The Minnesota Department of Health on Friday said at least 60 people became sick after eating contaminated food at two events at downtown Duluth’s Greysolon Plaza Ballroom on Dec. 3.

That report was up from 40 people as of Thursday.

Trisha Robinson, a senior epidemiologist with the health department, said it appears the culprit was norovirus, the most common food-related illness in Minnesota, which is often spread by food-handlers who don’t thoroughly wash their hands.

People who have been ill should also refrain from preparing food, commercially or for their own families, for an additional 72 hours after they recover, Robinson said. The virus, which moves from anal to oral contact, is not easily spread by casual contact but moves fast through contaminated food.

Greysolon Ballroom remains open and able to serve food, Robinson said, but Department of Health staff members have been on site to make sure the facility is taking proper precautions to prevent the problem from happening again.

About 250 people attended one event and 100 attended the other at the Greysolon, state officials said. One was a wedding and the other a private party.

Tina Rosenberg of the New York Times writes that in the intensive care units at North Shore University Hospital in Manhasset, N.Y., two L.E.D. displays adorn the wall across from each nurses’ station. They show the hand hygiene rate achieved: last Friday in the surgical I.C.U., the weekly rate was 85 percent and the current shift had a rate of 91 percent. “Great Shift!!” the sign said. At the medical I.C.U. next door, the weekly rate was 81 percent, and the current shift 82 percent.

Those L.E.D. displays are very demanding — health care workers must clean their hands within 10 seconds of entering and exiting a patient’s room, or it doesn’t count. Three years ago, using the same criteria, the medical I.C.U.’s hand hygiene rate was appalling — it averaged 6.5 percent. But a video monitoring system that provides instant feedback on success has raised rates of handwashing or use of alcohol rubs to over 80 percent, and kept them there.

Hospitals do impossible things like heart surgery on a fetus, but they are apparently stymied by the task of getting health care workers to wash their hands. Most hospitals report compliance of around 40 percent — and that’s using a far more lax measure than North Shore uses.

How do hospitals even know their rates? Some hospitals track how much soap and alcohol gel gets used — a very rough measure. The current standard of care is to send around the hospital equivalent of secret shoppers — staff members who secretly observe their colleagues and record whether they wash their hands.

This has serious drawbacks: it is expensive and the results are distorted if health care workers figure out they’re being observed. One reason the North Shore staff was so shocked by the 6.5 percent hand-washing rate the video cameras found was that measured by the secret shoppers, the rate was 60 percent.

The North Shore study, published this week in the journal Clinical Infectious Diseases, is the first use of video in promoting hospital handwashing, and the first controlled study in a peer-reviewed journal of a high-tech effort to increase hand hygiene rates.

North Shore instead uses a video monitoring system made by a company called Arrowsight. Cameras on the ceiling are trained on the sinks and hand sanitizer dispensers just inside and outside patient rooms. (Patients are not photographed.) A monitor at each door tracks when someone enters or leaves the room — anyone passing through a door has 10 seconds to wash hands. Arrowsight employees in India monitor random snippets of tape and grade each event as pass or fail.

What makes the system function is not the videotaping alone — it’s the feedback.

The nurse manager gets an e-mail message three hours into the shift with detailed information about hand hygiene rates, and again at the end. The L.E.D. signs are a constant presence in both the surgical and medical I.C.U.s

This is Arrowsight’s first foray into health care. The company’s main business is meat: half the beef processing plants in America use its video system to monitor workers’ hygienic practices.

Adam Aronson, Arrowsight’s chief executive, said that at one plant cameras focused on a hand sanitizer dispenser right outside the bathroom. With monitoring and feedback, hand hygiene rates went from about 4 percent to over 95 percent, and the achievement was sustained.

At first Farber feared he wouldn’t be able to get approval; the conventional wisdom was that employees don’t like being videotaped. But then he thought about a recent experience at the dry cleaner: he had picked up some of his daughter’s clothes, but one of her suits was missing. He went back to the shop and told them the date and approximate time of his visit. They pulled up a video that indeed showed him leaving her suit behind. “If dry cleaners are doing that, we need to do that in the hospital,” he thought.

