Rhode Island Department of Health

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Rhode IslandDepartment of Health

• State of the Plate
• Ernest Julian, Ph.D., Chief
• Office of Food Protection
• RI Department of Health
• October 24, 2007

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State of the Plate

• Spinach, Lettuce, Ground beef E. coli 0157H7
• Tomatoes Salmonella
• Castleberry recall Botulism
• Carrot juice Botulism
• Raw Oysters Vibrio vulnificus
• Toothpaste Antifreeze

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Foodborne Illness in the U.S.

• 76 million illnesses each year
• 325,000 hospitalizations
• 5,200 deaths
• 3 Billion in hospitalizations
• 20-40 Billion lost productivity

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TOTAL REPORTED CAMPYLOBACTERIOSIS, SALMONELLOSIS,
HEPATITIS A, E. COLI 0157H7, LISTERIOSIS,
SHIGELLOSISRHODE ISLAND, 1990-2006
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Healthy People 2010 Objectives
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Most common causes of foodborne Illness est. 76
million illnesses
Paul Mead, et al. Food-Related Illness and
Death in the United (Source Art Liang
CDC) States Emerging Infectious Diseases
19995(5) 607-625
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Campylobacter

• Foreign travel
• Undercooked poultry
• Turkey or chicken cooked outside the home
• Other meat cooked outside the home
• Raw milk
• Raw seafood
• Living on or visiting a farm
• Contact with farm animals
• Contact with puppies
• Source Art Liang CDC
• C. Friedman et al, Intl Conf Emerging Infect.
  Diseases, 2000

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Campylobacteriosis

• Diarrhea (may contain blood)
• Fever
• Occurs 2-5 days after ingestion
• Lasts 7-10 days, relapses not uncommon
• Possible complications Reactive arthritis,
  septicemia, infections of nearly any organ,
  meningitis, recurrent colitis, and Guillain-Barre
  syndrome

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How to Avoid Campylobacteriosis

• Thoroughly cook poultry and eggs
• Campy found in egg yolks in breeder hens
• Thoroughly wash hands, cutting boards, etc. after
  handling raw poultry.
• Avoid unpasteurized milk (basket cheese)
• Avoid contact with the infected stool of an ill
  dog or cat.

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Population-based Case-control Studies

• E. coli O157
• pink hamburger
• farm animals
• eating at a table-service restaurant
• (Source Art Liang CDC)

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E. coli 0157H7

• Severe abdominal pain, diarrhea which is
  initially watery but becomes grossly bloody.
• Lasts for an average of 8 days.
• HUS
• Undercooked or raw hamburger implicated in many
  outbreaks, alfalfa sprouts, unpasteurized fruit
  juices, dry-cured salami, lettuce, game meat,
  cheese curds, and raw milk

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E. coli 0157H7 Controls

• Thorough Cooking of Ground Beef Especially for
  Kids under 5 Years Old
• Do not allow commercial service of ground beef to
  children 12 years of age and younger (RI)
• Consumer advisory
• Pasteurize Cider
• Dont Use Uncomposted Manure for Fertilizer
  (Organic) or contaminated water for irrigation

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Salmonella group B and D

• eggs (Heidelberg)
• Reptiles
• Antibiotics (DT104)
• Breast-feeding protective
• chicken outside home (Enteritidis)
• USDA Under Secretary for Food Safety
• 16 of broilers positive
• 40 of ground poultry products positive

FoodNet
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EHS-Net Tomato Handling Study Issues

• Several outbreaks have implicated cut, raw
  tomatoes as a mechanism for foodborne illness .
  
• The Conference for Food Protection has proposed
  requiring refrigeration for cut, raw tomatoes.

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RI EHS-Net Tomato Study Results

• General Prep Non-compliances (approx )
• 5 didn't use gloves during preparation
  (BHC).
• 5 cored the tomatoes before washing (cut
  skins).
• 5 didn't wash the tomatoes at all before
  slicing.
• 3 had more than one preparation error.

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To avoid Salmonella infections

• Don't drink unpasteurized milk.
• Don't eat undercooked poultry (including turkey)
  and poultry products such as eggs.
• Avoid contact with infected domestic and wild
  animals, including poultry, pigs, cattle, and
  pets such as turtles, iguanas, chicks, dogs, and
  cats.

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REPORTED SHIGELLOSISRHODE ISLAND 1978-2005
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Hepatitis A

• Prevention
• No hand contact of ready-to-eat foods
• Thorough handwashing
• Exclude ill personnel
• 10 bleach for cleanup of vomitus
• (Same Controls for Shigella, Noro virus)
• Johnson and Wales and childhood vaccinations will
  reduce illness

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FDA Foodborne Illness Risk Factors

• Exceeded 40 Out of Compliance in 1998 Still High
  in 2003
• Cold holding of potentially hazardous foods
• Date marking of refrigerated ready-to-eat
  potentially hazardous foods
• Surfaces/utensils cleaned/sanitized
• Proper, adequate handwashing

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FDA Foodborne Illness Risk Factors

• Certified Manager Had a Positive Effect on
• Poor Personal Hygiene
• Contaminated Equipment
• Holding Temperatures

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Improper Hold/Time Temperature
Rapid Cooling

• Significant for full-service restaurants (56/66
  85 OOC rate).

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Poor Personal Hygiene
Bare hand contact with RTE foods

• Significant for schools and all restaurants

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Contaminated Equipment
Separation of raw animal foods from RTE foods

• Significant in full-service restaurants

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RECOMMENDATIONS for INDUSTRY

• Establish monitoring procedures that focus on
  critical processes and practices
• Cooling
• Hot Holding
• Cooking
• Cold Holding (check refrigeration temps twice
  daily)
• Receiving/transportation
• Sanitization

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Direction

• New Food Code Effective October 23
• Tablet computers and computerized inspections
• Blast fax/email
• Third Party inspections of schools
• School and other inspections on the web
• Go After the Bad Guys

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Dine Safer Award for Excellence in Food Safety

• Counter showing number of hits on inspection
  reports
• Consumers can have latest inspections emailed to
  them
• Make Dine Safer facilities searchable by name,
  town, type of cuisine and relative cost
• Pull up menus, directions, coupons, etc
• Number of hits on establishment page can be
  emailed to restaurant

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What Will Drive Industry Participation

• As number of hits on visible counter on site
  increases, so does potential participants
• Document and publicize increases in business
• Promote with establishments trying to increase
  their business
• New establishments

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Consultants Assist the Industry in Meeting the
Standard

• Develop HACCP plan
• Certify manager for each shift
• Train employees
• Assist in correcting problems and in preparing to
  meet standard

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For Further Information

• www.foodsafety.gov
• fightbac.org
• health.ri.gov