Module 13: Review

Putting it All Together www.foodpoisoningbulletin.com

What Happened The health department calls and says 6 people have reported getting ill after eating at your restaurant. Little information is known, just the dates they ate at your restaurant, all within a week of each other. What questions do you ask of the health department? What do you ask of your staff? This case study is different, as the case study is one we walk through as a review Health department questions: what days did they eat, what did they eat, are they in the same family, what are the symptoms, have any been tested, what days did symptoms start, etc Staff: have any of you been sick, if so when and what symptoms, did anything look out of place, have the recipes and food safety plans been followed, etc  

So it’s not just your restaurant…what do you think now? And Then … April 27, 2012, Asheville, NC Buncombe County Department of Health, NC Division of Public Health and the CDC investigates link between 27 sick people. Each of them ate at restaurants in the Asheville area. So it’s not just your restaurant…what do you think now? Is this a supplier issue? Workers with commonalities?

What They Found Ill people tested positive for Salmonella Paratyphi B Samples linked with genetic fingerprint Bacteria from all the people had the same DNA This means all illnesses are linked Thanks to modern microbiological testing, microorganisms can be tested to reveal unique strains and DNA. Outbreak strains can be linked across the country and entered into databases to track spread of illness Blogs.cdc.gov

Salmonella Salmonella bacteria that infects the digestive system and produces toxins What do we call this type of illness? Usually can be treated with antibiotics. Some people are more susceptible Remember YOPI? Toxin-mediated infection Young, old, pregnant, immunocompromised

Discussion What are other causes of illness? What types of contamination have we discussed?

Other Causes Of Illness/Contamination Bacteria Viruses Parasites Toxins Chemical hazards Physical hazards Pests Review each of these categories with the class.

Reporting Illness Sick employees must report to the person in charge What symptoms and conditions must be reported? Sore throat with fever Infected cuts, wounds or lesions containing pus on the hand, wrist or other exposed body part Persistent sneezing, coughing or runny nose that causes discharges from the eyes, nose or mouth Diarrhea Vomiting Jaundice (yellowing of the skin and eyes) Have participants list symptoms Do you remember which require restriction and which require exclusion?  

HENSS Reportable Illnesses Employees must be excluded if diagnosed with: Hepatitis A virus Shiga-toxin producing E.coli (STEC) Norovirus Salmonella species (Typhoidal and nontyphoidal) Shigella species HENSS HENSS can be used as an acronym for the exclusion diseases Again, have participants list

Outbreak Update May 5, 2012 More illnesses have been reported, taking the group to 71 people 9 hospitalizations Your restaurant is linked to 12 of the illnesses

What Caused it?

Cross-contamination is not always obvious! What Went Wrong? Source Raw, unpasteurized tempeh (kind of like tofu) was contaminated with Salmonella Problem People handled it like a vegetable or other low risk ingredient Ordered from a producer who didn’t tell you it was unpasteurized Cross-contamination is not always obvious!

Approved Supplier All the restaurants got tempeh from a producer in Asheville, NC Producer was inspected They weren’t pasteurizing the tempeh Pasteurization isn’t required, but it is common It is important to know your products, especially if you change suppliers Salmonella traced back to a guy selling starter mold packets from his apartment in New York Knowing suppliers and product specs is important How should the tempeh have been handled if people knew it was unpasteurized?

Cross-Contamination Improper handling led to cross-contamination Surfaces, cutting boards and knives were used on tempeh and fresh fruits and vegetables Cleaning and sanitizing could have prevented this outbreak Storage could be a factor in cross-contamination

What are some important aspects of personal hygiene? Handwashing could have been a factor in cross-contamination What are some important aspects of personal hygiene? Handwashing; bathing; clean clothes, aprons and uniforms; preventing bare hand contact; hair restraints; clean, trimmed fingernails, no fake nails

Do you remember the Temperature Danger Zone and proper cooling? Cooking Tempeh was not cooked to a safe temperature Do you remember the Temperature Danger Zone and proper cooling? TDZ: above 41F and below 135F Cooling from 135F to 70F in two hours, 70F to 41 in four hours What are the final cook temps for various foods?

What would you have done to prevent this outbreak? Know the specifics of the products Handle tempeh like its raw meat Use designated work area for raw and RTE foods Clean and sanitize surfaces, cutting boards, utensils, etc. Wash hands after handling product Heat foods to a safe temperature

What risks are involved with these foods? Buffet: hot and cold holding, customer contamination, chicken: Salmonella or Campy, hamburger: E. coli, salad: contaminated produce or ill food worker, peanut butter and jelly: allergens, peanut and wheat, clams: shell, toxin, pathogens

What if it was your place? How would you have controlled the risk? Discussion What if it was your place? How would you have controlled the risk?

How Did It End? Regulators identified the cause Tempeh company went out of business temporarily and has since reopened Tempeh was produced in a plant with a bunch of other products Plant had to shut down for major cleaning and sanitizing

Could this happen to you? What are you going to do to prevent it?