Multiple outbreaks of a novel norovirus GII.4 linked to an infected post-symptomatic food handler in NZ

Thornley et al write in the current issue of Epidemiology and Infection that multiple norovirus outbreaks following catered events in Auckland, New Zealand, in September 2010 were linked to the same catering company and investigated.

Retrospective cohort studies were undertaken with attendees of two events: 38 (24·1%) of 158 surveyed attendees developed norovirus-compatible illness. Attendees were at increased risk of illness if they had consumed food vomit(7)that had received manual preparation following cooking or that had been prepared within 45 h following end of symptoms in a food handler with prior gastroenteritis. All food handlers were tested for norovirus. A recombinant norovirus GII.e/GII.4 was detected in specimens from event attendees and the convalescent food handler. All catering company staff were tested; no asymptomatic norovirus carriers were detected.

This investigation improved the characterization of norovirus risk from post-symptomatic food handlers by narrowing the potential source of transmission to one individual. Food handlers with gastroenteritis should be excluded from the workplace for 45 h following resolution of symptoms.

Ooey, Ooey, Ooey, Ooey Allergies

The Wiggles, Australia’s highest-grossing and soon to be retired musical act, played a farewell gig last week after an 18 month reunion of their original lineup. The make-up album brought a song about allergies that Sam, our two-year-old, likes with the line, You can have a reaction to foods that you eat, it can be really serious with shellfish nuts and seeds.

I don’t have any food allergies that I know of, but I’ve had a couple of reactions to ASA (the compound found in Aspirin) resulting in a body full of hives for six weeks. That sucked, but it was just an inconvenience. Food allergy sufferers have reactions somewhere on a continuum between this nuisance and death. If The Wiggles are an indicator, the recognition and public discussion around allergens has increased but along with the attention comes a potentially dangerous attitude that an allergy isn’t severe, or the kid’s parents are overly protective.

And then comes the bullying. NJ.com reports that Dr. Eyal Shemesh and colleagues at the Icahn School of Medicine at Mount Sinai have published a study in Pediatrics that shows that kids with allergies are bullied at a higher rate than their peers, which might cause them to avoid interventions.

The suffering is often done in silence. Nearly half of parents surveyed said they were unaware of the bullying, though both the bullied children and their parents reported experiencing higher stress levels and lower quality of life.

“Parents and pediatricians should routinely ask children with food allergy about bullying,” said Dr. Eyal Shemesh, Associate Professor of Pediatrics and Psychiatry at the Icahn School of Medicine at Mount Sinai. “Finding out about the child’s experience might allow targeted interventions, and would be expected to reduce additional stress and improve quality of life for these children trying to manage their food allergies.”

Food service staff, the front-line folks for allergy protection, can’t tell whether an allergic reaction is going to lead to patron’s slight discomfort or worse. Allergen control and food safety practices are similar, but at the root of both issues is the organization and employee’s recognition of risks, reduction methods and evaluating whether everyone is really doing it. In the June 2013 issue of Food Control, Ji Hee Choi and Lakshman Rajagopal discuss knowledge, attitude and self-reported practices of food service employees regarding food allergies. When asked on a survey, food service staff report that allergens are important – but they couldn’t always identify what the allergens of concern are, and seemed to not retain specific allergen knowledge from training.

From the discussion:
Respondents in this study were knowledgeable about what a food allergy is and how to handle customers with food allergies; however, most respondents were not knowledgeable about the top eight food allergens from a given list of allergens…
 Employees scored higher on attitudinal statements related to the importance of foodservice staff providing accurate information to customers with food allergies to prevent incidences of food allergy reactions. However, employees were not confident about effectively handling food allergy emergencies. Employees’ positive attitudes toward food allergies and handling patrons with food allergies might be explained by the possession of food safety certification, which could also be a proxy for training received. However, no significant differences in knowledge scores were observed between employees who had received food safety certification and those who were not certified. This indicates that while certification and training maybe crucial for improving knowledge, it might not always be the case, as employees might not retain the knowledge or the training may not have contained updated information about food allergies.

