1. Metro-Nashville and Tennessee NEARS
Metro-Nashville Public Health Department
Nashville, TN
Danny Ripley
Metro-Nashville Public Health Department
Food & Public Facilities Protection

2. Tennessee Demographics
95 Counties
7 Regions
5 Contract Counties
169 EHS
Centralized food regulations
Tennessee Department of Health
Based on the 2009 FDA Food Code
63 Million population
28 Thousand Food Establishments
Metro-Nashville Public Health Department
Food & Public Facilities Protection

3. Outbreak Investigation Procedures
Outbreak Investigation Team
Environmental Health
Epidemiology
Laboratory
Factors that influence an investigation
Data
Communication
Individual abilities
EHS OB training opportunities
Metro-Nashville Public Health Department
Food & Public Facilities Protection

4. EHS Outbreak Investigation Challenges
Very few outbreaks identified per county
Limits outbreak investigation experience
Necessitates outbreak training
Designation of outbreak investigators
Metro-Nashville Public Health Department
Food & Public Facilities Protection

5. Addressing the Challenges
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13 Regions
Primary Contacts: 13
Secondary Contacts: 23
Field EHS: 6
"Primary Contact"/"Secondary Contact"/"Field EHS"
Metro-Nashville Public Health Department
Food & Public Facilities Protection

6. Regional Outbreak Investigators
Senior EHS staff
Participated in Epi-Ready and NEARS training
Completed E-Learning web-based training
Continued Central Office EHS-Net support
All outbreaks
NEARS data collection and entry
Metro-Nashville Public Health Department
Food & Public Facilities Protection

7. Metro Nashville Public Health Department
Local Government
Food regulations contracted with TDH and TDA
20 Environmental Health Specialists
4900 Food establishments
Restaurants, schools, mobile units, daycare facilities
Markets, groceries & convenience stores
Metro-Nashville Public Health Department
Food & Public Facilities Protection

8. NEARS Assisting an Outbreak Investigation January 2017
Overview:
Three clinically confirmed cases identified through pathogen surveillance
One food establishment in common
Several reported foods in common
Lab:
Known etiology (Campylobacter)
No food for additional testing
Epidemiology:
Very limited data for studies
Environmental:
Significant time gap between incident and notification
Several implicated foods
Metro-Nashville Public Health Department
Food & Public Facilities Protection

9. Environmental Assessment and NEARS Data Collection
Subtle cross contamination
Hand contact
Inappropriate use of wiping towels
Mild temperature abuse
No glaring contributing factors observed
NEARS Manager Interview
Policy questions prompted further investigation
Prep table policies
Foods used
Cleaning policies
Significant CF identified
Occasionally, one table used raw chicken and RTE food
Policy did not address proper sanitization
Employees were not trained in proper sanitization between raw and RTE production
Metro-Nashville Public Health Department
Food & Public Facilities Protection

10. Why do we participate in NEARS?
Improves outbreak investigations
Improved Team Communication
Epi and Environmental (contributing factor reporting)
Environmental and operators
Improved consistency of environmental assessments
Training
Outbreak support
Use of NEARS data
Evaluate outbreaks across the entire state
Better understand contributing factors and antecedents
Routine inspection
Training provided
Provides documentation of the work we do
Contributes to nationwide research
Metro-Nashville Public Health Department
Food & Public Facilities Protection

11. Thank You Metro-Nashville Public Health Department
Food & Public Facilities Protection