1. Module 13: Review

2. Putting it All Together

3. 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

4. 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?

5. 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

6. 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

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

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

9. 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?

10. 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

11. 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

12. What Caused it?

13. 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!

14. 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?

15. 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

16. 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

17. 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?

18. 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

19. 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

20. 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?

21. 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

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