Associated Press reports tonight that recent illnesses connected to an Iowa farmers' market are linked to Mexican foods sold by a common vendor,  La Reyna Supermarket & Taqueria of Iowa City.

The products were sold at farmers' markets in Linn, Johnson and Dubuque counties and may be contaminated with salmonella. The departments say any guacamole, salsa and uncooked tamales should be thrown away and not eaten. The salmonella investigation was initiated by Linn County Public Health officials and illnesses were traced to products produced by the restaurant in Johnson County.

At pretty well every conference or meeting I went to in 2008 and 2009 I was given a reusable grocery bag. A decent registration gift to hold programs, promotional materials and goodies – that served some post-meeting utility as well. Not a bad replacement for the laptop bags that were ubiquitous in the five years before. Lately meeting organizers have been giving out aluminum water bottles, another usable item. We’ve collected 6 or 7 reusable grocery bags and they are now in rotation for our weekly shops. 

A couple of weeks ago a press release about a study looking at the handling and microbiological content of a select group of bags was released.  What I wrote then was:

The study, when and if it is published will provide some nice baseline results on what people say they do, demonstrates the effect of washing, and doesn’t like some try to point out really say that plastic bags are any safer (there was no comparison) but there are a couple of things missing that could really have been useful. Two big questions still need to be answered:

- Generic E. coli is floating around in bags, recoverable in the Gerba study in 12 % of those tested, but can it be (or is it likely) to be transferred to any ready-to-eat foods, or somehow to food contact surfaces in the home?

- What effect does drying have on the bags, if at any? According to Gerba et al., washing works, no one reports doing it; but what about flipping them inside out and drying bags for a few days after use?

After that post, a local TV station called about the study and conclusions and wanted to know a bit more about potential risks what people could do in their homes to reduce the chance of foodborne illness. My tips were what we do in our house: Wrap raw meats in a secondary plastic bag to create a barrier and catch any dripping juices; washing our bags every couple of weeks to remove anything that might be floating around and dedicating a reusauable bag as the “meat bag” and washing it more often, usually after every shop.
 

I think I was first introduced to Kenosha, Wisconsin from Weezer's Happy Days-themed Buddy Holly video. It then resurfaced in That 70s Show as a big town where Eric and friends went to see my favorite movie of all time, Star Wars. I figured it was the burbs-heavy halfway stop between Chicago and Milwaukee that looked a lot like Shermer, Illinois.

Kenosha is home to a growing Salmonella outbreak where additional 16 cases have been confirmed over the past couple of days. According to Fox6, although a business has been temporarily closed as a precaution, health officials do not believe that it is the only source of the outbreak. The Milwaukee Journal Sentinel also reports:

The health department has not pinpointed a single source of the outbreak, although the department has closed Baker Street Restaurant and Pub on Green Bay Road in Kenosha and is testing employees, Bosovich said.

"We have not found anything there. We did it as a precaution to make sure the employees are negative before returning to work," she said.

The hospital emergency room doctor in the below video has a few gems on Salmonella that aren't quite correct:

You will be vomiting within 6 hours after eating that food" (more like 12-72 hours -ben)

Mostly it's because a restaurant has recieved a shipment of food that sits out with no refrigeration (food handler hygiene, common supplier of a ready-to-eat food or cooking temps are probably more likely -ben).
 

According to Fox31, fourteen are ill with pathogenic E. coli after an outbreak at the Little Sailors Child Development center in Northglenn, CO. The health officials say that it's "less severe"; press reports that it's a mild strain. Seems a bit weird to me. Thirteen kids and a staff member ill with pathogenic E. coli (not sure what kind) seems pretty serious. Especially when the owner's son displayed symptoms for over a month.

The Tri-County Health Department has announced that 14 people, 13 children and a teacher have been diagnosed with a mild strain of E. coli.
"It appears less severe," said Richard Vogt, M.D., with Tri-County. "We have to see how this plays out."
Saker Sus, the owner of Little Sailors, said his own son was showing symptoms for over a month.
Sus says his center is separating the children that show symptoms. "The reason we're not sending them home is because we don't want the parents to take them to a different child-care setting and spread the disease around."

