7/20/2017 Faculty Food Safety at Retail Food Establishments: Ron Dawsey, MPH Preventing Food-borne Outbreaks Environmental Services Investigating Food-borne Outbreaks Alabama Department of Public Health Satellite Conference and Live Webcast Wednesday, July 26, 2017 2:00 – 3:30 p.m. Central Time Produced by the Alabama Department of Public Health Distance Learning and Telehealth Division Rules for Food Rules for Food Establishment Sanitation Establishment Sanitation • Each state develops its own retail • A PERMIT is required prior to food safety program opening a retail food establishment • Alabama law authorizes the State • A PERMIT is required for continued Board of Health to adopt rules and operation of a retail food regulations governing the SALE of establishment food at retail Rules for Food Rules for Food Establishment Sanitation Establishment Sanitation • Based on federal recommendations • Critical Items (the “Food Code”) – Priority – 3 days to correct • EXCEPT where contradictory to state – Other – 10 days to correct law or general operations • Core sanitation items • Administered and enforced by each county health department 1 7/20/2017 Rules for Food Rules for Food Establishment Sanitation Establishment Sanitation • Immediate closure • Immediate closure – Emergency – Emergency Order of the Order of the Health Officer Health Officer – www.alabamappgublichealth.gov/ • Sewage backup, no refrigeration, foodsafety/closings.html leaks onto food prep areas, score less than 60, complete lack of hot water, ... CDC Estimates: CDC Risk Factors For • 48 million people get sick Foodborne Illness • Unapproved source for the food • 128,000 are hospitalized • Inadequate cooking • 3,000 die from food-borne diseases • Improper hot / cold holding each year in the United States temperature • Unclean equipment / cross contamination • Poor employee health / hygiene (hand washing) CDC Risk Factors For CDC Risk Factors For Foodborne Illness Foodborne Illness • Unapproved source • Inadequate • Foods must come from inspected cooking production facilities, or from sources exempt by law; straight from the farm for example 2 7/20/2017 CDC Risk Factors For CDC Risk Factors For Foodborne Illness Foodborne Illness • Improper hot / cold holding • Unclean equipment / cross temperature contamination • Hot = 135°F or above, or hold no longer than 4 hours • Refrigeration = 41°F or below CDC Risk Factors For CDC Risk Factors For Foodborne Illness Foodborne Illness • Poor employee • Ill employees report certain health / hygiene diagnoses to manager (hand washing) – Norovirus – HtitiAiHepatitis A virus • Keep hands – Shigella spp washed and – Shiga toxin producing Escherichia coli clean – Salmonella typhi, or – Non-typhoidal Salmonella Preventive Measures • Clean • Cook • Chill • Separate 3 7/20/2017 What happens when there is an outbreak? • Situation is reported to the Health What Happens When There Department is an Outbreak? • Infectious Diseases and Outbreaks (ID&O) leads the investigation • Environmental investigates food preparation, collects food samples • Lab runs the appropriate tests Sunnyside Childcare Sunnyside Daycare Outbreak Montgomery County A Health Department June 2015 B Sunnyside Daycare Summer Feeding Program • Two locations: – (A) 3874 South Court Street (B) 3784 Norman Bridge Road – Location (A) had a kitchen permittdbthhlthditted by the health depart ment • The d aycare was enroll ed i n th e D epart ment but did not typically have kids of Education’s summer feeding program – Location (B) did not have a • The Montgomery County Health Department permitted kitchen but had the kids was NOT notified as required for daycare so food was supposed • There were over 300 children attending the to be transported daily two daycare locations 4 7/20/2017 Day of Outbreak – Day of Outbreak – June 23, 2015 June 23, 2015 • 3:30PM - Received a phone call from • 4:00PM - Received a phone call from a parent saying her child was Area Investigator stating that 18 attending summer camp at children were currently at the Sunnyside Childcare and was sick hospital • 4:30PM – Environmentalists departed – She said there were several kids from the Montgomery County Health throwing up in the hallways when Department to retrieve samples and she picked her child up complete an Environmental – Emailed Area Investigator Assessment Report (EAR) Day of Outbreak – Spoke with Owner June 23, 2015 • What foods were served for 3874 South Court Street breakfast / lunch? • Was there a copy of a menu available? • How was the food prepared, held, and