Philadelphia Dept of Public Health- Environmental Health Services Risk Based Food Inspections, Standardization, Foodborne Illness, & Keeping Deli Slicers Safe George Van Note, Program Manager of Food Protection

Environmental Health Services (EHS) Office of Food Protection Office of Food Protection Environmental Engineering Environmental Engineering Vector Control Services Vector Control Services Child Lead Poisoning Prevention Child Lead Poisoning Prevention

Why Is Food Safety Important? Foodborne illness is preventable Foodborne illness is preventable Children younger than age 4 at risk Children younger than age 4 at risk older than age 50 are at greater risk for death older than age 50 are at greater risk for death costly health care costly health care

2011 Estimates of Foodborne Illness in United States 48 million people get sick per year (1 in 6) 48 million people get sick per year (1 in 6) 128,000 are hospitalized 128,000 are hospitalized 3,000 deaths 3,000 deaths $3 billion for hospitalization $3 billion for hospitalization

National Standardization of Food Code & Retail Food Inspections FDA model food code FDA model food code FDA program for standardization & certification of retail Food inspection officers FDA program for standardization & certification of retail Food inspection officers FDA guide to conducting risk-based inspections FDA guide to conducting risk-based inspections

FDA Statistic: Population of States & Territories That Have Adopted the Food Code

Risk Based Food Inspections foodborne illness risk factors foodborne illness risk factors not just “walls, floors & ceilings” not just “walls, floors & ceilings” active managerial control active managerial control Observing practices Observing practices asking questions asking questions

Foodborne Illness Risk Factors & Public Health Interventions Demonstration of Knowledge Demonstration of Knowledge Employee Health Employee Health Good Hygienic Practices Good Hygienic Practices Preventing Contamination by Hands Preventing Contamination by Hands Approved Source Approved Source Protection From Contamination Protection From Contamination

Foodborne Illness Risk Factors & Public Health Interventions Potentially Hazardous Food Time/Temperature Potentially Hazardous Food Time/Temperature Consumer Advisory Consumer Advisory Highly Susceptible Population (HSP) Highly Susceptible Population (HSP) Chemical Chemical Conformance w/ Approved Procedures Conformance w/ Approved Procedures

Employee Health Diseases or medical conditions that must be reported. Norovirus Norovirus Hepatitis A Hepatitis A Shigella spp. Shigella spp. Shiga toxin-producing E. Coli Shiga toxin-producing E. Coli Salmonella Typhi Salmonella Typhi

Employee Health Diseases or medical conditions that must be reported. Diarrhea Diarrhea Fever Fever Vomiting Vomiting Jaundice Jaundice Sore throat w/ fever Sore throat w/ fever Lesion containing pus Lesion containing pus

FDA 2004 report

Highly Susceptible Population (HSP) persons who are more likely to experience foodborne disease persons who are more likely to experience foodborne disease immunocompromised persons immunocompromised persons preschool-age children preschool-age children older adults older adults custodial care, healthcare, assisted living services, nutritional services or socialization services custodial care, healthcare, assisted living services, nutritional services or socialization services

SPECIAL REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS Prepackaged juice w/ warning label prohibited. Prepackaged juice w/ warning label prohibited. juice that is prepared on site requires HACCP plan juice that is prepared on site requires HACCP plan Pasteurized eggs required in certain foods. Pasteurized eggs required in certain foods.

SPECIAL REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS Prohibited ready-to-eat foods. Prohibited ready-to-eat foods. - raw animal-derived foods - a partially cooked animal-derived food - raw seed sprouts

Evaluate facilities Good retail practices (GRP) Pest control Pest control Food protection Food protection Equipment maintenance Equipment maintenance Water Water Plumbing Plumbing Toilet facilities &Sewage Toilet facilities &Sewage Garbage & refuse Garbage & refuse Physical facilities Physical facilities

Risk based inspection requirements: Proper equipment. Proper equipment. Adequate training. Adequate training. Lead by example. Lead by example. Conduct inspections at variable times. Conduct inspections at variable times.

Risk based inspection priorities: open dialogue w/ Person in Charge (PIC) open dialogue w/ Person in Charge (PIC) previous inspection reports previous inspection reports menu/food list review menu/food list review walk-through walk-through

Achieving long term compliance. Active Managerial Control Active Managerial Control On-site correction. On-site correction. Standard operating procedures. Standard operating procedures. Closing conference. Closing conference.

Schedule Inspections Based on Risk History of non-compliance History of non-compliance Specialized process Specialized process Food prepared in advance Food prepared in advance Large number of people served Large number of people served History of foodborne illness or complaints History of foodborne illness or complaints Highly susceptible population Highly susceptible population

Achieving long term compliance. Active Managerial Control Active Managerial Control On-site correction. On-site correction. Standard operating procedures. Standard operating procedures. Closing conference. Closing conference.

