CDCs Retail Deli Practices Study Erik Coleman MPH

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CDC’s Retail Deli Practices Study Erik Coleman, MPH National Center for Environmental Health Division

CDC’s Retail Deli Practices Study Erik Coleman, MPH National Center for Environmental Health Division of Emergency and Environmental Health Services

CDC’s Environmental Health Specialists Network (EHS-Net) q Since 2000, CDC has funded state and

CDC’s Environmental Health Specialists Network (EHS-Net) q Since 2000, CDC has funded state and local health departments to conduct research that contributes to our understanding of environmental causes of foodborne illness outbreaks q Focus on retail food safety policies and practices q EHS-Net is a collaborative program of federal, state, and local environmental health/food safety specialists and epidemiologists CDC USDA FDA EHS-Net CDCfunded state and local sites 2

EHS-Net Retail Deli Practices Study In 2012, EHS-Net conducted a USDA-FSIS-funded study Retail deli

EHS-Net Retail Deli Practices Study In 2012, EHS-Net conducted a USDA-FSIS-funded study Retail deli policies and practices likely associated with Listeria monocytogenes cross-contamination 3

Listeria monocytogenes About 1, 600 people in the US get sick from Listeria germs

Listeria monocytogenes About 1, 600 people in the US get sick from Listeria germs each year. Listeria is the 3 rd leading cause of death from food poisoning. At least 90% of people who get Listeria infections are either pregnant women and their newborns, people 65 or older, or people with weakened immune. Source: http: //www. cdc. gov/vitalsigns/listeria/index. html

Preventing Listeria monocytogenes Rinse raw produce, such as fruits and vegetables. Scrub firm produce

Preventing Listeria monocytogenes Rinse raw produce, such as fruits and vegetables. Scrub firm produce (e. g. melons). Separate uncooked meats and poultry from vegetables, cooked foods, and ready-to-eat foods. Cook meat and poultry thoroughly. Avoid raw (unpasteurized) milk, and avoid foods made with unpasteurized milk Source: http: //www. cdc. gov/listeria/prevention. html

EHS-Net Retail Deli Practices Study Why Listeria? • It is a foodborne bacterium that

EHS-Net Retail Deli Practices Study Why Listeria? • It is a foodborne bacterium that causes a serious infection (listeriosis). • It causes the 3 rd highest number of deaths from foodborne disease annually. • It mostly affects: • older adults • pregnant women • newborns • adults with weakened immune systems. Why retail delis? • Deli meats are the major source of listeriosis illnesses. • Deli meats sliced and packaged at retail are the major source of listeriosis illnesses linked with deli meat. Why crosscontamination? • Listeria is persistent in the environment, providing crosscontamination opportunities. • Eliminating crosscontamination in delis would decrease risk of illness from ready-toeat retail deli food by 34%. 6

EHS-Net Retail Deli Practices Study- Goals 1. Collect descriptive data on deli workers’ actions

EHS-Net Retail Deli Practices Study- Goals 1. Collect descriptive data on deli workers’ actions • Data to be used to inform USDA-FSIS risk assessment activities • Identify events that could lead to cross-contamination • Estimate the risk of cross-contamination associated with specific actions 2. Collect descriptive data on delis’ crosscontamination policies and practices • Cleaning policies and practices- slicers, other equipment • Hand washing 3. Assess relationships among deli and staff characteristics, and deli practices • Deli size, ownership • Staff food safety knowledge and training 7

EHS-Net Retail Deli Practices Study: Data collection q q EHS-Net CDC and site staff

EHS-Net Retail Deli Practices Study: Data collection q q EHS-Net CDC and site staff developed the study protocol, with FSIS input EHS-Net site staff collected data in randomly selected retail delis in 6 CDC-funded sites: • California New York City • Minnesota Rhode Island • New York State Tennessee Manager interview (N=298) • Deli and manager characteristics • Crosscontamination and food safety policies and practices Worker interview (N=294) • Worker characteristics • Crosscontamination and food safety practices Structured observation (N=298) • Slicer and sink number and condition Notational observation (N=298) • Individual workers’ actions • Crosscontamination evidence 7

EHS-Net Retail Deli Practices Study: Deli and staff characteristics Deli Characteristics Ownership type (N=298)

