FOOD SAFETY: THE MOUNTAIN IS HIGH BUT THE PATH IS WELL-TRODDEN JOHN H. HANLIN, PH.D.

Transcription

1 FOOD SAFETY: THE MOUNTAIN IS HIGH BUT THE PATH IS WELL-TRODDEN JOHN H. HANLIN, PH.D. VICE-PRESIDENT FOOD SAFETY AND PUBLIC HEALTH, ECOLAB

2 Agenda A few thought starters. Prevention Prevention Prevention Food safety landscape Food safety a series of interconnected risks 10 well-trodden paths Key takeaways

3 A Few Thought Starters What makes food unsafe? Are imported foods inherently less safe than domestic sources of food? Do we have complete control over food safety? Within your organization, who has responsibility for food safety? Can we impact food safety?

4 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

5 10 WELL-TRODDEN PATHS TO GUIDE YOU ON YOUR FOOD SAFETY JOURNEY

6 Path 1: The Food Safety Landscape

7 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

8 Food Safety Today in the U.S 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 Our changing immunity Age People with cancer People with diabetes Transplant recipients People with HIV/AIDS

9 US FoodNet Estimates of Foodborne Illness Illness rates per 100,000 Pathogen 2015 Illness/ 100,000 Change from 2012 (NC = no change) 2020 National health objective Salmonella NC Campylobacter NC 8.50 Shigella 5.53 NC - Cryptosporidium % - E. coli O NC 0.60 STEC non-o % - Vibrio 0.39 NC 0.20 Listeria monocytogenes 0.24 NC 0.20 Yersinia 0.29 NC 0.30 Source:

10 Food Allergens Food safety issue for sensitive population Peanuts Tree nuts Crustaceans Fish Eggs Milk Soy Wheat Awareness and education is vital Know you customers, know your ingredients Cleaning is essential!

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

12 Path 2: Know Your Consumer

13 Age Makes A Difference! 2011 US Foodborne Estimates Case:Fatality Ratio Deaths < Age Group Source: CDC

14 Path 3: Supply Chain Collaboration

15 Supply Chain Collaboration Today s supply chain is complex and global Develop relationships and partnerships Purchasing, suppliers and local public health officials Establish shared food safety goals with stakeholders How do you manage recalls? Do you have a process to hear about recalls and determine if you have a recalled product in your system?

16 Path 4: Food Groups, Attribution and Contributing Factors

17 No. Outbreaks US Reported Foodborne Illness 2014: Attributed to Food Commodity Groups Rank Order and Number Of Outbreaks Attributed To Food Groups Source:

18 Foodborne Illnesses Attribution Key Insights Top 5 pathogens causing illness Norovirus Salmonella C. perfringens Campylobacter Shiga-toxin producing strains of Escherichia coli Poultry caused more deaths than any other food group (19%) Source:

19 CDC Contributing Factors to Foodborne Illness USA 2014, Reported data Unsafe Source, 17.3% Other, 6.3% Improper Holding, 22.7% Inadequate Cooking, 15.2% Contam. Equipment/ Environment, 11.7% Poor Personal Hygiene, 26.9% Source: CDC

20 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% Source: Gould, et al JFP 76(11):1824.

21 WHAT IS NOROVIRUS?

22 What is Norovirus? A viral infection affecting the stomach and intestines, causing vomiting and diarrhea First identified in 1968 in Norwalk, OH, from an outbreak in a school Commonly called Norovirus Used to be called Norwalk virus Most common cause of acute gastroenteritis ~ 20 million cases are estimated to occur in the US each year As few as 18 viral particles can cause illness Highly contagious Cause at least 50% of all outbreaks Source: and

23 Norovirus Annual burden of illness #1 cause of acute gastroenteritis # 2 cause of hospitalization # 4 cause of death Annually, contributes to: > 50,000 hospitalizations > 500 deaths, mostly among the young and older adults Norovirus exhibits strong winter seasonality. 80% of outbreaks occur between November and April Also known as winter vomiting disease Source:

24 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.

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 Why is Norovirus a Concern? The virus is difficult to kill and if not controlled, it can spread quickly in a large population Review of 1,270 norovirus outbreaks in the US over the two year period ( ) Mean # of cases/outbreak = 44 Range of cases/outbreak = Long-term care facilities #1 setting Public health risk Illness and potentially deaths Regulatory risk - Health departments can institute mandatory closures Public Image and financial risk - Outbreaks can lead to negative publicity and loss of business CDC

27 What is the Source of Norovirus? Feces or vomit of an infected person, including food service staff As many as 1,000 infectious doses could fit on the head of a pin As many as 5 billion infectious doses in one gram of vomit or diarrhea 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 after recovery The Perfect Human Pathogen?

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 Risk Reduction Plan Have a hygiene plan in place with robust cleaning and disinfection procedures Review your SOP and re-train associates Encourage frequent handwashing and freshen-up your handwash signage Do not permit infected workers to prepare food while they have symptoms and at least 3 days after recovery Discard food that may have been contaminated by an ill person 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?

30 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

31 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:

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

33 Path 5: Food Code

34 20 Years of Food Code 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. As of 2013, retail food regulations in every state and three territories are modeled after the FDA Food Code though still from years going back to 1993

35 FDA Food Code Updates

36 Adoption of the National Model Ideally, uniform adoption of the national standards of the Model Food Code could reduce complexity across the US by all choosing or being required to adopt the same guidelines. The approximately 3000 state, local, territorial and tribal regulatory agencies can adopt the food in a variety of ways: Portions of updated Food Code are: - Adopted as written - Adapted as desired - Ignored Recently Wyoming did not include leafy green as TCS foods while adopting 2009 Food Code Oregon adopted the 2009 Food Code but allows Bare Hand Contact

37 Federal Food Code Adoption by State As of August 2103 Note: Iowa and Nevada moved to 2009 Code FederalStateCooperativePrograms/ucm htm

38 Paths 6-9: Clean, Separate, Cook, Chill

39 Clean Hand hygiene Does your staff know when and how to wash their hands Wash fruit and vegetables Don t wash meat, poultry, eggs Cleaning, sanitization and disinfecting Surfaces Utensils Dishware Cutting boards Incident response and biohazard spill kit norovirus

40 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

41 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

42 Cook Cook to the right temperatures Know your temperatures Use a meat thermometer Ground Beef Poultry Leftovers Seafood Pork Eggs Hot Food Holding

43 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 Don t let raw meat, poultry, eggs, cooked food or cut fresh fruits or vegetables sit at room temperature for more than two hours 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

44 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 barehand contact with food Bare-hand contact by 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.

45 A Holistic Approach to Food Safety Leverage the scientific evidence to; Make smart dietary choices 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

46 On a Scheduled Basis: 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

47 Our Paths 1. Food safety landscape 2. Recognize your customer 3. Supply chain collaboration 4. Food groups attribution and contributing factors 5. Food code 6. Clean 7. Separate 8. Cook 9. Chill 10. Awareness, education, systematic approach to food safety

48 48 Thank you John H. Hanlin, Ph.D. Ecolab Inc.