Coaching vs. enforcement: Wash. restaurant inspector says ‘I’m an advocate for public health’

Jerry Caird, the Thurston County environmental health specialist, is one of 6 inspectors who oversee more than 1,000 food establishments in Thurston County. That includes full-service restaurants, grocery store delis, fast food outlets and espresso stands.

olympia.wash“I’ve never worked in a restaurant in my entire life,” he said. “But I feel like I have.”

Instead, Caird has a bachelor of science in environmental health and extensive training on looking for food-related situations that can make people sick, such as room temperature potato salad, lettuce that’s contaminated with raw meat juice and workers who aren’t handling food safely.

He was an inspector for the state of Nevada for nine years, before taking a job with Thurston County 11 years ago.

“I think of myself as an advocate for public health,” he said.

Thurston County’s full-service and fast-food restaurants, along with its grocery store delis are inspected at least twice a year.

Cassie Andreotti, the manager at the Vic’s Pizzeria on Olympia’s west side, said she usually gets a little nervous when Caird shows up. But she said she appreciates the work he does.

“I think it’s incredibly important,” said Andreotti said during a recent inspection. “Without these guys, who knows what people would be serving.”

Businesses that only have a small amount of food preparation such as espresso stands, bakeries, meat markets and the non-deli sections of grocery stores are inspected once a year.

A typical inspection can take one to two hours, depending on the size of the kitchen.

“They’re all unannounced,” Caird said.

Most violations that are noted during an inspection are corrected immediately, said Sammy Berg, a senior environmental health specialist who supervises the county’s health inspectors.

“It’s not just to find people doing things wrong,” Caird said. “But to show them a better way that will help protect public health.”

Mom and pop businesses tend to struggle the most with food inspections, Berg said. One of the big reasons why is because a lot of fast food companies have their own corporate inspectors that are in charge of quality control, he added.

When problems are found, Caird said he tries to work with restaurant owners and managers to make sure there’s a pattern of improved scores.

“A lot of owners tend to focus on what the customer sees — the bathrooms, the dining rooms,” Caird said. “But they really should focus on the kitchen.”

Thurston County’s Environmental Health Division also tracks complaints that are emailed or telephoned in by consumers. The department had 226 complaints about restaurants in 2014.

Most of those were about possible food-borne illness that callers believed were picked up at local restaurants.

“The last thing you ate isn’t necessarily the thing that made you sick,” Berg said, adding that signs of a food borne illness can take 24 to 72 hours to appear.

If the department receives several phone calls that correlate to the same restaurant, they check it out.

Make Hep A vaccinations mandatory for everyone, especially those who serve food

Guelph, the town and the university, is like every other cow-town, eager to blow itself (it’s in Canada).

hepatitis.AThe Guelph Mercury says in an op-ed the Wellington-Dufferin-Guelph Public Health board received a review this week of the agency’s response to a public health scare arising from a local restaurant staffer being diagnosed with hepatitis A.

The board heard that the organization was quickly informed by the worker’s physician of the diagnosis and made prompt, effective and smart moves upon receipt of that information.

Among other correct and timely moves the board heard the agency made in this case was using a variety of media formats to spread the word of this situation and to communicate times and locations where concerned residents could obtain vaccinations at rapidly convened clinics.

(They contacted barfblog.com to get an estimation of reach; how the hell do I know, we just put stuff out there.)

The organization also adjusted quickly and resourcefully to meet higher than anticipated public demand for vaccines, the board heard.

By the account of the board, it was a case well-handled by health unit staff — and commendations were offered to that team following the briefing.

An earlier story declared the response to the Hepatitis A outbreak was public health’s finest hour.

When a family doctor alerted Wellington-Dufferin-Guelph Public Health that he had a patient with hepatitis A, the health protection and prevention agency leapt into action.

Dr. Nicola Mercer, the local medical officer of health, painted a picture of a responsive staff and an amicable public to the board of health Wednesday as she described the series of events that led to some 1,400 vaccinations being administered after a food handler at the popular Marj’s Kitchen in Alma was diagnosed with the hepatitis A virus.

Mercer said she received the call from the physician on Jan. 21.

“Normally you wouldn’t hear about a hepatitis A case,” Mercer said. “But in this case, the patient was a food handler who had worked the entire time of being infectious.”