served? • Were there any leftovers available for sampling? Spoke with Owner Conducted an Inspection of • Were there any sick children / the Establishment to Check: employees recently? • Temperatures. of refrigerators / freezers • What was the sick employee policy on file? • Hot water temperatures at hand sinks / three - compartment sink • Were there invoices / receipts for • Hand sinks stocked with paper the food? towels and soap • Availability of bleach and chemical test strips 5 7/20/2017 Conducted an Inspection of Day of Outbreak-June 23, 2015 the Establishment to Check: 3874 South Court Street • Storage. of chemicals • Stove was removed • Food sources / expiration dates • Building storage for a double oven Day of Outbreak-June 23, 2015 Day of Outbreak-June 23, 2015 3874 South Court Street 3874 South Court Street • About 5 - 6 crock pots were being • Using residential refrigerators used in place of a stove Collected Samples Day of Outbreak-June 23, 2015 (from trash can, by that time) 3874 South Court Street • All leftover food was in the trash • Apple slices • Samples were retrieved from • Bread trash bins • Bologna • Noodles with chicken 6 7/20/2017 Day of Outbreak-June 23, 2015 Day of Outbreak-June 23, 2015 3874 South Court Street 3784 Norman Bridge Road • Food was commingled • Traveled to the second location – 3784 Norman Bridge Road Day of Outbreak-June 23, 2015 Day of Outbreak-June 23, 2015 3784 Norman Bridge Road 3784 Norman Bridge Road • No food was supposed to be • Refrigerator at second location prepared / stored / held at the second location Day of Outbreak-June 23, 2015 Day of Outbreak-June 23, 2015 3784 Norman Bridge Road 3784 Norman Bridge Road • There was a milk cooler with several • A commercial microwave oven gallon jugs of milk 7 7/20/2017 Day of Outbreak-June 23, 2015 Day of Outbreak-June 23, 2015 3784 Norman Bridge Road 3784 Norman Bridge Road • A microwave, toaster, and a • ID&O requested samples of soiled slushie machine diapers Day of Outbreak-June 23, 2015 Day after Outbreak – 3784 Norman Bridge Road June 24, 2015 • Everything was packaged using the • Staff returned to the daycare to ask the DETECT Kit and labeled cook questions about the kitchen and food preparation as well as retrieve more samples: – There was no thermometer available except for a meat thermometer – Cook stated that he never took food temperatures during preparation, serving, transport, or reheating Day after Outbreak – Day after Outbreak – June 24, 2015 June 24, 2015 • Timeline of food preparation prior to – 6/22/15 – Thawed chicken placed in outbreak as told by owner: roasters with water and cream of – 6/21/15 – Frozen chicken leg chicken soup to cook quarters purchased from Food • Cooked chicken was served Outlet and thawed in kitchen • Leftovers put back in refrigerator refrigerator 8 7/20/2017 Day after Outbreak – Environmental Assessment June 24, 2015 Report (EAR) – 6/23/15 – Leftover chicken was • Environmentalists competed the taken from refrigerator, torn off Environmental Assessment Report bone and placed in roaster to for both locations reheat and cook with pasta • This covers items associated with • This was served for lunch the the food borne illness risk factors day of the outbreak June 25-26, 2015 The Lab Results • One of the requirements for re-opening • Positive for Staph aureus in Chicken included Environmental and ID&O staff and Noodle sample conducting an in-house training session with all employees of the daycares on June – Staph is a toxin that is formed in 26, 2015 food held at improper temperature and is heat stable • PFGE results from clinical (stool) and environmental samples with matching bacterial DNA profiles Media Attention The Aftermath • A total of 86 children went to the hospital with symptoms • 30 were hospitalized overnight • Staph aureus tested positive in an environmental sample of chicken and noodles that matched six clinical samples 9 7/20/2017 The Aftermath ADPH Food Safety Program • The daycare was reopened on June • Retail food – restaurants, grocery 29, 2015 after complying with the stores, convenience stores, schools, requirements set forth by the hospitals, day care centers, Montgomery County Health temporary events, jail and prison Department kitchens • 4 separate lawsuits were filed ADPH Food Safety Program • Other than retail food establishments: – Milk and milk products, bottlers, bottled water, bakeries, ice, peanut butter, juice, vegetable processors, vending, candy, beer, wine, sweeteners, tea, yeast, containers,……. • NOT red meat and poultry processors 10.