ADVANCEMENT OF THE PRACTICE
Open Access
THE PRACTITIONER’S TOOL KIT
Complexities and Strategies for Controlling Contamination
James J. Balsamo, Jr., MS, MPH, MHA, RS, CP-FS, CSP, CHMM, DEAAS Nancy Pees Coleman, MPH, PhD, RPS, RPES, DAAS
Brian Collins, MS, REHS, DLAAS Gary P. Noonan, CAPT (Retired), MPA, RS/REHS, DEAAS Robert W. Powitz, MPH, PhD, RS, CP-FS, DABFET, DLAAS Vincent J. Radke, MPH, RS, CP-FS, CPH, DLAAS Charles D. Treser, MPH, DEAAS
Editor’s Note: The National Environmental Health Association (NEHA) strives to provide relevant and useful information for environmental health practitioners. In a recent membership survey, we heard your request for information in the Journal that is more applicable to your daily work. We listened and are pleased to feature this column from a cadre of environmental health luminaries with over 300 years of combined experience in the environmental health field. This group will share their tricks of the trade to help you create a tool kit of resources for your daily work. The conclusions of this column are those of the authors and do not necessarily represent the ocial position of NEHA, nor does it imply endorsement of any products, services, or resources mentioned.
form of reasoning is where the problem or situation is identified and understood. Instead of relying on conventional wisdom, this approach encourages us to start with what we know to be true—good science— and reason up from there. By dissecting problems into their most basic components, we can devise new insights and solutions. In short, this process is the best way to reverse-engineer complicated situations and separate underlying ideas or facts from any assumptions based on them. Simply stated, this process is Occam’s razor (also known as the principle of parsimony)! Following this step, we need to correct or alter the situation that we have identified. The best approach is to use second-order thinking. Second-order thinking requires us to consider our actions and their immediate consequences and the subsequent eects of those actions. All too often, what we think is a reasonable solu- tion can create another problem. For example, in trying to eliminate Listeria from a food production environment, we all too often rely exclusively on disinfectants. Remember, these products can be potentially deleterious to things downstream, including destroying the biome of a sewage disposal plant. While the solution is eective in destroying Listeria , it is not so good for the environment. Finally, we need to apply contamination control strategies that follow a general hier- archy of ecacy. Most of this application is directed at preventing future contamination occurrences. It starts with a simple concept: Keep the contaminants out. Ideally, if we can accomplish this goal, our job is done. Like integrated pest management, keeping pests
M ost of our activities involve some form of contamination control. Most situations in which con- tamination control is of concern—and particularly its subset, cross-contamina- tion—involve food and food preparation. Interestingly, however, the Food and Drug Administration’s model Food Code does not define cross-contamination or the newly in- troduced term: cross-contact. Yet, frequent and repetitive occurrences are found during our food safety inspections. We are trained to easily recognize both conditions when we see them. We respond in kind, by citing the Food Code , the details and many risk factors involved in both cross- and contact-contam- ination conditions. Let us start by defining the current use of these two terms. Cross-contamination is the transfer of harmful bacteria, viruses, or other biological hazards (as well as chemical and physical contaminants) from one surface or food to another. The newest term in our lexicon, cross-contact, although similar to cross-contamination, is the transfer of a food allergen rather than a pathogen from one surface or food item to another. “Potato” ver-
sus “potahto.” In either situation, developing straightforward strategies to prevent any form of cross-contamination is not easy. In our collective experiences, we never found any situation that had a single causa- tion. Rather, each cross-contamination con- dition we encountered required a multifacto- rial response that involved three tiers: people, places, and things. This challenge means that simply using the word “don’t” does not work. Unlike straightforward time and tempera- ture controls, comprehensive contamination control requires programmed responses that follow a hierarchy of prevention strategies. To achieve this goal, there are two distinct approaches to contamination control: 1) intervention and 2) prevention. They overlap. Here is how it works. We start by identifying problems (inter- vention) relating to contamination through applied epidemiology, such as a response to a foodborne illness along with inspecting, auditing, sampling, and process monitoring. Simple and straightforward. Next, we need to define the problem or problems that we find. Ideally, we do this step by using first-principle thinking. This
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Volume 87 • Number 6
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