1. FOOD SAFETY Suzette DeCastro, Ph.D student, MS, RD, LD Walden University PUBH 8165-01 Dr Robert Marino spring quarter 4/11/11

2. Purpose of this service based project Introduction to concepts and principles on how to serve safe food Introduction to concepts and principles on how to serve safe food Understanding the food safety risks faced in food service establishments Understanding the food safety risks faced in food service establishments Identifying risks in food service and finding ways to reduce them Identifying risks in food service and finding ways to reduce them maintaining quality food services in ones operation as well as keeping customers and employees safe. maintaining quality food services in ones operation as well as keeping customers and employees safe.

3. Learning Outcomes Will Recognize the importance of food safety Will Recognize the importance of food safety Will Recognize the risks associated with high risk populations Will Recognize the risks associated with high risk populations Will Avoid potential hazards to food safety Will Avoid potential hazards to food safety Will Understand the process of how food becomes unsafe Will Understand the process of how food becomes unsafe Will understand prevention measures to keeping food safe Will understand prevention measures to keeping food safe

4. Food Borne Illnesses A disease transmitted to people by food. A disease transmitted to people by food. Two or more people get the same illness after eating the same food. Two or more people get the same illness after eating the same food. Each year CDC estimates 1 in 6 or 48 million people will get sick from unsafe food. Each year CDC estimates 1 in 6 or 48 million people will get sick from unsafe food. 128,000 are hospitalized and 3000 persons die from food borne illnesses (National Restaurant Assoc, 2005) 128,000 are hospitalized and 3000 persons die from food borne illnesses (National Restaurant Assoc, 2005)

5. Foodborne Active Surveillance Network, United States, 1996–2009 2

6. Costs of Food Borne Illnesses Illnesses cost the US billions of dollars each year. Associated costs are medical, lost productivity, and death. Illnesses cost the US billions of dollars each year. Associated costs are medical, lost productivity, and death. Serious Health Issue according to the Economic Research Service of the USDA Serious Health Issue according to the Economic Research Service of the USDA Each year 6.9 billion in costs are associated with five bacterial pathogens Each year 6.9 billion in costs are associated with five bacterial pathogens Campylobacter, Salmonella, Listeria monocytogenes, and types of E. Coli. (CDC, 2011) Campylobacter, Salmonella, Listeria monocytogenes, and types of E. Coli. (CDC, 2011)

7. Figure 2. Changes in incidence of laboratory-confirmed bacterial infections, United States, 2009 1 compared with 1996–1998 Rates of lab confirmed infections

8. FOODNET SURVEILLANCE in 1996, CDC has seen important declines in infections caused by six of the seven bacterial pathogens tracked—Yersinia, Shiga toxin–producing Escherichia coli (STEC) O157, Shigella, Salmonella, Listeria, and Campylobacter. Salmonella, the most commonly diagnosed and reported food borne illness, continues to be a challenge. The incidence of Salmonella infections has declined by only 10% since FoodNet surveillance began. (CDC, 2011)

9. Rates of infection were substantially higher for Vibrio in 2009 than in 1996–1998. Rates of infection were at least 25% lower for Shigella, Yersinia, Campylobacter, and Listeria than they were a decade ago. Rates of infection with STEC O157, which causes one of the most severe forms of foodborne illness, decreased by 25% in 2009 compared with the most recent 3 years, reaching the lowest level since 2004. (CDC, 2011)

10. Table 2. TOP five pathogens contributing to domestically acquired foodborne illnesses Pathogen Estimated number of illnesses 90% Credible Interval % Norovirus5,461,731 3,227,078– 8,309,480 58 SalmonellaSalmonella, nontyphoidal 1,027,561 644,786– 1,679,667 11 Clostridium perfringens 965,958 192,316– 2,483,309 10 Campylobacter spp. 845,024 337,031– 1,611,083 9 Staphylococcus aureus 241,148 72,341– 529,417 3 Subtotal91

