Philadelphia Dept of Public Health- Environmental Health Services

1. Philadelphia Dept of Public Health-Environmental Health Services Risk Based Food Inspections, Standardization, Foodborne Illness, & Keeping Deli Slicers Safe George Van Note, Program Manager of Food Protection

2. Environmental Health Services (EHS) • Office of Food Protection • Environmental Engineering • Vector Control Services • Child Lead Poisoning Prevention

3. Why Is Food Safety Important? • Foodborne illness is preventable • Children younger than age 4 at risk • older than age 50 are at greater risk for death • costly health care

4. 48 million people get sick per year (1 in 6) 128,000 are hospitalized 3,000 deaths $3 billion for hospitalization 2011 Estimates of Foodborne Illness in United States

5. National Standardization of Food Code & Retail Food Inspections • FDA model food code • FDA program for standardization & certification of retail Food inspection officers • FDA guide to conducting risk-based inspections

6. FDA Statistic: Population of States & Territories That Have Adopted the Food Code

7. Risk Based Food Inspections • foodborne illness risk factors • not just “walls, floors & ceilings” • active managerial control • Observing practices • asking questions

8. Foodborne Illness Risk Factors & Public Health Interventions • Demonstration of Knowledge • Employee Health • Good Hygienic Practices • Preventing Contamination by Hands • Approved Source • Protection From Contamination

9. Foodborne Illness Risk Factors & Public Health Interventions • Potentially Hazardous Food Time/Temperature • Consumer Advisory • Highly Susceptible Population (HSP) • Chemical • Conformance w/ Approved Procedures

10. Employee Health Diseases or medical conditions that must be reported. • Norovirus • Hepatitis A • Shigella spp. • Shiga toxin-producing E. Coli • Salmonella Typhi

11. Employee Health Diseases or medical conditions that must be reported. • Diarrhea • Fever • Vomiting • Jaundice • Sore throat w/ fever • Lesion containing pus

12. FDA 2004 report

16. Highly Susceptible Population(HSP) • persons who are more likely to experience foodborne disease • immunocompromised persons • preschool-age children • older adults • custodial care, healthcare, assisted living services, nutritional services or socialization services

17. SPECIAL REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS • Prepackaged juice w/ warning label prohibited. • juice that is prepared on site requires HACCP plan • Pasteurized eggs required in certain foods.

18. SPECIAL REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS • Prohibited ready-to-eat foods. - raw animal-derived foods - a partially cooked animal-derived food - raw seed sprouts

19. Evaluate facilitiesGood retail practices (GRP) • Pest control • Food protection • Equipment maintenance • Water • Plumbing • Toilet facilities &Sewage • Garbage & refuse • Physical facilities

20. Risk based inspection requirements: • Proper equipment. • Adequate training. • Lead by example. • Conduct inspections at variable times.

21. open dialogue w/ Person in Charge (PIC) previous inspection reports menu/food list review walk-through Risk based inspection priorities:

22. Achieving long term compliance. • Active Managerial Control • On-site correction. • Standard operating procedures. • Closing conference.

23. Schedule Inspections Based on Risk • History of non-compliance • Specialized process • Food prepared in advance • Large number of people served • History of foodborne illness or complaints • Highly susceptible population

24. Achieving long term compliance. • Active Managerial Control • On-site correction. • Standard operating procedures. • Closing conference.

25. FDA Standardization & Certification of Retail Food Inspection Offices

26. Standardization of Food Inspection Officers • audited on performance • not intended to provide basic training to individual candidates • promote uniformity • lack of training programs for food inspectors

27. Standardization of Food Inspection Officers • 8 joint field inspections of food establishments • risk control plan • process flow charts • verification of existing Hazard Analysis Critical Control Point Plan (HACCP)

28. Standardization of Food Inspection Officers The standard evaluates the candidate on: • Foodborne Illness Risk Factors • Good Retail Practices • HACCP • Inspection Equipment • Communication

29. Standardization of Food Inspection Officers • Score is based on agreements with standard. • Passing - risk factors- 90%, 11 or less disagreements - GRPs- 85% agreement on GRPs, 5 or less disagreements

30. Unsatisfactory performance • cannot meet the requirements • additional training • Conference for Food Protection has published a Field Training Manual for Regulatory Retail Food Safety Inspection Officers.

31. Foodborne Illness Common Pathogens

33. CDC- Top 5 pathogens causing foodborne illnesses- • Norovirus • Salmonella nontyphoidal • Clostridium perfringens • Campylobacter spp. • Staphylcoccus aureus

34. Change in E. coli O157 & Salmonella infection, 1996–2010 Source: Foodborne Diseases Active Surveillance Network, 2010.

35. Changes in Foodborne Illness 1996-2010 • Decrease - Campylobacter -27% - Listeria -38% - E. Coli O157 -44% - Shigella -57% - Yersinia -52% • Increase • - Vibrio +115 %

36. Local Gastrointestinal Illness Outbreaks • Salmonella Enteritidis • Salmonella Typhimurium • Bacillus cereus • Shigella • Norovirus- Frozen Oysters Korean Import • Unknown Illnesses

37. Onset Time of Common GI/Foodborne Illnesses • Salmonella: 6-48 hrs • Listeria: 9-48 hrs GI, 2-6 weeks for invasive disease • Norovirus: 12-48 hrs. • Campylobacter: 2-5 days • Shigella: 4-7 days

38. Symptoms of Common GI/Foodborne Illness • Salmonella: Diarrhea, fever, abdominal cramps, vomiting • Shigella: cramps, fever, & diarrhea. Stools contain blood & mucus • Norovirus: Nausea, vomiting, cramping, diarrhea, fever, headache. • Campylobacter: Vomiting, diarrhea, blurred vision, double vision, difficulty in swallowing, muscle weakness. respiratory failure & death • Listeria: Fever, muscle aches, & nausea or diarrhea.

39. Foods associated w/ Salmonella Outbreaks Foods associated with Salmonella outbreaks*

40. Food Source of Common Food Borne Illness • Campylobacter: Improperly canned foods, home-canned vegetables, fermented fish, baked potatoes in aluminum foil. • Listeria: Unpasteurized milk, soft cheeses made with unpasteurized milk, ready-to-eat deli meats

41. Source of Common Food Borne Illness • Shigella: Raw produce, contaminated drinking water, uncooked foods & cooked foods that are not reheated after contact with an infected food handler • Norovirus: Raw produce, contaminated drinking water, uncooked foods & cooked foods that are not reheated after contact with an infected food handler; shellfish from contaminated waters

42. Listeria- High Risk Groups • Pregnant women, fetuses & newborns • weakened immune systems • People with cancer, diabetes, alcoholism, liver or kidney disease • AIDS • Older adults

43. Listeria- High Risk Groups “Do Not Eat” • Hot dogs, luncheon meats, cold cuts, unless they are heated to an internal temperature of 165ºF • Pate or meat spreads • Raw milk & soft cheese from raw milk • Refrigerated smoked seafood

44. Prevention of Foodborne Illness- Handwashing • “Handwashing is the single most important prevention step for reducing disease transmission.”- Center for Disease Control • Handwashing reduces the spread of microorganisms.

45. Prevention of Foodborne Illness • Wash hands • Clean/Sanitize/Disinfect equipment & clothing • Wash fruits & vegetables • Date mark • Avoid cross contamination • Refrigerate • Cook raw animal products properly • Ill people should not prepare food • Careful w/ HSP

46. Challenges to Tracking Foodborne Illness • Public’s lack of understanding of foodborne illness • lack of healthcare • medical cost • No specific diagnosis • person-to-person or foodborne • stereotypes