Ground beef handling and cooking practices in restaurants in eight States

Developing a risk management framework to improve public health outcomes by enumerating and serotyping Salmonella in ground turkey

Salmonella enterica continues to be a leading cause of foodborne morbidity worldwide. A quantitative risk assessment model was developed to evaluate the impact of pathogen enumeration and serotyping strategies on public health after consumption of undercooked contaminated ground turkey in the USA. The risk assessment model predicted more than 20,000 human illnesses annually that would result in ~700 annual reported cases. Removing ground turkey lots contaminated with Salmonella exceeding 10 MPN/g, 1 MPN/g, and 1 MPN/25 g would decrease the mean number of illnesses by 38.2, 73.1, and 95.0%, respectively. A three-class mixed sampling plan was tested to allow the detection of positive lots above threshold levels with 2-6 (c = 1) and 3-8 samples per lot (c = 2) using 25-g and 325-g sample sizes for a 95% probability of rejecting a contaminated lot. Removal of positive lots with the presence of highly virulent serotypes would decrease the number of illnesses by 44.2-87.0%. Based on these model prediction results, risk management strategies should incorporate pathogen enumeration and/or serotyping. This would have a direct impact on illness incidence linking public health outcomes with measurable food safety objectives, at the cost of diverting production lots.

Salmonella Outbreaks Linked to Beef, United States, 2012-2019

The Centers for Disease Control and Prevention (CDC) has identified nontyphoidal Salmonella as one of the top five pathogens contributing to foodborne illnesses in the United States. Beef continues to be a common source of Salmonella outbreaks, despite the implementation of interventions at slaughter and processing facilities to reduce contamination of beef. We described Salmonella outbreaks linked to beef in the United States during 2012-2019, examined trends, and identified potential targets for intervention and prevention strategies. We queried CDC's Foodborne Disease Outbreak Surveillance System (FDOSS) for all foodborne nontyphoidal Salmonella outbreaks linked to beef as the single contaminated ingredient or implicated food, with the date of first illness onset from 2012 to 2019. Information on antimicrobial resistance (AR) for outbreak-related isolates was obtained from CDC's National Antimicrobial Resistance Monitoring System (NARMS). We calculated the number of outbreaks, outbreak-related illnesses, hospitalizations, and deaths overall, by beef processing category and Salmonella serotype. During 2012-2019, 27 Salmonella outbreaks were linked to beef consumption, resulting in 1103 illnesses, 254 hospitalizations, and two deaths. The most common category of beef implicated was nonintact raw, ground beef (12 outbreaks, 44%), followed by intact raw (six outbreaks, 22%). Ground beef was responsible for the most illnesses (800, 73%), both of the reported deaths, and was the source of the largest outbreak. AR data were available for 717 isolates from 25 (93%) outbreaks. Nine (36%) of these outbreaks had isolates resistant to one or more of the antibiotics tested by NARMS, of which eight (89%) contained multidrug-resistant isolates. Several outbreaks reported highlight challenges faced during investigations, areas where further research may be warranted, and opportunities to prevent future outbreaks along the farm-to-fork continuum.

Quantitative Risk Assessment of Salmonella in Ground Beef Products and the Resulting Impact of Risk Mitigation Strategies on Public Health

Salmonellosis incidence rates have not declined over the last 15 years in the US despite a significant Salmonella prevalence reduction in meat and poultry products. Ground beef is currently regulated using only qualitative Salmonella criteria, and Salmonella enumeration values have been proposed as an alternative for implementing risk-based mitigation strategies to prevent illnesses. The purpose of this study was to develop a quantitative microbial risk assessment (QMRA) model to estimate the annual number of salmonellosis cases attributable to the consumption of ground beef contaminated with Salmonella and investigate the impact of risk management strategies on public health. Model results estimated 8,980 (6,222-14,215, 90% CI) annual illnesses attributable to ground beef consumption in the US. The removal or diversion of highly contaminated ground beef production lots containing levels above 10 MPN/g (0.4%) and 1 MPN/g (2.4%) would result in a 13.6% (5369-12280, 90% CI) and 36.7% (3939-8990, 90% CI) reduction of annual salmonellosis illnesses, respectively. Frozen ground beef cooked at home was the consumption scenario of highest risk for acquiring salmonellosis. Highly virulent serotypes accounted for 96.7% of annual illnesses despite only being present in 13.7% of ground beef samples. The removal of MDR Salmonella would result in decreased burden of disease with a 44% reduction in acute DALY annually. Focusing salmonellosis reduction efforts on removing highly contaminated ground beef lots, highly virulent Salmonella serotypes, and MDR Salmonella from not-ready-to-eat (NRTE) products were predicted to be effective risk prevention strategies.