11. Populations at High Risk for Food borne Illnesses The Elderly The Elderly Infants and pre-school age children Infants and pre-school age children Pregnant women Pregnant women Persons with diagnosed medical condition that have a compromised immune system such as AIDS patients and cancer patients (National Restaurant Assoc, 2005) Persons with diagnosed medical condition that have a compromised immune system such as AIDS patients and cancer patients (National Restaurant Assoc, 2005)

12. Safe Internal food temperatures CLEAN Clean your hands with soap and warm water before handling food. Clean surfaces before preparing food on them. SEPARATE Separate cooked foods from ready-to-eat foods. Do not use utensils on cooked foods that were previously used on raw foods and do not place cooked foods on plates where raw foods once were unless it has been cleaned thoroughly. (CDC, 2011)

13. Safe Internal Food temperatures CHILL Chill foods promptly after serving and when transporting from one place to another. Keep your refrigerator at 40°F or below. Keep hot foods hot and cold foods cold. COOK Cook foods to a safe internal temperature (see chart). Use a meat thermometer to make sure foods are cooked to a safe temperature. Color is not an indicator of doneness. ( CDC, 2011)

14. If a public health official contacts you to find out more about an illness you had, your cooperation is important. In public health investigations, it can be as important to talk to healthy people as to ill people. Your cooperation may be needed even if you are not ill. For more information on preventing food borne illnesses visit FoodSafety.gov, the federal gateway for food safety information. (CDC, 2011)FoodSafety.gov Safe food temperatures

15. SAFE FOOD TEMPERATURES REPORT: Report suspected food borne illnesses to your localREPORT health department. The local public health department is an important part of the food safety system.health department Often calls from concerned citizens are how outbreaks are first detected. ( CDC, 2011)

16. THE FDA FOOD CODE is issued by the FOOD and Drug Administration. It outlines the federal governments recommendations for food safety regulations for the food service industry. Health inspectors from state health departments conduct food service inspections of food service establishments. Self- Inspections- A well managed food service operation have frequent self inspections to keep food safe. (CDC, 2011)

17. FOOD Safety Regulations & Standards The FDA Food Safety Modernization Act (FSMA) was signed into law by President Obama on January 4th, 2011. It aims to ensure the U.S. food supply is safe by shifting the focus of federal regulators from responding to contamination to preventing it. (FDA, 2011)

18. Preventing Food Borne Illnesses Practicing Good Personal Hygiene Practicing Good Personal Hygiene Controlling the time and temperature of foods Controlling the time and temperature of foods Avoiding cross contamination of foods Avoiding cross contamination of foods Purchasing from approved reputable suppliers (National Restaurant Assoc, 2005) Purchasing from approved reputable suppliers (National Restaurant Assoc, 2005)

19. The Costs of Foodborne Illness Foodborne illness is much more than the “stomach flu”, and it is a serious health issue and economic burden for consumers. According to the Economic Research Service (ERS) of the USDA, each year $6.9 billion in costs are associated with five bacterial pathogens, Campylobacter, Salmonella, Listeria monocytogenes, E. coli O157:H7, and E. coli non-O157:H7 STEC (2000). These costs are associated with medical expenses, lost productivity, and even death. The Costs of Foodborne Illness Foodborne illness is much more than the “stomach flu”, and it is a serious health issue and economic burden for consumers. According to the Economic Research Service (ERS) of the USDA, each year $6.9 billion in costs are associated with five bacterial pathogens, Campylobacter, Salmonella, Listeria monocytogenes, E. coli O157:H7, and E. coli non-O157:H7 STEC (2000). These costs are associated with medical expenses, lost productivity, and even death.