After examining the lab work, staff determined the individual was infectious between Jan. 2 and Jan. 20 and that potentially 4,000 people had been exposed.

A number of things happened in tandem. Staff interviewed all staff at Marj’s Kitchen and administered vaccinations since these were the people most at risk of infection.

Lost in the platitudes is a simple message: make Hepatitis A vaccinations mandatory for everybody, especially food service workers.

Food safety’s gotta rule: Uni student says my fridge is your fridge – until the health department shows up

Ernst Bertone and two fellow University of California, Davis graduate students began their experiment last fall with a simple idea: Build a closer community and reduce food waste by sharing food with their neighbors. They placed a community refrigerator on their lawn, called the project “free.go” and watched it take off.

free.goNeighbors and fellow students picked up and dropped off dozens of food items at the front yard fridge, following free.go’s mantra: “Take what you need. Leave what you don’t.” More than 100 items were exchanged in a month’s time outside Bertone and Eric Yen’s Douglas Avenue home last September.

By the end of the month, neighbors were sharing books, too, and another exchange was born.

“It worked exactly as it was supposed to. … People took (the food) and it worked. People took it and used it,” said Bertone, a graduate teaching assistant in UC Davis’ agriculture and resource economics department.

But the food sharing project quickly ran afoul of state health and safety codes and was unplugged late last year by Yolo County health officials amid food safety concerns. Bertone and friends, however, refuse to call free.go a failed experiment. Rather, they hope it will launch a broader conversation on the notion of food sharing in the city, including other “fridge sharing mechanisms,” as Bertone calls them, and its connection to an emerging “sharing economy.”

Bertone, Yen and Ali Hill, another UC Davis graduate student, plan to lobby Davis city leaders. They want to plead their case for food sharing and community refrigerators at a future City Council meeting. The idea has already spawned lively debate in community websites such as People’s Vanguard of Davis and drawn about 130 signers to an online petition that the trio plan to submit to the city.

“The fridge is a great idea even aside from (reducing) food waste,” Hill said. “It encourages a great sense of community that’s lacking in most communities. This is kind of a cool way to encourage it.”

But there are practical concerns, with food safety at the top of the list.

“I think the spirit is in the right place and the thought of not wasting food is good, but with the (health) issue, you balance progressive thinking with the fact there’s no control over it,” said neighbor Robert Weidenfeld. He suggested working with local food banks and other relief groups.

“I had no problem with it being out there and they’ll probably say that it’s a good idea, but maybe their energies would be best put toward groups that are shown to be effective,” he added.

Yolo County health officials who red-tagged the refrigerator as an illegal food facility back in November determined that because the free.go refrigerator was an unregulated food exchange, Bertone could not guarantee the food inside was safe to eat.

“He’s started a food business. The food’s not from an approved source. He can’t guarantee its safety. There are so many unknowns that there is a high risk to the public,” said April Meneghetti, a Yolo County environmental health specialist.

Meneghetti said the potential health risks are many: contamination; exposure to foodborne illnesses; unintentional exposure to those with food allergies and compromised immune systems; and the risk of eating recalled foods.

“It may not be anything malicious, but the food code is based on potential risk,” Meneghetti said. “If it’s completely unregulated, it’s too risky. There’s no way to trace back the food if someone got sick.”

Public health concern? STEC in swine

This descriptive longitudinal study was conducted to investigate the fecal shedding of Shiga toxin-producing E. coli (STEC) in finishing swine and to characterize the swine STEC isolates that were recovered.

swine.stec.jan.15Three cohorts of finishing swine (n = 50/cohort; total 150 pigs) were included in the longitudinal study. Individual fecal samples were collected every 2 weeks (8 collections/pig) from the beginning (pig age 10 weeks) to the end (pig age 24 weeks) of the finishing period. STEC isolates were recovered in at least one sample from 65·3% (98/150) of the pigs, and the frequency distribution of first-time STEC detection during the finishing period resembled a point-source outbreak curve.

Nineteen O:H serotypes were identified among the STEC isolates. Most STEC isolates (n = 148) belonged to serotype O59:H21 and carried the stx2e gene. One O49:H21 STEC isolate carried the stx2e and eae genes. High prevalence rates of STEC during the finishing period were observed, and STEC isolates in various non-O157 serogroups were recovered. These data enhance understanding of swine STEC epidemiology, and future research is needed to confirm whether or not swine STEC are of public health concern.

