2011 NEHA AEC FS1104 Food Safety Tools for Regulatory ... · 1 2011 NEHA AEC FS1104 Food Safety...
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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 [email protected]
• 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
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: [email protected] 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