21. Potential Hazards to Food Safety Biological- pathogens such as viruses, parasites, fungi, and bacteria. Biological- pathogens such as viruses, parasites, fungi, and bacteria. These harmful microorganisms may produce poisons or toxins in the food or the host. These harmful microorganisms may produce poisons or toxins in the food or the host. Chemical- cleaners and sanitizers Chemical- cleaners and sanitizers Physical- foreign objects can get into food. Moeller, 2005) Physical- foreign objects can get into food. Moeller, 2005)

22. How Food Becomes Unsafe? Purchasing food from unsafe sources. Purchasing food from unsafe sources. Failing to cook food adequately. Failing to cook food adequately. Holding food at the incorrect temperatures. Holding food at the incorrect temperatures. Using contaminated equipment Using contaminated equipment Practicing poor personal hygiene (CDC, 2011) Practicing poor personal hygiene (CDC, 2011)

23. What Pathogens need to grow? Food or an energy source. Food or an energy source. Acidity- Pathogens grow best in food that contains no or little acid (ph of 4-7) Acidity- Pathogens grow best in food that contains no or little acid (ph of 4-7) Temperature- Pathogens grow well in food in the range known as the temperature danger zone (41F- 135F) Temperature- Pathogens grow well in food in the range known as the temperature danger zone (41F- 135F) Time- Pathogens need time to grow especially after four hours.( National Restaurant Assoc, 2005) Time- Pathogens need time to grow especially after four hours.( National Restaurant Assoc, 2005)

24. Cont.. What conditions do Pathogens need to grow?? Oxygen- Some pathogens need oxygen to grow. While others can grow in anaerobic conditions Oxygen- Some pathogens need oxygen to grow. While others can grow in anaerobic conditions Moisture- Pathogens need moisture in food to grow. Moisture- Pathogens need moisture in food to grow. Viruses are leading cause of food borne illness, such as with hepatitis A and the Norovirus. These illnesses are linked with ready to eat food and shellfish (National Restaurant Assoc, 2005). Viruses are leading cause of food borne illness, such as with hepatitis A and the Norovirus. These illnesses are linked with ready to eat food and shellfish (National Restaurant Assoc, 2005).

25. Bacteria and food borne illness Bacteria can change into different forms called spores that keep them from dying when they don’t have enough food Bacteria can change into different forms called spores that keep them from dying when they don’t have enough food Other types of bacteria can produce toxins in food or in the host. Other types of bacteria can produce toxins in food or in the host. National Restaurant Assoc, 2005) National Restaurant Assoc, 2005)

26. Causes of illness in 1,565 single food commodity outbreaks, 2003–2008

27. Foods identified in Food borne illnesses Bacillus cereus- cooked rice dishes Bacillus cereus- cooked rice dishes Listeriosis- raw meat and deli meats Listeriosis- raw meat and deli meats Hemorrohagic colitsis- ground beef Hemorrohagic colitsis- ground beef Clostridium perfringens-meat and poultry (Moeller, 2005) Clostridium perfringens-meat and poultry (Moeller, 2005)

28. Cont. Foods identified in Food borne illnesses Shigellosis- salads Shigellosis- salads Staphylcoccal- deli meats and salads Staphylcoccal- deli meats and salads Vibrio vulnificus- oysters from contaminated waters Vibrio vulnificus- oysters from contaminated waters ( Moeller, 2005) ( Moeller, 2005)

29. Foods contaminated with Parasites Foods contaminated with Parasites Anisakiasis- raw and undercooked fish Anisakiasis- raw and undercooked fish such as cod, mackerel and salmon such as cod, mackerel and salmon Cryptosporidiosis- produce and Cryptosporidiosis- produce and contaminated water contaminated water Giardiasis- produce and contaminated Giardiasis- produce and contaminated water (National Restaurant assoc, water (National Restaurant assoc, 2005) 2005)

30. Foods identified in food borne illness Fungi, molds, and yeasts in produce, jams and jellies. Fungi, molds, and yeasts in produce, jams and jellies. Some molds produce toxins such as aflatoxins Some molds produce toxins such as aflatoxins poisonous Mushrooms and plant toxins poisonous Mushrooms and plant toxins ( Moeller, 2005) ( Moeller, 2005)

31. Seafood and shellfish poisoning PSP-paralytic shellfish poison, NSP- neurotoxic shellfish, ASP- amnesic shellfish PSP-paralytic shellfish poison, NSP- neurotoxic shellfish, ASP- amnesic shellfish Clams, oysters, and scallops Clams, oysters, and scallops Seafood toxins- Scombroid poisoning-tuna fish also known as histamine poisoning Ciguatera- jacks and red snapper (Moeller, 2005)

