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Food Safety Global Trends
This document discusses leveraging food safety data to improve management practices and reduce foodborne illness. It provides an overview of foodborne illness statistics globally and in various countries. Restaurant inspections commonly cite improper holding temperatures, poor hygiene, and contaminated equipment as contributing factors. The document analyzes inspection data and outbreak reports to identify correlations. It recommends using such data to guide focused training, procedures, and product offerings to effectively address risk areas. Connecting data insights to action is key to advancing food safety.
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Food Safety Global Trends
- 1. Leveraging Information To ImproveFood Safety Management RUTH L. PETRAN, PHD 1 29 April 2015 VP FOOD SAFETY & PUBLIC HEALTH, ECOLAB
- 2. Discussion Overview Foodborneillness is a significant public health concern Need to take action to drive rates down Leverage available data to glean insights CDC contributing factors related to illnesses FDA risk factor studies Health department inspections Learnings from outbreaks Identify mitigating strategies that will work At the restaurant level To guide R&D development efforts, etc.
- 3. Foodborne Illness AnnualEstimates 3 United States 48 million cases 120,000 hospitalizations 3000 deaths Australia 4.1 million cases 86 deaths EU 45.5 million cases China - Surveillance beginning Global foodborne illness estimate: 582 million cases & 351,000 deaths Canada 4 million cases South Korea 336,000 cases Africa - Surveillance beginning
- 4. Where Was ContaminatedFood Consumed? Restaurant or deli 57% Private home 12% Workplace, office, not cafeteria 0% Hospital, Nursing Home 2% Banquet facility 13% School 4% Church, temple 1% Wedding reception 0% Caterer 0% Prison, jail 2% Other 9% USA 2012 WHEN LOCATION IS KNOWN Source: CDC 2014 http://www.cdc.gov/features/foodborne-diseases-data/?s_cid=cdc_homepage_feature_003
- 5. Norovirus: Leading Causeof Foodborne Illness 5 TOP 5 US REPORTED OUTBREAKS (CONFIRMED AND SUSPECTED) 0 100 200 300 400 500 600 700 800 900 #OutbreaksReported Norovirus Salmonella C. perfringens E. coli Campylobacter Unknown Source: http://www.cdc.gov/foodsafety/pdfs/foodborne-disease-outbreaks-annual-report-2012-508c.pdf
- 6. 2014 Total HumanCost of Foodborne Illness Salmonella is #1 cause of foodborne illness in terms of cost Norovirus is #1 in terms of cases Impact of : Size of Outbreak Severity of illness Complications Long term health effects Total human cost of top 15 pathogens more than $15 billion annually http://www.ers.usda.gov/data-products/cost-estimates-of-foodborne-illnesses.aspx Norovirus Salmonella Listeria Mean Annual Cost $2.3 Billion $3.7 Billion $2.8 Billion Number of Cases 5.5 Million 1.2 Million 1,591 cases Cost per Case $413 $3,568 $1.7 Million
- 7. Call to Action The problem of food safety is significant. 1 in 6 of us suffers from a foodborne illness each year. Clearly action is needed to drive rates of illnesses down, and to be most impactful, efforts need to be focused where they will have the biggest impact. Leverage data to help guide efforts appropriately.
