STRENGTHENING YOUR FOOD SAFETY PROGRAMS: LET THE EVIDENCE BE YOUR GUIDING

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1 STRENGTHENING YOUR FOOD SAFETY PROGRAMS: LET THE EVIDENCE BE YOUR GUIDING JOHN H. HANLIN, PH.D. VICE-PRESIDENT FOOD SAFETY AND PUBLIC HEALTH, ECOLAB September 20, 2018

2 Disclosure Dr. John Hanlin is employed by Ecolab Ecolab Ecolab USA USA Inc. Inc. All All rights rights reserved. reserved.

3 Humanity has but three great enemies: fever, famine and war, of these by far the greatest, by far the most terrible, is fever Sir William Osler, MD

4 Agenda Part 1: Today s Food Safety Landscape 10 lanterns to guide you on your food safety journey Part 2: Open Forum Opportunity for conference attendees to discuss current or past food safety issues/challenges Conference attendees are encourage to share a specific food safety issue that they have dealt with - Root cause investigation - How they prevented it from happening again - A unique opportunity for all to learn from each other and share best practices - Elevate the collective food safety knowledge for all attendees. Prevention Prevention Prevention Ecolab Ecolab USA USA Inc. Inc. All All rights rights reserved. reserved.

5 A Few Thought Starters What makes food unsafe? Are imported food inherently less safe than domestic sources of food? Are your sourcing produce locally? Do we have complete control over food safety? Who has responsibility for food safety within your organization? Can we impact food safety? How? Ecolab USA USA Inc. Inc. All All rights rights reserved.

6 Is The Food Supply Less Safe Today? No, but food safety incidents are increasingly more visible Improved detection & surveillance identifies broad issues Microbial forensics enables better detection and differentiation Good news! From a public health standpoint Emphasizes need for flawless execution of food safety programs across supply chain Food safety facts can help direct efforts appropriately 6

7 Safe Food is Fundamental to Life Food safety is integral in brand protection and enterprise risk management Tidal wave of interest in fresh, organic, exciting flavors, local (hyper-local), hydroponic, balanced diet Population growth, population aging, diet shift, more calories, less calories, challenges in water quality/availability and arable land Stressors on the food supply can lead to unsafe foods unless robust programs exist Laser focus on operational, regulatory and reputational risks 7

8 US FDA & USDA Recall Incidence Calendar Year 2017 Clostridium botulinum 1% Other 2% FDA Undeclared ingredient Foreign material 2% E. coli 3% Hepatitis A 2% GMPs 1% 1% Chemical hazard 1% Undeclared Substance 5% Extraneous Material 18% USDA Processing Deviations 4% Residue 2% STECs 6% Other 13% L. monocytogene s 19% Undeclared allergens 50% Listeria monocytogenes 30% Undeclared Allergens 40% Salmonella 1% Salmonella 7% 8

9 Iowa Department of Public Health 9 D/158137/New-Food-Poisoning-Detection-and- Response-Initiative-Announced

10 A Series of Interconnecting Risks Food Safety Risk Regulatory Risk Legal Risk Public Image Risk Financial Risk Rising Tide of Renewed Focus on Prevention

11 10 LANTERNS TO GUIDE YOU ON YOUR FOOD SAFETY JOURNEY

12 Lantern 1: Food Safety Landscape U.S. Foodborne illness estimates (annually) 48 million cases The equivalent of sickening 1 in 6 Americans each year. 120,000 hospitalizations 3,000 deaths The USDA estimates that foodborne illnesses cost $15.6 billion each year. Who s at risk? Older adults residing in nursing homes are ten times more likely to die from bacterial gastroenteritis than the general population 12 Our changing immunity Age People with cancer People with diabetes Transplant recipients People with HIV/AIDS

13 Food Safety Outbreak Visibility Outbreaks increasingly visible Improved detection & surveillance identifies issues Expect to see more outbreaks reported 1994 Ice Cream 1997 Pork Ground Beef 1999 Unpast. Juice Eggs, Chicken, Beef, 2002 Ground Beef (2) RTE Turkey & Chicken 2006 Bagged Spinach, Restaurant Lettuce 2008 Peppers, Tomatoes, Cereal Milk, Pork Lunch Meat 2010 Peppers, HVP, Shell Eggs, Sprouts (2), Chicken Casserole, Raw Milk 2012 Spinach, Mixed Greens Ground Beef, Raw Tuna, Mangoes, Cantaloupe, Peanut Butter Ricotta Cheese 2014 Cucumbers Caramel Apples Sprouts Sprouts Sprouts Cilantro Nut butter Chicken Ground Beef 1993 QSR Burgers 1998 Cereal 1996 Unpast. Juice Mad Cow 2000 Steak House 2003 Green Onions 2005 Bagged Lettuce 2007 Ground Beef (2) Pot Pies, Peanut Butter Chili Sauce 2009 Cookie Dough Milk Powder, Peanut Butter, Pistachios 2011 Sprouts- Ground Turkey, Cantaloupe Cantaloupe 2013 Chicken Cucumbers Berries Salad Salmonella Listeria E. coli O157:H7 Hepatitis A Cyclospora Botulism Chemical 2015 Ice cream Raw Nut Butter Pork Cucumbers Chicken Salad Mexican food Raw tuna

