N E A R S National Environmental Assessment Reporting System NEARS Webinar Erik W. Coleman, MPH Health Scientist (Informatics)

National Environmental Assessment Reporting System People Captures environmental factors through environmental assessments Serves as a companion surveillance system to the National Outbreak Reporting System (NORS) Process Economics Equipment Food Foodborne illness is a significant problem in the United States, but addressing environmental causes can help prevent it. Foodborne illness outbreaks reported to CDC’s NORS often include little or no information on the environmental causes of foodborne illness outbreaks. NEARS serves as a companion surveillance system to CDC’s National Outbreak Reporting System (NORS) for reporting of environmental assessments. NEARS captures environmental factors and provides the information needed to recommend effective short and long-term interventions to stop ongoing foodborne outbreaks and prevent them in the future.

Environmental assessment

Environmental Assessments as Part of Foodborne Illness Outbreak Investigations Describes how the environment contributes to the introduction and/or transmission of agents that cause illness Objectives of an environmental assessment Identify contributing factors Identify environmental antecedents Generate recommendations for informed interventions Historically, CDC has collected the epi and lab component of foodborne illness outbreaks, but lack the environmental component of outbreaks. NEARS collects environmental assessment data that helps us understand how and why outbreaks occurs. Typically conducted by an environmental health specialist, a foodborne outbreak environmental assessment is very different from the other types of environmental activities food programs conduct on a daily basis. The challenge of a foodborne outbreak Environmental Assessment is the reconstruction of past events. Even more challenging is the fact that these assessments represent one component of a response that involves not only the food program but often, epidemiologists, laboratory professionals and possibly others from other program areas, who are working as a team to help reconstruct past events.

Environmental Antecedents Environmental Assessments as Part of Foodborne Illness Outbreak Investigations Contributing Factors Factors that caused the outbreak How the outbreak occurred Environmental Antecedents Factors that led to the contributing factors Why the outbreak occurred Contributing factors are determinants that directly or indirectly cause an outbreak. They describe how the outbreak occurred. They are categorized as Contamination Factors, Proliferation Factors and Survival Factors. Environmental Antecedents are factors that led to the contributing factors and describe why the outbreak occurred. Based on our work with EHS-Net we have identified categories of potential antecedents. They include people, equipment, process, food, and economic factors.

Environmental Assessments as Part of Foodborne Illness Outbreak Investigations Norovirus Outbreak caused by coleslaw eaten at a restaurant Contributing Factors Worker did not properly wash hands after using restroom Worker prepared coleslaw using bare hands Worker worked while ill Environmental Antecedents Hand sinks did not have soap Workers lacked training on proper handwashing Restaurant did not offer workers paid sick leave

The Need to Improve Reporting of Environmental Assessment Data Environmental assessment data are key to: Understand how and why outbreaks occur Develop appropriate guidelines, policies and practices Prevent future outbreaks Engage food safety officials responsible for conducting environmental assessments Limited environmental assessment data reported to CDC Link to National Outbreak Reporting System (NORS) We can not overstate the value of reporting environmental assessment data.

Programs Reporting Environmental Assessment Data to NEARS State Agencies Alaska Department of Environmental Conservation California Department of Public Health Connecticut Department of Public Health Iowa Department of Public Health Massachusetts Department of Public Health Michigan Department of Agriculture and Rural Development Minnesota Department of Health New York State Department of Health North Carolina Department of Health and Human Services Oregon Health Authority Rhode Island Department of Health South Carolina Department of Health and Environmental Control Tennessee Department of Health Washington State Department of Health Wisconsin Department of Agriculture, Trade & Consumer Protection Local Agencies Albuquerque (NM) Environmental Health Department Coconino County (AZ) Public Health Services District Davis County (UT) Health Department Fairfax County (VA) Health Department Harris County (TX) Health Department Kansas City (MO) Health Department New York City of Health and Mental Hygiene Southern Nevada Health District

