1. Buckets of Bath Tub Cheese
Winston Salem, NC
2001

2. The Story Winston-Salem, NC, November 2001
12 individuals admitted to hospital
11 females, 1 male with poor immune system
Symptoms: fever, chills, abdominal cramps, stiff neck, vomiting, and light sensitivity

3. Investigating Agencies
NC Communicable Disease Control Branch
Forsyth County Health Department
NC Department of Agriculture & Consumer Services
Environmental and Natural Resources
FDA
CDC

4. What Happened Sick with Listeria monocytogenes 10 sick pregnant women
5 stillbirths, 3 premature deliveries, 2 infected newborns
1 woman with meningitis
1 man with a poor immune system spent 1 month in the hospital
Listeria is involved with receptors of the immune system and has a 30% fatality rate-especially susceptible YOPI

5. What Went Wrong
Soft Mexican style (Queso Fresco) cheese made from contaminated raw milk
Made in 5 gallon buckets fermented in someone's home bathtub
Cheese sold in small grocery stores, parking lots, and door-to door
According to a NC Dept of Ag inspector Hispanic Gentleman approached a local dairy farmer to purchase raw milk. Offered farmer twice the rate of the commercial truck. Farmer knew it was against the law and refused to sell. Gentleman returns the next day and offers to pay 3 times what the truck would offer, farmer had a change of heart and sold the man the cheese. The man opens packet of rennin (coagulating enzyme in powder form) on each bucket and sticks his arm into the milk to stir the rennin to the milk. Carried out several 5 gal buckets of milk to his vehicle and firmed up cheese at home. Home wrapped and delivered from his car/van to area Hispanic grocery stores. 6 OTHER STORIES LIKE THIS IN WASHINGTON STATE AND CHICAGO.

6. Problems Food not from approved source
Raw (unpasteurized) milk used as an ingredient
Cheese made in non-approved facility
Lack of temperature control for transporting cheese before sale
Result: Contaminated cheese caused 12 illnesses

7. Big Changes Resulted
NC health authorities stopped sale of raw milk by dairy farmers to noncommercial processors
Education of store owners – illegal to sell unregulated dairy products
FDA requires pasteurization of all dairy products sold across state lines except cheese that has aged a minimum of 60 days
We discussed creating a list of questions for purchasers to ask of suppliers.
Remember that all food that is required to be inspected is inspected. Herbs-no approved supplier for herbs. Remember story of school selling herbs for a restaurant baked product? With food sales one needs to always remember you are taking on some form of risk.

8. Discuss the case study briefly, why it is important, and transition into what we teach in this lesson.

9. Learning Objectives
Identify growth conditions, control, and symptoms for Listeria monocytogenes
List groups of susceptible individuals
Define approved suppliers and list requirements
Explain proper procedures for receiving
Describe: Good Agricultural Practices, Good Manufacturing Practices, and HACCP

10. Listeria monocytogenes
Likes moist environments
Grows at refrigeration temperatures
Tough to kill, survives months if not sanitized
Not the most common source of food poisoning, but a leading cause of food related deaths
Naturally present in the environment (soil, decomposing plant materials)
Bad Bug Book:
Although the number of people infected by foodborne Listeria is comparatively small, this bacterium is one of the leading causes of death from foodborne illness. It can cause two forms of disease. One can range from mild to intense symptoms of nausea, vomiting, aches, fever, and, sometimes, diarrhea, and usually goes away by itself. The other, more deadly form occurs when the infection spreads through the bloodstream to the nervous system (including the brain), resulting in meningitis and other potentially fatal problems. Pregnant women are more susceptible to Listeria infection than are most other people, and although they generally recover, their babies usually don’t survive. People with weak immune systems also are more vulnerable (for example, those with AIDS or chronic diseases, or who are on certain immune- suppressing arthritis drugs or cancer chemotherapy). Because our immune systems weaken as we age, the elderly also are especially vulnerable to this pathogen. Listeria cases have been traced back to several foods; for example, raw or under-pasteurized milk; smoked fish and other seafood; meats, including deli meats; cheeses (especially soft cheeses); and raw vegetables. Listeria is hardy; it tolerates salty environments and cold temperatures, unlike many other foodborne bacteria. You can help protect yourself from infection with Listeria by not drinking unpasteurized milk (also called "raw" milk) or certain cheeses or other foods made with raw milk; and by cooking food according to instructions; washing fruits and vegetables; keeping raw foods from touching other foods, dinnerware, kitchen counters, etc.; and washing your hands and other things that have come into contact with raw THIS PATHOGEN IS THE BENCH MARK FOR USED BY DATE MARKING.

11. Listeria
Unpasteurized milk, soft cheeses, soft serve ice cream, cured meats and cold cuts, fish, fresh fruits and vegetables
Symptoms include: diarrhea, vomiting, fever
Can cause stillbirths in pregnant mothers
Symptoms start after a few hours or 2-3 days.
At risk populations are susceptible (YOPI)
Fatality rate may be 15 – 30%
Reminder for Pregnant women caution no HOT DOGS IN MICROWAVE-uneven heating may not kill the bacteria
Reminder cold cuts now have a bacteria inhibitor added to the process to make them safer. Nothing is 100% safe!

12. How does this case study affect purchasing?

13. Prevention Approved Suppliers Know your products
Inspect incoming products
… An ounce of prevention is worth a pound of cure!

14. FDA Food Code Definition
Approved supplier means acceptable to Regulatory Authority
Follow best principles, practices, and generally recognized standards that protect public health
Is a food produced in a private home an approved supplier?
Inspector observes food products, food labels and packaging, water analyses, and discussion with the PIC or other food employees. Must be able to determine approved food sources. A review of supplier names, shipment invoices, buyer specification plans, shellfish tags, proof of regulatory permit/licensure of a food source, etc. can be used to document approved food sources.

