1. BILL 307-31 PROPOSED GUAM FOOD CODE 06.21.12 GHRA 2 nd Quarter General Membership Meeting Presented by M. Thomas Nadeau Division of Environmental Health Department of Public Health & Social Services

2. DID YOU KNOW…  “Stomach flu” is not a flu but an intestinal disease caused by Norovirus  Norovirus infection causes Projectile vomiting Projectile vomiting Diarrhea Diarrhea Abdominal pains Abdominal pains Nausea Nausea Fever (sometimes) Fever (sometimes) 2GHRA 2 ND Qtr. Membership Meeting Norovirus Courtesy of National Institute of Health

3. DID YOU KNOW…  Infective dose for Salmonella is 100,000 to 1,000,000 cells, while E. coli is 100,000,000 - Salvato, 1992  But NOROVIRUS infection requires the ingestion of only less than 10 viral particles - USFDA, Annex 3, Model Food Code 3GHRA 2 ND Qtr. Membership Meeting

4. DID YOU KNOW…  Norovirus Causes more food-borne illness in US annually than any other pathogens Causes more food-borne illness in US annually than any other pathogens - U.S. Centers for Disease Control and Prevention Is spread by fecal-oral route Is spread by fecal-oral route Can also be transmitted via airborne route (projective vomiting) Can also be transmitted via airborne route (projective vomiting) 4GHRA 2 ND Qtr. Membership Meeting

5. DID YOU KNOW… 1 gram of diarrhea (3 drops) from a person infected with Norovirus may have up to 10,000,000 viral particles - USFDA, Annex 3, Model Food Code 5GHRA 2 ND Qtr. Membership Meeting

6. DID YOU KNOW…  Listeria is a hardy bacterium that can tolerate high salt and low temperature  Pregnant women are more susceptible to Listeria; infection can lead to stillborn or abortion 6GHRA 2 ND Qtr. Membership Meeting

7. 7 PURPOSE Provide a summary of the proposed “Guam Food Code” (Bill 307-31) and how it will impact retail food facilities when the code is adopted and implemented.

8. 8 AGENDA   Background of Division of Environmental Health   Guam Food Code and affected Establishments   Components of Guam Food Code   Guam Food Code vs. Eating and Drinking Establishment Rules and Regulations GHRA 2 ND Qtr. Membership Meeting

9. 9 DIVISION OF ENVIRONMENTAL HEALTH (DEH)   One of 5 divisions of DPHSS   To serve and protect the people of Guam from environmental hazards through education and the implementation of governing laws designed to prevent injuries, disabilities, diseases, and deaths GHRA 2 ND Qtr. Membership Meeting

10. 10 Sanitation GHRA 2 ND Qtr. Membership Meeting

11. BILL 307-31  Introduced by Sen. Dennis Rodriguez on Sept. 2011  Through the efforts of the Guam Food Safety Task Force (GFSTF) Regulatory agencies, GHRA, food industry, military, healthcare community, and academia Regulatory agencies, GHRA, food industry, military, healthcare community, and academia  “GUAM FOOD CODE”  Proposed regulations to replace existing “Rules and Regulations Relative to Eating and Drinking Establishments” 11 GHRA 2 ND Qtr. Membership Meeting

12. 12 RETAIL FOOD FACILITIES   Retail Food Facilities (RFF)   Food establishments providing food directly to consumers   Ex: Restaurants, groceries, delis, bakeries   Does NOT include food manufacturers and distributors   RFF inspected by the DEH for compliance (sanitation and safety)   “Guam Food Code” will be the rules and regulations for retail food facilities GHRA 2 ND Qtr. Membership Meeting

13. 13 GUAM FOOD CODE (GFC)   GFC mirrors Model Food Code developed by U.S. Food and Drug Administration (FDA) Model Food Code is a science-based guide for food protection FDA encourages all U.S. jurisdictions to adopt for uniformity Many states have adopted model code in parts or in whole Model code reviewed every 2 years   GFC reflects 2005 version of model code Reviewed and approved by GFSTF Some changes made specific to Guam GHRA 2 ND Qtr. Membership Meeting

14. 14 GFC COMPONENTS   Chapter 1: Purpose Definitions Specific meanings for important words used in GFC   Chapter 2: Management & Personnel Employee health and Managerial knowledge   Chapter 3: Food Preventing contamination of food   Chapter 4: Equipment, Utensils, & Linens Specifications, use, and sanitizing GHRA 2 ND Qtr. Membership Meeting

15. 15 GFC COMPONENTS   Chapter 5: Water, Plumbing, and Waste Water use and wastewater disposal   Chapter 6: Physical Facilities Fixed assets and its specifications   Chapter 7: Poisonous & Toxic Materials Use, restriction, and storage of haz. mat.   Chapter 8: Compliance and Enforcement Permitting, inspections, and enforcement   Annexes: Supporting information GHRA 2 ND Qtr. Membership Meeting

