food safety global trends
TRANSCRIPT
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Leveraging Information To Improve Food Safety Management
RUTH L. PETRAN, PHD
29 April 2015
VP FOOD SAFETY & PUBLIC HEALTH, ECOLAB
Discussion Overview
Foodborne illness is a significant public health concern
Need to take action to drive rates down
Leverage available data to glean insights CDC contributing factors related to illnesses FDA risk factor studies Health department inspections Learnings from outbreaks
Identify mitigating strategies that will work At the restaurant level To guide R&D development efforts, etc.
Foodborne Illness Annual Estimates
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United States 48 million cases 120,000 hospitalizations 3000 deaths
Australia 4.1 million cases 86 deaths
EU 45.5 million cases
China - Surveillance beginning
Global foodborne illness estimate: 582 million cases & 351,000 deaths
Canada 4 million cases
South Korea 336,000 cases
Africa - Surveillance beginning
Where Was Contaminated Food Consumed?
Restaurant or deli57%
Private home12%
Hospital, Nursing Home 2%Banquet facility
13%
School4%
Church, temple1%
Prison, jail2%
Other9%
USA 2012
WHEN LOCATION IS KNOWN
Source: CDC 2014 http://www.cdc.gov/features/foodborne-diseases-data/?s_cid=cdc_homepage_feature_003
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Norovirus: Leading Cause of Foodborne IllnessTOP 5 US REPORTED OUTBREAKS (CONFIRMED AND SUSPECTED)
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
0
100
200
300
400
500
600
700
800
900
NorovirusSalmonellaC. perfringensE. coliCampylobacterUnknown
# O
utbr
eaks
Rep
orte
d
Source: http://www.cdc.gov/foodsafety/pdfs/foodborne-disease-outbreaks-annual-report-2012-508c.pdf
2014 Total Human Cost of Foodborne Illness
Salmonella is #1 cause of foodborne illness in terms of cost
Norovirus is #1 in terms of cases
Impact of : Size of Outbreak Severity of illness Complications Long term health effects
Total human cost of top 15 pathogens more than $15 billion annually
http://www.ers.usda.gov/data-products/cost-estimates-of-foodborne-illnesses.aspx
Norovirus Salmonella Listeria
Mean Annual Cost $2.3 Billion $3.7 Billion $2.8 Billion
Number of Cases 5.5 Million 1.2 Million 1,591 cases
Cost per Case$413 $3,568 $1.7 Million
Call to Action
The problem of food safety is significant. 1 in 6 of us suffers from a foodborne illness each year.
Clearly action is needed to drive rates of illnesses down, and to be most impactful, efforts need to be focused where they will have the biggest impact.
Leverage data to help guide efforts appropriately.
USA 2012
Adapted from CDC 2014 - http://www.cdc.gov/foodsafety/pdfs/foodborne-disease-outbreaks-annual-report-2012-508c.pdf
Improper Hold-ing 23%
Poor Personal Hygiene
30%Contaminated Equipment/
Environment 11%
Inadequate Cooking
14%
Unsafe Source 12%
Other11%
CDC Contributing Factors to Foodborne Illness
FDA Risk Factor Observational Studies
Done in food service & retail establishments 1998-2008 in three phases
Results Generally, there were improvements over time Risk Factors most in need of attention:
- Improper Holding/Time and Temperature- Poor Personal Hygiene- Contaminated Equipment/Protection from Contamination
Studies being repeated 2013-2025 One outcome is to assess impact of various industry and regulatory
intervention strategies
Health Department Inspections
Focus on factors contributing to foodborne illness
No consistent reporting format across the country
Certain jurisdictions posting results for consumers
Potential impact on consumer trust
Inspections Record Observed Violations
Millions of restaurant health department (HD) inspections done annually in US
Opportunity exists to mine data to determine role that inspection results can play in helping to identify risks
From this, identify major, modifiable risks
Focus efforts appropriately
US Model Food Code Is Basis For Restaurant Inspections
A uniform set of provisions that address the safety & protection of food offered at retail and in food service
A model to safeguard public health & ensure food is not adulterated
Guidance document from FDA that evaluates: Foodborne illness risk factors Good retail practices
Adopted by local & state health departments in a variety of ways Requirements vary among jurisdictions Frequency of inspections and scoring varies among jurisdictions
Health Dept Insight: State VariabilityAverage Total Findings By State
High Variability in Total Findings from State to State
Most Findings
Kansas 5.5
Connecticut 5.3
Oklahoma 5.1
Nebraska 5.1
Tennessee 5.1
Least Findings
Mississippi 0.4
Washington 1.3
Nevada 1.5
Arizona 1.5
Arkansas 1.6
0-1 1-2 2-3 3-4 4-5 5+
Health Dept Insight: Top Findings
3 of the 5 Top Findings May Directly Result in Food Borne Illness
Most Commonly Cited Issues 2011-2013
Item Level Frequency
