STRENGTHENING YOUR FOOD SAFETY PROGRAMS: LET THE … · strengthening your food safety programs:...

STRENGTHENING YOUR FOOD SAFETY PROGRAMS:

LET THE EVIDENCE BE YOUR GUIDING

JOHN H. HANLIN, PH.D.

September 20, 2018

VICE-PRESIDENT FOOD SAFETY AND PUBLIC HEALTH, ECOLAB

© 2018 Ecolab USA Inc. All rights reserved.

Disclosure


Dr. John Hanlin is employed by Ecolab


“Humanity has but three great enemies:

fever, famine and war, of these by far the

greatest, by far the most terrible, is fever”Sir William Osler, MD

1849 - 1919


Agenda


Part 1: Today’s Food Safety Landscape

▪ 10 lanterns to guide you on your food safety journey

Part 2: Open Forum▪ Opportunity for conference attendees to discuss

current or past food safety issues/challenges

▪ Conference attendees are encourage to share a specific food safety issue that they have dealt with

- Root cause investigation

- How they prevented it from happening again

- A unique opportunity for all to learn from each other and share best practices

- Elevate the collective food safety knowledge for all attendees.

Prevention

Prevention

Prevention


A Few Thought Starters…

What makes food unsafe?

Are imported food inherently less safe than domestic sources of food?

Are your sourcing produce locally?

Do we have complete control over food safety?

Who has responsibility for food safety within your organization?

Can we impact food safety? How?



Is The Food Supply Less Safe Today?

No, but food safety incidents are increasingly more visible

Improved detection & surveillance identifies broad issues

▪ Microbial forensics enables better detection and differentiation

Good news!

▪ From a public health standpoint

Emphasizes need for flawless execution of food safety programs across supply chain

Food safety facts can help direct efforts appropriately

6

© 2018 Ecolab USA Inc. All rights reserved.7

Safe Food is Fundamental to Life

Food safety is integral in brand protection

and enterprise risk management

Tidal wave of interest in fresh, organic,

exciting flavors, local (hyper-local),

hydroponic, balanced diet

Population growth, population aging,

diet shift, more calories, less calories,

challenges in water quality/availability

and arable land

Stressors on the food supply can lead to

unsafe foods unless robust programs exist

Laser focus on operational, regulatory and

reputational risks


US FDA & USDA Recall IncidenceCalendar Year 2017

STECs6%

Other13%

L. monocytogene

s19%

Salmonella1%

Undeclared Allergens

40%

Extraneous Material

18%

Undeclared Substance

5%

Processing Deviations

4% Residue2%

FDA USDA

Clostridium botulinum

1%

Undeclared ingredient

2% E. coli2%

Foreign material3%

Hepatitis A1%GMPs

1% Chemical hazard1%

Listeria monocytogenes

30%

Salmonella7%

Undeclared allergens

50%

Other2%


Iowa Department of Public Health

9

https://idph.iowa.gov/News/ArtMID/646/ArticleI

D/158137/New-Food-Poisoning-Detection-and-

Response-Initiative-Announced

https://idph.iowa.gov/News/ArtMID/646/ArticleID/158137/New-Food-Poisoning-Detection-and-Response-Initiative-Announced


A Series of Interconnecting Risks

Food Safety Risk

Public Image Risk

Regulatory Risk

Legal Risk

Financial Risk

Rising Tide of Renewed Focus on Prevention


10 LANTERNS TO GUIDE YOU ON YOUR FOOD SAFETY JOURNEY


Lantern 1: Food Safety Landscape

12

U.S. Foodborne illness estimates (annually)

▪ 48 million cases

▪ The equivalent of sickening 1 in 6 Americans each year.

▪ 120,000 hospitalizations

▪ 3,000 deaths

▪ The USDA estimates that foodborne illnesses cost $15.6 billion each year.

Who’s at risk?

▪ Older adults residing in nursing homes are ten times more likely to die from bacterial gastroenteritis than the general population

