CIFOR Guidelines for Foodborne Disease Outbreak Response and the CIFOR Toolkit: An Overview New York Integrated Center of Food Safety Center of Excellence – May 24, 2016 Daniel Kuhles, MD, MPH, Director Bureau of Communicable Disease Control New York State Department of Health

2 Background First in a series of monthly webinars from the New York Integrated Center of Food Safety Center of Excellence (CoE) –Sessions will cover each of the 11 CIFOR Toolkit Focus Areas –Supplementary sessions will be devoted to assist states that wish to complete internal evaluations using the metrics and target ranges developed for the 16 CIFOR performance measures. –Additional topics will focus on emerging issues in food safety including culture ‐ independent diagnostic testing, antimicrobial resistance, and advanced molecular detection/whole genome sequencing. –All webinars will be recorded and available through the CoE website at

3 Objectives Define CIFOR and it’s mission and vision Understand the goal of the CIFOR Guidelines Understand how the CIFOR Toolkit can help agencies/jurisdictions improve their response to foodborne outbreaks Understand the basic process of prioritizing Focus Areas Understand the process of examining priority Focus Areas

4 What is CIFOR? Council to Improve Foodborne Outbreak and Response Vision: Local, state and federal partners collaborating effectively to reduce the burden of foodborne illness in the United States Mission: To improve methods at the local, state, and federal levels to detect, investigate, control, and prevent foodborne disease outbreaks

5 CIFOR Organization The CIFOR Council is made up of various food safety public health partners –Governance committee includes ASTHO, APHL, CDC, CSTE, FDA, NACCHO and NEHA CIFOR has several workgroups that focus on various projects and ensure participation of the larger foodborne outbreak response community including: –Guidelines/Toolkit –Law project –Metrics project (Performance Measures)

6 CIFOR Guidelines

7 Comprehensive description of foodborne disease outbreak response –Describes the major functions that should occur before, during and after a foodborne disease outbreak Developed by representatives from local, state and federal level with expertise in epidemiology, environmental health, food regulation, and laboratory sciences Released in 2009; revised in 2014

8 CIFOR Guidelines Sections Fundamental concepts of public health surveillance, response and control –Planning and preparation –Surveillance and outbreak detection –Investigations of clusters and outbreaks –Control measures Special considerations for multijurisdictional outbreaks Performance measures for foodborne disease programs Legal considerations for the surveillance/control of foodborne disease

9 CIFOR Guidelines Challenges Lengthy document A wide range of recommended practices Implementation of any particular recommendation depends on both –Agency factors (staff expertise, organizational structure, and resources) –Outbreak-specific factors (agent, number of cases, likely source of exposure)

10 CIFOR Toolkit

11 CIFOR Toolkit A stepwise process (and supporting worksheets) to help agencies and jurisdictions: –Better understand current foodborne disease outbreak response activities in their agency/jurisdiction –Become more familiar with the CIFOR Guidelines and recommended practices –Identify specific CIFOR recommendations and activities that will improve the agency’s/jurisdiction’s performance during future foodborne disease outbreak responses –Make plans to implement those activities

12 Target Audience Staff in local and state public health, environmental health, and food regulatory agencies and laboratories Ideally, the Toolkit will be used by an interdisciplinary workgroup within a jurisdiction with knowledge and practical experience in –Epidemiology –Environmental health –Food regulation –Laboratory science –Communication

13 Toolkit Materials Worksheets that help users get started with the process, identify areas in need of improvement, and support the examination of CIFOR recommendations specific to the program’s/agency’s/jurisdiction’s needs List of tips for facilitators Sample work sheets to demonstrate how they are used Participant evaluation form to provide feedback on the process

14 Preparing to Use the Toolkit Identify program, agency, or jurisdiction for which decisions will be made Brief decision-makers from program, agency, or jurisdiction Select workgroup to use Toolkit Identify support staff (e.g., a facilitator and a recorder) Make sure participants are familiar with CIFOR Guidelines Assemble the necessary supporting materials Decide on a time frame for completing the process