Physical facilities installed, maintained, and clean GRP 31.5%
Food contact surfaces are clean and sanitized FBI 29.0%
Food and non-food contact surfaces cleanable, properly designed, constructed, and used
GRP 27.3%
Adequate hand-washing sinks – properly supplied and accessible
FBI 18.9%
Proper cold holding temperatures FBI 17.4%
Top HD Violations Overall
Top 10 Violations for Specific Chain Industry All (2,587)
Q53-Physical facilities installed, maintained and clean 12.10%
Q20-Proper cold holding temperatures 4.67%Q45-Food and non food-contact surfaces cleanable, properly designed, constructed and used 9.26%
Q47-Nonfood-contact surfaces clean 8.99%
Q49-Plumbing installed; proper backflow devices 4.52%
Q8-Adequate handwashing sinks properly supplied and accessible 6.12%
Q14-Food-contact surfaces: cleaned and sanitized 9.93%
Q54-Adequate ventilation and lighting; designated areas use 2.71%
Q42-Utensils, equipment and linens: properly stored, dried and handled 3.00%
Q37-Contamination prevented during food preparation, storage and display 4.23%
Use Data to Drive Improvements
Understanding risks is the starting point
Changing the food safety behaviors of individuals requires a total system approach, including: Education and Manager Certifications Inspections and Audits Hands-on training Motivation and Encouragement
Focused service, training and procedures Having a Certified Manager onsite reduces violations by 24% Completing daily Food Safety Logs reduces violations by 44% Restaurants that submit Corrective Actions average 22% less
findings
How to Best Leverage Data
Analyze the data to identify trends Which locations/regions to focus on What type of solution might have the biggest effect?
Ask for help How could your vendors help you
- What solutions or tools do they have- What could they develop for you
Should you reach out to a training provider
Look for ways to verify that solutions are effective Continue to analyze data
Connecting the dots…
CDC Data - Top Risk Factors for FBI
1. Improper Holding Temperatures
2. Poor Personal Hygiene
3. Inadequate Cooking
4. Unapproved Source
5. Contaminated Equipment
HD Data - Top reasons restaurants fail inspections
1. Food and non food-contact surfaces cleanable, properly designed, constructed and used
2. Physical facilities installed, maintained and clean
3. Food-contact surfaces: cleaned and sanitized
4. Nonfood-contact surfaces clean
5. Adequate handwashing sinks properly supplied and accessible
Illustration: HD Data Research
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Methodology: Compared routine health inspection data between outbreak and non-outbreak restaurants
Results: • Identified 11 key violations linked to outbreak restaurants• Surprisingly, many were Good Retail Practices, not critical risks of
foodborne illness
Source:Petran et al. 2012.JFP 75(11):2007-2015.
Example 1: Contaminated Equipment & Food Contact Surfaces Cleaned and Sanitized
Understand the flow of food through your establishment
Understand where there is a possibility of cross-contamination
Set up barriers and procedures to block pathogen transfer and growth
Use proper sanitization procedures and chemicals, following the label instructions
Make sure your kitchen is free of pests
#1 Real Life Outbreak
14 patrons at a food service establishment became ill
Two hospitalizations. Camplybacter jejuni isolated from all patients
Investigation revealed multiple sources of contamination Countertop too small to separate raw poultry and other foods Cook cut up raw chicken before preparing salads Lettuce for salads was shredded with a knife Cook wore a towel around her waist, frequently used to dry hands Uncertain whether the cook had cleaned the countertop after cutting
up the chicken
Lettuce likely contaminated with raw chicken
http://www.cdc.gov/mmwr/preview/mmwrhtml/00051427.htm
#1 Response: Offerings from a Coach or Provider Contamination prevention
Hand care programs Cleaning & sanitation products,
equipment and services Supply chain antimicrobial
treatments for meat, poultry, and produce
Color coded equipment Pest elimination Hand care compliance
Example 2: Poor Personal Hygiene & Adequate Handwashing Guidelines
Food Code Reference (2013)
Description
2-301.12 Hands and Arms - Cleaning Procedures
5-203.11A Provide the number of handwash sinks necessary for the convenient use of employees in food preparation, dispensing, and warewashing area
5-203.11C Use chemically treated towelettes for handwashing a vending machine locations…
5-204.11 Locate a handwashing sink to allow convenient use in food preparation, food dispensing, and Warewashing Areas.…
5-205.11 Maintain a hand washing sink so it is accessible at all times…
6-301.12A Provide and maintain at each handwash sink… a supply of individual disposable towels…
6-501.18 Clean and maintain the handwashing sinks.