- 8. USA 2012 Adapted fromCDC 2014 - http://www.cdc.gov/foodsafety/pdfs/foodborne-disease- outbreaks-annual-report-2012-508c.pdf Improper Holding 23% Poor Personal Hygiene 30% Contaminated Equipment/Env ironment 10% Inadequate Cooking 14% Unsafe Source 12% Other 11% CDC Contributing Factors to Foodborne Illness
- 9. FDA Risk FactorObservational Studies Done in food service & retail establishments 1998-2008 in three phases Results Generally, there were improvements over time Risk Factors most in need of attention: - Improper Holding/Time and Temperature - Poor Personal Hygiene - Contaminated Equipment/Protection from Contamination Studies being repeated 2013-2025 One outcome is to assess impact of various industry and regulatory intervention strategies
- 10. Health Department Inspections Focus on factors contributing to foodborne illness No consistent reporting format across the country Certain jurisdictions posting results for consumers Potential impact on consumer trust
- 11. Inspections Record ObservedViolations Millions of restaurant health department (HD) inspections done annually in US Opportunity exists to mine data to determine role that inspection results can play in helping to identify risks From this, identify major, modifiable risks Focus efforts appropriately
- 12. US Model FoodCode Is Basis For Restaurant Inspections A uniform set of provisions that address the safety & protection of food offered at retail and in food service A model to safeguard public health & ensure food is not adulterated Guidance document from FDA that evaluates: Foodborne illness risk factors Good retail practices Adopted by local & state health departments in a variety of ways Requirements vary among jurisdictions Frequency of inspections and scoring varies among jurisdictions
- 13. Health Dept Insight:State Variability Average Total Findings By State High Variability in Total Findings from State to State Most Findings Kansas 5.5 Connecticut 5.3 Oklahoma 5.1 Nebraska 5.1 Tennessee 5.1 Least Findings Mississippi 0.4 Washington 1.3 Nevada 1.5 Arizona 1.5 Arkansas 1.6 0-1 1-2 2-3 3-4 4-5 5+
- 14. Health Dept Insight:Top Findings 3 of the 5 Top Findings May Directly Result in Food Borne Illness Most Commonly Cited Issues 2011-2013 Item Level Frequency Physical facilities installed, maintained, and clean GRP 31.5% Food contact surfaces are clean and sanitized FBI 29.0% Food and non-food contact surfaces cleanable, properly designed, constructed, and used GRP 27.3% Adequate hand-washing sinks – properly supplied and accessible FBI 18.9% Proper cold holding temperatures FBI 17.4%
- 15. Top HD ViolationsOverall Top 10 Violations for Specific Chain Industry All (2,587) Q53-Physical facilities installed, maintained and clean 12.10% Q20-Proper cold holding temperatures 4.67% Q45-Food and non food-contact surfaces cleanable, properly designed, constructed and used 9.26% Q47-Nonfood-contact surfaces clean 8.99% Q49-Plumbing installed; proper backflow devices 4.52% Q8-Adequate handwashing sinks properly supplied and accessible 6.12% Q14-Food-contact surfaces: cleaned and sanitized 9.93% Q54-Adequate ventilation and lighting; designated areas use 2.71% Q42-Utensils, equipment and linens: properly stored, dried and handled 3.00% Q37-Contamination prevented during food preparation, storage and display 4.23%
- 16. Use Data toDrive Improvements Understanding risks is the starting point Changing the food safety behaviors of individuals requires a total system approach, including: Education and Manager Certifications Inspections and Audits Hands-on training Motivation and Encouragement Focused service, training and procedures Having a Certified Manager onsite reduces violations by 24% Completing daily Food Safety Logs reduces violations by 44% Restaurants that submit Corrective Actions average 22% less findings
- 17. How to BestLeverage Data Analyze the data to identify trends Which locations/regions to focus on What type of solution might have the biggest effect? Ask for help How could your vendors help you - What solutions or tools do they have - What could they develop for you Should you reach out to a training provider Look for ways to verify that solutions are effective Continue to analyze data
- 18. Connecting the dots… CDC Data - Top Risk Factors for FBI 1. Improper Holding Temperatures 2. Poor Personal Hygiene 3. Inadequate Cooking 4. Unapproved Source 5. Contaminated Equipment HD Data - Top reasons restaurants fail inspections 1. Food and non food-contact surfaces cleanable, properly designed, constructed and used 2. Physical facilities installed, maintained and clean 3. Food-contact surfaces: cleaned and sanitized 4. Nonfood-contact surfaces clean 5. Adequate handwashing sinks properly supplied and accessible
- 19. Illustration: HD DataResearch 19 Methodology: Compared routine health inspection data between outbreak and non-outbreak restaurants Results: • Identified 11 key violations linked to outbreak restaurants • Surprisingly, many were Good Retail Practices, not critical risks of foodborne illness Source: Petran et al. 2012.JFP 75(11):2007-2015.