Efficacy of Common Antimicrobial Interventions at and above Regulatory Allowable Pick-Up Levels on Pathogen Reduction

The objective of this study was to evaluate the food safety efficacy of common antimicrobial interventions at and above required uptake levels for processing aids on the reduction of Shiga-toxin producing E. coli (STEC) and Salmonella spp. through spray and dip applications. Beef trim was inoculated with specific isolates of STEC or Salmonella strains. Trim was intervened with peracetic or lactic acid through spray or dip application. Meat rinses were serially diluted and plated following the drop dilution method; an enumerable range of 2-30 colonies was used to report results before log transformation. The combination of all treatments exhibits an average reduction rate of 0.16 LogCFU/g for STEC and Salmonella spp., suggesting that for every 1% increase in uptake there is an increase of 0.16 LogCFU/g of reduction rate. There is a statistical significance in the reduction rate of Shiga-toxin producing Escherichia coli in relation to the uptake percentage (p < 0.01). The addition of explanatory variables increases the R² of the regression for STEC, where all the additional explanatory variables are statistically significant for reduction (p < 0.01). The addition of explanatory variables increases the R² of the regression for Salmonella spp., but only trim type is statistically significant for reduction rate (p < 0.01). An increase in uptake percentages showed a significant increase in reduction rate of pathogens on beef trimmings.

A Farm-to-Fork Quantitative Microbial Exposure Assessment of β-Lactam-Resistant Escherichia coli among U.S. Beef Consumers

Integrated quantitative descriptions of the transmission of β-lactam-resistant Escherichia coli (BR-EC) from commercial beef products to consumers are not available. Here, a quantitative microbial exposure assessment model was established to simulate the fate of BR-EC in a farm-to-fork continuum and provide an estimate of BR-EC exposure among beef consumers in the U.S. The model compared the per-serving exposures from the consumption of intact beef cuts, non-intact beef cuts, and ground beef. Additionally, scenario analysis was performed to evaluate the relative contribution of antibiotic use during beef cattle production to the level of human exposure to BR-EC. The model predicted mean numbers of BR-EC of 1.7 × 10⁻⁴, 8.7 × 10⁻⁴, and 6.9 × 10⁻¹ CFU/serving for intact beef cuts, non-intact beef cuts, and ground beef, respectively, at the time of consumption. Sensitivity analyses using the baseline model suggested that factors related to sectors along the supply chain, i.e., feedlots, processing plants, retailers, and consumers, were all important for controlling human exposure to BR-EC. Interventions at the processing and post-processing stages are expected to be most effective. Simulation results showed that a decrease in antibiotic use among beef cattle might be associated with a reduction in exposure to BR-EC from beef consumption. However, the absolute reduction was moderate, indicating that the effectiveness of restricting antibiotic use as a standalone strategy for mitigating human exposure to BR-EC through beef consumption is still uncertain. Good cooking and hygiene practices at home and advanced safety management practices in the beef processing and post-processing continuum are more powerful approaches for reducing human exposure to antibiotic-resistant bacteria in beef products.

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

ABSTRACT

Suboptimal food worker health and hygiene has been a common contributing factor in foodborne disease outbreaks for many years. Despite clear U.S. Food and Drug Administration (FDA) Model Food Code recommendations for hand washing and glove use, food worker compliance with hand washing recommendations has remained poor for >20 years. Food workers' compliance with recommended hand washing guidelines is adversely impacted by a number of barriers, including complaints of time pressure, inadequate number and/or location of hand washing sinks and hand washing supplies, lack of food knowledge and training regarding hand washing, the belief that wearing gloves obviates the need for hand washing, insufficient management commitment, and adverse skin effects caused by frequent hand washing. Although many of the issues related to poor hand washing practices in food service facilities are the same as those in health care settings, a new approach to health care hand hygiene was deemed necessary >15 years ago due to persistently low compliance rates among health care personnel. Evidence-based hand hygiene guidelines for health care settings were published by both the Centers for Disease Control and Prevention in 2002 and by the World Health Organization in 2009. Despite similar low hand washing compliance rates among retail food establishment workers, no changes in the Food Code guidelines for hand washing have been made since 2001. In direct contrast to health care settings, where frequent use of alcohol-based hand sanitizers (ABHSs) in lieu of hand washing has improved hand hygiene compliance rates and reduced infections, the Food Code continues to permit the use of ABHSs only after hands have been washed with soap and water. This article provides clear evidence to support modifying the FDA Model Food Code to allow the use of ABHSs as an acceptable alternative to hand washing in situations where heavy soiling is not present. Emphasis on the importance of hand washing when hands are heavily soiled and appropriate use of gloves is still indicated.