15 Toolkit Tracks and Focus Areas

16 Prioritization of Focus Areas A critical step in using the Toolkit May be done by the full workgroup or a smaller group of decision makers Concentrate on the prioritized Focus Areas during the remainder of the process Prioritizing Focus Area 1, “Relationships with relevant agencies and organizations”, is recommended

17 How to Prioritize Focus Areas Review Focus Area Worksheets –Lists “keys to success” for each Focus Area –Activities, relationships, and resources that are felt to be critical to achieving success in that Focus Area Determine what “keys to success” are already in place –Can also use worksheet to determine which keys to success are partially or fully in place Undertaken by key staff with expertise, practical experience

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21 After Reviewing Keys to Success Determine if keys to success are already in place –If only a few of the keys to success are in place, it could mean the Focus Area needs work. Consider priorities in other capacity development or quality assurance initiatives Review past foodborne outbreak response experiences

22 Examination of Priority Focus Areas Step-by-step worksheets for all 11 Focus Areas –Describe current activities –Prioritize CIFOR recommendations to address needed improvements –Make plans to implement recommendations

23 Examination of Priority Focus Areas – Step 1 Describe your current activities and procedures in the Focus Area and identify areas in need of improvement –Consider existing activities and keys to success –Identify those which might need work to improve your program’s/agency’s/jurisdiction’s response to foodborne disease outbreaks –Review outbreak investigation after-action reports and summaries of debriefings to help in this effort

24 Examination of Priority Focus Areas – Step 2 Prioritize CIFOR recommendations to address needed improvements –Refer to the CIFOR Guidelines related to the Focus Area using the links on the worksheet Rank CIFOR recommendations to address targets –Likely impact on foodborne diseases –Ease of implementation –Dependent on other factors

25 Examination of Priority Focus Areas – Step 3 Make plans to implement selected CIFOR recommendations –Identify who will take the lead to implement each recommendation and set timeframe –Identify factors that could positively or negatively influence full implementation –Set a date to check-in on progress Incorporate the recommendation into your standard operating procedures so the activity will be continued into the future

26 Samples of Completed Worksheets

27 Example: Focus Area 3 – Communication

28 Prioritization of CIFOR Recommendations

29 Planning to Implement Change

30 Uses of the CIFOR Toolkit: Examples from the field

31 Toolkit Tips for Facilitators

32 Participant Evaluation Form

33 Helpful Tips for Using the Toolkit Don’t get distracted by the volume Be clear on the process Keep moving – don’t get caught up in too much detail Focus on a few realistic changes End with specific action plans with time frames and responsible persons Appoint a facilitator and a recorder for each discussion

34 Why Should My State Use the Toolkit? Improve overall foodborne outbreak investigation and response Enhance partnerships with agencies/partners in foodborne outbreak investigations Identify areas needing improvement that may have gone unrecognized

35 Where to Find the CIFOR Products Online at: Paper copies are also available from CSTE –Contact Dhara Shah at Examples of CIFOR product use by other states:

36 Next Scheduled NY CoE CIFOR Webinars Thursday, June 9, 2-3 PM –Focus Area 1: Relationships with Relevant Agencies and Organizations Wednesday, July 27, 2-3 PM –Focus Area 2: Necessary Resources Course announcement and link to register is posted on the DOH Learning Management System (LMS):

37 NY CoE Food Safety Symposium Cornell University, Ithaca, NY from July 19-21, 2016 REMINDER TO REGISTER! Each participant from your state (maximum of 3) is required to register for the symposium by June 17, 2016 using the following link: There is no registration fee associated with the symposium

38 Resources Comments or questions for NY CoE can be directed to: Paula Huth, NY CoE Program Coordinator or Integrated Food Safety CoE Websites: NY CoE: CDC: