Module 3: Environmental Assessment · Module 3: Environmental Assessment Bureau of Environmental...

Module 3: Environmental Module 3: Environmental AssessmentAssessment

Bureau of Environmental ServicesFood, Milk, and Lodging Division

Epidemiology DivisionBureau of Clinical Laboratories

Bureau of Environmental Services

Module Learning Objectives Module Learning Objectives g jg jFoundational Knowledge ReviewDescribe Differences & Priorities BetweenDescribe Differences & Priorities Between Process I, II, and III FoodsDescribe Environmental AssessmentDescribe Environmental Assessment ObjectivesDescribe Basic Steps of EnvironmentalDescribe Basic Steps of Environmental AssessmentConstruct a Well Documented Environmental ReportPerform Group Exercise

Bureau of Environmental Services2

Various Sources of FBO Various Sources of FBO Various Sources of FBO Various Sources of FBO

RestaurantsGrocery store delis Church potluck suppersChurch potluck suppersSummer campsFood processorsFarmsTrucks

Know the Agent to TargetKnow the Agent to TargetI ti ti & C t l MI ti ti & C t l MInvestigation & Control MeasuresInvestigation & Control Measures

Contributing Factors toHAZARD

Contributing Factors to Investigate During Field Visit

Spore-FormersPreformed Toxins

Cooling, Re-Heating, Hot Holding,Bare Hand Contact Room Temp StoragePreformed Toxins

(i.e. Clost perf, B cereus, staph)Bare Hand Contact, Room Temp Storage, Cold Holding

Viral Infections (i e norovirus)

Ill Food Worker, Bare Hand Contact, Handwashing Contaminated Raw Product(i.e. norovirus) Handwashing, Contaminated Raw Product

Bacterial Infections Ill Food Worker, Bare Hand Contact, Handwashing, Contaminated Raw Product, Cross Contamination, CookingCross Contamination, Cooking

Parasitic Infections Contaminated Raw Product and Source

See IAFP manual for details on specific diseases 4

Contributing FactorsContributing FactorsggAssociated with FBOAssociated with FBO

Improper holding temperatures

Unsafe sourcePoor personal

Inadequate cooking

phygieneCross

Contaminated equipment

contamination

Food Safety Management Food Safety Management y gy gSystems: The PrerequisitesSystems: The Prerequisites

E l H lthEmployee HealthPersonal Hygiene ProgramTime Temperature ManagementCleaning and Sanitizing of FoodCleaning and Sanitizing of Food Contact SurfacesCross Contamination PreventionCross Contamination PreventionDate Marking

Routine InspectionRoutine InspectionRoutine InspectionRoutine Inspection

Emphasis has evolvedEmphasis has evolvedOld days - legal compliance checklist mentalitymentality Current recommendations are risk-b d i ti t id tifbased inspections to identify cause foodborne illness

See Document Library or http://adph.org/foodsafety/Default.asp?id=1140

Process 1: Process 1: N C k StN C k StNo Cook StepNo Cook Step

Receiving Store Prepare Hold Serve

Example: Sandwiches w/ RTE FillingsCanned TunaCanned TunaCanned ChickenLunch MeatLunch Meatetc.

Process 1: Process 1: No Cook Step PrioritiesNo Cook Step Priorities

Cold Holding or Time Alone as aCold Holding or Time Alone as a ControlFood SourceFood SourceDatemarkingReceiving Temperatures Freezing to Destroy Parasites (Fish g y (for Sushi)

Process 2: Process 2: Same Day ServiceSame Day Service

Receiving Store Prepare Cook Hold ServeServe

Example: Hamburgersp gMost Fast Foods

Process #2: Process #2: Same Day Service PrioritiesSame Day Service Priorities

Cooking

H t H ldiHot HoldingTime Alone as a MicrobialTime Alone as a Microbial Growth Barrier

Process 3: Process 3: Complex Food PreparationComplex Food Preparation

Receive Store Prepare Cook Coolp

Reheat Hot Hold Serve

Example: Hot Catered MealCasserole

Process 3: Process 3: Complex Food Prep PrioritiesComplex Food Prep Priorities

CookingHot HoldingHot HoldingTime Alone as a Microbial Growth BarrierBarrierCoolingReheating

Risk Factors in Process FlowsRisk Factors in Process FlowsRisk Factors in Process FlowsRisk Factors in Process Flows

All Processes No bare hand contact with RTE foodProper handwashingProper handwashingRestriction and exclusion of ill employees Prevention of cross-contaminationPrevention of cross-contamination

Danger Zone DiagramDanger Zone Diagram

Conducting RiskConducting Risk--based Inspectionsbased InspectionsConducting RiskConducting Risk--based Inspectionsbased Inspections1. Inspection focusp2. Identify food process

categories presentg p3. Establish priorities4 Determine risk factors in4. Determine risk factors in

process flows5 Assess active managerial5. Assess active managerial

control of risk factors in process flows

Environmental Assessment Environmental Assessment (Food Preparation Review)(Food Preparation Review)

Definition: a systematic evaluation of a food establishment suspected of causing a FBO.

A cluster of consumer complaints of illillness. Lab and/or epidemiological information associated and causative agentassociated and causative agent identified.

Environmental Assessment Environmental Assessment ObjectivesObjectives

1. Identify foods and beverages offered

2. Reconstruct past events - when pfood(s) were produced

InvestigationFood Preparation Outbreak

66Service

26 27 28 29 30 1 2 3 4 5J J lJune July

Reconstructing Past EventsReconstructing Past EventsEpidemiology Division

Bureau of Clinical LaboratoriesBureau of Environmental ServicesHealth Department Notified

3. Identifying Contributing factors

What happened?ContaminationSurvivalProliferationProliferation

CC t i tit i tiCContaminationontamination

R i i t tiReceiving, storage, preparation, transport, serviceWorker hands, ill workersEquipment, utensilsq pCross-contaminationUse of leftovers returned foodUse of leftovers, returned food

SSurvivalurvivalSSurvivalurvivalIngredients that inhibit growth: acids, salts and preservativesalts, and preservativeTime/temperature abuseSurvival on contaminated surfaces, ingredients

Bacteria: spores, toxinsViruses and parasitesp

Will the agent survive the process?Epidemiology Division

Bureau of Clinical LaboratoriesBureau of Environmental Services

PProliferationroliferationPProliferationroliferation

Food -NutrientsAcidity - pH T tTemperatureTimeeOxygen – or Lack of OxygenMoisture - Water activity (aw)

FAT TOMFAT TOMFAT TOMFAT TOM

4. Identify environmental antecedents Why did this happen?y ppWhat happened?

Cutting board and knife used to cut raw chicken th d t li t f th l dwere then used to slice carrots for the salad.

Why did it happen? Employee was unaware of the dangers of cross-Employee was unaware of the dangers of cross-contamination

5. Implement effective controltiactions

What can be done now?Improve food safety education for employees

E i t l A t StE i t l A t StEnvironmental Assessment StepsEnvironmental Assessment Steps

PlanningPlanningSite VisitInterviews – Food WorkersAssessment of Food Preparation (CSP)

Collecting SamplesControl StrategiesControl Strategies

Planning/PreparationPlanning/Preparation

Review available Epi information

a g/ epa at oa g/ epa at o

Dates of onsetIncubation periodLikely exposure dates/meals

For commercial food productspExact product description Purchase datesPurchase dates

R i F d F ilit I f tiR i F d F ilit I f tiReview Food Facility InformationReview Food Facility Information

Existing regulatory recordsEmployee work schedulesEmployee work schedulesMenus, recipes, product formulationsWeekend menusWeekend menus

Review Causative Review Causative Agent InformationAgent InformationAgent InformationAgent Information

