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Environmental Investigation
Epi-Ready Environmental Investigation Module 7
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Module Objectives By the end of this module, participants will be able to evaluate the environmental approaches used in an effective foodborne outbreak response. Describe environmental assessment as a means to identify contributing factors and their environmental antecedents as part of a foodborne illness outbreak investigation Discuss product tracing activities to identify and eliminate foods that may cause foodborne illness Explain the control measures available to reduce or eliminate foodborne illness associated with an outbreak
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The Environmental Investigator
Environmental Assessment Product Tracing Control Measures
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Cross-Disciplinary Activities
Epidemiologic Investigator Focus the epidemiologic investigation Assists with product tracing Laboratory Investigator Identifies appropriate environmental and food samples for collection and analysis
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Application of Subject Matter Expertise
Environmental Assessment HACCP Regulatory Inspection Past Present Future
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Environmental Assessment
Retrospective Analysis Contributing Factors Environmental Antecedents
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Contributing Factors Contamination Survival Proliferation
How pathogens or other hazards are introduced into food Contamination How pathogens survive a process to kill or reduce them Survival How pathogens in food grow Proliferation
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Farm to Fork Continuum Source:
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Contributing Factors at the Source
Salmonella Enteritidis in eggs (2010) Cyclospora in cilantro (2015) E. coli outbreak associated with romaine lettuce (2018)
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Contributing Factors at Processing
Listeriosis Linked to Whole Cantaloupes (2011) Listeriosis Linked to Blue Bell Ice Cream (2015) Multidrug-Resistant Salmonella Heidelberg
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Contributing Factors at Distribution
Salmonella Enteritidis Infections from Ice Cream
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Contributing Factors at Point of Service
Chipotle Mexican Grill Norovirus Outbreak (2017) Chipotle Mexican Grill E. coli O26 Outbreak (2016) Jack in the Box E. coli O157:H7 Outbreak (1993)
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Environmental Antecedents
Equipment Economics Processes Food People
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Retail Food Establishment System
Processes Customer Health Satisfaction Profit Ingredients Organisms Chemicals Final Food Item Receive Serve Store Internal System Variables Assemble External Feedback to System Prep Hold Cook Reheat Cool Original Source: CDC
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Activity Several cases of Salmonella infection have occurred at Restaurant A. Table groups will be assigned a contributing factor of either contamination, survival, or proliferation. Review Slide Using the contributing factor assigned, describe two process failures and possible environmental antecedents that would have lead to the contributing factor. Table Groups This activity should take 20 minutes; 10 minute of work in table groups and 10 minute to report Record Responses in Participant Guide
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The Environmental Assessment Process
Food Process Flow Review Records Interview Information Gather Available Information Reporting
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Food Process Diagram Receive Store Freeze Refrigerate Dry Storage Prep
Serve Cool Cook Hold Cool Reheat Serve Serve Serve Serve
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Food Flow Diagram Source: Selman and Guzewich
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The Effective Interviewer
Informed Prepared Engaging Apply proper questioning techniques Avoid leading question Avoid bias Consider communication barriers
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Product Tracing Investigational Regulatory Implicated Food
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Investigational Product Tracing
Strong laboratory evidence of a common exposure with multiple points of service identified Epidemiologic association with one or more commonly consumed food(s) and limited recall Food source not clearly implicated by traditional methods often the result of a small sample size
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Cyclosporiasis in British Columbia
Source: Shah et al. (2009)
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Regulatory Product Tracing
Find the point where the contributing factor occurred Find all the points of distribution for recall efforts Conduct an environmental assessment to determine the root cause of the outbreak
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E. coli O157:H7 Outbreak 2018 Romaine Lettuce
Source: FDA (2018)
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Challenges with Product Tracing
Timeliness Uncooperative industry Collaboration Lack of Records Confidentiality of records Comingling of Foods
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Promising Practice - Blockchain
Distributed ledger technology that allows all members of a supply chain to record transactions in a decentralized data log maintained on a network of computers, rather than a physical ledger or a single database. Early adopters include Walmart, Kroger, McCormick and Company, Tyson Foods, Nestlé and Dole. United Arab Emirates
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Control Measures Factors to Consider:
Virulence and Pathogenicity of the Foodborne Illness Agent Population Susceptibility Number of Cases Involved Economic Impact Political Considerations
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Categories of Control Measures
Notification Removal of Food from Distribution Exclusion/Restriction of Ill Food Workers Prophylaxis
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Notification CONSUMER ADVISORY
Alert – Advisory – Health Update – Info Service CONSUMER ADVISORY Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration
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Removal of Food from Distribution
Embargo/Detention Product Recall Cease and Desist Orders Facility Closure
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Product Recall Firm Initiated FDA Requested Mandatory Class 1: Will cause serious adverse health consequences or death Class 2: The probability of serious adverse health consequences is remote Class 3: The product is not likely to cause adverse health consequences
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Facility Closure Broad Public Health Power - State and Local Public Health Regulatory Powers – State Public Health and Agriculture Administrative Order Suspending Registration – FDA Revoke Grant of Inspection – FSIS Closure Procedures
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Restriction or Exclusion of Ill Food Employees
Exclude from work or restrict from food preparation based on the disease causing agent Follow state and local guidance where applicable FDA food code has a section on food employee exclusion and restriction Exclusions and restrictions may not be adequate in all situations - Norovirus
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Post-Exposure Prophylaxis
Timely Investigation Risk Communication Point of Dispensing
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Summary The environmental assessment is a means to identify the contributing factors and their environmental antecedents as part of a foodborne illness outbreak investigation Product tracing activities can identify and eliminate foods that may cause foodborne illness Control measures may reduce or eliminate foodborne illness associated with an outbreak
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Multistate and Complex Outbreak Investigation
Coming Up Next Multistate and Complex Outbreak Investigation
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