreventionDate Marking
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services6
Routine InspectionRoutine InspectionRoutine InspectionRoutine Inspection
Emphasis has evolvedEmphasis has evolvedOld days - legal compliance checklist mentalitymentality Current recommendations are risk-b d i ti t id tifbased inspections to identify cause foodborne illness
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services7
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services8
See Document Library or http://adph.org/foodsafety/Default.asp?id=1140
Process 1: Process 1: N C k StN C k StNo Cook StepNo Cook Step
Receiving Store Prepare Hold Serve
Example: Sandwiches w/ RTE FillingsCanned TunaCanned TunaCanned ChickenLunch MeatLunch Meatetc.
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services9
Process 1: Process 1: No Cook Step PrioritiesNo Cook Step Priorities
Cold Holding or Time Alone as aCold Holding or Time Alone as a ControlFood SourceFood SourceDatemarkingReceiving Temperatures Freezing to Destroy Parasites (Fish g y (for Sushi)
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services10
Process 2: Process 2: Same Day ServiceSame Day Service
Receiving Store Prepare Cook Hold ServeServe
Example: Hamburgersp gMost Fast Foods
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services11
Process #2: Process #2: Same Day Service PrioritiesSame Day Service Priorities
Cooking
H t H ldiHot HoldingTime Alone as a MicrobialTime Alone as a Microbial Growth Barrier
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services12
Process 3: Process 3: Complex Food PreparationComplex Food Preparation
Receive Store Prepare Cook Coolp
Reheat Hot Hold Serve
Example: Hot Catered MealCasserole
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services13
Process 3: Process 3: Complex Food Prep PrioritiesComplex Food Prep Priorities
CookingHot HoldingHot HoldingTime Alone as a Microbial Growth BarrierBarrierCoolingReheating
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services14
Risk Factors in Process FlowsRisk Factors in Process FlowsRisk Factors in Process FlowsRisk Factors in Process Flows
All Processes No bare hand contact with RTE foodProper handwashingProper handwashingRestriction and exclusion of ill employees Prevention of cross-contaminationPrevention of cross-contamination
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
Danger Zone DiagramDanger Zone Diagram
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services1616
Conducting RiskConducting Risk--based Inspectionsbased InspectionsConducting RiskConducting Risk--based Inspectionsbased Inspections1. Inspection focusp2. Identify food process
categories presentg p3. Establish priorities4 Determine risk factors in4. Determine risk factors in
process flows5 Assess active managerial5. Assess active managerial
control of risk factors in process flows
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
p
17
Environmental Assessment Environmental Assessment (Food Preparation Review)(Food Preparation Review)
Definition: a systematic evaluation of a food establishment suspected of causing a FBO.
A cluster of consumer complaints of illillness. Lab and/or epidemiological information associated and causative agentassociated and causative agent identified.
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services18
Environmental Assessment Environmental Assessment ObjectivesObjectives
1. Identify foods and beverages offered
2. Reconstruct past events - when pfood(s) were produced
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services19
InvestigationFood Preparation Outbreak
12
9
66Service
2
26 27 28 29 30 1 2 3 4 5J J lJune July
Reconstructing Past EventsReconstructing Past EventsEpidemiology Division
Bureau of Clinical LaboratoriesBureau of Environmental ServicesHealth Department Notified
gg
20
Environmental Assessment Environmental Assessment ObjectivesObjectives
3. Identifying Contributing factors
What happened?ContaminationSurvivalProliferationProliferation
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services21
CC t i tit i tiCContaminationontamination
R i i t tiReceiving, storage, preparation, transport, serviceWorker hands, ill workersEquipment, utensilsq pCross-contaminationUse of leftovers returned foodUse of leftovers, returned food
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services22
SSurvivalurvivalSSurvivalurvivalIngredients that inhibit growth: acids, salts and preservativesalts, and preservativeTime/temperature abuseSurvival on contaminated surfaces, ingredients
Bacteria: spores, toxinsViruses and parasitesp
Will the agent survive the process?Epidemiology Division
Bureau of Clinical LaboratoriesBureau of Environmental Services
23
PProliferationroliferationPProliferationroliferation
Food -NutrientsAcidity - pH T tTemperatureTimeeOxygen – or Lack of OxygenMoisture - Water activity (aw)
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services24
FAT TOMFAT TOMFAT TOMFAT TOM
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services25
Environmental Assessment Environmental Assessment ObjectivesObjectives
4. Identify environmental antecedents Why did this happen?y ppWhat happened?
Cutting board and knife used to cut raw chicken th d t li t f th l dwere then used to slice carrots for the salad.