From the don't-bring-spoiled-meat-onto-a-plane-file, a flight from Atlanta to Charlotte was forced to return to the gate prior to takeoff as maggots fell from the overhead bin onto passengers below.

U.S. Airways spokesman Todd Lehmacher says the maggots were in a container of spoiled meat that a passenger brought onto the plane Monday.

The plane returned to the gate and passengers got off so cleaning crews could clean the overhead bin.

Lehmacher says the flight then continued on to Charlotte, where the plane was taken out of service and fumigated out of an "abundance of caution."

A

Snakes on a Plane

trifecta is now in play.

Kellogg's has recalled four cereal products due to an off odor and flavor linked to white foil packaging. Twenty customers have reported a waxy smell associated with the cereal; five of those individuals had nausea and diarhea. 

According to Kellogg's:

Consumers should not eat the recalled products because they do not meet our quality standards.  A few consumers have experienced temporary symptoms, including nausea and diarrhea.  Consumers with concerns should consult their health care provider.

Recalled products include:

Kellogg's® Apple Jacks®
UPC 3800039136
17 ounce package with Better if Used Before Dates between APR 10 2011 and JUN 22 2011

UPC 3800039132 3
8.7 ounce packages with Better if Used Before Dates between JUN 03 2011 and JUN 22 2011

Kellogg's® Corn Pops®
UPC 3800039109
12.5 ounce packages with Better if Used Before Dates between MAR 26 2011 and JUN 22 2011

UPC 3800039111
17.2 ounce packages with Better if Used Before Dates between MAR 26 2011 and JUN 22 2011

UPC 3800039116
9.2 ounce packages with Better if Used Before Dates between APR 05 2011 and JUN 22 2011

Kellogg's® Froot Loops®
UPC 3800039118
12.2 ounce packages with Better if Used Before Dates between MAR 26 2011 and JUN 22 2011

UPC 3800039120
17 ounce packages with Better if Used Before Dates between MAR 26 2011 and JUN 22 2011

UPC 3800039125
8.7 ounce packages with Better if Used Before Dates between MAR 26 2011 and JUN 22 2011

Kellogg's®Honey Smacks®
UPC 3800039103
15.3 ounce packages with Better if Used Before Dates between MAR 26 2011 and JUN 22 2011

Only products with the letters "KN" following the Better If Used Before Date are included in the recall.

In 2009 the Fat Duck, Heston Blumenthal’s chic-chic restaurant in Bray, UK, was the source of a norovirus outbreak that led to over 500 illnesses. According to health official investigators, the initial source of contamination was raw oysters from a less-than-reputable harvest bed.

Investigators found that things got worse and the outbreak continued for at least six weeks (between January 6 and February 22) because of ongoing transmission at the restaurant- through continuous contamination of foods prepared by ill food workers.

In 2006, a Carrabba’s restaurant in Michigan had its own you-should-have-stayed-home-because-you-are-sick moment.  At least 364 restaurant patrons became ill with norovirus after eating meals prepared by employees who had reported to work while ill. According to the CDC’s report on this outbreak:

"Vomiting by a line cook at the work station might have contributed to transmission … Because of the open physical layout of the restaurant, no barrier impeded airborne spread of the virus from the kitchen to the main dining area."

Yummy.

According to a New York Times blog post, there’s a recent poll on that demonstrates what happens (at least self-reported) in the absence of paid sick days.

The survey found that 55 percent of respondents who said they were not eligible for paid sick days said they had at some point gone to work with a contagious illness like the flu or a viral infection, compared with 37 percent who said they received paid sick days.

Paid sick days are a touchy issue in the foodservice industry because the threat of abuse of the benefit. If I ran a restaurant I’d want to have some mechanism in place to encourage self-reporting of illness so I could get the individual away from the meals I’m trying to sell.