HIGHLIGHTS

A Comparative Quantitative Assessment of Human Exposure to Various Antimicrobial-Resistant Bacteria among U.S. Ground Beef Consumers

ABSTRACT

Consumption of animal-derived meat products is suspected as an important exposure route to antimicrobial resistance, as the presence of antimicrobial-resistant bacteria (ARB) along the beef supply chain is well documented. A retail-to-fork quantitative exposure assessment was established to compare consumers' exposure to various ARB due to the consumption of ground beef with and without "raised without antibiotics" claims and to inform potential exposure mitigation strategies related to consumer practices. The microbial agents evaluated included Escherichia coli, tetracycline-resistant (TETr) E. coli, third-generation cephalosporin-resistant E. coli,Salmonella enterica, TETrS. enterica, third-generation cephalosporin-resistant S. enterica, nalidixic acid-resistant S. enterica, Enterococcus spp., TETrEnterococcus spp., erythromycin-resistant Enterococcus spp., Staphylococcus aureus, and methicillin-resistant S. aureus. The final model outputs were the probability of exposure to at least 0 to 6 log CFU microorganisms per serving of ground beef at the time of consumption. It was estimated that tetracycline resistance was more prevalent in ground beef compared with other types of resistance, among which the predicted average probability of ingesting TETrEnterococcus was highest (6.2% of ingesting at least 0 log CFU per serving), followed by TETrE. coli (3.1%) and TETrSalmonella (0.0001%), given common product purchase preferences and preparation behaviors among beef consumers in the United States. The effectiveness of consumer-related interventions was estimated by simulating the differences in exposure as a result of changes in consumer practices in purchasing, handling, and preparing ground beef. The results indicated that proper use of recommended safe cooking and food preparation practices mitigates ARB exposure more effectively than choosing raised without antibiotics compared with conventional beef.

HIGHLIGHTS

Restaurant Policies and Practices Related to Norovirus Outbreak Size and Duration

ABSTRACT

Norovirus is the leading cause of foodborne illness outbreaks in the United States, and restaurants are the most common setting of foodborne norovirus outbreaks. Therefore, prevention and control of restaurant-related foodborne norovirus outbreaks is critical to lowering the burden of foodborne illness in the United States. Data for 124 norovirus outbreaks and outbreak restaurants were obtained from Centers for Disease Control and Prevention surveillance systems and analyzed to identify relationships between restaurant characteristics and outbreak size and duration. Findings showed that restaurant characteristics, policies, and practices were linked with both outbreak size and outbreak duration. Compared with their counterparts, restaurants that had smaller outbreaks had the following characteristics: managers received food safety certification, managers and workers received food safety training, food workers wore gloves, and restaurants had cleaning policies. In addition, restaurants that provided food safety training to managers, served food items requiring less complex food preparation, and had fewer managers had shorter outbreaks compared with their counterparts. These findings suggest that restaurant characteristics play a role in norovirus outbreak prevention and intervention; therefore, implementing food safety training, policies, and practices likely reduces norovirus transmission, leading to smaller or shorter outbreaks.

HIGHLIGHTS

Listeria monocytogenes Occurrence and Adherence to Recommendations: Small and Large Retail Delicatessens in Iowa

The goal of this research was to determine the prevalence of Listeria monocytogenes in Iowa retail delicatessens and assess environmental aspects that mitigate L. monocytogenes. Fifty-seven small and large retail delicatessens in Iowa were selected randomly. More small operations (n = 43) were included as compared with larger stores, given the higher frequency of violations. An environmental assessment instrument was used to determine environmental factors and practices. At least five microbial samples were collected per site. We collected 286 (74.3%) of 385 microbial samples from small deli operations and 99 (25.7%) of 385 samples from large deli operations. Samples were taken from various zone 1 and 2 areas, such as the slicer, deli case, and meat scale; three (0.08%) samples were positive for L. monocytogenes. Regarding environmental aspects, not preparing, holding or storing ready-to-eat products near raw products (n = 30, 53%) was practiced by the fewest delis. The majority of establishments were observed covering, wrapping, or protecting ready-to-eat products when not in use to prevent contamination (n = 56, 98.2%). Comparisons were made to the U.S. Department of Agriculture Food Safety and Inspection Service Guidance on environmental practices, and 60% of the operations surveyed were in adherence with at least seven of the eight recommendations.