Why did it happen? Employee was unaware of the dangers of cross-Employee was unaware of the dangers of cross-contamination
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services26
Environmental Assessment Environmental Assessment ObjectivesObjectives
5. Implement effective controltiactions
What can be done now?Improve food safety education for employees
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services27
E i t l A t StE i t l A t StEnvironmental Assessment StepsEnvironmental Assessment Steps
PlanningPlanningSite VisitInterviews – Food WorkersAssessment of Food Preparation (CSP)
Collecting SamplesControl StrategiesControl Strategies
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services28
Planning/PreparationPlanning/Preparation
Review available Epi information
a g/ epa at oa g/ epa at o
Dates of onsetIncubation periodLikely exposure dates/meals
For commercial food productspExact product description Purchase datesPurchase dates
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services29
R i F d F ilit I f tiR i F d F ilit I f tiReview Food Facility InformationReview Food Facility Information
Existing regulatory recordsEmployee work schedulesEmployee work schedulesMenus, recipes, product formulationsWeekend menusWeekend menus
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services30
Review Causative Review Causative Agent InformationAgent InformationAgent InformationAgent Information
Bacterial Bacillus
ParasiticCrypto-
ViralNorovirus
ChemicalScombrotoxinBacillus
Campylobacter ClostridiumEscherichia
CryptosporidiumCyclosporaGiardiaT l
NorovirusRotavirusAstrovirusHepatitis A
ScombrotoxinCiguatoxinMushroom poisoningH t lEscherichia
- e-coliListeriaSalmonella Typhi
ToxoplasmaTrichinella
Heavy metals
Salmonella TyphiShigellaStaphylococcusVibrio
Mode of transmissionSneeze, dirty hands, ill worker, etc. Vibrio S ee e, d y a ds, o e , e c
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services31
Investigation ApproachesInvestigation ApproachesInvestigation ApproachesInvestigation ApproachesNo Implicated Food:
C ’t f i l it i f d iCan’t focus on a single item in food prep review in the early stages, if no food association established.Conduct general risk-based assessment using most up to date information availableDetermine which samples investigators are mostDetermine which samples investigators are most interested in (food, clinical, environmental, water/ice)
Implicated Food:Implicated Food:Food Preparation Review is Key!
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services32
Other ActionsOther ActionsOther ActionsOther ActionsDevelop initial plan and timetableAssemble materials/personnel
Pre-meetings w/ Lab and EpiBe sure your DETECT kit is stocked (Epi to provide forms and kits)List documents you want Alert laboratoryAlert other agencies
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services33
Site VisitSite VisitSite VisitSite Visit
Manager InterviewManager InterviewFacility walk throughA t f f d tiAssessment of food preparationObserve operationsWorker interviewsCollect recordsCollect records
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services34
M g I t iM g I t iManager InterviewsManager Interviews
Explain reason for the investigation
Outline investigation objectives
Create cooperative relationshipCreate cooperative relationship
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services35
M g I t i ( t )M g I t i ( t )Manager Interviews (cont.)Manager Interviews (cont.)
F d f t k l dFood safety knowledge (Is he/she Food Safety Certified?)
Attit dAttitudeCredibility of information being provided
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services36
Manager Interviews (cont.)Manager Interviews (cont.)Food Worker HealthFood Worker Health
Review health, hygiene and education practicesIdentify who worked with the implicated food(s)Worker ill during time period of interest?Document findings
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services37
Facility Walk ThroughFacility Walk Throughy gy g
Initial facility walk throughInitial facility walk throughMeasure critical operations before
difi dmodifiedCollect samples while availableVerify who worked with implicated foods
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services38
Ob O tiOb O ti G lG lObserve OperationsObserve Operations-- GeneralGeneral
Wh t d th f d fit i t ?What process do the foods fit into?Process 1 – No Cook StepProcess 2 – Same Day ServiceProcess 3 – Complex Foods
What controls are essential for the foods in this process?
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services39
Observe Operations Observe Operations SpecificSpecificObserve Operations Observe Operations -- SpecificSpecificHow the same items are prepared p ptodayAttempt to reconstruct how theyAttempt to reconstruct how they were prepared during the time period of interestperiod of interestTake measurements (time, temperature product dimensionstemperature, product, dimensions, locations)
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services40
F d W k I t iF d W k I t iFood Worker InterviewsFood Worker Interviews
I t i ith t tInterview without manager presentAsk questions in chronological sequenceReconstruct timelineLet them tell their story
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services41
Food Worker Interviews (cont )Food Worker Interviews (cont )Food Worker Interviews (cont.)Food Worker Interviews (cont.)