32. Chemical Contaminants Some utensils and equipment contain toxic metals that contaminate acidic food. Some utensils and equipment contain toxic metals that contaminate acidic food. A person who eats this food can get toxic-metal poisoning A person who eats this food can get toxic-metal poisoning Illness is caused by storing or prepping food with equipment contaminating heavy metals such as Lead, Copper, and Zinc. Illness is caused by storing or prepping food with equipment contaminating heavy metals such as Lead, Copper, and Zinc. Cleaners, sanitizers, polishes, and machine lubricants should be kept ot stored away form food. Cleaners, sanitizers, polishes, and machine lubricants should be kept ot stored away form food. ( Moeller, 2005) ( Moeller, 2005)

33. Common Food Allergens Milk and Dairy products Milk and Dairy products Eggs Eggs Fish and shellfish Fish and shellfish Wheat Wheat Soy products Soy products Nuts (National Restaurant assoc, 2005) Nuts (National Restaurant assoc, 2005)

34. Food Allergens The number of people in the US is increasing who have allergies to food. The number of people in the US is increasing who have allergies to food. It is the body’s negative reaction to a food protein. It is the body’s negative reaction to a food protein. symptoms such as hives, rashes, breathing difficulties, swelling of face, abdominal cramps, and death with severe reactions (National Restaurant assoc, 2005) symptoms such as hives, rashes, breathing difficulties, swelling of face, abdominal cramps, and death with severe reactions (National Restaurant assoc, 2005)

35. Prevent Food Contamination Avoid cross contamination Avoid cross contamination Avoid time –temperature abuse Avoid time –temperature abuse Use of the correct types of thermometers in food preparation Use of the correct types of thermometers in food preparation Use of proper personal hygiene Use of proper personal hygiene Purchasing from approved reputable suppliers (Partnership for Food Safety Education, 2011) Purchasing from approved reputable suppliers (Partnership for Food Safety Education, 2011)

36. Food Safety Management Systems Develop and implement a personal hygiene program Develop and implement a personal hygiene program Establish supplier selection and a specification program Establish supplier selection and a specification program Implement a sanitation and pest and rodent control program (National Restaurant assoc, 2005) Implement a sanitation and pest and rodent control program (National Restaurant assoc, 2005)

37. Food service management Establish facility design and equipment maintenance program Establish facility design and equipment maintenance program Implement a food safety training program Implement a food safety training program Implement a food defense program in times of emergency or crisis Implement a food defense program in times of emergency or crisis (National Restaurant association, 2005) (National Restaurant association, 2005)

38. Taking an active managerial control approach Mangers need to consider risk factors Mangers need to consider risk factors Mangers need to create policies and procedures Mangers need to create policies and procedures Mangers need to monitor policies and procedures Mangers need to monitor policies and procedures Employees and mangers need to verify the system (National Restaurant Association, 2005) Employees and mangers need to verify the system (National Restaurant Association, 2005)

39. HACCP (Hazard Analysis and Critical Control Points) A system used to control risks and hazards throughout the flow of food. A system used to control risks and hazards throughout the flow of food. It is based on identifying significant biological, chemical and physical hazards at specific points within a products flow. It is based on identifying significant biological, chemical and physical hazards at specific points within a products flow. ( Moeller, 2005) ( Moeller, 2005)

40. HACCP continued Created by the National Advisory Committee on Microbiological Criteria for Foods Created by the National Advisory Committee on Microbiological Criteria for Foods Once hazards are identified they can prevent, eliminate, and reduce them to safe levels. Once hazards are identified they can prevent, eliminate, and reduce them to safe levels. Must be based on a written plan.(National Restaurant Assoc, 2005) Must be based on a written plan.(National Restaurant Assoc, 2005)

41. HACCP Principles Conduct a hazard analysis Conduct a hazard analysis Determine critical control points (CCP’s) Determine critical control points (CCP’s) Establish critical limits Establish critical limits Establish monitoring procedures Establish monitoring procedures National Restaurant Association, 2005) National Restaurant Association, 2005)

