Food Protection Connection: What to Do if You Suspect a Foodborne Illness Outbreak

(reprinted from Dietary Manager, July 2010)

One of the greatest fears of any foodservice operator is that someone will get sick from the food served in their operation.  Unfortunately, even with stringent precautions in place it can sometimes happen.  It’s important to have policies and procedures in place to prevent foodborne illness in the first place. It’s just as important to have a crisis management plan to follow in the event a foodborne illness occurs on your watch. 

What is the likelihood this will happen to you?  The best source of information about the incidence of foodborne illness is the Centers for Disease Control and Prevention (CDC).  They compile and analyze information from a variety of sources and estimate that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Of these illnesses, known pathogens (ones that can be identified) only account for about 20 percent of those statistics, while unknown pathogens (that can’t be specifically identified) account for the remainder.  The CDC reports that overall, foodborne diseases appear to cause more illnesses but fewer deaths than previously estimated.  That is good news and bad news – fewer people die from foodborne illness, but more people are getting sick.  It reinforces the need to make sure food in your establishment is handled safely.

Hundreds of known diseases are transmitted through food. The causes of foodborne illness include viruses, bacteria, parasites, toxins, metals, and prions¹, and the symptoms of foodborne illness range from mild gastroenteritis to life-threatening conditions.  With ongoing changes in the food supply, new foodborne diseases are being identified, and better techniques for identifying pathogens, there may be many more than previously known. The impact of a foodborne illness on a facility, patients or residents, and their families can be enormous.  So it pays to be prepared.

Identifying a Possible Outbreak
How do you know if you might have a possible outbreak of foodborne illness?  It could start with a call from nursing when a resident is exhibiting foodborne illness symptoms or there seems to be a pattern to illness in the facility.  It could also begin with a concern expressed by a family member.  In any case, the inquiry should be taken seriously. Staff members should be instructed to report any call or comment that might indicate a foodborne illness to their supervisor immediately so it can be investigated.   It is helpful to have a form or report that guides you or your staff in the investigation process and that provides valuable documentation of the incident. This form should include the following information:

• Date and time the information was received;
• Resident or patient name and room number or contact information if the person was a visitor or customer;
• Physician contact information and if the physician was contacted and/or the person hospitalized?
• Health Department contact name and the date the incident was reported to the regulatory authority;
• Suspected food item and details including
• Manufacturer’s product information
• Supplier’s information (invoice, date received, etc.)
• Description of preparation, storage, and service of the food item including staff members involved in those processes.
• Symptoms the person is experiencing, meals eaten, suspected food eaten and amount consumed, other activities the resident may have been involved in (such as outings or eating outside of the facility and any sensitivities, allergies, or food preferences that may pertain to the symptoms;
• Documentation of any other persons (include resident, staff, family members, visitors) that have reported illness or exhibited symptoms; and
• Documentation that your supervisor, administrator, and/or nursing director have been notified.

Follow Up
If the complaint is regarding a patient or resident, you should work closely with the nursing director and administrator during the process. Once you have documented all pertinent information you should follow the lead of administration and the health department.   Any food suspected should be removed from service, stored in the refrigerator, and labeled with the date and a “DO NOT EAT” sign.  The health department may require a sample for testing in order to confirm an outbreak.  You should also review food handling processes and employee hygiene to spot possible problems and to reinforce food safety principles and practices. This would include the following:

• Document the process by which the suspect food is handled from receipt to service (i.e., source, condition received, storage practices/temperatures, preparation/cooking processes, temperatures (holding/serving), chilling/reheating procedures and service).  Identify if food safety was compromised during any of these steps.  If so, begin corrective action.
• Document food temperatures, especially the foods implicated. Confirm that your staff routinely tracks and documents temperatures.
• Observe food handling processes and record any potential or occurring cross-contamination or temperature abuse.
• Observe employees. Identify if anyone has been out sick or exhibited symptoms of illness 10 days prior to or after the incident date. Check employees for the presence of cuts, burns, or absorbent bandages on the hands/arms or infected sores on the face. Document status of personal hygiene.
• Document whether frequent and proper handwashing occurs. Are ready-to-eat foods being handled with bare hands or are gloves/utensils being used?
• Check for proper cleaning and sanitizing of equipment/utensils. Check the dishmachine and/or 3-compartment sink for proper operation.
• Check wiping cloth water for proper sanitizer level and note if wiping cloths are being utilized properly. Document water supply and sewage disposal system. Check for cross connections or wastewater back up.
•  Document storage of toxic/poisonous substances (they may have been accidentally or intentionally added).  Are they properly stored and labeled?

You should also know the process for reporting foodborne illness to the regulatory authority and who has that responsibility. It may be the responsibility of the nursing director or the administrator – or you may be charged with doing it.  The contact person and the procedure should be somewhere where you can easily access it if needed.  This is also something that should be reviewed with other staff that may be placed in charge when you are out of the facility.

One last thing that needs to be in place is a policy and procedure for handling media inquiries should the incident be newsworthy.  This applies to more than a possible foodborne illness outbreak, but is increasingly necessary in today’s world. 

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More Info

For more information on developing a crisis management plan for your facility these resources may be useful to you.

Most states have foodborne illness reporting forms. Consult your state health department for a form you can adapt to your operation. 

Operating Procedure: Responding to a Foodborne Illness Complaint. Iowa State University Extension, HACCP Information Center. Includes sample policies and procedures for schools, healthcare and restaurants.  http://www.extension.iastate.edu/HRIM/HACCP/
Florida Division of Hotels and Restaurants Complaint Forms (sample state form) http://www.myfloridalicense.com/dbpr/hr/forms/complaint-forms.html

¹Prion is an infectious protein particle similar to a virus but lacking nucleic acid. It is thought to be the agent responsible for scrapie² and other degenerative diseases of the nervous system.
²Scrapie is a fatal disease of sheep characterized by chronic itching and loss of muscular control and progressive degeneration of the central nervous system.  Its counterpart in human illness is Creutzfeldt-Jakob disease³. 
³Creutzfeldt–Jakob disease or CJD, (sometimes incorrectly referred to as mad cow disease) is a degenerative brain disease that is incurable and invariably fatal.  It is the most common among the types of transmissible spongiform encephalopathy found in humans.

by Colleen Zenk, MS, CDM, CFPP
Colleen Zenk, MS, CDM, CFPP is Director of Nutrition and Consumer Information for the Minnesota Beef Council. She is a member of ANFP’s Certifying Board for Dietary Managers, and a past ANFP Chair of the Board.