Our changing immunity

Age

People with cancer

People with diabetes

Transplant recipients

People with HIV/AIDS

http://www.fsis.usda.gov/wps/portal/fsis/topics/food-

safety-education/get-answers/food-safety-fact-sheets

http://www.cdc.gov/foodsafety/outbreaks/index.html

http://www.foodsafety.gov/risk/olderadults/index.html

http://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets

http://www.cdc.gov/foodsafety/outbreaks/index.html

http://www.foodsafety.gov/risk/olderadults/index.html


Food Safety Outbreak Visibility

Salmonella Listeria E. coli O157:H7 Hepatitis A Cyclospora Botulism Chemical

1993• QSR Burgers

1994• Ice Cream

1998• Cereal

1996• Unpast. Juice• Mad Cow

1997• Ground Beef

1999• Unpast. Juice• Eggs, Chicken, Beef, Pork

2000• Steak House

2002• Ground Beef (2)• RTE Turkey & Chicken

2003• Green Onions

2005• Bagged Lettuce

2006• Bagged Spinach, Restaurant Lettuce

2007• Ground Beef (2)• Pot Pies, Peanut Butter• Chili Sauce

2008• Peppers, •Tomatoes, Cereal• Milk, Pork• Lunch Meat

2009• Cookie Dough• Milk Powder, •Peanut Butter, Pistachios

2010• Peppers, HVP, Shell Eggs, Sprouts (2), Chicken Casserole, •Raw Milk

2011• Sprouts-• Ground •Turkey, •Cantaloupe• Cantaloupe

2012• Spinach, Mixed •Greens• Ground Beef, Raw •Tuna, Mangoes, Cantaloupe, Peanut •Butter• Ricotta Cheese

Outbreaks increasingly visible

Improved detection & surveillance identifies issues

Expect to see more outbreaks reported

2013• Chicken• Cucumbers• Berries• Salad

2014• Cucumbers•Caramel Apples•Sprouts•Sprouts•Sprouts•Cilantro•Nut butter•Chicken•Ground Beef

2015• Ice cream•Raw Nut Butter•Pork•Cucumbers•Chicken Salad•Mexican food•Raw tuna


What’s Happened in 2018

14

Romaine lettuce – E. coli O157:H7

Fresh cut vegetable trays - Cyclospora

National brand supplying produce to a national QSR chain - ?

Breakfast cereal – Salmonella

Pre-cut melon – Salmonella

Shell eggs – Salmonella

Dried coconut – Salmonella

Frozen shredded coconut - Salmonella


2011 US Foodborne Estimates

Source: CDC 2011. http://www.cdc.gov/foodnet/factsandfigures.htm

0

0.5

1

1.5

2

<5 5-9 10-19 20-64 65+Ca

se

:Fa

talit

y R

atio

Age Group

Deaths

Lantern 2: Age Makes a Difference


Lantern 3: Pathogens, Food Groups and Contributing Factors

Top 5 pathogens causing illness

▪ Norovirus

▪ Salmonella

▪ C. perfringens

▪ Campylobacter

▪ Escherichia coli (shiga-toxin producing strains)

Others to recognize

▪ Listeria monocytogenes

▪ Vibrio

▪ Staphylococcus aureus

▪ Clostridium botulinum (botulism)

▪ Cyclospora


US Reported Foodborne Illness

17

2015: Foodborne Disease Outbreaks Attributed to Food Commodity Groups

Rank Order and Number Of Outbreaks Attributed To Food Groups

0

5

10

15

20

25

30

35

40

Source: https://www.cdc.gov/foodsafety/pdfs/2015FoodBorneOutbreaks_508.pdf

**

* **

* Outbreaks of 4 commodity groups

combined and added to vegetable row crops

https://www.cdc.gov/foodsafety/pdfs/2015FoodBorneOutbreaks_508.pdf


Contributing Factors to Restaurant Outbreaks

18

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Handling by infected person

Bare Hand Contact

Inadequate Cold Holding

Slow Cooling

Inadequate Cleaning

USA 2006-07

Source: Gould, et al. 2013 JFP 76(11):1824.


CDC Contributing Factors to Foodborne Illness

USA 2014, Reported data

Source: CDC http://www.cdc.gov/foodsafety/pdfs/foodborne-

outbreaks-annual-report-2014-508.pdf

Improper Holding,

22%

Poor Personal Hygiene,

27%

Contam. Equipment/

Environment, 12%

Inadequate Cooking,

15%

Unsafe Source,

17%

Other, 7%

http://www.cdc.gov/foodsafety/pdfs/foodborne-outbreaks-annual-report-2014-508.pdf


Foodborne Illnesses Attribution – Key Insights

Top 5 pathogens causing illness

▪Norovirus

▪ Salmonella

▪ C. perfringens

▪ Campylobacter

▪ Shiga-toxin producing strains of Escherichia coli

Source: http://wwwnc.cdc.gov/eid/article/19/3/11-1866_article.htm


Settings of Norovirus Outbreaks, US, 2009-2013

(n=3,960)

Source: Vega, et al. 2014 J. Clin Micro 52:147.

