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Open Access
DIRECT FROM CDC ENVIRONMENTAL HEALTH SERVICES
Resources for Conducting Foodborne Outbreak Environmental Assessments: From Just-in-Time to Anytime
Laura Brown, PhD
Environmental Assessment Activities
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 views of CDC. Dr. Laura Brown works with the Water, Food, and Environmental Health Services Branch at CDC. She conducts research and surveillance to understand and prevent the environmental factors that lead to foodborne illness and outbreaks.
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investigations can be challenging. The assess- ment requires knowledge and skills in not only food safety but also other areas such as critical thinking, interviewing techniques, and the ability to synthesize and interpret data from dierent sources. Additionally, environmental health professionals are not always provided with environmental assess- ment training. When they are, environmental health professionals might not be able to use their training often, given the relative rarity of foodborne outbreaks. • ntervie< out(rea0 e8ta(li8hment mana-er8 an* <or0er8 a(out foo* 5re5aration 5oli)ie8 an* 5ra)ti)e8 • !evie< the 5re5aration of an> foo* item8 lin0e* to the out(rea0 • #a0e 8am5le8 of foo* 8urfa)e8 an* e6ui5ment • #a0e the tem5erature8 of foo* (ein- 8tore* an* 5re5are* • !evie< re)or*8 8u)h a8 foo* tem5erature an* 8i)0 <or0er lo-8 • (8erve <or0er a)tivitie8 in)lu*in- foo* 5re5aration an* )leanin-
H ealth departments are responsible for investigating and stopping the approximately 800 foodborne outbreaks that occur annually in the U.S. (Dewey-Mattia et al., 2018). Environmental health programs are key to outbreak investi- gations—they focus on identifying the fac- tors that contributed to the agent’s introduc- tion or survival in the environment (i.e., how the outbreak happened) and the root causes of the outbreak (i.e., why the outbreak hap- pened). This information is critical to identi- fying interventions to stop the ongoing out- break and prevent future outbreaks. Environ- mental health investigators conduct a variety of activities to identify these factors and root causes. Taken together, these activities make up an environmental assessment (Sidebar 1). Let us consider an example of an E. coli restaurant outbreak linked with hummus. Investigators learned from observing food
preparation that before grinding chickpeas for the hummus, workers first grind raw beef for another food item and do not clean the grinder between uses. An investigator inter- view with the restaurant manager revealed that workers had not been trained to wash the grinder between uses to prevent ingredient cross-contamination. An investigator envi- ronmental sampling found the same E. coli strain in both the grinder and the hummus. After reviewing the findings, investigators concluded that cross-contamination from raw beef to chickpeas was a contributing fac- tor to the outbreak, and lack of worker train- ing on cross-contamination prevention was a root cause of the outbreak. Investigators then helped the restaurant develop a worker train- ing program on cross-contamination preven- tion and how to prepare the hummus safely. Conducting successful environmental assessments during foodborne outbreak
Environmental Assessment Resources for Investigators
Given these challenges—and the value of outbreak environmental assessments—the
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