Bacterial Bacillus

ParasiticCrypto-

ViralNorovirus

ChemicalScombrotoxinBacillus

Campylobacter ClostridiumEscherichia

CryptosporidiumCyclosporaGiardiaT l

NorovirusRotavirusAstrovirusHepatitis A

ScombrotoxinCiguatoxinMushroom poisoningH t lEscherichia

- e-coliListeriaSalmonella Typhi

ToxoplasmaTrichinella

Heavy metals

Salmonella TyphiShigellaStaphylococcusVibrio

Mode of transmissionSneeze, dirty hands, ill worker, etc. Vibrio S ee e, d y a ds, o e , e c

Investigation ApproachesInvestigation ApproachesInvestigation ApproachesInvestigation ApproachesNo Implicated Food:

C ’t f i l it i f d iCan’t focus on a single item in food prep review in the early stages, if no food association established.Conduct general risk-based assessment using most up to date information availableDetermine which samples investigators are mostDetermine which samples investigators are most interested in (food, clinical, environmental, water/ice)

Implicated Food:Implicated Food:Food Preparation Review is Key!

Other ActionsOther ActionsOther ActionsOther ActionsDevelop initial plan and timetableAssemble materials/personnel

Pre-meetings w/ Lab and EpiBe sure your DETECT kit is stocked (Epi to provide forms and kits)List documents you want Alert laboratoryAlert other agencies

Site VisitSite VisitSite VisitSite Visit

Manager InterviewManager InterviewFacility walk throughA t f f d tiAssessment of food preparationObserve operationsWorker interviewsCollect recordsCollect records

M g I t iM g I t iManager InterviewsManager Interviews

Explain reason for the investigation

Outline investigation objectives

Create cooperative relationshipCreate cooperative relationship

M g I t i ( t )M g I t i ( t )Manager Interviews (cont.)Manager Interviews (cont.)

F d f t k l dFood safety knowledge (Is he/she Food Safety Certified?)

Attit dAttitudeCredibility of information being provided

Manager Interviews (cont.)Manager Interviews (cont.)Food Worker HealthFood Worker Health

Review health, hygiene and education practicesIdentify who worked with the implicated food(s)Worker ill during time period of interest?Document findings

Facility Walk ThroughFacility Walk Throughy gy g

Initial facility walk throughInitial facility walk throughMeasure critical operations before

difi dmodifiedCollect samples while availableVerify who worked with implicated foods

Ob O tiOb O ti G lG lObserve OperationsObserve Operations-- GeneralGeneral

Wh t d th f d fit i t ?What process do the foods fit into?Process 1 – No Cook StepProcess 2 – Same Day ServiceProcess 3 – Complex Foods

What controls are essential for the foods in this process?

Observe Operations Observe Operations SpecificSpecificObserve Operations Observe Operations -- SpecificSpecificHow the same items are prepared p ptodayAttempt to reconstruct how theyAttempt to reconstruct how they were prepared during the time period of interestperiod of interestTake measurements (time, temperature product dimensionstemperature, product, dimensions, locations)

F d W k I t iF d W k I t iFood Worker InterviewsFood Worker Interviews

I t i ith t tInterview without manager presentAsk questions in chronological sequenceReconstruct timelineLet them tell their story

Food Worker Interviews (cont )Food Worker Interviews (cont )Food Worker Interviews (cont.)Food Worker Interviews (cont.)

Ask about any unusual circumstancesythat may have occurred that day--equipment that wasn’t working, short-staffing someone illstaffing, someone illReword questions when needed, if information isn’t provided or pinconsistencies are identifiedInconsistent information may indicate sensitive areas Consider addressing atsensitive areas. Consider addressing at end of interview

When Food Workers Cannot When Food Workers Cannot Remember DetailsRemember Details

Ask about typical work practices and routinesThen ask about any unusual events or changes during time period?Remember that outbreaks frequently occur the system was “ t d”“stressed”

C l di g th I t iC l di g th I t iConcluding the InterviewsConcluding the InterviewsAsk if individuals haveAsk if individuals have unanswered questions or additional commentsadditional comments

May have information not previously consideredpreviously consideredMay reveal other useful information

Leave your business card for future contact

Records & Other Records & Other Information Sources Information Sources

What SOPs or food safety systemsWhat SOPs or food safety systems are in place?