No Change in Risk for Antibiotic-Resistant Salmonellosis from Beef, United States, 2002-2010

Restricting antibiotic use in food production animals is a target for reducing antimicrobial drug–resistant infections in humans. To estimate the probability of antibiotic-resistant nontyphoidal salmonellosis per meal made with beef during 2002–2010, we used US surveillance data. Applying data for nontyphoidal Salmonella in raised-without-antibiotics cattle, we tested the effect of removing antibiotic use from all beef cattle production. We found an average of 1.2 antibiotic-resistant nontyphoidal salmonellosis cases per 1 million beef meals made with beef initially contaminated with antibiotic-resistant nontyphoidal Salmonella at slaughter or retail and 0.031 cases per 1 million meals irrespective of beef contamination status. Neither outcome showed sustained change except for increases in 2003 and 2009 (>98% confidence) when larger or more outbreaks occurred. Switching all beef production to a raised-without-antibiotics system may not have a significant effect on antibiotic-resistant nontyphoidal salmonellosis (94.3% confidence).

Zoonotic implications of camel diseases in Iran

Approximately 60% of all human pathogens and 75% of emerging infectious diseases are zoonotic (of animal origin). Camel zoonotic diseases can be encountered in all camel-rearing countries. In this article, all studies carried out on camel zoonotic diseases in Iran are reviewed to show the importance of camels for public health in this country. More than 900 published documents were systematically searched to find relevant studies from 1,890 until late 2018. The collected articles were classified according to the aetiological agents. In this study, 19 important zoonotic diseases were reported among Iranian camels including listeriosis, leptospirosis, plague, Q fever, brucellosis, campylobacteriosis, tuberculosis, pasteurellosis, clostridiosis, salmonellosis, Escherichia coli infections, rabies, camelpox, Middle East respiratory syndrome coronavirus, Crimean-Congo haemorrhagic fever, echinococcosis, cryptosporidiosis, toxoplasmosis and dermatophytosis, most of which belong to bacterial, viral, parasitic and fungal pathogens, respectively. Results show that camels are one of the most important sources of infections and diseases in human; therefore, continuous monitoring and inspection programs are necessary to prevent the outbreak of zoonotic diseases caused by this animal in humans.

Restaurant Characteristics Associated With the Use of Specific Food-Cooling Methods

Pathogen growth caused by improper or slow cooling of hot foods was a contributing factor in 504 of restaurant- and deli-related outbreaks in the U.S. from 1998-2008. Little is known, however, about restaurant cooling practices. To fill this gap, the Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted an observational study to identify and understand factors that might determine which methods restaurants follow to rapidly cool food. These methods include refrigerating food at ≤41 °F, at shallow depths, and in containers that are ventilated, unstacked, and have space around them. EHS-Net personnel collected data through manager interviews and observation of cooling processes in 420 randomly selected restaurants. Regression analyses revealed characteristics of restaurants most likely to use the cooling methods assessed. These characteristics included ownership by restaurant chains, manager food safety training and certification, few foods cooled at a time, many meals served daily, and a high ratio of workers to managers. These findings suggest that regulatory food safety programs and the retail industry might improve cooling methods-and reduce outbreaks-by providing and encouraging manager food safety training and certification, and by focusing intervention efforts on independent and smaller restaurants.

Inactivation of Shiga Toxin-Producing Escherichia coli in Refrigerated and Frozen Meatballs Using High Pressure Processing

High pressure processing (HPP) was evaluated to inactivate Shiga toxin-producing Escherichia coli (STEC) in raw meatballs. Ground meat (>90% lean) was inoculated (ca. 7.0 log CFU/g) with a rifampicin-resistant cocktail of eight STEC strains (O26:H11, O45:H2, O103:H2, O104:H4, O111:H-, O121:H19, O145:NM, and O157:H7). Inoculated ground beef, ground veal, or a mixture of ground beef, pork, and veal were separately mixed with liquid whole eggs and seasonings, shaped by hand into meatballs (40 g each), and stored at −20 or at 4 °C for at least 18 h. Samples were then exposed to 400 or 600 MPa for 0 to 18 min. There were no differences (p > 0.05) in pathogen reduction related to the species of meat used or for meatballs that were refrigerated (0.9 to 2.9 log CFU/g) compared to otherwise similar meatballs that were stored frozen (1.0 to 3.0 log CFU/g) prior to HPP treatment. However, less time was needed to achieve a ≥ 2.0 log CFU/g reduction at 600 MPa (1 to 3 min) compared to 400 MPa (at least 9 min). This work provides new and practically useful information on the use of HPP to inactivate STEC in raw meatballs.