Child Care Centers

1%

Correctional facilities

1%

Cruises, Vacation

3%

Hospitals4%

Long term care facilities

62%

Parties & events

5%

Restaurants10%

Schools6%

Unknown8%


WHAT IS NOROVIRUS?


Norovirus

What is Norovirus?▪ Viral infection affecting stomach and intestines,

causing vomiting and diarrhea – highly contagious

▪ #1 cause of acute gastroenteritis

▪ # 2 cause of hospitalization

▪ # 4 cause of death

▪ 80% of outbreaks occur from November - April

What are the Symptoms and Sources?▪ Nausea, vomiting, diarrhea, stomach cramps

▪ Fecal/oral route of transmission. Symptoms begin 12 – 48 hrs after exposure

- Person-to-person, Foodborne, hands, hard surfaces

How Can We Reduce Risk?▪ Have a hygiene plan in place

▪ Rigorous hand hygiene

▪ Robust cleaning and disinfection

▪ Training awareness education

▪ Response protocol and policy for ill food workers

Public Health Impact* ~ 20 million cases

> 50,000 hospitalizations

>500 deaths mostly elderly &

young

Mean # of cases per outbreak

is 44; range is 2 – 357* Annual estimates U.S.

Source:

U.S. CDC

Charles D.

Humphrey

Norovirus outbreak

sickens residents and staff

http://www.cdc.gov/norovirus/index.html

http://www.cdc.gov/norovirus/index.html


What is Norovirus and What is the Source?

A highly contagious viral infection affecting the stomach and intestines, causing vomiting and diarrhea

Most common cause of acute gastroenteritis

▪ ~ 20 million cases are estimated to occur in the US each year

▪ About 50% of all outbreaks of FBD are caused by norovirus

Feces or vomit of an infected person, including food service staff

Spreads :

▪ Directly from person to person

▪ Through unwashed hands

▪ Via ingestion of contaminated food or water

▪ Through contact with contaminated surfaces

An infected person may be contagious for up to 2 weeks or more after recovery

Source:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6003a1.htm?s_cid=rr6003a1_

e&source=govdelivery#Fig2 and http://www.cdc.gov/eid/content/17/1/7.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6003a1.htm?s_cid=rr6003a1_e&source=govdelivery#Fig2

http://www.cdc.gov/eid/content/17/1/7.htm


25

What are the Symptoms?

Include nausea, vomiting, diarrhea and stomach cramps

Begin 12-48 hours after exposure

Last 1-2 days

People can contract norovirusand become ill more than once.

▪ Some short term resistanceCourtesy CDC: Amanda Mills, 2011 (with thanks)

No specific medicine to treat people with norovirus.

Infections cannot be treated with antibiotics because

it is a viral (not bacterial) infection


Transmission route varies with setting

% of Outbreaks

USA 2000-2004 Foodborne Person to Person

Waterborne Other

Nursing homes, retirement centers, hospitals

4 62 0 34

Restaurant and catered events

83 3 0 14

Vacation settings & cruise

5 43 5 46

Schools and day-care centers

22 44 6 28

Other 14 28 25 33

TOTAL 30 35 5 30

Source: Blanton et al. 2006. J Inf. Dis.:193:413-21.


LESSONS FROM PAST OUTBREAKS


How is Norovirus Inactivated?

Difficult to inactivate

▪ Persists in chlorinated drinking water

Persists in the environment

▪ Survives freezing and refrigeration

▪ Requires very high temperature to inactivate

▪ Survives in acidic environments

Choose the “right” products for disinfection

▪ Products registered with EPA and effective against target organism

And the right PPE to protect your staff !!!!!

Source: Doultree, et. al. 1999. J. Hosp. Infection 41:51-57

http://www.about-norwalk.com/


Case Study: Noro Knows

126 people attended a dinner at a large hotel - December 7th

During the meal, a guest vomited onto a polished wooden floor

Guest had not been ill prior to meal

The vomit was cleaned with a mop and disinfectant and the meal continued….

Reports of illness came to light by Thursday December 10th

Dinner Party*

* Source – Marks, 2000. Epidemiol. Infect. 124:481-487


Layout Plan of Restaurant

Source - Marks. 2000. Epidemiol. Infect. 124:481-487


Layout Plan of Restaurant

Source - Marks. 2000. Epidemiol. Infect. 124:481-487

Lessons Learned: Inadequate clean-up and action plans caused a

large # of people to get sick - Within 48 hours, 52

people reported norovirus symptoms

Have a plan, an SOP, the right products and trained

staff in place to respond to this eventuality


Risk Reduction Plan

Have a hygiene plan in place with robust cleaning and disinfection procedures

Does your staff know what to do when the “event” occurs at 9 pm on a Sunday night?