Avoid unsanitary habits
Maintain and monitor their personal health
Report illness and wounds
Follow hygienic hand practices: good hand washing and proper glove use
#2 Real Life Outbreak
Guests at different events received sandwiches from common source
≥100 people estimated to be affected
Illness associated with sandwiches containing lettuce
Employee with norovirus symptoms returned to work the same day that symptoms ended
Was still excreting norovirus in his stool
Food prep sink used to wash lettuce also used for hand washing
Food handlers can contaminate food and cause consumers to become ill
Source - MMWR 55(14):395-7
#2 Response: Offerings from a Coach or Provider
Heath Department – Top Violations
Address Staff Behavior Offer Tools & Products
Adequate handwashing sinks properly supplied and accessible
Wash after cough
Blocked Sink
Wash before glove
Towels not available
Soap not available
Signs not posted
• Onsite Review & Coaching • Suggestion of products• Solutions that influence behavior
Example 3: Improper Holding Temperatures Tied to Foodborne Illness
Can allow pathogens to persist and in some cases, increase to harmful levels
Proper hot and cold holding are crucial to food safetyKeep food out of the Temperature
Danger Zone- Below 41˚F (5˚C) and above 135˚F (57˚C)
Monitor proper temperature control with a calibrated thermometer
Use equipment designed for keeping food at the proper temperature
#3 Foodborne Illness Intoxications
Illness attributed to C. perfringens, B. cereus and S. aureus
Account for 1.3 million illnesses each year 14% of the 9.4 million illnesses
Spores are frequent contaminants Cooking activates the spores allowing for rapid growth of cells These cells grow much faster than other types of bacteria
Cells grow in food with poor temperature control Inadequate cooling or cold holding are key risk factors
How significant of an issue is this?
Source: Scallan, et al. 2011.
#3 Real Life Outbreak
Typically large numbers of people are affected Under-reporting factor is very large
Between 1998 and 2008, improper cooling practices contributed to 504 outbreaks in foodservice settings. (CDC, 2012)
Pasta Salad http://jcm.asm.org/content/43/8/4277.full
Prepared on Friday for Saturday picnic. Leftovers stored in refrigerator (set at 57F) & consumed on Monday night
1 child died High levels of B. cereus toxin found in salad
#3 Cold Holding Data
On-site data collection at 420 restaurants & 596 foods 69% chains and 31% independents, most served “American” menu Cooling methods: refrigerator>ice bath>room temp>ice wand>blast
16% of ambient temps in cooling units were >41F Reach-in coolers were among the worst
Other observations: Depths not shallow enough, Limited ventilation, Stacked foods on
top of each other, Lack of ice in ice baths
Most managers reported being trained, yet… Did not monitor time or temp 41% of time Thermometer calibration issues 31% of time
Source: Brown, et al. 2012. JFP 75(12)2172
#3 Response: Offerings to Mitigate
Recognize that problem exists Cold Hold #1 or #2 issue
Target interventions appropriately Equipment - ambient air temp, machine maintenance issues,
gaskets in poor repair, thermostat not set properly… Behaviors - containers filled too high, improper pre-chill, importance
of monitoring & verification Cooling devices
Call to Action!
Parting Thoughts
How could data from inspections and industry be used? In R&D development chemistry and equipment efforts Insight on where to focus training and coaching Broad service solutions
Can this be tied to foodborne illness decrease?
Goal: Move from Information to Action!
Consider… what can you do to prevent another outbreak from being attributed to
one of these factors?
Questions?