Shiga toxin-producing E. coli (STEC) in swine: prevalence over the finishing period and characteristics of the STEC isolates

Epidemiology and Infection / Volume 143 / Issue 03 / February 2015, pp 505-514

M. Tseng, P.M. Fratamico, L.Bagi, D. Manzinger and J.A. Funk

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9527904&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG&utm_reader=feedly

Get off of my cloud, get out of my restaurant: interfering with public health types in Canada

Toronto food safety inspector guru and friend of the barfblog, Jim Chan (left exactly as shown), writes with Si Le and Paul Di Salvo about the safety and legal implications of getting in the way when an inspector comes to visit.

jim.chanThe full paper is a good read, and available at http://pubs.ciphi.ca/doi/full/10.5864/d2012-015.

This case study outlines an obstruction incident involving a Public Health Inspector (PHI) being obstructed while conducting an inspection. PHIs are empowered by legislation to conduct inspections and investigations without obstruction or hindrance from any person. Managers and employers have a duty to ensure PHIs are able to conduct their work free from harm or harassment.

Previous case law provides an excellent perspective as to what actions constitute obstruction. In the current case, previous case law was used to substantiate the evidence and perspective of the Prosecutor and PHI when prosecuting the offender. To better safeguard PHIs during incidents involving obstructive behaviour, implementing an administrative warning system of problematic premises in addition to working in pairs, when feasible, will ensure inspection services are carried out safely and effectively.


 

How would a cafe crawling with adorable kittens pass a D.C. health inspection?

Washington, D.C. learned this week that it could be getting a cat cafe by next year, and Twitter got more excited than a kitten chasing a laser pointer’s red dot. The concept combines a coffee shop and a feline petting zoo; they’re big in Asia, and cat cafes have opened stateside in the Bay Area and New York. But with cats come fur, hairballs and litter boxes. So how does all of this work in an establishment that also offers food service?

catsUnder the current D.C. health code, only service animals are permitted in food establishments. But Crumbs and Whiskers founder Kanchan Singh has been in talks with the D.C. Department of Health as she looks for a space for her business, and thinks she’s worked out a reasonable arrangement.

“Basically, after a couple of months of convincing, what the DOH and I agreed on is that the cat area must be completely sectioned off from the cafe area,” Singh said.

That means that the cat cafe could actually be two separate but adjacent storefronts: One with a kitchen dishing out cake, ice cream and tea, and the other, a jungle gym for cats. Another option is to have a common entrance that leads to both businesses, but with completely segregated entrances to both.

Cross-contamination?

Publicizing outbreak info matters; even stuff about falsified poop samples

There’s a troubling trend popping up in our food safety-related Google Alerts: public health folks looking less-than-transparent by blocking the releases of outbreak and illness information. Releasing the details on an investigation or exposure can reduce immediate public health impacts and lead to better informed decision-making by consumers.

I don’t want to eat at places that falsify employee stool samples (below, exactly as shown).stool.sample.ben_.nov_.09-285x300

Last week A health alert was issued by Maine officials stating that people may have been exposed to the hep a after a food handler tested positive somewhere in Cumberland County. Bizarrely, that’s all they said (except for check your poop and urine). Patrons eating at any restaurants in the county might have been exposed to hepatitis A. Or maybe not.

The Portland Press-Herald highlighted issues with the state’s Center for Disease Control funding as a root cause, arguing that practice of protecting the business shouldn’t outweigh the public health impacts:

[T]he state has refused to name the restaurant, saying that to do so would “risk identifying” the employee, thus violating patient privacy laws. This is a puzzling departure from previous practice; last year, the Maine CDC identified the site of a church supper where about 100 people were potentially exposed to the virus. And in 2008, a state alert about a cluster of hepatitis A cases noted that several of those affected were students at the same school, which the state named.

The state has also emphasized that it didn’t learn of the potential Cumberland County exposure until after a 14-day window for restaurant patrons to receive a preventive vaccine. But naming the site is still a valid protective measure. Because the symptoms of hepatitis A can mimic the signs of flu or chronic fatigue, people who know they may have been exposed to the virus are more likely than others to raise the possibility with their doctor and receive the right diagnosis and treatment.