What is your SOP? Do you have biohazard spill kits and the right disinfectant on site?

Review your SOP and re-train associates

▪ Encourage frequent handwashing and freshen-up your handwash signage – CREATE THE CULTURE

▪ Do not permit infected workers to prepare food while they have symptoms and for at least 3 days after recovery

▪ Discard food that may have been contaminated by an ill person


Norovirus: Tips for Being Prepared

Have appropriate spill kits and other products on hand

▪ With EPA-registered norovirus claims

Have personal protective equipment (PPE) on hand

Audit your products and procedures: An “event” will occur!

Consult with your local health department. Find out what actions will be required in the event of an incident or outbreak

Post handwashing signage and procedures



Food Allergens

Peanuts

Tree nuts

Crustaceans

Fish

Eggs

Milk

Soy

Wheat

Food safety issue for sensitive population

Staff awareness and education is vital

Know your ingredients

Cleaning is essential

If possible, know your residents


Today’s supply chain is complex and global

▪ 80% of seafood is imported

▪ 50% of fresh fruit is imported

▪ 20% of fresh vegetables are imported

Food safety issues can become amplified along the supply chain

Develop relationships and partnerships

▪ Especially meat, poultry, seafood and fresh produce suppliers

▪ Suppliers, distributors, culinary schools, local public health officials

▪ Establish shared food safety goals with your key stakeholders

Lantern 4: Supply Chain Collaboration


Food Safety Solutions

Food Service

Retail

Consumption

Agricultural

Production

Processing

INTERVENTIONS AT MULTIPLE SITES


Lantern 5: Resources Abound

Food Code

Food Code was first published in1993

FDA Model Food Code: set of recommendations of Best Practices and current science from the Conference for Food Protection (CFP)and other agencies

Government and industry stakeholders have come to recognize the FDA Food Code as a source of practical, science-based guidance and manageable, enforceable provisions for mitigating known risks of foodborne illness.


Food Code

Food Code

Information available at;▪ https://www.legis.iowa.gov/docs/iac/chapter/12-23-2015.481.58.pdf

www.foodsafety.gov

www.cdc.gov/foodsafety/

https://dia.iowa.gov/food-consumer-safety/food-safety

38

https://www.legis.iowa.gov/docs/iac/chapter/12-23-2015.481.58.pdf

http://www.foodsafety.gov/

http://www.cdc.gov/foodsafety/

https://dia.iowa.gov/food-consumer-safety/food-safety


U.S. CDC, Iowa State Extension, Local Public Health, WHO

39

http://www.who.int/foodsafety/publications/

consumer/en/5keys_en.pdf?ua=1

http://www.cdc.gov/foodsafety/groups/cons

umers.html

Be Food Safe

http://www.who.int/foodsafety/publications/consumer/en/5keys_en.pdf?ua=1

http://www.cdc.gov/foodsafety/groups/consumers.html


Lanterns 6-9: Clean, Separate, Cook, Chill

Be Food Safe


Lantern 6: Clean

41

Hand hygiene

▪ Does your staff know when and how to wash their hands

Wash fruit and vegetables

▪ Consider using a registered antimicrobial wash

▪ Don’t wash meat, poultry, eggs

Cleaning, sanitization and disinfecting

▪ Surfaces

▪ Utensils

▪ Dishware

▪ Cutting boards

▪ Incident response and biohazard spill kit


Produce Safety

42

Recent foodborne disease outbreaks highlight the risks associated with fresh produce

Food Code requires all fresh produce, except commercially washed, pre-cut, and bagged produce, to be thoroughly washed under running, potable water or with antimicrobial washes (or both)

If produce is soaked in water alone, pathogens can be transferred to non-contaminated produce

Antimicrobial wash can play an important role in your food safety program


Lantern 7: Separate:

43

Separate raw meat, poultry, seafood and eggs from other foods

Use one cutting board for fresh produce and a separate one for raw meat, poultry, eggs and seafood

Never place cooked food on a plate or serving platter that previously held raw meat, poultry, seafood or eggs


Lantern 8: Cook

44

Cook to the right temperatures*

Know your temperatures

Use a meat thermometer

Ground

Beef

Pork Eggs

Seafood

Leftovers

Hot Food

Holding

Poultry160oF

145oF

3 mins

165oF

Firm or

160oF

165oF

> 135oF

Foodsafety.

gov

* temp/time recommendations

may vary by code and jurisdiction


Lantern 9: Chill:

45

Refrigerator temperature of 40oF or below

Use an appliance thermometer to be sure the temperature is consistently 40oF or below