- 20. Example 1: ContaminatedEquipment & Food Contact Surfaces Cleaned and Sanitized Understand the flow of food through your establishment Understand where there is a possibility of cross-contamination Set up barriers and procedures to block pathogen transfer and growth Use proper sanitization procedures and chemicals, following the label instructions Make sure your kitchen is free of pests
- 21. #1 Real LifeOutbreak 14 patrons at a food service establishment became ill Two hospitalizations. Camplybacter jejuni isolated from all patients Investigation revealed multiple sources of contamination Countertop too small to separate raw poultry and other foods Cook cut up raw chicken before preparing salads Lettuce for salads was shredded with a knife Cook wore a towel around her waist, frequently used to dry hands Uncertain whether the cook had cleaned the countertop after cutting up the chicken Lettuce likely contaminated with raw chicken http://www.cdc.gov/mmwr/preview/mmwrhtml/00051427.htm
- 22. #1 Response: Offeringsfrom a Coach or Provider Contamination prevention Hand care programs Cleaning & sanitation products, equipment and services Supply chain antimicrobial treatments for meat, poultry, and produce Color coded equipment Pest elimination Hand care compliance
- 23. Example 2: PoorPersonal Hygiene & Adequate Handwashing Guidelines Food Code Reference (2013) Description 2-301.12 Hands and Arms - Cleaning Procedures 5-203.11A Provide the number of handwash sinks necessary for the convenient use of employees in food preparation, dispensing, and warewashing area 5-203.11C Use chemically treated towelettes for handwashing a vending machine locations… 5-204.11 Locate a handwashing sink to allow convenient use in food preparation, food dispensing, and Warewashing Areas.… 5-205.11 Maintain a hand washing sink so it is accessible at all times… 6-301.12A Provide and maintain at each handwash sink… a supply of individual disposable towels… 6-501.18 Clean and maintain the handwashing sinks. Avoid unsanitary habits Maintain and monitor their personal health Report illness and wounds Follow hygienic hand practices: good hand washing and proper glove use
- 24. #2 Real LifeOutbreak Guests at different events received sandwiches from common source ≥100 people estimated to be affected Illness associated with sandwiches containing lettuce Employee with norovirus symptoms returned to work the same day that symptoms ended Was still excreting norovirus in his stool Food prep sink used to wash lettuce also used for hand washing Food handlers can contaminate food and cause consumers to become ill Source - MMWR 55(14):395-7
- 25. #2 Response: Offeringsfrom a Coach or Provider Heath Department – Top Violations Address Staff Behavior Offer Tools & Products Adequate handwashing sinks properly supplied and accessible Wash after cough Blocked Sink Wash before glove Towels not available Soap not available Signs not posted • Onsite Review & Coaching • Suggestion of products • Solutions that influence behavior
- 26. Example 3: ImproperHolding Temperatures Tied to Foodborne Illness Can allow pathogens to persist and in some cases, increase to harmful levels Proper hot and cold holding are crucial to food safety Keep food out of the Temperature Danger Zone - Below 41˚F (5˚C) and above 135˚F (57˚C) Monitor proper temperature control with a calibrated thermometer Use equipment designed for keeping food at the proper temperature
- 27. #3 Foodborne IllnessIntoxications Illness attributed to C. perfringens, B. cereus and S. aureus Account for 1.3 million illnesses each year 14% of the 9.4 million illnesses Spores are frequent contaminants Cooking activates the spores allowing for rapid growth of cells These cells grow much faster than other types of bacteria Cells grow in food with poor temperature control Inadequate cooling or cold holding are key risk factors How significant of an issue is this? Source: Scallan, et al. 2011.
- 28. #3 Real LifeOutbreak Typically large numbers of people are affected Under-reporting factor is very large Between 1998 and 2008, improper cooling practices contributed to 504 outbreaks in foodservice settings. (CDC, 2012) Pasta Salad http://jcm.asm.org/content/43/8/4277.full Prepared on Friday for Saturday picnic. Leftovers stored in refrigerator (set at 57F) & consumed on Monday night 1 child died High levels of B. cereus toxin found in salad
- 29. #3 Cold HoldingData On-site data collection at 420 restaurants & 596 foods 69% chains and 31% independents, most served “American” menu Cooling methods: refrigerator>ice bath>room temp>ice wand>blast 16% of ambient temps in cooling units were >41F Reach-in coolers were among the worst Other observations: Depths not shallow enough, Limited ventilation, Stacked foods on top of each other, Lack of ice in ice baths Most managers reported being trained, yet… Did not monitor time or temp 41% of time Thermometer calibration issues 31% of time Source: Brown, et al. 2012. JFP 75(12)2172
- 30. #3 Response: Offeringsto Mitigate Recognize that problem exists Cold Hold #1 or #2 issue Target interventions appropriately Equipment - ambient air temp, machine maintenance issues, gaskets in poor repair, thermostat not set properly… Behaviors - containers filled too high, improper pre-chill, importance of monitoring & verification Cooling devices Call to Action!