Training matters, but not much (if retention counts) – and self reported practices don’t always match real life. The studied staff know something is up with allergens (maybe because the consequences are high), but don’t know exactly what to focus on. The less-trusting patrons of a food business who are looking for verification that their food is allergen-free can explore a bevy of apps to track symptoms, explore product ingredients or do uh, colormetric assays to look for traces of proteins (test reliability might be problematic).

From NPR’s The Salt:

Ozcan’s lab on a phone looks like it could take care of the inaccuracy problem. But the prototype requires users to undertake a mini chemistry experiment. They would have to grind up the food, mix it in a test tube with hot water and a solvent, and then mix it with a series of testing liquids. That process takes about 20 minutes.

 

Surveys still suck; useless at measuring culture

Food safety culture is all the rage. I was gassing on about it in 2007 in Calgary based on funding proposals me and Amy wrote in 2006, Chris had started down that path much earlier, and Frank wrote book about it in 2008.

Now, it’s everywhere, and seems to have already jumped the shark.

A self-reported survey does not measure culture; it measures what people think they’re supposed to say. Observation, direct or indirect, is much more powerful.

Neal et al invoke the food safety culture brand in the latest issue of Food Protection Trends, which I glanced at while luffaing in my Kansas hot tub (which seemed ridiculous since it was 105F or 40.5C outside).

The authors say, “One of the most important procedures that retail food establishments
(RFEs) can implement to decrease the chance of foodborne illness is training employees on proper food handling practices.”

There’s no evidence that works.

So in a study allegedly designed to “assess food safety practices contributing to food safety culture in food service operations,” the authors conclude the “two most important factors for developing a food safety culture in food service operations are management commitment and worker food safety behavior."

Jumped the shark.

Brote de norovirus 
en California Pizza Kitchen, relacionado 
con empleados enfermos

 Traducido por Gonzalo Erdozain

Resumen del folleto informativo mas reciente:
– Mas de 20 clientes de un restaurant de la cadena California Pizza Kitchen reportaron vomito, diarrea, dolor de estomago y nausea.
– Tres empleados también fueron afectados por dicho brote.
– No prepare alimentos si esta enfermo, sobre todo si los síntomas incluyen diarrea (durante la cual la transmisión es mas común) o vomito (ya que partículas del virus pueden esparcirse a otras superficies, ropa y manos).
Los folletos informativos son creados semanalmente y puestos en restaurantes, tiendas y granjas, y son usados para entrenar y educar a través del mundo. Si usted quiere proponer un tema o mandar fotos para los folletos, contacte a Ben Chapman a benjamin_chapman@ncsu.edu.

Puede seguir las historias de los folletos informativos y barfblog en twitter
@benjaminchapman y @barfblog.

Food server fired for Facebook post

 I keep telling my kids, what you put on facebook or anywhere will follow you around, so be sure you want it public.

I also tell them I walked 5 miles to school in massive piles of snow and that things aren’t as good as they used to be (I walked about 50 yards).

Eater reports that a California Chili’s waitress was fired for posting the following on Facebook: "Next time you tip me $5 on a $138 bill, don’t even bother coming in cause I’ll spit in your food and then in your fuckig [sic] face you cheap bastards!!!!!!!!!" The Daily Dot breaks down the story, which involves the websites Reddit, 4Chan, and a Chili’s customer service rep repeatedly insisting "the quality of food we serve is of utmost importance."

Everything you wanted to know about gloves but were afraid to ask

“A clean hand is better than a dirty glove,” say the Aussies.

For years – decades – I’ve heard from food safety types at food service that they know gloves don’t do much during food prep, but the public complains if workers aren’t wearing their gloves; the gloves stay.

Which comes first, food service mindlessly blaming public perception, or taking responsibility and influencing public opinion based on evidence?

