Risk Factors—Challenges & Opportunities

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SWhat is VDH’s mission?

• 44004.02.01:– Objective—reduce environmental

and communicable disease hazards at food establishments

– Measure—conduct 65% of all restaurant inspections in accordance with PIM 95-03 Risk-based Inspections within 30 days of due date

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SInspection demographics

21000

22000

23000

24000

25000

26000

27000

28000

2003 2004 2005 2006 2007

# Restaurants

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SViolation Summary

0

2000

4000

6000

8000

10000

12000

14000 Holding

Cup w/o lid

Unclean icebins/can openers

Uncovered food

Date marking

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SVirginia Foodborne Outbreaks

Distribution of Outbreaks by Pathogen Type (2003-2006)

50%44%

3%

3%

Bacteria

Virus

Chemical

Unknown

Virginia N= 37

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SVirginia Foodborne Illness

Distribution of Illness by Pathogen Type (2003-2006)

51%

34%

0%

15%

Virus

Bacteria

Chemical

Unknown

Virginia N= 1441

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SHistoric Virginia Foodborne Illness

Distribution of Foodborne Outbreaks by Pathogen Type (1990-2006)

0

1

2

3

4

5

6

7

1990

1992

1994

1996

1998

2000

2002

2004

2006

Virus

Bacteria

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SOutbreak Risk Factor Patterns

012345678

Risk Factors

2003

2004

2005

2006

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SShifting the burden

Side Effects:

It’s faster to make ‘snap-shot’ inspections

Less time to understand establishment operation

Contributing risk factors for foodborne illness

outbreaks are not evaluated

Pressure to meet inspection frequency

Perception that current inspection focus helps prevent

foodborne outbreaks

Change inspection focus to risk factor

diagnosis

Increasedtraining on

identification of risk factors

Increased public interest in website of inspection data

since 2003

State publishes annual list of uninspected

facilities

State and local performance

measures tied to # of inspections

EHS: I need to keep my caseload up to date so I don’t

get in trouble

B

B

R

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S

Are we protecting

the public’s health?

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SVirginia’s Opportunity

• Educate & energize stakeholders

• Create State Food Committee task-group to develop framework for aligning Ten Essential Services & FDA Program Standards

• Develop ‘Training Roadmap’ for EHS KSA’s

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SVirginia’s Opportunity

• Replace existing performance measure with program measures that support outcome-based outputs

• Deploy new training curriculum to EHS & focus on risk-factors

• Make Standardization a requirement for EHS in EWP’s