- 31. Parting Thoughts Howcould data from inspections and industry be used? In R&D development chemistry and equipment efforts Insight on where to focus training and coaching Broad service solutions Can this be tied to foodborne illness decrease? Goal: Move from Information to Action! Consider… what can you do to prevent another outbreak from being attributed to one of these factors?
- 32.
Editor's Notes
- #3 Food borne illness is a growing public health problem around the globe. Diets moving from grains to proteins in emerging markets. Population growth plus diet shift means 75-100% more calories needed to feed the world. Aging population requires focus on food safety Everyone has a role in promoting food safety.
- #4 Food safety has received global attention. Globally, the World Health Organization has embarked on a project to better estimate global estimates of disease via the “Foodborne Disease Burden Epidemiology Reference Group” (FERG). Final results are expected to be out in October 2015, and preliminary estimates were released April 2015. These represent a shift down from earlier estimates (a billion cases every year and over a million deaths) but these are considered to be more accurate and reflective of just foodborne contaminants. Previous figures included illnesses attributed to water borne contaminants. http://www.who.int/mediacentre/news/releases/2015/food-safety/en/ The data for the US was just updated in December 2010, and represents an update to data last released in 1999, but because different assumptions were used to compute the new numbers, these data sets cannot be compared. Among the 9.4 illnesses with identified causative agents, norovirus causes 58 percent of the illnesses; nontyphoidal salmonella is at 11 percent, clostridium perfringens 10 percent, and campylobacter 9 percent. The majority of these illnesses were caused by unspecified agents with an estimated 38.4 million cases occurring annually. Norovirus remains the top cause of foodborne illness, and Salmonella is the leading cause of hospitalizations and deaths. (http://www.cdc.gov/eid/content/17/1/7.htm) The European Union is beginning to publish foodborne illness summaries by country and causative agent. They do not adjust for under reporting so their numbers are not reported on this slide. In 2008, 5332 outbreaks involving 45,622 people were reported by member states. (http://www.efsa.europa.eu/en/efsajournal/doc/s1496.pdf) Australia estimates their illnesses as well. Link to the most recent info is - http://www.health.gov.au/internet/main/publishing.nsf/Content/E829FA59A59677C0CA257D6A007D2C97/$File/Foodborne-Illness-Australia-circa-2010.pdf. Data for Canada were published in 2013 - Estimates of the Burden of Foodborne Illness in Canada for 30 Specified Pathogens and Unspecified Agents, Circa 2006. M. Kate Thomas, Regan Murray, Logan Flockhart, Katarina Pintar, Frank Pollari, Aamir Fazil, Andrea Nesbitt, and Barbara Marshall. Foodborne Pathogens and Disease. -Not available-, ahead of print. doi:10.1089/fpd.2012.1389. Surveillance systems that are being implemented around the world are being modeled on the system first established by the US CDC. These systems are very useful in identifying the foods and agents that cause the most illness, which can then be used to target control strategies where it does the most good. An unfortunate consequence of these surveillance programs is the fact that they make news when new estimates are reported and sometimes increase consumer anxiety about the safety of the food supply. South Korean data were FBI data were published in 2015 – the first such estimate. Ref - http://online.liebertpub.com/doi/pdfplus/10.1089/fpd.2014.1858
- #6 However, since the numbers of outbreaks attributed to norovirus are so high, we see that this agent is the leading cause of foodborne illness in the US, as well. This slide illustrates how much more Norovirus occurs than the other pathogens. The outbreak numbers do fluctuate each year, perhaps due to short term immunity which might cause a temporary decrease, but the rise shows that the virus quickly mutates to overcome this.