Refrigerate or freeze meat, poultry, eggs and other perishables as soon as you receive them

The 2 hour rule - Don’t let raw meat, poultry, eggs, cooked food or cut fresh fruits or vegetables sit at R/T

Divide large amounts of cooked food (soup, chilis) into shallow containers for quicker cooling in the refrigerator

Use or discard refrigerated food on a regular basis


Meat and Poultry

High Risk

▪ Raw or undercooked

Recommended

▪ Meat and poultry cooked to a safe minimal internal temperature

46

Meat, Poultry and Milk

Milk

High Risk

▪ Unpasteurized (raw) milk

Recommended

▪ Pasteurized milk


Seafood

Seafood

High Risk

▪ Raw or undercooked fish or shellfish

▪ Refrigerated smoked fish

▪ Partially cooked seafood such as shrimp and crab

Recommended

▪ Cook fresh seafood to 145°F

▪ Heat previously cooked seafood to 165°F

▪ Use canned fish and seafood


Eggs

High Risk

▪ Foods with raw or undercooked eggs

- Kitchen-prepared Caesar salad dressings

- Kitchen-prepared raw cookie dough

- Kitchen-prepared eggnog

- Kitchen-prepared mayonnaise

Recommended

▪ Use pasteurized eggs or egg products when preparing recipes that call for raw or undercooked eggs

48

Eggs


Sprouts

High Risk

▪ Raw sprouts – alfalfa, bean and other kinds of sprouts

Recommended

▪ Use cooked sprouts or remove from your menu planning

49

Sprouts and Pates

Pates

High Risk

▪ Unpasteurized and/or refrigerated pates or meat spreads

Recommended

▪ Canned or shelf-stable pates or meat spreads


Cheese

High Risk

▪ Soft cheeses made from unpasteurized (raw)

- Feta

- Brie

- Blue-veined

- Camembert

- Queso fresco

Recommended

▪ Hard cheeses

▪ Processed cheese

▪ Cream cheese

▪ Mozarella

▪ Soft cheeses made with pasteurized milk (stated on label)

50

Cheese


Hot dogs and deli meats

High Risk

▪ Hot dogs, deli and luncheon meats that have not been reheated

Recommended

▪ Reheat hot dogs

▪ Luncheon and deli meats to steaming hot or 165°F

▪ Luncheon or deli meats that are pasteurized using thermal or non-thermal technologies

51

Hot Dogs and Deli Meats


Lantern 10: Awareness, Education, a Systematic Approach to Food Safety


On a Pre-determined Scheduled…

Re-train your staff including your culinary team

Remind your residents that food safety is a top priority

Freshen-up your hand washing signage

Work with your supply chain partners

Remind everyone that food safety is a shared responsibility

Strengthen your policies and practices

53


Policies and Practices

54

Strengthen policies and practices in 3 areas:

Preventing restaurant workers from working when sick

▪ Food handling by a sick worker is a contributing factor in 46% of restaurant-related outbreaks

Improving handwashing practices and minimize bare-hand contact with food

▪ Bare-hand contact by a food worker is a contributing factor in 29% of restaurant-related outbreaks

Requiring trained, certified kitchen managers to be present during all hours of operation

▪ Restaurants with certified managers are less likely to be linked with outbreaks.

http://www.cdc.gov/nceh/ehs/ehsnet/foodborne_illness_outbreaks.htm

http://www.cdc.gov/nceh/ehs/ehsnet/foodborne_illness_outbreaks.htm


A Systematic Approach to Food Safety

Leverage the scientific evidence to;

▪ Make smart dietary choices for your stakeholders

▪ Implement robust operational practices

- Cleaning, sanitization disinfection

- Rigorous hand hygiene – staff and residents

- Food safety tools – thermometers, colored cutting boards, antimicrobial vegetable and fruit wash

Collaborate with purchasing and your supply chain partners – developed shared food safety goals

Verify - systems, audits, preventative maintenance, documentation and record keeping

Train, train, train


Awareness and Education

September is National Food Safety Month

A great time to re-train your staff

A great time to remind your residents

Work with your supply chain partners

Develop and commit to shared goals

Remind everyone that food safety is a shared responsibility

56


Our Paths

1. Food safety landscape

2. Age makes a difference

3. Pathogens, food groups and

contributing factors

4. Supply chain collaboration

5. Resources abound

6. Clean

7. Separate

8. Cook

9. Chill

10. Awareness, education, and a

systematic approach to food safety



58

Thank you

John H. Hanlin, Ph.D.

Ecolab Inc.

[email protected]

mailto:[email protected]

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