A Multidisciplinary Approach to Investigating Foodborne Illness - - PowerPoint PPT Presentation

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A Multidisciplinary Approach to Investigating Foodborne Illness - - PowerPoint PPT Presentation

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A Multidisciplinary Approach to Investigating Foodborne Illness Outbreaks June 26, 2019 Overview Seattle-King Countys Approach to Foodborne Illness Investigation Q&A Session Housekeeping Items Throughout the presentation,

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A Multidisciplinary Approach to Investigating Foodborne Illness Outbreaks

June 26, 2019

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SLIDE 2

Overview

  • Seattle-King County’s

Approach to Foodborne Illness Investigation

  • Q&A Session
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SLIDE 3

Housekeeping Items

Throughout the presentation, please use the Q&A box to ask questions and the chat box to share your experiences. The facilitator will pose your questions to the presenters.

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SLIDE 4

Recordingg

A link to the recorded webinar will be emailed to all participants. This recording and past food safety sharing sessions can also be found the NACCHO website: https://www.naccho.org/programs/envir

  • nmental-health/hazards/food-safety/
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PUBLIC HEALTH – SEATTLE & KING COUNTY FOODBORNE ILLNESS INVESTIGATION TEAM June 26, 2019 NACCHO Sharing Session

FOODBORNE ILLNESS OUTBREAK INVESTIGATION OVERVIEW

Doug Dyer, MS, RS Elysia Gonzales, RN, MPH

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KING COUNTY, WASHINGTON

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SEATTLE

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Environmental Health Food Program: 65 staff Communicable Disease Epidemiology: 40 staff Communications: 8 staff

STAFF – BY THE NUMBERS

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PREVIOUS SYSTEM

E P I E H C O M M S E P I E H C O M M S

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TEAM APPROACH

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EH Members in Training EH Experienced Members EH Food Program Leads

FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)

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EH Members in Training: 7 staff EH Experienced Members: 10 staff EH Food Program Leads: 12 staff

Responsibilities

FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)

Provide technical advice and support Partner with restaurant investigator in the field Back-up to experienced members

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EH Members in Training: 7 staff EH Experienced Members: 10 staff

FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)

Epi Food Program Leads: 12 staff

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EH Members in Training EH Experienced Members EH Food Program Leads

Comms Foodborne Lead Epi Foodborne Liaison Lead Senior Foodborne Technical Lead

Lead Roles

FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)

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Small group with expertise Increases investigation consistency & effectiveness Clear roles/responsibilities FIIT members are:

  • Capable to perform many roles as needed
  • Ready to deploy
  • Mentors

WHY HAVE A FIIT?

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OUTBREAK INVESTIGATION PROCESS

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Reports received Plan Approach Investigation request Team prep call Field investigation Team field call Team disclosure meeting Public disclosure Follow-up steps After action

INVESTIGATION PROCESS

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  • 1. RECEIVE REPORTS

Salmonella

Epi

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  • 2. PLAN APPROACH

Epi EH Comms Lab

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  • 2. TEAM PREP

Fie ield in ld investig igatio ion t team am

EH Restaurant Investigator EH FIIT Investigator Epi Investigator (as needed) Comms

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  • 2. TOOLKIT ESSENTIALS

 Planning checklist

  • Guides prep for field investigation (before, during, after)
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  • 2. TOOLKIT ESSENTIALS

 Planning checklist

  • Guides prep for field investigation (before, during, after)

 Organism-specific resource guide

  • Guide to tailor investigation into CF’s for typical foodborne pathogens
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SLIDE 23

ORGANISM-SPECIFIC RESOURCE GUIDE

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  • 2. TOOLKIT ESSENTIALS

 Planning checklist

  • Guides prep for field investigation (before, during, after)

 Organism-specific resource guide

  • Guide to tailor investigation into CF’s for typical foodborne pathogens

 Resources for operators

  • Includes chlorine concentrations for noro; FDA illness policy forms
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VOMITING AND DIARRHEA CLEANUP

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  • 2. TOOLKIT ESSENTIALS

 Planning checklist

  • Guides prep for field investigation (before, during, after)

 Organism-specific resource guide

  • Guide to tailor investigation into CF’s for typical foodborne pathogens

 Resources for operators

  • Includes chlorine concentrations for noro; FDA illness policy forms

 Employee illness screening forms

  • Self-report form in multiple languages
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  • 2. TOOLKIT ESSENTIALS

 Planning checklist

  • Guides prep for field investigation (before, during, after)

 Organism-specific resource guide

  • Guide to tailor investigation into CF’s for typical foodborne pathogens

 Resources for operators

  • Includes chlorine concentrations for noro; FDA illness policy forms

 Employee illness screening forms

  • Self-report form in multiple languages

 Environmental Assessment (EA) Form

  • WA’s modified version of the CDC NEARS form
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ENVIRONMENTAL ASSESSMENT FORM

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  • 2. TOOLKIT ESSENTIALS

 Planning checklist

  • Guides prep for field investigation (before, during, after)

 Organism-specific resource guide

  • Guide to tailor investigation into CF’s for typical foodborne pathogens

 Resources for operators

  • Includes chlorine concentrations for noro; FDA illness policy forms

 Employee illness screening forms

  • Self-report form in multiple languages

 Environmental Assessment (EA) Form

  • WA’s modified version of the CDC NEARS form

 Sampling kits

  • Specimen kits and cooler for use if indicated
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  • 3. FIELD INVESTIGATION REQUEST