- #9 Data from the CDC (CDC, 2014 – Surveillance for Foodborne Disease Outbreaks United States, 2012: Annual Report) tells us that more than 2/3rds of outbreaks were related to contributing factors of improper holding temperatures, contamination on equipment and the environment, and poor personal hygiene. Frankly, these are rather basic practices that aren’t all that hard to implement…. Estimated using the following contributing factors in each risk factor category from 2012 data released in June 2014: Poor personal hygiene = Bare hand contact (c10) + Infected worker (c12) + Gloved hand contact (c11) + Foods contaminated by non-food handler/worker/preparer who is suspected to be infectious (c13) Other = C2 – Poisonous substance intentionally/deliberately added + C3 – Poisonous substance accidentally/inadvertently added + C4 – Addition of excessive quantities of ingredients that are toxic in large amounts + P10 – Inadequate modified atmosphere packaging + P11 – Inadequate processing (acidification, water activity, fermentation) + P12 – Other situations that promoted or allowed microbial growth or toxic production + S4 – Insufficient or improper use of chemical processes designed for pathogen destruction + S5 – Other process failures that permit pathogen survival Inadequate cooking = C6 – Contaminated raw product – food was intended to be consumed after a kill step + S1 – Insufficient time and/or temperature control during initial cooking/heat processing + S2 – Insufficient time and/or temperature during reheating Improper holding = P1 – Food preparation practices that support proliferation of pathogens (during food preparation) + P2 – No attempt was made to control the temperature of implicated food or the length of time food was out of temperature control + P3 – Improper adherence of approved plan to use Time as a Public Health Control + P4 – Improper cold holding due to malfunctioning refrigeration equipment + P5 – Improper cold holding due to an improper procedure or protocol + P6 – Improper hot holding due to malfunctioning equipment + P7– Improper hot holding due to improper procedure or protocol + P8 – Improper/slow cooling + P9 – Prolonged cold storage + S3 – Insufficient time and/or temperature control during freezing Contaminated equipment/ environment = C5 – Toxic container + C9 – Cross-contamination of ingredients (cross-contamination does not include ill food workers) + C14 – Storage in contaminated environment + C15 – Other source of contamination Unsafe Source = Toxic substance part of tissue (c1) + C7 – Contaminated raw product – food was intended to be consumed raw or undercooked/under-processed + C8 – Foods originating from sources shown to be contaminated or polluted (such as a growing field or harvest area)
- #14 Continuing on this theme of variability, here are average total findings by state. If you think of this in terms of PR risk, you’d guess that your most likely to face a “dirty dining” scandal in Kansas and Connecticut, and least likely to see one in Mississippi. Now let’s say you want to reduce your PR risk and try to reduce health dept violations across the country – where would you focus? [next page] -State budgets? -FL is more structured as it has dedicated departments specialized in restaurants and hotels. Local counties are only responsible for schools, hospitals, prisons and convenient stores etc. Therefore, they have budget and resources available. FL is digital for quite some times as it has more public awareness and transparency -MS, what we have noticed is that they have more assessment forms instead of formal inspection forms. In addition, with the assessment forms inspectors write observations instead of citing violations.
- #15 These are the most commonly cited issues. [Note how these are similar / different than typical EcoSure findings]
- #18 3rd Bullet Data Source – EcoSure has done these correlations several times over the years.
- #20 Implemented Project “Risk Zone” to help Ecosure customers identify risks
- #21 Lettuce contaminated with raw chicken (http://www.cdc.gov/mmwr/preview/mmwrhtml/00051427.htm)
- #25 Norovirus Outbreak Subs – Michigan, 2005 MMWR 55(14):395-7 Guests at different events received sandwiches from common source > 100 people estimated to be affected Illness associated with sandwiches containing lettuce Employee with norovirus symptoms returned to work the same day his symptoms ended Was still excreting Norovirus in his stool Food prep sink used to wash lettuce also used for hand washing After this… Michigan issued guidelines that food service workers with suspected norovirus not return to work until they are asymptomatic for 48-72 hours
- #30 Methods: Refrigeration – 47% Ice bath – 19% Room temp – 17% Ice wand – 8% Blast – 0.5% Thermometer calibration “issues” defined as - frequency < monthly, not done or unsure if done.