14 What s Happened in 2018 Romaine lettuce E. coli O157:H7 Fresh cut vegetable trays - Cyclospora National brand supplying produce to a national QSR chain -? Breakfast cereal Salmonella Pre-cut melon Salmonella Shell eggs Salmonella Dried coconut Salmonella Frozen shredded coconut - Salmonella 14

15 Case:Fatality Ratio Lantern 2: Age Makes a Difference 2011 US Foodborne Estimates Deaths < Age Group Source: CDC

16 Lantern 3: Pathogens, Food Groups and Contributing Factors Top 5 pathogens causing illness Norovirus Salmonella C. perfringens Campylobacter Escherichia coli (shiga-toxin producing strains) Others to recognize Listeria monocytogenes Vibrio Staphylococcus aureus Clostridium botulinum (botulism) Cyclospora 16

17 US Reported Foodborne Illness 2015: Foodborne Disease Outbreaks Attributed to Food Commodity Groups Rank Order and Number Of Outbreaks Attributed To Food Groups * * * * * 17 * Outbreaks of 4 commodity groups combined and added to vegetable row crops Source:

18 Contributing Factors to Restaurant Outbreaks USA Inadequate Cleaning Slow Cooling Inadequate Cold Holding Bare Hand Contact Handling by infected person 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 18 Source: Gould, et al JFP 76(11):1824.

19 CDC Contributing Factors to Foodborne Illness USA 2014, Reported data Unsafe Source, 17% Other, 7% Improper Holding, 22% Inadequate Cooking, 15% Contam. Equipment/ Environment, 12% Poor Personal Hygiene, 27% Source: CDC

20 Foodborne Illnesses Attribution Key Insights Top 5 pathogens causing illness Norovirus Salmonella C. perfringens Campylobacter Shiga-toxin producing strains of Escherichia coli Source: 20

21 Settings of Norovirus Outbreaks, US, (n=3,960) Schools 6% Restaurants 10% Unknown 8% Child Care Centers 1% Correctional facilities 1% Cruises, Vacation 3% Hospitals 4% Parties & events 5% Long term care facilities 62% Source: Vega, et al J. Clin Micro 52:147.

22 WHAT IS NOROVIRUS?

23 Norovirus What is Norovirus? Viral infection affecting stomach and intestines, causing vomiting and diarrhea highly contagious #1 cause of acute gastroenteritis # 2 cause of hospitalization # 4 cause of death 80% of outbreaks occur from November - April What are the Symptoms and Sources? Nausea, vomiting, diarrhea, stomach cramps Fecal/oral route of transmission. Symptoms begin hrs after exposure - Person-to-person, Foodborne, hands, hard surfaces How Can We Reduce Risk? Have a hygiene plan in place Rigorous hand hygiene Robust cleaning and disinfection Training awareness education Response protocol and policy for ill food workers Public Health Impact* ~ 20 million cases > 50,000 hospitalizations >500 deaths mostly elderly & young Mean # of cases per outbreak is 44; range is * Annual estimates U.S. Norovirus outbreak sickens residents and staff Source: U.S. CDC Charles D. Humphrey

24 What is Norovirus and What is the Source? A highly contagious viral infection affecting the stomach and intestines, causing vomiting and diarrhea Most common cause of acute gastroenteritis ~ 20 million cases are estimated to occur in the US each year About 50% of all outbreaks of FBD are caused by norovirus Feces or vomit of an infected person, including food service staff Spreads : Directly from person to person Through unwashed hands Via ingestion of contaminated food or water Through contact with contaminated surfaces An infected person may be contagious for up to 2 weeks or more after recovery Source: e&source=govdelivery#fig2 and

25 What are the Symptoms? 25 Include nausea, vomiting, diarrhea and stomach cramps Begin hours after exposure Last 1-2 days People can contract norovirus and become ill more than once. Some short term resistance Courtesy CDC: Amanda Mills, 2011 (with thanks) No specific medicine to treat people with norovirus. Infections cannot be treated with antibiotics because it is a viral (not bacterial) infection