EH Submits standardized request form Epi

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INVESTIGATION REQUEST FORM

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  • 4. TEAM PREP CALL

Epi EH

Field team included

EH Restaurant Investigator EH FIIT Investigator Epi Investigator

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  • 5. FIELD INVESTIGATION

SAM & ELLA'S DINER

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  • 5. FIELD INVESTIGATION ROLES
  • Explains process

to person in charge at restaurant

  • NEARS form data
  • Diffuses tension
  • Collects samples

(if indicated)

EH FIIT INVESTIGATOR

  • Conducts routine

inspection, with focus on contributing factors for Salmonella

EH RESTAURANT INVESTIGATOR EPI INVESTIGATOR

  • Screens staff

for illness

  • Observational

data

  • Assists EH

investigators

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  • 6. TEAM FIELD CALL

Field investigation team

EH Restaurant Investigator EH FIIT Investigator Epi Investigator

EH / Epi leads

 Review field findings  Answer questions from restaurant management  Make decisions on immediate interventions  Discuss sample collection

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  • 7. TEAM DISCLOSURE MEETING

Review:  Findings from Epi, EH, and Lab  Strength of evidence  Interventions and remaining steps  Need for disclosure  Need for blog

EH + Epi + Comms

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  • 8. PUBLIC DISCLOSURE

www.kingcounty.gov/outbreak

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  • 8. PUBLIC EXPECTATIONS FOR

TRANSPARENCY

Health officials, who investigated the outbreak, did not inform the public. "I find that completely, unequivocally wrong," said Bill Marler, a food safety litigator in Seattle. "They have a responsibility to the public."

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Investigation led by King County, and cluster was:

CONFIRM RMED: FBD outbreak with lab evidence confirming the outbreak etiology PROBA BABL BLE: FBD outbreak with observational evidence and contributing factors without lab evidence SUSPEC PECT [ [po possibl ssible] e]: Group of cases linked by time

  • r place without strong evidence linking to a

common food

  • 8. WHICH OUTBREAKS TO DISCLOSE?
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  • 8. TIMING OF DISCLOSURE

Disclose while investigation is ongoing if:

 Risk to the public still exists  Public can take action to protect their health  Severe outcomes seen  Case finding is needed  Need to prevent or interrupt misinformation  High profile concerns (media or political)  Novel vehicle identified

Otherwise, disclose once investigation is complete

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Follow-up site visit(s) by EH Work with WA DOH Lab on testing specimens Work with local, state, and federal partners Update public disclosure with final outcomes Complete report forms (NEARS/NORS)

  • 9. FOLLOW-UP STEPS
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  • 10. AFTER ACTION REVIEW

What was supposed to happen? What actually happened? What worked & what was challenging? What can be improved next time?

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BENEFITS OF TEAM APPROACH

Many perspectives More effective & efficient Delineates roles Builds expertise Increases trust Increased cultural competency

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CHALLENGES OF TEAM APPROACH

Filling absences Every investigation is unique Maintaining experience Too many cooks in the kitchen Balancing thoroughness with efficiency

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LESSONS LEARNED

Hold after action debriefs Maintain equal partnerships, not hierarchical Quarterly FIIT meetings and frequent trainings

  • Table top exercises
  • Case reviews

Disclosure process is time intensive but effective

  • PH leads by speaking first, reducing misinformation
  • Decreased media calls
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LESSONS LEARNED

Identify points-of-contact for each program Include Epi investigator in EH field visits Share data across programs Team approach requires broad engagement Make time for process improvement activities Develop consistent tools internally and externally

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Elysi sia G Gonza nzales, s, Epidemiology Foodborne Disease Program Manager elysia.gonzales@kingcounty.gov Dou Doug Dy Dyer, Environmental Health Senior Technical Lead ddyer@kingcounty.gov Ki Ki S Str traughn, ghn, Environmental Health Services Supervisor kstraughn@kingcounty.gov Kat ate C Col

  • le, Communications Specialist

kacole@kingcounty.gov

THANK YOU!

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 Counc ncil t il to Improve e Foodborne e Outbrea eak R Response ( e (CIFOR OR): www.cifor.us  FD FDA R A Retail P Progr

  • gram Standard 5

5 - Foodborne ne Il Illne ness ss and nd Food D Defense nse Prepa paredne dness a ss and nd Response nse: www.fda.gov/media/86813/download  Epi pi-Read ady T Team eam Train aining ng: www.neha.org/professional- development/education-and-training/epi-ready-team-training  CD CDC C Integra rated F Food S Safety Ce y Centers o

  • f Ex

Excellence (CO (COE): E): www.cdc.gov/foodsafety/centers/pdfs/coe-factsheet.pdf  Council of f St State and nd Territorial E Epi pidemiologist sts ( s (CSTE): www.cste.org/page/WebinarLibrary  Rapi pid R Response nse T Teams ( s (RRTs) s): www.fda.gov/federal-state-local-tribal- and-territorial-officials/national-integrated-food-safety-system-ifss- programs-and-initiatives/rapid-response-teams-rrts  USD SDA/ A/FSIS: S: www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and- public-health-alerts/audience-public-health/resources-for  National E Environme mental A Assessme ment R Reporti ting S System ( m (NEARS): www.cdc.gov/nceh/ehs/nears/index.htm  CDC Natio ational al Ou Outb tbreak R Rep eporti ting S System ( (NOR ORS): www.cdc.gov/nors/resources.html

RESOURCES

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Q&A Session

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Tha hank you

  • u f

for

  • r your

pa participation i in n toda day’s sh sharing se session!

For more information about NACCHO’s Food Safety and Infectious Disease Programs, contact:

  • Amy Chang(achang@naccho.org)
  • Erin Laird (elaird@naccho.org)

NACCHO Food Safety Webpage: http://www.naccho.org/programs/environmental

  • health/hazards/food-safety

NACCHO Infectious Disease Webpage: https://www.naccho.org/programs/community- health/infectious-disease