Car time used to be the best thinking time for me. While living in Guelph and working on my MSc I’d drive semi-weekly to the greenhouse vegetable capital of North America, Leamington, Ontario (that’s in Canada) to do some on-farm food safety work with the industry. I’d throw some tunes on, rock out and try to get stuff straight in my head. On the drive I’d dream up my next activity or op-ed idea; between Tim Horton’s stops and refinement conversations (I had just got my first cell phone) some salient ideas might have developed.

Today I spent 15 hours in the car driving from Port Hope, Ontario (also in Canada) to Raleigh, NC with Dani and  21-month old Jack in the vehicle (which is now a family friendly minivan equipped with a DVD player). Elmo and The Wiggles DVDs (4 and 6 viewings today, respectively) have replaced rock-out-friendly tunes and phone conversations have been replaced by pointing out buses, cows, planes and boats to Jack.

Regardless, I still had some time to think about some stuff.

Coverage surrounding our food safety infosheet evaluation paper last week has been pretty decent, with pick-up from Scientific American, AP and USA Today (which Doug has already mentioned) as well as a few blogs. The focus of the paper has been represented pretty well, but there have been a few things worth clarifying and addressing.

From Scientific American:

- And recent research by food safety specialist Ben Chapman of North Carolina State University found that meals prepared in commercial kitchens have been involved in up to 70 percent of food poisoning.

Our team didn’t look at tracing where contamination happens and how many meals have led to outbreaks in the study, although we reported in the intro that up to 70% of outbreaks have been traced to meals outside of the home. We grabbed that estimate from a few sources including a combination of CDC outbreak line listing summaries and Ontario, Canada outbreak statistics. 

A limitation of the data is that it is an estimate derived only from confirmed outbreaks, which are usually reported by year. We saw estimates as low as 14% (Lee, M., and D. Middleton. 2003. Enteric illness in Ontario, Canada, from 1997 to 2001. J. Food Prot. 66:953–961. ) and as high as 83% for one year. We settled on up to 70% after looking at all the papers and eliminating/combining sources with assumptions and averaging outbreaks data out over a 5-year timeframe.

Casey and Doug tackled this question in a much more succinct way in a Foodborne Pathogens and Disease paper last year (Where Does Foodborne Illness Happen—in the Home, at Foodservice, or Elsewhere—and Does It Matter?):  Current surveillance systems focus on the place where food is consumed rather than the point where food is contaminated. Rather than focusing on the location of consumption—and blaming consumers and others—analysis of the steps leading to foodborne illness should center on the causes of contamination in a complex farm-to-fork food safety system.

Colin Caywood at Marler Clark’s Food Poisoning Journal used the paper to make the point that cross-contamination in restaurant kitchens can magnify the impact of an outbreak:

With that in mind, a recent article by Nicole Norfleet caught my attention for its insight into the way that outbreaks such as Subway's can be made exponentially worse by poor food safety practices at the restaurant…. Among the risky behaviors cited were workers using aprons and other garments to dry hands, as well as using the same utensils and surfaces to prepare both raw and cooked foods.

I definitely agree with cross-contamination making things worse, but I’m not sure if the current Subway-linked outbreak, where illnesses have been associated with food at 46 outlets, making it appear to be a common supplier source is the best example. Several foodhandlers testing positive for Salmonella serotype Hvittingfoss is beginning to look like the 2009 Fat Duck outbreak.

From The AP story:

Joan McGlockton, a food policy representative for the National Restaurant Association, was cited as saying that while the study is disconcerting, the association doesn't feel it is representative of the entire restaurant industry.

Yeah, I agree and the study wasn’t built to allow for generalizations. Our aim was to evaluate the efficacy of the infosheets as a behavior-changing intervention. While we were also able to gain some data that can be used in risk assessments, it has to be used carefully with realistic assumptions, because it’s the only video data set out there. Based on the time, effort and resources committed by the company we worked with, what we saw might represent the best practices out there. But maybe it doesn’t. We’re both guessing and if the NRA has some behavior data that we can compare our findings to that would be great.

