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Epi-Ready

Epi-Ready. Environmental Investigation. Module 7. Module Objectives. By the end of this module, participants will be able to evaluate the environmental approaches used in an effective foodborne outbreak response.

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Epi-Ready

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  1. Epi-Ready Environmental Investigation Module 7

  2. Module Objectives • By the end of this module, participants will be able to evaluate the environmental approaches used in an effective foodborne outbreak response. • Describe environmental assessment as a means to identify contributing factors and their environmental antecedents as part of a foodborne illness outbreak investigation • Discuss product tracing activities to identify and eliminate foods that may cause foodborne illness • Explain the control measures available to reduce or eliminate foodborne illness associated with an outbreak

  3. The Environmental Investigator

  4. Cross-Disciplinary Activities

  5. Application of Subject Matter Expertise Past Present Future

  6. Environmental Assessment

  7. Contributing Factors

  8. Farm to Fork Continuum Source: https://www.cdc.gov/nceh/ehs/nears/ea-definitions.htm

  9. Contributing Factors at the Source • Salmonella Enteritidis in eggs (2010) • Cyclospora in cilantro (2015) • E. coli outbreak associated with romaine lettuce (2018)

  10. Contributing Factors at Processing • Listeriosis Linked to Whole Cantaloupes (2011) • Listeriosis Linked to Blue Bell Ice Cream (2015) • Multidrug-Resistant Salmonella Heidelberg

  11. Contributing Factors at Distribution SalmonellaEnteritidis Infections from Ice Cream

  12. Contributing Factors at Point of Service • Chipotle Mexican Grill Norovirus Outbreak (2017) • Chipotle Mexican Grill E. coli O26 Outbreak (2016) • Jack in the Box E. coli O157:H7 Outbreak (1993)

  13. Environmental Antecedents

  14. Retail Food Establishment System Processes Customer Health Customer Satisfaction Profit Ingredients Organisms Chemicals Final Food Item Serve Receive Internal System Variables Store Assemble External Feedback to System Hold Prep Cook Reheat Cool Original Source: CDC

  15. Activity • Several cases of Salmonella infection have occurred at Restaurant A. Table groups will be assigned a contributing factor of either contamination, survival, or proliferation. Review Slide 7-14. Using the contributing factor assigned, describe two process failures and possible environmental antecedents that would have lead to the contributing factor. Table Groups This activity should take 20 minutes; 10 minute of work in table groups and 10 minute to report Record Responses in Participant Guide

  16. The Environmental Assessment Process

  17. Food Process Diagram Receive Store Freeze Refrigerate Dry Storage Prep Serve Cook Cool Hold Cool Reheat Serve Serve Serve Serve

  18. Food Flow Diagram Source: Selman and Guzewich

  19. The Effective Interviewer • Informed • Prepared • Engaging • Apply proper questioning techniques • Avoid leading question • Avoid bias • Consider communication barriers

  20. Product Tracing Implicated Food

  21. Investigational Product Tracing

  22. Cyclosporiasis in British Columbia Source: Shah et al. (2009)

  23. Regulatory Product Tracing Conduct an environmental assessment to determine the root cause of the outbreak

  24. E. coli O157:H7 Outbreak 2018Romaine Lettuce Source: FDA (2018)

  25. Challenges with Product Tracing

  26. Promising Practice - Blockchain • Distributed ledger technology that allows all members of a supply chain to record transactions in a decentralized data log maintained on a network of computers, rather than a physical ledger or a single database. • Early adopters include Walmart, Kroger, McCormick and Company, Tyson Foods, Nestlé and Dole. • United Arab Emirates

  27. Control Measures Factors to Consider: • Virulence and Pathogenicity of the Foodborne Illness Agent • Population Susceptibility • Number of Cases Involved • Economic Impact • Political Considerations

  28. Categories of Control Measures • Notification • Removal of Food from Distribution • Exclusion/Restriction of Ill Food Workers • Prophylaxis

  29. Notification Alert – Advisory – Health Update – Info Service CONSUMER ADVISORY Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration

  30. Removal of Food from Distribution

  31. Product Recall • Class 1: Will cause serious adverse health consequences or death • Class 2: The probability of serious adverse health consequences is remote • Class 3: The product is not likely to cause adverse health consequences

  32. Facility Closure

  33. Restriction or Exclusion of Ill Food Employees • Exclude from work or restrict from food preparation based on the disease causing agent • Follow state and local guidance where applicable • FDA food code has a section on food employee exclusion and restriction • Exclusions and restrictions may not be adequate in all situations - Norovirus https://www.fda.gov/downloads/Food/GuidanceRegulation/RetailFoodProtection/IndustryandRegulatoryAssistanceandTrainingResources/UCM194575.pdf

  34. Post-Exposure Prophylaxis

  35. Summary

  36. Coming Up Next

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