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Emmy S. Myszka, MPH, REHS Principal Investigator San Mateo County Environmental Health Services Division
AN UPDATE: PREVENTION OF
CAMPYLOBACTER IN THE RETAIL FOOD ENVIRONMENT
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History: Why San Mateo? The Grant Goals & Objectives
Review of Campylobacter & campylobacteriosis Overview of Activities: What are we doing? Case Investigations Case Control Study Restaurant Intervention Study
The Future Outlook: What next?
OUTLINE
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HISTORY
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Environmental Health Services Network (EHS-Net)
Centers for Disease Control and Prevention’s National Center for Environmental Health
Cooperative agreement awarded to San Mateo County Environmental Health in 2010
July 1, 2010 to June 30, 2015
$149,000 annually
THE GRANT
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1. To reduce Campylobacter infections
2. To reduce facility risk factors related to raw chicken handling
3. To increase food handler knowledge of safe chicken handling practices
GOALS
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CAMPY REVIEW
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Campylobacter Campylobacter jejuni
natural occurs in chickens & other avian mammals
Symptoms: 2-5 days after exposure
Include: diarrhea, abdominal pain or cramps, fever, nausea
Infectious dose: >500 organisms
FACTS REVIEW
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P i c t u r e f r o m : h t t p : / / w w w . n p r . o r g / b l o g s / t h e s a l t / 2 0 1 3 / 0 8 / 2 7 / 2 1 3 5 7 8 5 5 3 / j u l i a - c h i l d -w a s - w r o n g - d o n - t - w a s h - y o u r - r a w - c h i c k e n - f o l k s
TO WASH OR NOT TO WASH?
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Est. 2.4 million Campylobacter infections annually in United States
Approx. $1.7 billion morbidity: 8,400 hospitalizations, medical care expenses, lost productivity
2010: 13.6 cases per 100,000
persons in United States
14.4 cases per 100,000 persons in California
32.6 cases per 100,000 persons in San Mateo County
Healthy People 2010 target: 12.3 per 100,000
DID YOU KNOW THAT…?
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ACTIVITIES
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In 2011, 246 cases In 2012,
264 cases Ages 1-92 57% male 52% white
CASE INVESTIGATIONS
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Facilities named vs. facilities not named
How well do routine inspections predict whether or not a restaurant may be implicated in a foodborne illness?
Initial Results: Need standardization
among inspection staff
Demonstrate need to adopt FDA’s risk-based inspection model & conduct standardization training
CASE CONTROL STUDY
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RESTAURANT INTERVENTION
STUDY
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700 food facilities included in study Handle raw chicken Primary language:
English, Spanish, or Chinese
Control Group: 200 restaurants Intervention Lite
Group: 250 restaurants Intervention Full
Group: 250 restaurants
STUDY DESIGN
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Lite Campy Training Kit Hand delivery
Full Campy Training Kit Hand delivery In-person training with
REHS
INTERVENTION
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Campy Training Kit
Training Manual Quick Reference Cards Video Poster Thermometer Shelving Label Postcards
In-Person Training
1-hour In-language: 40% English 40% Spanish 20% Chinese
Purpose: train the manager/owner to train the food handlers
INTERVENTION TRAINING
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CAMPY TRAINING KIT
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RAW CHICKEN HANDLING TRAINING MANUAL FOR OWNERS & MANAGERS
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• Poster • Thermometer • Shelv ing
Label • Video
TRAINING MATERIALS
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Surveys conducted before and after the intervention
Facility Assessments & Food Handler/Manager Interviews
Collected by all REHS district inspectors
Replace a routine for the fiscal year
EVALUATION
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Facility Assessment
Observation of raw chicken handling practices in facility Storage Preparation Cooking
Interviews
Two Parts: Food Handler & Manager
Food Handler: Support Knowledge
Manager: Facility demographics
EVALUATION
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Classroom Training
Aug 27 & 29 Conducted by a
contracted trainer: Vicki Everly
Review Marking Guide, Facility Assessment, Food Handler/Manager Interview
Field Training
Sept 3-6 Trainers: EHS IV &
Supervisors 3 facilities/training Facilities included in study Opt out of 3rd if do well
Used modified field worksheet from CFP
STANDARDIZATION TRAINING
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2013: Aug 27-29 Sep 3-6 Sep 9-Oct 11 Sep 20 Oct-Dec
2014: Jan 9 Jan 13-Feb 14
Assessment/Interview classroom
standardization training Assessment/Interview field
standardization Pre-Assessments & Interviews Intervention standardization training Intervention delivery
Standardization review Post-Assessments & Interviews
TIMELINE
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Is there a reduction in risk factors related to raw chicken handling?
Do food handlers have increased knowledge about the dangers of raw chicken & safe chicken handling practices?
Do food handlers feel increased support from their managers to prepare food safely?
Is there a difference between Intervention-Lite & Intervention-Full?
Did the incidence rate of Campylobacter infection go down?
DATA ANALYSIS
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Deliver Campy Training Kits to control group via mail
PDFs of Training Manual, Quick Reference Cards & Posters
Production of Campy Kits for remaining high-risk food facilities
Standardization of REHS in risk-based inspection methods
Better data to conduct additional research projects
FUTURE OUTLOOK