Aliza Green, a Philadelphia chef-consultant and author, had a great take on the glove-or-no-glove issue in the Washington Post a couple of days ago. Excerpts below:

A food preparation worker washes her hands and puts on gloves. She needs to make chicken salad. She starts by seasoning the poultry pieces, rubbing them with salt, pepper and herbs, and then spreads them out in a pan for steaming. Wearing the same pair of gloves, she dices celery and onions. She makes the dressing. Finally, she cuts up the cooked chicken, mixes the salad and packs it away, ready to sell.

A line cook with gloves on his freshly washed hands gets an order for a hamburger, grabs the raw patty from the refrigerator and slaps it on the grill. Once the burger is cooked, he picks up a bun and plates up the burger with lettuce, tomato and fries — all without pulling on a new pair.

In my more than 35 years in the food business as a chef and consultant, I have seen a lot of scary things. And those common scenes are among them.

I’ve been in and out of the kitchens in hotels and independent restaurants, of caterers and commissaries. These days, food handlers are expected to wear gloves especially when they’re working in public view. However, those gloves are good only if the hands they are covering are clean. To my mind, gloves are problematic; people equate them with food safety.

According to a 2007 study in the Journal of Food Protection, “Hand washing and glove use were also related to each other — hand washing was less likely to occur with activities in which gloves were worn.” A 2010 study in the same journal concludes, “Glove use can create a false sense of security, resulting in more high-risk behaviors that can lead to cross-contamination when employees are not adequately trained.” Also in the report: “Occlusion of the skin during long-term glove use in food operations creates the warm, moist conditions necessary for microbial proliferation and can increase pathogen transfer onto foods through leaks or exposed skin or during glove removal.” In other words, just wearing gloves can create dangerous conditions.

With the use of food-safe gloves of various materials, we have created a new set of problems as well: the huge waste of resources in producing and disposing of billions of pairs every year. It’s money that could be spent on kitchen improvements such as providing automatic or foot pedal-operated hand sinks and enough time for workers to wash their hands a reasonable number of times per day. People may be allergic to gloves, especially those made from latex, while potentially carcinogenic and toxic materials are used in making certain types of gloves.

Although there are some very good arguments to be made for wearing gloves in certain circumstances, such as when mixing a batch of meatballs and when workers have a wound on their hands, we should reevaluate the automatic and ubiquitous usage.

“People put those darn gloves on and they think they’re protected,” says Denise Korniewicz, dean of the college of nursing at the University of North Dakota and an expert on the efficacy of gloves. “The best way to prevent the transmission of bacteria, virus or other bug is to wash hands thoroughly, adhering to the protocols that we know work. When evaluating food safety, it’s not the gloves I observe; rather it’s what workers are doing with their hands, like using the phone or wiping their nose.”

Studies done in the United Kingdom and published in 2010 concluded that gloved hands can contribute as much, if not more, bacteria to foods than bare hands. That same year, an American study in a fast-food restaurant found more than twice as much coliform bacteria in tortilla samples handled by gloved workers compared with bare hands.

“We may need to make sure workers wash by putting cameras in the sink area of restrooms,” Korniewicz says. “All too often, they haven’t been provided with convenient, clean hand sinks with plenty of soap and paper towels. If enough time and proper materials for washing were provided, we could all have more confidence in the safety of prepared food, reducing our dependence on gloves.”

Using gloves in the kitchen dates back further than you might realize. In Rome about 2,500 years ago, “the wealthier classes kept slave bakers; very grand people made these slaves wear gloves to knead the dough and masks to protect it from perspiration and the breath of the common person,” according to “A History of Food,” by Maguelonne Toussaint-Samat. The first use of rubber gloves was in 1883. Eleven years later, they were included in the standard surgical procedure at Johns Hopkins Hospital. An Australian company, Ansell, created the first disposable latex medical gloves in 1964 by adapting the technique they use for the manufacture of condoms.