In somewhat related news, NBC Connecticut reports that following a couple of cases of salmonellosis linked to a pizza place, health officials aren’t super forthcoming with information.

“It was one of the worst experiences I have ever dealt with in my life,” said Kamran Niazi, recalling the effects of three slices of chicken pizza from Oregano Joe’s on Boston Post Road in Orange. “I had 104-degree fever, diarrhea – extreme diarrhea – extreme vomiting.

Niazi said doctors told him he had a bad case of salmonella, and he wasn’t alone.

“One of the doctors actually told me there was one other person in the hospital who ate at the same place, Oregano Joe’s, and he was in very bad condition as well,” Niazi said.

But when he was released from the hospital, Niazi couldn’t get any information on his case from the Orange Health Department, even though inspectors had called him with questions while he was hospitalized.

Now Niazi and his attorney, Jose Rojas, are suing Oregano Joe’s for $15,000 to cover Niazi’s hospital bills.

The Orange Health Department and the state DPH cite several statutes that they said forbid them from speaking with the Troubleshooters about any information in a food-borne illness case.

The Orange Health Department told the Troubleshooters it has ordered Oregano Joe’s to close down twice, once for a day on May 30 and then again on June 20 for a span of five weeks. But the department won’t say why.

Some information is available on the Oregano Joe’s closings, but not from the health department. When the restaurant owner needed to get inside during one of the closures, police had to let him in.

An officer wrote in his report that the owner said the health department was “shutting down his business… due to multiple confirmed cases of salmonella poisoning.”

Court papers from Niazi’s case against the health department indicate Oregano Joe’s was served with a violation for “falsified employee stool samples” during one of its investigations this year.

What I really want to know about is the falsified employee stool samples (and the conversation that went along with acquiring them).

Public health always gets hit first: Maine CDC missing top hepatitis expert for recent case

When the Maine Center for Disease Control and Prevention decided last week how to respond to a potential hepatitis A exposure at a Cumberland County restaurant, it did so without its top hepatitis coordinator and two leading epidemiologists, positions that have been vacant for months.

public.healthThe state’s handling of that case has drawn criticism from public health leaders who say the state should have named the restaurant to alert diners who may have been exposed to the virus during the weeks when the worker served food there.

The Maine CDC is operating without a full staff trained to deal with such infectious diseases. And while the department grapples with concerns over Ebola and the approaching flu season, 14 of its roughly 50 public health nurse positions remain vacant – more than 25 percent of the workforce. Public health nurses are front-line workers who run vaccination clinics and respond to outbreaks.

“Our public health infrastructure is woefully inadequate,” said MaryAnne Turowski, legislative and politics director for the Maine State Employees Association, the union that represents public health nurses. The state is “not prepared for an infectious disease outbreak,” she said.

Food safety culture has jumped the shark?

I gave a talk in the middle of the night Thursday to the summer session of public health students at Kansas State University.

doug.sorenne.hockey.apr.14Sure, the bloated K-State administration had no trouble firing my full-professor ass, but that doesn’t mean students should suffer: I’ll always talk with students.

The talk is below and slides can be found here.

Saying goodbye to good public health folks

There are good public health folks and not so good ones. The not so good ones announce the source of an outbreak by eating a taco. Or don’t announce the outbreak at all. image

The good ones, like Toronto Public Health’s Jim Chan and Mount Sinai Hospital’s Don Low, are innovative, welcome transparency, get the science right and are accessible.
Today marks a change for public health in Ontario as Jim announced his retirement and Don tragically passed away from a brain tumor.

I didn’t know Don, but as a risk analysis-studying graduate student a decade ago I followed his daily updates and media interactions during the largest infectious disease event to hit Canada in my lifetime: 2003’s SARS outbreak. Don’s openness and frank discussion of risk and what was being done to manage it was a model for others to follow. jim_chan_4.jpg.size.xxlarge.promo

Jim, another fantastic public health communicator and creative mind, was one of the drivers of the DineSafe program, Toronto’s restaurant inspection disclosure system as well as being the dude who was quoted in pretty much every food safety related story in the city. From uninspected meat to rat infestations in Chinatown, Jim exemplified what the risk communication literature says: tell folks what you know, what you don’t, what you’re doing and update often.