Ask about any unusual circumstancesythat may have occurred that day--equipment that wasn’t working, short-staffing someone illstaffing, someone illReword questions when needed, if information isn’t provided or pinconsistencies are identifiedInconsistent information may indicate sensitive areas Consider addressing atsensitive areas. Consider addressing at end of interview
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services42
When Food Workers Cannot When Food Workers Cannot Remember DetailsRemember Details
Ask about typical work practices and routinesThen ask about any unusual events or changes during time period?Remember that outbreaks frequently occur the system was “ t d”“stressed”
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services43
C l di g th I t iC l di g th I t iConcluding the InterviewsConcluding the InterviewsAsk if individuals haveAsk if individuals have unanswered questions or additional commentsadditional comments
May have information not previously consideredpreviously consideredMay reveal other useful information
Leave your business card for future contact
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services44
Records & Other Records & Other Information Sources Information Sources
What SOPs or food safety systemsWhat SOPs or food safety systems are in place?
HACCPHACCPBuyer Specifications/Approved SourcesPersonal HygienePersonal HygieneCleaning & SanitizingTime/Temperature ProceduresTime/Temperature ProceduresRecipe InstructionsMenu Epidemiology Division
Bureau of Clinical LaboratoriesBureau of Environmental Services
Menu
45
C ll ti g S lC ll ti g S lCollecting SamplesCollecting SamplesPlan your approach inPlan your approach in advance as much as possible (in consultationpossible (in consultation with Epi & Lab)
Type (food water)Type (food, water)Size Number
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services46
Sampling IssuesSampling IssuesSampling IssuesSampling Issues
After reviewing product flow adjustAfter reviewing product flow, adjust sampling plan as neededC id d f li tConsider need for sampling to pinpoint contamination source
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services47
Environmental Sampling Environmental Sampling StrategiesStrategies
I liIn-lineBracketingEnvironmentalFinished productFinished product
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services48
Environmental Sampling Environmental Sampling St t gi ( t )St t gi ( t )Strategies (cont.)Strategies (cont.)
T k i t l l l iTake environmental samples early in the investigationHave equipment disassembled for environmental swabsFocus on hard-to-clean areasChain of custodyChain of custody
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services49
H t C ll t S lH t C ll t S lHow to Collect a SampleHow to Collect a Sample
1. Gloves2. Sterile Containers3. Sterile Utensils4 Representative selection of4. Representative selection of
implicated food
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services50
Precautionary Controls Needed?Precautionary Controls Needed?
Take action to prevent additional cases !
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services51
Control ActionsControl ActionsControl ActionsControl ActionsImmediately stop the outbreak:
H ld ClosureHoldSeizeCease/Desist
ClosureExclusions/ RestrictionsRecalls
Menu LimitationLong term strategies to prevent recurrence:
Recalls
recurrence:HACCP Risk Control Plans [“Mini-HACCP”]T i iTrainingMenu/Supplier/Recipe Modifications
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services52
Constructing a ReportConstructing a ReportConstructing a ReportConstructing a Report
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
C il I f tiC il I f tiCompile InformationCompile InformationCompare information gathered fromCompare information gathered from different sources (Env, Lab, Epi)Level of confidence in informationLevel of confidence in information gathered?Wh t i k d h t iWhat is known and what remains unknown?Organize information needed for report
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services54
A l fi di g A l fi di g CSPCSPAnalyze findings Analyze findings -- CSPCSPIdentify CSP at each stepIdentify CSP at each stepDetermine what happened and what did notdid not Interpret:
Laboratory findingsLaboratory findings Time/temperature proceduresFood flow diagramsFood flow diagramsFood preparation reviews/diagrams
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services55
W it tW it tWrite your reportWrite your report
Brief narrativeContributing factors (“What g (happened”) – CSPEnvironmental antecedents – “Why itEnvironmental antecedents Why it happened”
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services56
Module Learning Objectives Module Learning Objectives Module Learning Objectives Module Learning Objectives Foundational Knowledge ReviewDescribe Differences & Priorities Between Process I, II, and III FoodsDescribe Environmental Assessment ObjectivesD ib B i St f E i t lDescribe Basic Steps of Environmental AssessmentC t t W ll D t dConstruct a Well Documented Environmental Report
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services57
I C l iI C l iIn ConclusionIn ConclusionDocumentation ofDocumentation of findings is important for immediate controlfor immediate control of the outbreak and is a key to enlist a ey to e stprocedures, education, and/or educa o , a d/opolicies to prevent future outbreaks.
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services58
Group ExerciseGroup ExerciseGroup ExerciseGroup Exercise
Process I II and IIIProcess I, II, and III
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services5959
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