26 Transmission route varies with setting % of Outbreaks USA Foodborne Person to Person Nursing homes, retirement centers, hospitals Restaurant and catered events Vacation settings & cruise Schools and day-care centers Waterborne Other Other TOTAL Source: Blanton et al J Inf. Dis.:193:

27 LESSONS FROM PAST OUTBREAKS

28 How is Norovirus Inactivated? Difficult to inactivate Persists in chlorinated drinking water Persists in the environment Survives freezing and refrigeration Requires very high temperature to inactivate Survives in acidic environments Choose the right products for disinfection Products registered with EPA and effective against target organism And the right PPE to protect your staff!!!!! Source: Doultree, et. al J. Hosp. Infection 41:51-57

29 Case Study: Noro Knows Dinner Party* 126 people attended a dinner at a large hotel - December 7th During the meal, a guest vomited onto a polished wooden floor Guest had not been ill prior to meal The vomit was cleaned with a mop and disinfectant and the meal continued. Reports of illness came to light by Thursday December 10 th * Source Marks, Epidemiol. Infect. 124:

30 Layout Plan of Restaurant Source - Marks Epidemiol. Infect. 124:

31 Layout Plan of Restaurant Lessons Learned: Inadequate clean-up and action plans caused a large # of people to get sick - Within 48 hours, 52 people reported norovirus symptoms Have a plan, an SOP, the right products and trained staff in place to respond to this eventuality Source - Marks Epidemiol. Infect. 124:

32 Risk Reduction Plan Have a hygiene plan in place with robust cleaning and disinfection procedures Does your staff know what to do when the event occurs at 9 pm on a Sunday night? What is your SOP? Do you have biohazard spill kits and the right disinfectant on site? Review your SOP and re-train associates Encourage frequent handwashing and freshen-up your handwash signage CREATE THE CULTURE Do not permit infected workers to prepare food while they have symptoms and for at least 3 days after recovery Discard food that may have been contaminated by an ill person

33 Norovirus: Tips for Being Prepared Have appropriate spill kits and other products on hand With EPA-registered norovirus claims Have personal protective equipment (PPE) on hand Audit your products and procedures: An event will occur! Consult with your local health department. Find out what actions will be required in the event of an incident or outbreak Post handwashing signage and procedures 2019 Ecolab USA Inc. All rights reserved.

34 Food Allergens Food safety issue for sensitive population Peanuts Tree nuts Crustaceans Fish Eggs Milk Soy Wheat Staff awareness and education is vital Know your ingredients Cleaning is essential If possible, know your residents 34

35 Lantern 4: Supply Chain Collaboration Today s supply chain is complex and global 80% of seafood is imported 50% of fresh fruit is imported 20% of fresh vegetables are imported Food safety issues can become amplified along the supply chain Develop relationships and partnerships Especially meat, poultry, seafood and fresh produce suppliers Suppliers, distributors, culinary schools, local public health officials Establish shared food safety goals with your key stakeholders 35

36 Food Safety Solutions INTERVENTIONS AT MULTIPLE SITES Food Service Retail Agricultural Production Processing 36 Consumption

37 Lantern 5: Resources Abound Food Code Food Code was first published in1993 FDA Model Food Code: set of recommendations of Best Practices and current science from the Conference for Food Protection (CFP)and other agencies Government and industry stakeholders have come to recognize the FDA Food Code as a source of practical, science-based guidance and manageable, enforceable provisions for mitigating known risks of foodborne illness.

38 Food Code Food Code Information available at;

39 U.S. CDC, Iowa State Extension, Local Public Health, WHO Be Food Safe 39 consumer/en/5keys_en.pdf?ua=1 umers.html

40 Lanterns 6-9: Clean, Separate, Cook, Chill Be Food Safe

41 Lantern 6: Clean Hand hygiene Does your staff know when and how to wash their hands Wash fruit and vegetables Consider using a registered antimicrobial wash Don t wash meat, poultry, eggs Cleaning, sanitization and disinfecting Surfaces Utensils Dishware Cutting boards Incident response and biohazard spill kit 41

42 Produce Safety Recent foodborne disease outbreaks highlight the risks associated with fresh produce Food Code requires all fresh produce, except commercially washed, pre-cut, and bagged produce, to be thoroughly washed under running, potable water or with antimicrobial washes (or both) If produce is soaked in water alone, pathogens can be transferred to non-contaminated produce Antimicrobial wash can play an important role in your food safety program 2018 Ecolab USA Inc. All 42 rights reserved.

