Foodborne Illness Outbreaks at Retail Establishments — National Environmental Assessment Reporting System, 16 State and Local Health Departments, 2014–2016

Abstract

Problem/Condition State and local public health departments report hundreds of foodborne illness outbreaks each year to CDC and are primarily responsible for investigations of these outbreaks. Typically, investigations involve epidemiology, laboratory, and environmental health components. Health departments voluntarily report epidemiologic and laboratory data from their foodborne illness outbreak investigations to CDC through the Foodborne Disease Outbreak Surveillance System (FDOSS); however, minimal environmental health data from outbreak investigations are reported to FDOSS. Period Covered 2014–2016. Description of System In 2014, CDC launched the National Environmental Assessment Reporting System (NEARS) to complement FDOSS surveillance and to use these data to enhance prevention efforts. State and local health departments voluntarily report data from their foodborne illness outbreak investigations of retail food establishments. These data include characteristics of foodborne illness outbreaks (e.g., agent), characteristics of establishments with outbreaks (e.g., number of meals served daily), food safety policies and practices of these establishments (e.g., glove use policies), and characteristics of outbreak investigations (e.g., timeliness of investigation activities). NEARS is the only available data source that includes characteristics of retail establishments with foodborne illness outbreaks. Results During 2014–2016, a total of 16 state and local public health departments reported data to NEARS on 404 foodborne illness outbreaks at retail establishments. The majority of outbreaks with a suspected or confirmed agent were caused by norovirus (61.1%). The majority of outbreaks with identified contributing factors had at least one factor associated with food contamination by a worker who was ill or infectious (58.6%). Almost half (47.4%) of establishments with outbreaks had a written policy excluding ill workers from handling food or working. Approximately one third (27.7%) had a written disposable glove use policy. Paid sick leave was available for at least one worker in 38.3% of establishments. For most establishments with outbreaks (68.7%), environmental health investigators initiated their component of the investigation soon after learning about the outbreak (i.e., the same day) and completed their component in one or two visits to the establishment (75.0%). However, in certain instances, contacting the establishment and completing the environmental health component of the investigation occurred much later (>8 days). Interpretation Most outbreaks reported to NEARS were caused by norovirus, and contamination of food by workers who were ill or infectious contributed to more than half of outbreaks with contributing factors; these findings are consistent with findings from other national outbreak data sets and highlight the role of workers in foodborne illness outbreaks. The ...

Scientific Evidence Supports the Use of Alcohol-Based Hand Sanitizers as an Effective Alternative to Hand Washing in Retail Food and Food Service Settings When Heavy Soiling Is Not Present on Hands

“…Perhaps the presence of noticeable debris on workers' hands from working with raw food makes workers more inclined to wash their hands appropriately. However, in multiple subsequent studies, compliance with provision G continued to be suboptimal (2,17,89,97).…”

“…The lack of specificity of the Food Code recommendation may account in part for differences in glove policies in retail establishments. In a 2014 to 2016 survey, most establishments required gloves when handling ready-to-eat foods and when workers had cuts or other skin injuries, but only half required gloves to be worn at all times when working in a kitchen (89). The same survey revealed that bare-hand contact by potentially infectious workers (food handlers and preparers) was one of the top 10 factors contributing to outbreaks in retail food service establishments (89).…”

“…The five most common foodborne pathogens in the United States, in order of decreasing frequency of cases, are norovirus, non-typhoidal Salmonella, Clostridium perfringens, Campylobacter species, and Staphylococcus aureus (28). Norovirus accounted for 61% of outbreaks in retail food establishments reported to the National Environmental Assessment Reporting System from 2014 to 2016 (89). Although transmission of foodborne pathogens can occur in multiple settings (e.g., catering, institutional facilities, delicatessens, home kitchens, and grocery stores), analyses of data from the last two decades revealed that 56 to 80% of reported foodborne illness outbreaks were related to restaurants (2,40,89).…”

“…Between 1990 and 1999, poor hand washing by food workers was reported as a contributing factor in 31% of outbreaks in Washington State (145). Recent studies spanning 1998 to 2016 revealed that food worker health and hygiene were implicated as contributing causes in 59 to 76% of outbreaks of norovirus infection (2,89,97). Continuing to work while ill with vomiting and/or diarrhea undoubtedly contributes to outbreaks of foodborne illness, including those due to norovirus (18,23,139).…”

Foodborne Parasites in Europe: Present Status and Future Trends

“…Improved transportation, particularly the cold-chain, is an important reason for globalization of the food supply [10]. Consequently, foodborne disease outbreaks today are less likely to be limited geographically, and international foodborne disease outbreaks have become more common [11,12]. One example is recurrent outbreaks of cyclosporosis in the USA associated with imported fresh produce [13].…”