Jared Johnson, executive chef for the Heathland Hospitality Group in Philadelphia, told me “the average person is more aware of cross-contamination and food-borne illnesses than 10 years ago. If my crew wears gloves while serving, it puts the customer at ease and we can focus on the food and service. However, I’m not a fan of wearing gloves while chopping, because glove pieces could end up in the food.”

Wearing gloves is meant to protect the consumer from dangerous diseases that can be transmitted mostly through ready-to-eat foods. Culprits include the viruses hepatitis A and the highly contagious norovirus, responsible for about 50 percent of all outbreaks of food-related illness and transmitted through foods such as leafy greens, fresh fruits and shellfish. Bacteria that cause serious food-borne illnesses include E. coli, found in cattle and in infected humans; salmonella typhi, which lives only in humans; shigella, which is transmitted mostly through eating or drinking contaminated food or water; and listeria, which is found in unpasteurized dairy products and ready-to-eat foods such as deli meats and soft cheeses.

Regulations for glove use vary greatly within and outside the United States. FDA recommends handwashing before making food and putting on gloves to make food. In New York state, ready-to-eat food must be prepared and served without bare-hand contact by wearing gloves or, alternatively, using tongs, forks and spoons, deli paper, wax paper, napkins or spatulas. The Arkansas Department of Health has a different viewpoint: “Glove usage has not been proven to lower the incidence of food-borne illnesses. Gloves become just as dirty as the bare hand but are not as likely to be replaced as often as the hands are washed.”

Note that liquid hand sanitizers are to be used after handwashing, not as a substitute for it, and that hands must then be allowed to air-dry after using them and before working with food.

Regulations and practices must be workable, however. I recently had to take a ServeSafe course created by the National Restaurant Association. Food managers working in Philadelphia are required to take it and to pass the certification exam. My classmates included a young woman starting a specialty cookie business, the manager of a senior services facility in a church, the owner of a drive-in movie theater that serves food and the owner of a neighborhood pizzeria.

I found the information overly detailed, highly impractical and lacking in simple basic principles based on common sense. In one case study in the course book, a food worker was supposed to have washed his hands 12 times in the time between breakfast and lunch service. That would never happen in any kitchen I’ve ever seen.

To improve food safety in real-life conditions, the CDC recommends revising food preparation methods to reduce the number of handwashings needed, for example by decreasing the number of times a worker has to handle raw meat when making a sandwich. 

Fewer laws, more leaders: food safety culture key to, uh, food safety

“I don’t think we need more laws, we need more leaders.”

That’s one of several gems offered up by David Theno, buried in a too-long piece about food service food safety by Carolyn Surh of QSR.

An increased focus on raw produce safety has changed the way restaurants handle certain foods. For instance, the FDA now considers raw cut tomatoes a potentially hazardous food, in the same category as meats, seafood, eggs, and poultry.

For operations serving raw produce, well-known safety precautions such as storing or holding foods at appropriate temperatures, maintaining good personal hygiene, and avoiding cross-contamination are especially important. Even more vital, experts say, is sourcing a safe food supply chain.

For restaurants serving fresh, raw produce, ensuring that growers and processors are taking every precaution to avoid contamination can be difficult.

“On the supply side, one of the biggest risks today is produce,” Theno says. “There are many people who are trying to do a better job, so I don’t want to demean the [produce] industry, but I can tell you there are a lot of people who are not doing as well as others.”

Even the simplest food-safety practices continue to challenge restaurants where turnover rates are high and the staff tends to be young and inexperienced. Safety protocols and governmental regulations provide a framework by which to train employees, but the key is strong leadership, Theno says.

“How often is an inspector in a facility?” Theno asks. “Regulations give you a minimum set of standards, but if you’re going to make food safety happen, it’s a leadership thing. I don’t think we need more laws, we need more leaders.”