43 Lantern 7: Separate: Separate raw meat, poultry, seafood and eggs from other foods Use one cutting board for fresh produce and a separate one for raw meat, poultry, eggs and seafood Never place cooked food on a plate or serving platter that previously held raw meat, poultry, seafood or eggs 43

44 Lantern 8: Cook Cook to the right temperatures* Know your temperatures Use a meat thermometer Ground 160 o F Beef Poultry 165 o F Leftovers 165 o F 145 Pork o F 3 mins Firm Eggsor 160 o F Hot > 135 Food o F Holding Seafood Foodsafety. gov 44 * temp/time recommendations may vary by code and jurisdiction

45 Lantern 9: Chill: Refrigerator temperature of 40 o F or below Use an appliance thermometer to be sure the temperature is consistently 40 o F or below Refrigerate or freeze meat, poultry, eggs and other perishables as soon as you receive them The 2 hour rule - Don t let raw meat, poultry, eggs, cooked food or cut fresh fruits or vegetables sit at R/T Divide large amounts of cooked food (soup, chilis) into shallow containers for quicker cooling in the refrigerator Use or discard refrigerated food on a regular basis 45

46 Meat, Poultry and Milk Meat and Poultry High Risk Raw or undercooked Recommended Meat and poultry cooked to a safe minimal internal temperature Milk High Risk Unpasteurized (raw) milk Recommended Pasteurized milk 46

47 Seafood Seafood High Risk Raw or undercooked fish or shellfish Refrigerated smoked fish Partially cooked seafood such as shrimp and crab Recommended Cook fresh seafood to 145 F Heat previously cooked seafood to 165 F Use canned fish and seafood 47

48 Eggs Eggs High Risk Foods with raw or undercooked eggs - Kitchen-prepared Caesar salad dressings - Kitchen-prepared raw cookie dough - Kitchen-prepared eggnog - Kitchen-prepared mayonnaise Recommended Use pasteurized eggs or egg products when preparing recipes that call for raw or undercooked eggs 48

49 Sprouts and Pates Sprouts High Risk Raw sprouts alfalfa, bean and other kinds of sprouts Recommended Use cooked sprouts or remove from your menu planning Pates High Risk Unpasteurized and/or refrigerated pates or meat spreads Recommended Canned or shelf-stable pates or meat spreads 49

50 Cheese Cheese High Risk Soft cheeses made from unpasteurized (raw) - Feta - Brie - Blue-veined - Camembert - Queso fresco Recommended Hard cheeses Processed cheese Cream cheese Mozarella Soft cheeses made with pasteurized milk (stated on label) 50

51 Hot Dogs and Deli Meats Hot dogs and deli meats High Risk Hot dogs, deli and luncheon meats that have not been reheated Recommended Reheat hot dogs Luncheon and deli meats to steaming hot or 165 F Luncheon or deli meats that are pasteurized using thermal or nonthermal technologies 51

52 Lantern 10: Awareness, Education, a Systematic Approach to Food Safety 52

53 On a Pre-determined Scheduled Re-train your staff including your culinary team Remind your residents that food safety is a top priority Freshen-up your hand washing signage Work with your supply chain partners Remind everyone that food safety is a shared responsibility Strengthen your policies and practices 53

54 Policies and Practices Strengthen policies and practices in 3 areas: Preventing restaurant workers from working when sick Food handling by a sick worker is a contributing factor in 46% of restaurant-related outbreaks Improving handwashing practices and minimize bare-hand contact with food Bare-hand contact by a food worker is a contributing factor in 29% of restaurant-related outbreaks Requiring trained, certified kitchen managers to be present during all hours of operation Restaurants with certified managers are less likely to be linked with outbreaks. 54

55 A Systematic Approach to Food Safety Leverage the scientific evidence to; Make smart dietary choices for your stakeholders Implement robust operational practices - Cleaning, sanitization disinfection - Rigorous hand hygiene staff and residents - Food safety tools thermometers, colored cutting boards, antimicrobial vegetable and fruit wash Collaborate with purchasing and your supply chain partners developed shared food safety goals Verify - systems, audits, preventative maintenance, documentation and record keeping Train, train, train

56 Awareness and Education September is National Food Safety Month A great time to re-train your staff A great time to remind your residents Work with your supply chain partners Develop and commit to shared goals Remind everyone that food safety is a shared responsibility 56

57 Our Paths 1. Food safety landscape 2. Age makes a difference 3. Pathogens, food groups and contributing factors 4. Supply chain collaboration 5. Resources abound 6. Clean 7. Separate 8. Cook 9. Chill 10. Awareness, education, and a systematic approach to food safety Ecolab Ecolab USA USA Inc. Inc. All All rights rights reserved.

58 58 Thank you John H. Hanlin, Ph.D. Ecolab Inc.