I'm back in NC and starting a couple of new projects with the NC State team (Audrey Kreske and Allison Smathers) over the next week, further measuring what people actually do when it comes to food safety. More on these as data starts rolling in.

I'm all about investigating new messages and methods to communicate good food safety practices to foodhandlers with the aim of changing behavior. It's not enough to ask people whether they think they've changed what they do after being exposed to something -- behavior change needs to be measured. Behavior change-based evaluations messy, and can be a bit dicey gaining access to real working environments, but the results can be pretty cool. Last week I posted that a paper detailing the evaluation of food safety infosheets was published, and below is an NC State press release detailing some of the risk assessment data we collected.

How safe is the food we get from restaurants, cafeterias and other food-service providers? A new study from North Carolina State University -- the first study to place video cameras in commercial kitchens to see how precisely food handlers followed food-safety guidelines -- discovered that risky practices can happen more often than previously thought.

"Meals prepared outside the home have been implicated in up to 70 percent of food poisoning outbreaks, making them a vital focus area for food safety professionals," says Dr. Ben Chapman, assistant professor and food safety specialist in the department of family and consumer sciences at NC State and lead author of the paper. "We set out to see how closely food handlers were complying with food safety guidance, so that we can determine how effective training efforts are."

In order to get firsthand data on these food-safety practices, researchers placed small video cameras in unobtrusive spots around eight food-service kitchens that volunteered to participate in the study. There were as many as eight cameras in each kitchen, which recorded directly to computer files and were later reviewed by Chapman and others. What they found demonstrates the need for new food safety-focused messages and methods targeting food handlers.

"We found a lot more risky practices in some areas than we expected," Chapman says. For example, most previous studies relied on inspection results and self-reporting by food handlers to estimate instances of "cross-contamination" and found that cross-contamination was relatively infrequent. But Chapman's study found approximately one cross-contamination event per food handler per hour. In other words, the average kitchen worker committed eight cross-contamination errors, which have the potential to lead to illnesses, in the course of the typical eight-hour shift.

Cross-contamination occurs when pathogens, such as Salmonella, are transferred from a raw or contaminated source to food that is ready to eat. For example, using a knife to cut raw chicken and then using the same knife to slice a sandwich in half. Cross-contamination can also result from direct contact, such as raw meat dripping onto vegetables that are to be used in a salad.

"Each of these errors would have been deemed a violation under U.S. Food and Drug Administration Food Code inspection guidelines. But more importantly, cross-contamination has the potential to lead to foodborne illnesses and has in recent outbreaks" Chapman says. "And it's important to note that the food-service providers we surveyed in this study reflected the best practices in the industry for training their staff."

The study also confirmed the long-held supposition that more food-safety mistakes are made when things are busier in the kitchen. "During peak hours, we found increases in cross-contamination and decreases in workers complying with hand-washing guidelines," Chapman says.

But the researchers do more than identify problems in the new paper; they outline solutions that can be applied to the food service industry. One suggestion is that food-safety training for kitchen staff needs to address the "team-like" nature of a commercial kitchen, rather than focusing on food handlers as individuals. "This study shows us that each food handler is operating as part of a system," Chapman says, "and the food-safety culture of the overall organization—the kitchen and the management—needs to be addressed in order to effect change. For example, the general manager of a restaurant could take steps to highlight the value his or her business places on food safety."

Other steps that can be taken to address food-safety concerns include the introduction of new tools and procedures designed to minimize the risk of foodborne illness. New tools could be as simple as installing hand sanitizer units in accessible areas of the kitchen, which may be effective for reducing the likelihood of transfer of some pathogens. New procedures may include overhauling existing food-preparation schedules so that cooks face less time pressure during peak hours—and are therefore less likely to make food-safety mistakes.

The study, "Assessment of Food Safety Practices of Food Service Food Handlers: Testing a Communication Intervention" was co-authored by Dr. Douglas Powell and Katie Filion of Kansas State University, as well as Tiffany Eversley and Tanya MacLaurin of the University of Guelph in Canada. The study is published in the June issue of the Journal of Food Protection.