Interventions Targeting Deep Tissue Lymph Nodes May Not Effectively Reduce the Risk of Salmonellosis from Ground Pork Consumption: A Quantitative Microbial Risk Assessment

The inclusion of deep tissue lymph nodes (DTLNs) or nonvisceral lymph nodes contaminated with Salmonella in wholesale fresh ground pork (WFGP) production may pose risks to public health. To assess the relative contribution of DTLNs to human salmonellosis occurrence associated with ground pork consumption and to investigate potential critical control points in the slaughter-to-table continuum for the control of human salmonellosis in the United States, a quantitative microbial risk assessment (QMRA) model was established. The model predicted an average of 45 cases of salmonellosis (95% CI = [19, 71]) per 100,000 Americans annually due to WFGP consumption. Sensitivity analysis of all stochastic input variables showed that cooking temperature was the most influential parameter for reducing salmonellosis cases associated with WFGP meals, followed by storage temperature and Salmonella concentration on contaminated carcass surface before fabrication. The input variables were grouped to represent three main factors along the slaughter-to-table chain influencing Salmonella doses ingested via WFGP meals: DTLN-related factors, factors at processing other than DTLNs, and consumer-related factors. The evaluation of the impact of each group of factors by second-order Monte Carlo simulation showed that DTLN-related factors had the lowest impact on the risk estimate among the three groups of factors. These findings indicate that interventions to reduce Salmonella contamination in DTLNs or to remove DTLNs from WFGP products may be less critical for reducing human infections attributable to ground pork than improving consumers' cooking habits or interventions of carcass decontamination at processing.

Psychosocial and organizational determinants of safe food handling at retail and food service establishments: a systematic review and meta-analysis

Various psychosocial and organizational factors have been investigated as determinants of food handlers' food safety behaviours. A systematic review and meta-analysis of studies in this area was conducted to identify and synthesize the key behavioural determinants. Standard systematic review steps were followed: comprehensive search strategy; relevance screening; article characterization; risk of bias assessment; data extraction; and random-effects meta-analysis. Sixty-two relevant studies were identified, and knowledge was the most commonly investigated behavioural determinant (n = 51). Increased knowledge was consistently associated with safe food handing behaviours across both correlation (r = 0.30; 95% confidence interval [CI]: 0.12, 0.46; n = 24 studies; I² = 98%) and odds ratio (OR) measures (adjusted OR = 1.85; 95% CI: 1.27, 2.70; n = 3; I² = 0%). Seven other behavioural determinant categories were also consistently associated with various food safety behaviour outcomes. In contrast, no association was found between food handler experience and behaviour. The findings can inform the development of targeted training initiatives for food handlers.

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

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 relative lack of written policies for ill workers and glove use and paid sick leave for workers in establishments with outbreaks indicates gaps in food safety practices that might have a role in outbreak prevention. The environmental health component of the investigation for most outbreaks was initiated quickly, yet the longer initiation timeframe for certain outbreaks suggests the need for improvement.

Public Health Action

Retail establishments can reduce viral foodborne illness outbreaks by protecting food from contamination through proper hand hygiene and excluding workers who are ill or infectious from working. NEARS data can help prioritize training and interventions for state and local food safety programs and the retail food establishment industry by identifying gaps in food safety policies and practices and types of establishments vulnerable to outbreaks. Improvement of certain outbreak investigation practices (e.g., delayed initiation of environmental health investigations) can accelerate identification of the agent and implementation of interventions. Future analysis comparing establishments with and without outbreaks will contribute knowledge about how establishments’ characteristics and food safety policies and practices relate to foodborne illness outbreaks and provide information to develop effective prevention approaches.

Developing a risk management framework to improve public health outcomes by enumerating Salmonella in ground turkey

Salmonella spp. continue to be a leading cause of foodborne morbidity worldwide. To assess the risk of foodborne disease, current national regulatory schemes focus on prevalence estimates of Salmonella and other pathogens. The role of pathogen quantification as a risk management measure and its impact on public health is not well understood. To address this information gap, a quantitative risk assessment model was developed to evaluate the impact of pathogen enumeration strategies on public health after consumption of contaminated ground turkey in the USA. Public health impact was evaluated by using several dose–response models for high- and low-virulent strains to account for potential under- or overestimation of human health impacts. The model predicted 2705–21 099 illnesses that would result in 93–727 reported cases of salmonellosis. Sensitivity analysis predicted cooking an unthawed product at home as the riskiest consumption scenario and microbial concentration the most influential input on the incidence of human illnesses. Model results indicated that removing ground turkey lots exceeding contamination levels of 1 MPN/g and 1 MPN in 25 g would decrease the median number of illnesses by 86–94% and 99%, respectively. For a single production lot, contamination levels higher than 1 MPN/g would be needed to result in a reported case to public health officials. At contamination levels of 10 MPN/g, there would be a 13% chance of detecting an outbreak, and at 100 MPN/g, the likelihood of detecting an outbreak increases to 41%. Based on these model prediction results, risk management strategies should incorporate pathogen enumeration. This would have a direct impact on illness incidence linking public health outcomes with measurable food safety objectives.