16. 16 Proposed Guam Food Code vs. Current Eating & Drinking R&R   Chapter 1 (Purpose and Definitions)   Chapter 2 (Management and Personnel)   Chapter 3 (Food)   Chapter 8 (Compliance and Enforcement) GHRA 2 ND Qtr. Membership Meeting

17. 17 Chapter 1 (Purpose and Definitions)   Eating and Drinking Rules and Regulations: 19 words used in regulations defined (ex: food, utensil) Reflects knowledge and technology of the time (1984)   Proposed Guam Food Code: More expansive (119 words defined) Consistent with current knowledge and technology in the food service industry and food safety GHRA 2 ND Qtr. Membership Meeting

18. 18 Chapter 1 (Purpose and Definitions) continued   Examples of new terms defined: Water activity Balut Critical control point Major food allergen Reduced oxygen packaging Variance GHRA 2 ND Qtr. Membership Meeting

19. 19 Chapter 2 (Management and Personnel)   Eating and Drinking Rules and Regulations Exclusion of ill food workers from job is absolute Employee cleanliness/hygiene limited   Proposed Guam Food Code Ill employee maybe restricted, but not excluded, from job based on symptoms and population served Expanded provisions for employee cleanliness, practices, and hand hygiene requirements Ex: When, Where, and How for Hand-washing GHRA 2 ND Qtr. Membership Meeting

20. 20 Chapter 2 (Management and Personnel) continued   Greater emphasis on demonstration of knowledge and abilities of Person-In- Charge (PIC) Prevention of food-borne diseases Personal hygiene & sanitation practices Food microbiology   DEH inspector may “quiz” the PIC as part of the inspection GHRA 2 ND Qtr. Membership Meeting

21. 21 Chapter 3 (Food)   Eating and Drinking Rules and Regulations Cold holding temperature is 45 o F or less Gloves are not required   Proposed Guam Food Code Cold holding temperature is 41 o F or less Reason: Listeria grows at 45 o F No bare hand contact for ready-to-eat foods Reason: High infectivity of Norovirus Focuses on protecting Highly Susceptible Populations Preschool age children, elderly, pregnant women, immuno- compromised individuals GHRA 2 ND Qtr. Membership Meeting

22. 22 Chapter 3 (Food) continued   Eating and Drinking Rules and Regulations: No provisions for Consumer Advisory Not required to warn consumers about eating certain foods that may be dangerous (raw foods)   Proposed Guam Food Code: Consumer Advisory Applies to animal food served or sold raw or undercooked (i.e., sushi, eggs sunny-side up) Require brochures, deli-case or menu advisories, label statements, table tents, placards, etc. GHRA 2 ND Qtr. Membership Meeting

23. 23 Chapter 8 (Compliance & Enforcement)   Eating and Drinking Rules and Regulations: Waivers and modifications allowed only for Mobile or Temporary food establishments   Proposed Guam Food Code: Waiver and modification, known as “variance,” allowed for all retail food facilities Must be approved by DPHSS and such approval will not result in a health hazard HACCP and recordkeeping required GHRA 2 ND Qtr. Membership Meeting

24.   Hazard Analysis and Critical Control Point (HACCP) will not be required in the GFC, unless…   HACCP will be required if RFF is seeking a “variance” (modification/waiver) 24GHRA 2 ND Qtr. Membership Meeting Chapter 8 (Compliance & Enforcement)

25. ANNEX 1   “Public Health Reasons”   Provides justification and/or explanation for each section of the GFC   Helpful for regulator and regulatee 25GHRA 2 ND Qtr. Membership Meeting

26. CHALLENGES   Language barriers   HACCP plan development for variance   Record-keeping for HACCP   Resistance to change   Bare-hand contact   Consumer Advisory   Enforcement GHRA 2 ND Qtr. Membership Meeting

27. WHAT’S NEXT   Bill 307-31 requires a public hearing DEH will seek 1 year transition time   DEH conducting survey of financial impact No bare-hands, Lower holding temp., Consumer Advisory, Manager Certificate   Upon passage: Training of Code to DEH staff and industry Education and awareness campaign on Code Hand-hygiene campaign 27GHRA 2 ND Qtr. Membership Meeting

28. ECONOMIC BURDEN in U.S.  Food-borne Illness costs $77.7 billion a year 48 million cases; 128,000 hospitalizations; 3,000 deaths 48 million cases; 128,000 hospitalizations; 3,000 deaths $1,626 average per case $1,626 average per case Norovirus Norovirus $673 average cost per case$673 average cost per case $3.7 billion total cost per year$3.7 billion total cost per year Listeria Listeria $1.2 million average cost per case$1.2 million average cost per case $2 billion total cost per year$2 billion total cost per year  Excludes cost by PH to respond to outbreaks 28

29. Thank You ! Division of Environmental Health Department of Public Health and Social Services 735-7221 29GHRA 2 ND Qtr. Membership Meeting