EHS-Net Retail Deli Practices Study: Deli and staff characteristics Deli Characteristics Ownership type (N=298) Chain Independent # of customers served on busiest day (N=236) 0 -99 100 -299 > 300 # of slicers (N=294) 1 or 2 >3 N 164 134 85 92 59 167 127 Deli-required manager food safety training (N=295) Yes 220 No 75 Deli has written slicer cleaning policy (N=296) Yes No 194 102 % Manager Characteristics 55 45 36 39 25 57 43 N % Experience in deli (N=298) >5 years 156 142 52 48 Manager is food safety certified (N=297) Yes No 203 94 68 32 Food safety knowledge (N=298) Answered < 75% correctly Answered > 75% correctly 97 201 33 67 N % Experience in current deli (N=294) < 5 years 194 104 65 35 Food safety knowledge (N=294) Answered < 100% correctly Answered 100% correctly 157 137 53 47 Worker Characteristics 75 25 66 34 9

EHS-Net Retail Deli Practices Study: Slicer cleaning What proportion of delis are fully cleaning

EHS-Net Retail Deli Practices Study: Slicer cleaning What proportion of delis are fully cleaning their slicers at the FDA-recommended frequency of at least every 4 hours? Which deli and staff characteristics are linked with delis fully cleaning their slicers at the FDA-recommended frequency? Fully cleaning -Disassemble -Clean -Sanitize 1

EHS-Net Retail Deli Practices Study: Slicer cleaning findings What proportion of delis are fully

EHS-Net Retail Deli Practices Study: Slicer cleaning findings What proportion of delis are fully cleaning their slicers at the FDArecommended frequency of at least every 4 hours? All slicers fully cleaned at least every 4 hours, as reported by managers (N = 297) Yes [PE RCE NTA GE] No [PERCE NTAGE] All slicers fully cleaned at least every 4 hours, as reported by food workers (N=273) Yes [PERCE NTAGE] No [PE RCE NTA GE] 10

EHS-Net Retail Deli Practices Study: Slicer cleaning findings Which deli and staff characteristics are

EHS-Net Retail Deli Practices Study: Slicer cleaning findings Which deli and staff characteristics are linked with delis fully cleaning their slicers at the FDA-recommended frequency? Chain delis Deli-required food safety manager training More customers Deli manager is food safety certified More slicers Food safety knowledgeable workers Written slicer cleaning policies All slicers cleaned at FDA-recommended frequency 12

EHS-Net Retail Deli Practices Study: Slicer cleaning conclusions and recommendations Many delis are not

EHS-Net Retail Deli Practices Study: Slicer cleaning conclusions and recommendations Many delis are not engaging in FDA-recommended slicer cleaning practices that reduce cross-contamination risk • Required manager/worker training and certification should be encouraged • Development and implementation of written slicer cleaning policies should be considered • Interventions should focus on independent and smaller delis 13

EHS-Net Retail Deli Practices Study: Next Steps q USDA-FSIS will analyze and disseminate the

EHS-Net Retail Deli Practices Study: Next Steps q USDA-FSIS will analyze and disseminate the notational observation data on individual workers’ actions q CDC and USDA-FSIS will analyze and disseminate remaining data 14

Resources q CDC’s EHS-Net: http: //www. cdc. gov/nceh/ehs/EHSNet/index. htm q Retail deli slicer cleaning

Resources q CDC’s EHS-Net: http: //www. cdc. gov/nceh/ehs/EHSNet/index. htm q Retail deli slicer cleaning publication: http: //www. cdc. gov/mmwr/volumes/65/wr/mm 6512 a 2. htm q USDA-FSIS Listeria guidance: http: //www. fsis. usda. gov/wps/portal/fsis/topics/regula tory-compliance/listeria 15

Thank You! Erik W. Coleman - HYE 1@CDC. GOV For more information please contact

Thank You! Erik W. Coleman - HYE 1@CDC. GOV For more information please contact Centers for Disease Control and Prevention 4770 Buford Hwy, NE, Atlanta, GA 30341 Contact CDC at: 1 -800 -CDC-INFO or www. cdc. gov/info The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Environmental Health Division of Emergency and Environmental Health Services