Retail Deli Slicer Inspection Practices: An EHS-Net Study

The Centers for Disease Control and Prevention (CDC) estimates that 3,000 people die in the United States each year from foodborne illness, and Listeria monocytogenes causes the third highest number of deaths. Risk assessment data indicate that L. monocytogenes contamination of particularly delicatessen meats sliced at retail is a significant contributor to human listeriosis. Mechanical deli slicers are a major source of L. monocytogenes cross-contamination and growth. In an attempt to prevent pathogen cross-contamination and growth, the U.S. Food and Drug Administration (FDA) created guidance to promote good slicer cleaning and inspection practices. The CDC's Environmental Health Specialists Network conducted a study to learn more about retail deli practices concerning these prevention strategies. The present article includes data from this study on the frequency with which retail delis met the FDA recommendation that slicers should be inspected each time they are properly cleaned (defined as disassembling, cleaning, and sanitizing the slicer every 4 h). Data from food worker interviews in 197 randomly selected delis indicate that only 26.9% of workers ( n = 53) cleaned and inspected their slicers at this frequency. Chain delis and delis that serve more than 300 customers on their busiest day were more likely to have properly cleaned and inspected slicers. Data also were collected on the frequency with which delis met the FDA Food Code provision that slicers should be undamaged. Data from observations of 685 slicers in 298 delis indicate that only 37.9% of delis ( n = 113) had slicers that were undamaged. Chain delis and delis that provide worker training were more likely to have slicers with no damage. To improve slicer practices, food safety programs and the retail food industry may wish to focus on worker training and to focus interventions on independent and smaller delis, given that these delis were less likely to properly inspect their slicers and to have undamaged slicers.

Food Safety Practices Linked with Proper Refrigerator Temperatures in Retail Delis

Listeria monocytogenes (L. monocytogenes) causes the third highest number of foodborne illness deaths annually. L. monocytogenes contamination of sliced deli meats at the retail level is a significant contributing factor to L. monocytogenes illness. The Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted a study to learn more about retail delis' practices concerning L. monocytogenes growth and cross-contamination prevention. This article presents data from this study on the frequency with which retail deli refrigerator temperatures exceed 41°F, the Food and Drug Administration (FDA)-recommended maximum temperature for ready-to-eat food requiring time and temperature control for safety (TCS) (such as retail deli meat). This provision was designed to control bacterial growth in TCS foods. This article also presents data on deli and staff characteristics related to the frequency with which retail delis refrigerator temperatures exceed 41°F. Data from observations of 445 refrigerators in 245 delis showed that in 17.1% of delis, at least one refrigerator was >41°F. We also found that refrigeration temperatures reported in this study were lower than those reported in a related 2007 study. Delis with more than one refrigerator, that lacked refrigerator temperature recording, and had a manager who had never been food safety certified had greater odds of having a refrigerator temperature >41°F. The data from this study suggest that retail temperature control is improving over time. They also identify a food safety gap: some delis have refrigerator temperatures that exceed 41°F. We also found that two food safety interventions were related to better refrigerated storage practices: kitchen manager certification and recording refrigerated storage temperatures. Regulatory food safety programs and the retail industry may wish to consider encouraging or requiring kitchen manager certification and recording refrigerated storage temperatures.

Assessment of Risk Communication about Undercooked Hamburgers by Restaurant Servers

According to the U.S. Food and Drug Administration 2013 Model Food Code, it is the duty of a food establishment to disclose and remind consumers of risk when ordering undercooked food such as ground beef. The purpose of this study was to explore actual risk communication behaviors of food establishment servers. Secret shoppers visited 265 restaurants in seven geographic locations across the United States, ordered medium rare burgers, and collected and coded risk information from chain and independent restaurant menus and from server responses. The majority of servers reported an unreliable method of doneness (77%) or other incorrect information (66%) related to burger doneness and safety. These results indicate major gaps in server knowledge and risk communication, and the current risk communication language in the Model Food Code does not sufficiently fill these gaps. The question is "should servers even be acting as risk communicators?" There are numerous challenges associated with this practice, including high turnover rates, limited education, and the high stress environment based on pleasing a customer. If servers are designated as risk communicators, food establishment staff should be adequately trained and provided with consumer advisory messages that are accurate, audience appropriate, and delivered in a professional manner so that customers can make informed food safety decisions.

Compliance With Recommended Food Safety Practices in Television Cooking Shows

OBJECTIVE

Examine compliance with recommended food safety practices in television cooking shows.

METHODS

Using a tool based on the Massachusetts Food Establishment Inspection Report, raters examined 39 episodes from 10 television cooking shows.