Indeed, strong management is a constant that can be applied over the vast number of localities that monitor food safety. Throughout the country, there are approximately 3,500 state and local health jurisdictions. Subject to guidelines that are adopted differently from county to county, foodservice operators know just how complex multi-state compliance can be.

With so much variance from location to location, on top of daily pressures like labor and supply chain, Theno has seen the best results in organizations where management places food safety at the top of the list.

“Where it’s done exceptionally well it’s because the leadership really owns these matters—they walk the talk, they live it,” Theno says. “Every day they ask questions that show their team that food safety is as important if not more important than everything else they do every day in the restaurant. When that leadership philosophy is present, I find their restaurants are in much better shape.”

 

Nosestretcher alert: foodborne illness never happens to us: even if employees show up sick

Two separate cases of food poisoning at Indiana eateries in the past two weeks have sickened more than 100 people, and created one additional entry to the we’ve-always-done-things-this-way-and-no-one-has-ever-gotten-sick file.

The Journal Gazette cited Mindy Waldron, the Fort Wayne-Allen County Department of Health administrator, said customers fell ill with norovirus after eating at El Azteca Mexican restaurant at 535 E. State Blvd. on April 2.

That outbreak followed, but was not directly related to, another norovirus outbreak among those who dined at Cebolla’s Mexican Grill at 5930 W. Jefferson Blvd. in Time Corners on March 25.

The Journal Gazette reported the outbreak at Cebolla’s on March 31 after being alerted by a reader. The health department responded to requests for information, saying there were at least 20 patrons involved in the outbreak at that time.

The outbreak at El Azteca was not reported publicly until Waldron’s report Monday to the Allen County Board of Health, with the report noting the investigations had been concluded. Both outbreaks were traced to sick employees who reported for work in spite of their illness, according to Waldron.

Co-owner of El Azteca, Cristina Ray Durnell, said they took the issue seriously and did everything asked by the Department of Health.

“We’ve been here 38 years and never had anything like this happen,” Ray Durnell said. “Our customers and their safety are our No. 1 priority. That was two weeks ago and we have dealt with it.”

At Cebolla’s, health officials were able to identify 249 patrons who were potentially exposed. The health department received 66 complaints and 109 people had symptoms of the virus, Waldron said. The El Azteca outbreak involved 35 patrons – all of whom had symptoms – and 10 complaints were received.

Syracuse restaurant to undergo cleaning after 70 people ill with norovirus; food handler suspected

Twin Trees Too, a popular Syracuse, New York restaurant, will be undergoing a serious cleaning over the next 18 hours, as the number of customers with norovirus is now up to 70.

The health department says there’s no evidence the bug is still being spread, but as a precaution, the restaurant is voluntarily closing for the first half of the day on Wednesday so Serve-Pro can come in and do a thorough cleaning.

The Onondaga County Health Department suspects the norovirus – or stomach bug – was spread in the restaurant sometime around the last weekend of February and was likely caused by sick employees preparing food.

While the restaurant is well known for its pies, it may have been some other foods that were contaminated.

"The investigation is still pending, but we do think that it’s more likely to be related to a salad or antipasto than to the pizza at this time,” said Onondaga County Health Commissioner, Dr. Cynthia Morrow.

Sprout risk is too high

The Packer, the produce trade journal always on the cutting edge, has decided after 55 outbreaks in 14 years sickening about 15,000 and killing dozens, that sprouts may be too risky to serve.

Referring to the Jimmy John’s sprout outbreaks, the editorial says a year ago, an Oregon epidemiologist said clover sprouts were no safer than alfalfa and predicted a rise in clover sprout outbreaks if Jimmy John’s switched.

Unfortunately, he was right.

Last month, a rival chain, Jason’s Deli, announced it would drop sprouts from all 230 of its restaurants later this year in response to food safety concerns over the item. Wal-Mart reportedly dropped sprouts from its offerings nationwide late in 2010 because of food safety concerns.

Companies that sell or serve them to consumers know the risks, and more every month are deciding the risk isn’t worth it.