Why Programs Registered to Report Environmental Assessment Data to NEARS Receive training to conduct environmental assessments Ensure staff understand terminology used in conducting environmental assessments (contributing factors, environmental antecedents, etc.) Standardize outbreak response within their respective programs Obtain feedback from CDC on reported outbreak data Learn from outbreak investigations Respond more quickly to outbreak investigations Identify trends likely to cause foodborne illnesses In 2014, CDC began a formal evaluation of the National Environmental Assessment Reporting System (NEARS). The evaluation was conducted to determine the effectiveness of NEARS. Findings from this evaluation help inform things like why programs registered.

Outcomes and Benefits

Immediate Outcomes for Reporting Outbreak Data to NEARS Increase reporting of environmental assessment data Access to practical information about conducting environmental assessments Helps improve participants’ outbreak investigation ability and expertise NEARS Manual and Data Reporting Instrument CDC’s Environmental Assessment Training It is important to remember that NEARS is a surveillance system. By their nature, surveillance systems are not designed to provide immediate benefits to participants (unless they are being paid to participate!)-- they are designed to provide benefits over the long term. But, here are some thoughts on more immediate benefits: Increase the reporting of environmental assessment data. The NEARS manual and data reporting instrument, and its accompanying outbreak environmental assessment training, provides participants with useful, practical information about conducting environmental assessments during foodborne illness outbreaks.

Immediate Outcomes for Reporting Outbreak Data to NEARS (Cont’d) Access to a free data entry and storage system NEARS data is immediately accessible after entry NEARS provides an easy, free, and intuitive data entry and storage system. Each site’s data entered into NEARS are immediately accessible to them.

Long-Term Outcomes for Reporting Outbreak Data to NEARS Improve Retail Food Safety Identify what environmental antecedents are associated with outbreak occurrences Are outbreak establishments less likely to have ill worker policies than non-outbreak establishments? Identify what environmental antecedents are associated with outbreak types (e.g., bacterial vs. viral) or specific pathogens Are establishments that have viral outbreaks less likely to have ill worker and hand hygiene policies and practices than establishments that have bacterial outbreaks? Questions NEARS data may be able to answer.

Long-Term Outcomes for Reporting Outbreak Data to NEARS (Cont’d) Improve Retail Food Safety Identify what environmental antecedents are associated with specific contributing factor (CF) categories (contamination, proliferation, survival) or specific CFs Are outbreaks in which the establishment does not have an ill worker policy more likely to have an ill worker CF than outbreaks in which the establishment does have an ill worker policy? Questions NEARS data may be able to answer.

Benefits of Reporting Environmental Assessment Data to NEARS Environmental Health Programs Annual report from CDC summarizing your NEARS data https://www.cdc.gov/nceh/ehs/nears/docs/2014-summary-report.pdf

Benefits of Reporting Environmental Assessment Data to NEARS (Cont’d) Environmental Health Programs Collaboration/communication with other states/localities participating in NEARS Document and track foodborne outbreak response data Scientific publication opportunities Meet FDA Retail Food Regulatory Program Standards Standard 5 recommendation

Anticipated Benefits of Reporting Environmental Assessment Data to NEARS Epidemiology, Laboratory, and Environmental Health Programs Strengthen national description of foodborne illness outbreak data Prevent illness cases and deaths Mitigate social and economic disruptions (food production and manufacturing) when epidemics are prevented Cost savings Source: http://www.who.int/csr/resources/publications/surveillance/WHO_CDS_EPR_LYO_2005_25.pdf

Begin Reporting Your Program’s Environmental Assessment Data to NEARS Commit to conducting environmental assessments Complete NEARS Registration Form(s) State Notice and Acknowledgment of Local Participation Notice of Participation Form https://www.cdc.gov/nceh/ehs/nears/registration.htm Complete CDC’s free online environmental assessment training https://www.cdc.gov/nceh/ehs/elearn/ea_fio/index.htm

Thank You!