RESULTS

Chefs demonstrated conformance with good retail practices for proper use and storage of utensils in 78% of episodes; preventing contamination (62%), and fingernail care (82%). However, 50% to 88% of episodes were found to be out of compliance with other personal hygiene practices, proper use of gloves and barriers (85% to 100%), and maintaining proper time and temperature controls (93%). Over 90% failed to conform to recommendations regarding preventing contamination through wiping cloths and washing produce. In only 13% of episodes were food safety practices mentioned.

CONCLUSIONS AND IMPLICATIONS

There appears to be little attention to food safety during most cooking shows. Celebrity and competing chefs have the opportunity to model and teach good food safety practices for millions of viewers.

Restaurant Policies and Practices for Serving Raw Fish in Minnesota

The number of restaurants serving sushi within Minnesota is continuously increasing. The practices and protocols of serving raw fish are complex and require detailed planning to ensure that food served to patrons will not cause illness. Although the popularity of sushi is increasing, there is a lack of research on food safety issues pertaining to preparation of raw fish and sushi rice. To address this gap, the Minnesota Department of Health Environmental Health Specialists Network Food program collected descriptive data on restaurant practices and policies concerning the service of raw fish and sushi rice in 40 Minnesota restaurants. At each restaurant, a specialist interviewed a restaurant manager, conducted an observation of the sushi prep areas in the restaurant kitchen, and reviewed parasite destruction letters and invoices from fish supplier(s). Over half of the restaurants (59%) were missing one or more of the parasite destruction letters from their fish supplier(s) guaranteeing that fish had been properly frozen to the time and temperature requirements in the Minnesota Food Code. A total of 42 parasite destruction letters from suppliers were observed; 10% were considered "adequate" letters. The majority of the letters were missing details pertaining to the types of fish frozen, the length of time fish were frozen, or details on what temperatures fish were held frozen or a combination of all three. Most restaurants were using time as a public health control for their sushi rice. For those restaurants using time as a public health control, 26% had a written procedure on-site, and approximately 53% were keeping track of time. Bare hand contact during sushi prep was observed in 17% of restaurants, and in more than 40% of the restaurants, at least one fish was mislabeled on the menu. Findings from this study indicate that many Minnesota restaurants are not complying with the Food Code requirements pertaining to parasite destruction for the service of raw fish or the use of time as a public health control for sushi rice.

Comprehensive Evaluation and Implementation of Improvement Actions in Butcher Shops

Foodborne pathogens can cause acute and chronic diseases and produce a wide range of symptoms. Since the consumption of ground beef is a risk factor for infections with some bacterial pathogens, we performed a comprehensive evaluation of butcher shops, implemented improvement actions for both butcher shops and consumers, and verified the impact of those actions implemented. A comprehensive evaluation was made and risk was quantified on a 1-100 scale as high-risk (1-40), moderate-risk (41-70) or low-risk (71-100). A total of 172 raw ground beef and 672 environmental samples were collected from 86 butcher shops during the evaluation (2010-2011) and verification (2013) stages of the study. Ground beef samples were analyzed for mesophilic aerobic organisms, Escherichia coli and coagulase-positive Staphylococcus aureus enumeration. Salmonella spp., E. coli O157:H7, non-O157 Shiga toxin-producing E. coli (STEC), and Listeria monocytogenes were detected and isolated from all samples. Risk quantification resulted in 43 (50.0%) high-risk, 34 (39.5%) moderate-risk, and nine (10.5%) low-risk butcher shops. Training sessions for 498 handlers and 4,506 consumers were held. Re-evaluation by risk quantification and microbiological analyses resulted in 19 (22.1%) high-risk, 42 (48.8%) moderate-risk and 25 (29.1%) low-risk butcher shops. The count of indicator microorganisms decreased with respect to the 2010-2011 period. After the implementation of improvement actions, the presence of L. monocytogenes, E. coli O157:H7 and stx genes in ground beef decreased. Salmonella spp. was isolated from 10 (11.6%) ground beef samples, without detecting statistically significant differences between both study periods (evaluation and verification). The percentage of pathogens in environmental samples was reduced in the verification period (Salmonella spp., 1.5%; L. monocytogenes, 10.7%; E. coli O157:H7, 0.6%; non-O157 STEC, 6.8%). Risk quantification was useful to identify those relevant facts in butcher shops. The reduction of contamination in ground beef and the environment was possible after training handlers based on the problems identified in their own butcher shops. Our results confirm the feasibility of implementing a comprehensive risk management program in butcher shops, and the importance of information campaigns targeting consumers. Further collaborative efforts would be necessary to improve foodstuffs safety at retail level and at home.