HACCPHACCPBuyer Specifications/Approved SourcesPersonal HygienePersonal HygieneCleaning & SanitizingTime/Temperature ProceduresTime/Temperature ProceduresRecipe InstructionsMenu Epidemiology Division

Bureau of Clinical LaboratoriesBureau of Environmental Services

C ll ti g S lC ll ti g S lCollecting SamplesCollecting SamplesPlan your approach inPlan your approach in advance as much as possible (in consultationpossible (in consultation with Epi & Lab)

Type (food water)Type (food, water)Size Number

Sampling IssuesSampling IssuesSampling IssuesSampling Issues

After reviewing product flow adjustAfter reviewing product flow, adjust sampling plan as neededC id d f li tConsider need for sampling to pinpoint contamination source

Environmental Sampling Environmental Sampling StrategiesStrategies

I liIn-lineBracketingEnvironmentalFinished productFinished product

Environmental Sampling Environmental Sampling St t gi ( t )St t gi ( t )Strategies (cont.)Strategies (cont.)

T k i t l l l iTake environmental samples early in the investigationHave equipment disassembled for environmental swabsFocus on hard-to-clean areasChain of custodyChain of custody

H t C ll t S lH t C ll t S lHow to Collect a SampleHow to Collect a Sample

1. Gloves2. Sterile Containers3. Sterile Utensils4 Representative selection of4. Representative selection of

implicated food

Precautionary Controls Needed?Precautionary Controls Needed?

Take action to prevent additional cases !

Control ActionsControl ActionsControl ActionsControl ActionsImmediately stop the outbreak:

H ld ClosureHoldSeizeCease/Desist

ClosureExclusions/ RestrictionsRecalls

Menu LimitationLong term strategies to prevent recurrence:

Recalls

recurrence:HACCP Risk Control Plans [“Mini-HACCP”]T i iTrainingMenu/Supplier/Recipe Modifications

Constructing a ReportConstructing a ReportConstructing a ReportConstructing a Report

C il I f tiC il I f tiCompile InformationCompile InformationCompare information gathered fromCompare information gathered from different sources (Env, Lab, Epi)Level of confidence in informationLevel of confidence in information gathered?Wh t i k d h t iWhat is known and what remains unknown?Organize information needed for report

A l fi di g A l fi di g CSPCSPAnalyze findings Analyze findings -- CSPCSPIdentify CSP at each stepIdentify CSP at each stepDetermine what happened and what did notdid not Interpret:

Laboratory findingsLaboratory findings Time/temperature proceduresFood flow diagramsFood flow diagramsFood preparation reviews/diagrams

W it tW it tWrite your reportWrite your report

Brief narrativeContributing factors (“What g (happened”) – CSPEnvironmental antecedents – “Why itEnvironmental antecedents Why it happened”

Module Learning Objectives Module Learning Objectives Module Learning Objectives Module Learning Objectives Foundational Knowledge ReviewDescribe Differences & Priorities Between Process I, II, and III FoodsDescribe Environmental Assessment ObjectivesD ib B i St f E i t lDescribe Basic Steps of Environmental AssessmentC t t W ll D t dConstruct a Well Documented Environmental Report

I C l iI C l iIn ConclusionIn ConclusionDocumentation ofDocumentation of findings is important for immediate controlfor immediate control of the outbreak and is a key to enlist a ey to e stprocedures, education, and/or educa o , a d/opolicies to prevent future outbreaks.

Group ExerciseGroup ExerciseGroup ExerciseGroup Exercise

Process I II and IIIProcess I, II, and III

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