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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

4Industry‐Foodborne Illness Investigation Training & Recall Response

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

5Industry‐Foodborne Illness Investigation Training & Recall Response

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

6Industry‐Foodborne Illness Investigation Training & Recall Response

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

Module 3 – Environmental Assessment

7Industry‐Foodborne Illness Investigation Training & Recall Response

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

8Industry‐Foodborne Illness Investigation Training & Recall Response

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

9Industry‐Foodborne Illness Investigation Training & Recall Response

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

12Industry‐Foodborne Illness Investigation Training & Recall Response

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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Module 3 – Environmental Assessment

13Industry‐Foodborne Illness Investigation Training & Recall Response

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

14Industry‐Foodborne Illness Investigation Training & Recall Response

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

Module 3 – Environmental Assessment

15Industry‐Foodborne Illness Investigation Training & Recall Response

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.

Module 3 – Environmental Assessment

16Industry‐Foodborne Illness Investigation Training & Recall Response

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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

Module 3 – Environmental Assessment

17Industry‐Foodborne Illness Investigation Training & Recall Response

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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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Module 3 – Environmental Assessment

18Industry‐Foodborne Illness Investigation Training & Recall Response

Module 3 Review

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QUESTIONS?