ADVANCEMENT OF THE PRACTICE
Open Access
DIRECT FROM CDC ENVIRONMENTAL HEALTH SERVICES
Identify Contributing Factors and Root Causes to Help Stop and Prevent Foodborne Outbreaks
CDR Beth Wittry, MPH, REHS
Elaine Curtiss, MEd
Maggie Byrne, CPH
who often do routine restaurant inspections. The role of an investigator is very dierent from that of a routine food inspector. While routine inspectors look for violations hap- pening at the time of the inspection, an out- break investigator looks for clues to under- stand what happened in the past that led to an outbreak. The goal of the environmental assessment is to understand how and why a bacteria or virus was allowed to contami- nate, proliferate, and/or survive in the res- taurant environment. The Centers for Disease Control and Pre- vention (CDC) has created resources and training to help environmental health pro- fessionals prepare for their role in outbreak investigations by shifting their mindset from that of a routine inspector to that of an out- break investigator. Contributing Factors Are How an Outbreak Happens In the CDC video, From Inspector to Investi- gator , food safety inspectors are shown the dierence between inspections and investi- gations, which helps them shift their per- spectives (Figure 1). This quick training video also gives a brief overview of the types of contributing factors and how an environ- mental assessment can help investigators identify them. For example, there was a restaurant out- break of Salmonella linked to raw chicken, but the people who got sick had eaten raw salads. By observing and asking questions, investigators can uncover the contributing factors and root causes of the outbreak. In this example, investigators might dis- cover that the food worker who prepared the salads had also prepared raw chicken
Editor’s Note: The National Environmental Health Association strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we feature this column on environmental health services from the Centers for Disease Control and Prevention (CDC) in every issue of the Journal . In these columns, authors from CDC’s Water, Food, and Environmental Health Services Branch, as well as guest authors, will share tools, resources, and guidance for environmental health practitioners. The conclusions in these columns are those of the author(s) and do not necessarily represent the o cial position of CDC. CDR Beth Wittry is an environmental health o cer and Elaine Curtiss and Maggie Byrne are health communicators. All work at the National Center for Environmental Health within CDC.
F oodborne illnesses cost billions of dol- lars (U.S. Department of Agriculture, 2023) and can cost people their lives (Scallan et al., 2011). More than one half of all foodborne outbreaks in the U.S. are asso- ciated with restaurants, delis, banquet facili- ties, schools, and other institutions (Centers for Disease Control and Prevention, 2019), so ensuring food safety in these settings is im- portant. Food safety programs help keep the food we eat safe from contamination, bacte- ria, and viruses, and help prevent outbreaks and illnesses. When outbreaks do happen, public health professionals from several disciplines respond. During an investigation of a restaurant out- break, epidemiologists seek to understand who got sick and what food made them sick. Labo- ratorians test samples to identify the specific pathogen. Environmental health professionals
also play a key role in an outbreak investiga- tion. In fact, a recent study (Holst et al., 2023) found that successful outbreak investigations use environmental assessments to find out how and why an outbreak happened. These are known as the contributing factors and root causes of an outbreak. Contributing factors are unsafe practices and systematic failures that lead to out- breaks. Root causes are the reasons con- tributing factors occur. Identifying both contributing factors and root causes can help determine the steps needed to stop an outbreak and prevent future ones. In an out- break, contributing factors are the how and root causes are the why . Despite their importance, outbreak inves- tigations—including environmental assess- ments—are not always part of the day-to-day tasks of environmental health professionals
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Volume 86 • Number 6
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