Effect of Deep-Frying or Conventional Oven Cooking on Thermal Inactivation of Shiga Toxin-Producing Cells of Escherichia coli in Meatballs

We investigated the effects of deep-frying or oven cooking on inactivation of Shiga toxin-producing cells of Escherichia coli (STEC) in meatballs. Finely ground veal and/or a finely ground beef-pork-veal mixture were inoculated (ca. 6.5 log CFU/g) with an eight-strain, genetically marked cocktail of rifampin-resistant STEC strains (STEC-8; O111:H, O45:H2, O103:H2, O104:H4, O121:H19, O145:NM, O26:H11, and O157:H7). Inoculated meat was mixed with liquid whole eggs and seasoned bread crumbs, shaped by hand into 40-g balls, and stored at -20°C (i.e., frozen) or at 4°C (i.e., fresh) for up to 18 h. Meatballs were deep-fried (canola oil) or baked (convection oven) for up to 9 or 20 min at 176.7°C (350°F), respectively. Cooked and uncooked samples were homogenized and plated onto sorbitol MacConkey agar with rifampin (100 μg/ml) followed by incubation of plates at 37°C for ca. 24 h. Up to four trials and three replications for each treatment for each trial were conducted. Deep-frying fresh meatballs for up to 5.5 min or frozen meatballs for up to 9.0 min resulted in reductions of STEC-8 ranging from ca. 0.7 to ≥6.1 log CFU/g. Likewise, reductions of ca. 0.7 to ≥6.1 log CFU/g were observed for frozen and fresh meatballs that were oven cooked for 7.5 to 20 min. This work provides new information on the effect of prior storage temperature (refrigerated or frozen), as well as subsequent cooking via deep-frying or baking, on inactivation of STEC-8 in meatballs prepared with beef, pork, and/or veal. These results will help establish guidelines and best practices for cooking raw meatballs at both food service establishments and in the home.

Retail Deli Slicer Cleaning Frequency--Six Selected Sites, United States, 2012

Listeria monocytogenes (Listeria) causes the third highest number of foodborne illness deaths (an estimated 255) in the United States annually, after nontyphoidal Salmonella species and Toxoplasma gondii (1). Deli meats are a major source of listeriosis illnesses, and meats sliced and packaged at retail delis are the major source of listeriosis illnesses attributed to deli meat (4). Mechanical slicers pose cross-contamination risks in delis and are an important source of Listeria cross-contamination. Reducing Listeria contamination of sliced meats in delis will likely reduce Listeria illnesses and outbreaks. Good slicer cleaning practices can reduce this foodborne illness risk. CDC's Environmental Health Specialists Network (EHS-Net) studied how often retail deli slicers were fully cleaned (disassembled, cleaned, and sanitized) at the Food and Drug Administration (FDA) Food Code-specified minimum frequency of every 4 hours and examined deli and staff characteristics related to slicer cleaning frequency. Interviews with staff members in 298 randomly-selected delis in six EHS-Net sites showed that approximately half of delis fully cleaned their slicers less often than FDA's specified minimum frequency. Chain-owned delis and delis with more customers, more slicers, required manager food safety training, food safety-knowledgeable workers, written slicer-cleaning policies, and food safety-certified managers fully cleaned their slicers more frequently than did other types of delis, according to deli managers or workers. States and localities should require deli manager training and certification, as specified in the FDA Food Code. They should also consider encouraging or requiring delis to have written slicer-cleaning policies. Retail food industry leaders can also implement these prevention efforts to reduce risk in their establishments. Because independent and smaller delis had lower frequencies of slicer cleaning, prevention efforts should focus on these types of delis.

Risk Assessment of Escherichia coli O157 illness from consumption of hamburgers in the United States made from Australian manufacturing beef

We analyze the risk of contracting illness due to the consumption in the United States of hamburgers contaminated with enterohemorrhagic Escherichia coli (EHEC) of serogroup O157 produced from manufacturing beef imported from Australia. We have used a novel approach for estimating risk by using the prevalence and concentration estimates of E. coli O157 in lots of beef that were withdrawn from the export chain following detection of the pathogen. For the purpose of the present assessment an assumption was that no product is removed from the supply chain following testing. This, together with a number of additional conservative assumptions, leads to an overestimation of E. coli O157-associated illness attributable to the consumption of ground beef patties manufactured only from Australian beef. We predict 49.6 illnesses (95%: 0.0-148.6) from the 2.46 billion hamburgers made from 155,000 t of Australian manufacturing beef exported to the United States in 2012. All these illness were due to undercooking in the home and less than one illness is predicted from consumption of hamburgers cooked to a temperature of 68 °C in quick-service restaurants.