15. Approved Suppliers Good reputation = Reputable supplier
Get ingredients from approved sources
Inspected by regulators
May have additional food safety certifications or audits done by other companies

16. Know your product
Regulations a producer must meet to be an approved supplier
Risks
How to handle that product safely

17. Good Agricultural Practices(GAP)
Best practices to verify that fruits and vegetables are produced, packed, handled, and stored in the safest manner possible to minimize risks of microbial food safety hazards.
Water quality for irrigation, sprays, and washing produce
Proper use of compost and manure for fertilizer
Exclude animals from the field
Employee hygiene
Storage and transportation
Tracking product and notifying customers
For fruits and vegetables served fresh, there is no kill step to eliminate pathogens. Your only control is choosing an appropriate supplier.

18. Good Manufacturing Practices (GMP)
A lot like FDA Food Code, specific to food processors
Employee health, hygiene, and training
Building condition and pest control
Sanitary procedures for work areas, food contact surfaces, equipment and tools
Proper storage
Processing prevents and controls contamination
Distribution
Most food companies who sell processed products (not meat and dairy) must meet these standards. They are inspected by FDA or State food officials.

19. Special requirements Meat and poultry Dairy products Seafood
Fruit Juices
Meat and poultry products must be from an USDA inspected facility and a HACCP plan
Dairy products should meet FDA Pasteurized Milk Ordinance requirments
Seafood suppliers must have a HACCP Plan
Fruit Juices must have a HACCP Plan

20. Hazard Analysis Critical Control Points
HACCP is required for meat, poultry, seafood & fruit juice. Many processors choose to use this system to minimize risk of contamination.
Identify hazards
Determine critical control points
Set critical limits
Establish monitoring procedures
Set corrective actions
Establish verification procedures
Record keeping and documentation
Soft Cheese
Listeria
Pasteurize milk
145oF for 30 min.
Temp every batch
Heat longer
Check its done
Prove it!
Food Code: “After December 18, 1997, all processors of fish are required by 21 CFR 123 to have conducted a hazard analysis of their operation, identify each hazard that is reasonably likely to occur, and implement a HACCP plan to control each identified hazard. Retailers should assure that their seafood suppliers have complied with this requirement. Hazards known to be associated with specific fish species are discussed in the FDA Fish and Fishery Products Hazards and Controls Guide, available from the FDA Office of Seafood. Species-related hazards include pathogens, parasites, natural toxins, histamine, chemicals, and drugs.“
“Recreationally caught fish received for sale or service may be approved by the regulatory authority.“

21. Verifying Supplier Practices
Do they provide good service at receiving and dealing with quality issues?
How do they train their employees in food safety?
Rejecting and returning products?
Do their delivery trucks look/smell clean?
Have these discussions with new suppliers. Keep in mind they want to make the sale and may just tell you what they think you want to hear.

22. Inspect Before You Accept
Spot check delivery vehicles for cleanliness
Off odors
Proper temperature
41oF or lower
Eggs at 45oF or lower
Frozen foods signs of temperature abuse
Expiration dates
EXAMPLE: Truck drivers sometimes turn off refrigeration during transport to save gas… how does this impact the quality and safety of your ingredients?
How do you measure temperature? Puncture a milk carton? Press 2 cartons together? For products in bulk plastic bags you can fold the bag around the thermometer (Schools get salsa in large bags)
Fish that have been temperature abused will have a cloudy appearance to the eye.
Texture of spoiled items can be soft, wrinkled, or dried out
Transportation (delivery) vehicles need to be clean and sanitary. Dirty vehicles can contaminate food with harmful microorganisms. Foods should not be shipped in vehicles that have carried live animals or harmful substances. If these trucks must be used, they must be thoroughly washed, rinsed, and sanitized before they are used to transport food. Temperature-controlled vehicles must be at the proper temperature.

23. Inspect before You Accept
Condition of packages
dirty, discolored, wet
dents, tears, punctures
Signs of pests
Scheduling receiving
Time
Other activities & flow of food
Bill of sale to track products
Procedures for rejecting shipments
Ask about receiving surprise deliveries.

24. What’s your view?
Have you ever had to reject an incoming shipment? Why?

25. Case Study How it happened What they found
12 sick with Listeria 5 miscarriages 3 premature births 2 infected newborns
How it happened
Soft cheese sold in small grocers, from car trunk door to door
Not an approved supplier
What they found

26. Case Study What went wrong Prevention Products from approved suppliers
Cheese was produced in a bathtub
Made from raw milk
Contaminated with Listeria
What went wrong
Products from approved suppliers
Inspect incoming products
Prevention

27. Quiz
When receiving food, which of the following is not a reason for rejecting food: a) Frozen food is thawed or partially thawed b) There is visible mold or slime c) Temperature Control for Safety Foods are received at 41oF or below d) Packaging is damaged or dirty
Answer c).
Maker sure they read the question closely, notice the word “not”

28. Quiz
A shipment of frozen fish arrives at your food establishment. You see that the outside bottoms of shipping cartons have too much ice and the fish fillets held within the carton have brown edges. These are signs of:
Thawing and refreezing
Safe, high quality seafood
Seafood that has been kept in frozen storage too long
Seafood that has been blast chilled
Answer: a)

29. Review Listeria Susceptible individuals Use only approved suppliers
Know the requirements for an approved supplier
Communicate about food safety with your suppliers
Inspect incoming products