FDA Standardization & Certification of Retail Food Inspection Offices

Standardization of Food Inspection Officers audited on performance audited on performance not intended to provide basic training to individual candidates not intended to provide basic training to individual candidates promote uniformity promote uniformity lack of training programs for food inspectors lack of training programs for food inspectors

Standardization of Food Inspection Officers 8 joint field inspections of food establishments 8 joint field inspections of food establishments risk control plan risk control plan process flow charts process flow charts verification of existing Hazard Analysis Critical Control Point Plan (HACCP) verification of existing Hazard Analysis Critical Control Point Plan (HACCP)

Standardization of Food Inspection Officers The standard evaluates the candidate on: 1. Foodborne Illness Risk Factors 2. Good Retail Practices 3. HACCP 4. Inspection Equipment 5. Communication

Standardization of Food Inspection Officers Score is based on agreements with standard. Score is based on agreements with standard. Passing Passing - risk factors- 90%, 11 or less disagreements - GRPs- 85% agreement on GRPs, 5 or less disagreements

Unsatisfactory performance cannot meet the requirements cannot meet the requirements additional training additional training Conference for Food Protection has published a Field Training Manual for Regulatory Retail Food Safety Inspection Officers. Conference for Food Protection has published a Field Training Manual for Regulatory Retail Food Safety Inspection Officers.

Foodborne Illness Common Pathogens

CDC- Top 5 pathogens causing foodborne illnesses- Norovirus Salmonella nontyphoidal Clostridium perfringens Campylobacter spp. Staphylcoccus aureus

Change in E. coli O157 & Salmonella infection, 1996–2010 Source: Foodborne Diseases Active Surveillance Network, 2010.

Changes in Foodborne Illness Decrease Decrease - Campylobacter -27% - Listeria -38% - E. Coli O % - Shigella -57% - Yersinia -52% Increase Increase - Vibrio +115 % - Vibrio +115 %

Local Gastrointestinal Illness Outbreaks Salmonella Enteritidis Salmonella Enteritidis Salmonella Typhimurium Salmonella Typhimurium Bacillus cereus Bacillus cereus Shigella Shigella Norovirus- Norovirus- Frozen Oysters Korean Import Unknown Illnesses Unknown Illnesses

Onset Time of Common GI/Foodborne Illnesses Salmonella: 6-48 hrs Salmonella: 6-48 hrs Listeria: 9-48 hrs GI, 2-6 weeks for invasive disease Listeria: 9-48 hrs GI, 2-6 weeks for invasive disease Norovirus: hrs. 2-5 days Campylobacter: 2-5 days Shigella: 4-7 days

Symptoms of Common GI/Foodborne Illness Salmonella: Diarrhea, fever, abdominal cramps, vomiting Shigella: cramps, fever, & diarrhea. Stools contain blood & mucus Norovirus: Nausea, vomiting, cramping, diarrhea, fever, headache. Campylobacter: Vomiting, diarrhea, blurred vision, double vision, difficulty in swallowing, muscle weakness. respiratory failure & death Listeria: Fever, muscle aches, & nausea or diarrhea.

Foods associated w/ Salmonella Outbreaks Foods associated with Salmonella outbreaks*

Food Source of Common Food Borne Illness Campylobacter: Improperly canned foods, home-canned vegetables, fermented fish, baked potatoes in aluminum foil. Listeria: Unpasteurized milk, soft cheeses made with unpasteurized milk, ready-to-eat deli meats

Source of Common Food Borne Illness Shigella: Raw produce, contaminated drinking water, uncooked foods & cooked foods that are not reheated after contact with an infected food handler Norovirus: Raw produce, contaminated drinking water, uncooked foods & cooked foods that are not reheated after contact with an infected food handler; shellfish from contaminated waters

Listeria- High Risk Groups Pregnant women, fetuses & newborns Pregnant women, fetuses & newborns weakened immune systems weakened immune systems People with cancer, diabetes, alcoholism, liver or kidney disease People with cancer, diabetes, alcoholism, liver or kidney disease AIDS AIDS Older adults Older adults

Listeria- High Risk Groups “Do Not Eat” Hot dogs, luncheon meats, cold cuts, unless they are heated to an internal temperature of 165ºF Pate or meat spreads Raw milk & soft cheese from raw milk Refrigerated smoked seafood

Prevention of Foodborne Illness- Handwashing “Handwashing is the single most important prevention step for reducing disease transmission.”- Center for Disease Control “Handwashing is the single most important prevention step for reducing disease transmission.”- Center for Disease Control Handwashing reduces the spread of microorganisms. Handwashing reduces the spread of microorganisms.

Prevention of Foodborne Illness Wash hands Wash hands Clean/Sanitize/Disinfect equipment & clothing Clean/Sanitize/Disinfect equipment & clothing Wash fruits & vegetables Wash fruits & vegetables Date mark Date mark Avoid cross contamination Avoid cross contamination Refrigerate Refrigerate Cook raw animal products properly Cook raw animal products properly Ill people should not prepare food Ill people should not prepare food Careful w/ HSP Careful w/ HSP

Challenges to Tracking Foodborne Illness Public’s lack of understanding of foodborne illness Public’s lack of understanding of foodborne illness lack of healthcare lack of healthcare medical cost medical cost No specific diagnosis No specific diagnosis person-to-person or foodborne person-to-person or foodborne stereotypes stereotypes