42. HACCP Principles continued Identify corrective actions Identify corrective actions Verify that the system works Verify that the system works Establish procedures for record keeping and documentation Establish procedures for record keeping and documentation ( National Restaurant Association, 2005) ( National Restaurant Association, 2005)

43. Implement a Food Safety Program for Employees Topics to be provided and reviewed Topics to be provided and reviewed personal hygiene personal hygiene safe food preparation safe food preparation proper cleaning and sanitizing of kitchen and equipment proper cleaning and sanitizing of kitchen and equipment (Partnership for Food safety Education, 2011) (Partnership for Food safety Education, 2011)

44. Preparing for a Food Borne Illness Outbreak Implementation of a food safety program for all staff Implementation of a food safety program for all staff Develop a food borne illness incident report form Develop a food borne illness incident report form Train staff to fill out incident forms Train staff to fill out incident forms Prepare an emergency contact list Prepare an emergency contact list Develop and implement a crisis- communication plan Develop and implement a crisis- communication plan

45. CURRENT FOOD SAFETY CHALLENGES CHALLENGES TO FOOD SAFETY WILL CONTINUE TO ARISE LARGELY DUE TO: Changes in our food production and supply Changes in the environment leading to food contamination Rising number of multistate outbreaksmultistate outbreaks New and emerging germs, toxins, and antibiotic resistance New and different contaminated foods, such as prepackaged raw cookie dough, bagged spinach, and peanut butter, causing illnesses ( CDC, 2011)

46. Future Estimates/Implications in Food Borne Illnesses Need for improvements and new innovations Need for improvements and new innovations Future investments and innovations in surveillance and data analysis could help increase the accuracy of estimates. Future investments and innovations in surveillance and data analysis could help increase the accuracy of estimates. Future efforts can also be directed toward quantifying the illnesses caused by long-term effects of food borne infections and toxins and to estimate the economic costs associated with food borne illness. ( CDC, 2011) Future efforts can also be directed toward quantifying the illnesses caused by long-term effects of food borne infections and toxins and to estimate the economic costs associated with food borne illness. ( CDC, 2011)

47. Research in Food Science The need for more detailed information on norovirus will better inform future estimates due to the availability of improved surveillance and special studies conducted in the United States. Most of the data underlying the norovirus estimates is from other countries. A need for improved information on the cases of acute gastroenteritis that are reported during FoodNet survey. Telephone interviews will be needed to help discern whether they might be caused by noninfectious conditions. (CDC, 2011)

48. Food safety and Terrorism Accounting for illnesses caused by some of the unspecified agents that do not result in acute gastrointestinal illness, as such illnesses were not included in the current estimates. Refining estimates of the degree of underreporting of hospitalizations and deaths. Drinking water and food supplies is a means to dispersing biological agents such as Clostridium botulinum toxin and Staphylococcus enterotoxin B. ( Moeller, 2005)

49. Food Safety and Terrorism The American Medical Association has developed a CD-Rom that provides state of the art medical and clinical information for dealing with both biological and chemical attacks The American Medical Association has developed a CD-Rom that provides state of the art medical and clinical information for dealing with both biological and chemical attacks Diseases that have been linked to biological agents in food are Q fever(Coxiella burnetti), Brucellosis from brucellla species, Burkholderia mallei(glanders), ricin toxin (Ricinus communis or castor beans), epsilon toxin from Clostridium perfingens species (Moeller, 2005) Diseases that have been linked to biological agents in food are Q fever(Coxiella burnetti), Brucellosis from brucellla species, Burkholderia mallei(glanders), ricin toxin (Ricinus communis or castor beans), epsilon toxin from Clostridium perfingens species (Moeller, 2005)

50. Deliberate contamination of Food People may try to tamper with food using biological, chemical, or physical contaminants. People may try to tamper with food using biological, chemical, or physical contaminants. The best way to protect food is to make it hard for someone to tamper with it. The best way to protect food is to make it hard for someone to tamper with it. A food defense program should deal with the points in your operation where food is at risk. A food defense program should deal with the points in your operation where food is at risk. (National restaurant assoc, 2005) (National restaurant assoc, 2005)

51. References CDC(2011) Food Safety retrieved from http://www.cdc.gov/foodsafety/ CDC(2011) Food Safety retrieved from http://www.cdc.gov/foodsafety/ http://www.cdc.gov/foodsafety/ FDA(2011). Food Safety Modernization Act retrieved from http://www.fda.gov FDA(2011). Food Safety Modernization Act retrieved from http://www.fda.govhttp://www.fda.gov National Restaurant Association (2008). Servsafe Essentials (5 th ed) Chicago, IL National Restaurant Association (2008). Servsafe Essentials (5 th ed) Chicago, IL Partnership for Food Safety Education (2011) Food safety campaigns. Retrieved from www.fightbac.org Partnership for Food Safety Education (2011) Food safety campaigns. Retrieved from www.fightbac.org www.fightbac.org

52. USDA (2011) Food Safety & Inspection Service. Trends in Food Borne Illnesses retrieved from www.fsis.usda.gov USDA (2011) Food Safety & Inspection Service. Trends in Food Borne Illnesses retrieved from www.fsis.usda.govwww.fsis.usda.gov Moeller, Dade (2005)Environmental Health (3 rd ed) Cambridge, MA Harvard University Press Moeller, Dade (2005)Environmental Health (3 rd ed) Cambridge, MA Harvard University Press References continued

53. Sources for further reading Loaharan, P(2003) Irradiated foods(5 th ed) American Council on Science & Health, NY, NY Loaharan, P(2003) Irradiated foods(5 th ed) American Council on Science & Health, NY, NY Metcalfe, D (2003) “Intro:What are the issues in addressing the allergenic potential of gentically modified foods” Environmental Health perspectives 111(8) 1110-1113 Metcalfe, D (2003) “Intro:What are the issues in addressing the allergenic potential of gentically modified foods” Environmental Health perspectives 111(8) 1110-1113

54. Suggested readings Red Tide Research Group(2002) “The current of Red Tide research” Environmental Health perspectives. 110(3)A 132-A133 Red Tide Research Group(2002) “The current of Red Tide research” Environmental Health perspectives. 110(3)A 132-A133 FDA (1995) Food Code. Springfield, VA National Technical Information service FDA (1995) Food Code. Springfield, VA National Technical Information service Food Net retrieved from http:www.cdc.gov/foodnet/ Food Net retrieved from http:www.cdc.gov/foodnet/

55. Further readings Food Safety retrieved from http://www.foodsafety.gov Food Safety retrieved from http://www.foodsafety.gov http://www.foodsafety.gov HACCP Overview retrieved from http://www.fda.gov/food/foodsafety HACCP Overview retrieved from http://www.fda.gov/food/foodsafety http://www.fda.gov/food/foodsafety US EPA Pesticides & Food retrieved from http://www.epa.gov/pesticides/food US EPA Pesticides & Food retrieved from http://www.epa.gov/pesticides/food http://www.epa.gov/pesticides/food Arizona Department of Health Services( 2011) Ricin:Bioterrorism agent profile for Health acre workers retrieved from http://www.azdhs.gov Arizona Department of Health Services( 2011) Ricin:Bioterrorism agent profile for Health acre workers retrieved from http://www.azdhs.govhttp://www.azdhs.gov

56. Sources for Further Reading Bad Bud Book retrieved from http://www.fda.gov/food/foodsafety Bad Bud Book retrieved from http://www.fda.gov/food/foodsafety http://www.fda.gov/food/foodsafety Bryan, F(2002) Reflections on a career in Public health:Evolving food borne pathogens, environmental health, & food safety programs. Journal of Environmental Health 65(5) 14-25 Bryan, F(2002) Reflections on a career in Public health:Evolving food borne pathogens, environmental health, & food safety programs. Journal of Environmental Health 65(5) 14-25 WHO Food Safety retrieved at http:www.whoint/food safety/en WHO Food Safety retrieved at http:www.whoint/food safety/en