Dr. Pete gives good quote in a story from the I-Team at KHOU in Houston.

“They’re not following their own rules, and if they’re not following their own rules, they’re not protecting public health,” said food scientist Dr. Pete Snyder.

Just how often was the city not following its own rules? The I-Team found 4,009 restaurants, 65 percent of all Houston eateries, overdue for a health inspection.

And in hundreds of cases, the city was tardy by more than a year.

“Shape up and get their damn inspections fixed,” said Dr. Snyder, who was studying food safety and inspecting kitchens before we put a man on the moon.

As the founder and president of Minnesota-based Hospitality Institute of Technology and Management, he has educated thousands of executives, owners, chefs and employees on procedures for producing safe food.

He said delinquent inspections can undermine the entire regulatory process.

“Pretty soon the operator begins to believe that the health department is not real, they’re not going to punish him, and that’s bad,” Snyder said.

“Any restaurant in Houston that’s open for business is a safe place to eat,” said Patrick Key, Bureau Chief of Consumer Health Services.

At Ninfa’s in the 8500 block of the Gulf Freeway, Houston city inspectors closed the restaurant down in September 2010 after finding numerous violations. Those included live roaches, no soap in the kitchen sink, and food not safe for human consumption. The next day management corrected most of the violations, but was still written up for the treatment of roach activity.

It was due for another inspection in six months. But instead, the city waited more than a year. 



”You don’t let go of that restaurant until the restaurant has solved the problem,” Dr. Snyder said.
 
But repeat problems don’t always sound the city’s alarms either.

Consider the Triple J’s Smokehouse in the 6700 block of Homestead Road. It had 154 violations over the past three years. Its last inspection, November 2010, turned up equipment not washed, rinsed and sanitized, as well as potentially hazardous foods at unsafe temperatures. For that, the city should have checked up this past January, but has yet to do so.

There’s also KC’s Seafood and Grill in the 400 block of Maxey Road. City records showed it was a year and a half overdue for a health inspection, so we paid a visit with a food safety expert.

“Everything’s been corrected,” said the manager who identified herself as Debbie.

She told us everything was OK after a city inspector had finally shown up a few weeks before we did. But Dr. Snyder still found problems, from cooked food sitting out at room temperature, to problems with the kitchen sink.

“There’s no soap, there’s no paper towels, you couldn’t possibly use the hand sink to wash your hands in,” Dr. Snyder said, adding that hand washing is critical.

“That’s how half of the foodborne illness occurs,” Dr. Snyder said.

So the I-Team had some questions for that city bureau chief who said you should feel confident every Houston restaurant is a safe place to eat.

“I don’t think we’ve ever had enough staff,” said Patrick Key.

Key said the city just can’t keep up with its two requirements—annual inspections on all food permit establishments, as well as risk-based inspections on eateries with poor previous inspection scores.

But when the I-Team began digging, Key suddenly ordered 500 inspections at past due eateries. He said those were all done over the course of a week.
 
”90 percent of them got a score of one or two which are good scores,” Key said.

But for Dr. Snyder, good may not be good enough. Consider the Pho Saigon restaurant in the 2500 Block of Gessner, one of the 500 eateries the city had scrambled to inspect.

“They have bad cooling practices, they have bad hot holding practices, these are things that really make people sick,” said Dr. Snyder.

Dr. Snyder said the city should be saying this:

“We can’t have out-of-date facilities who are supposed to be inspected. We will have none of those anymore.”

As for Ninfa’s, the Gulf Freeway restaurant received a handful of non-critical violations on its most recent inspection last month. Additionally, Dr. Snyder gave the kitchen good marks during his tour of the restaurant.

The Pima County Board of Health wanted you to have some hand sanitizer before you have a hot dog, but the Board of Supervisors denied a proposal to require food trucks to provide the gel.

The proposed ordinance also would have required food festivals to provide a handwashing station for every five portable toilets.

During their meeting this morning, the supervisors voted unanimously to reject the proposed ordinance.

Some food truck owners and festival organizers said the county doesn't need to legislate handwashing.

"Hand sanitizer isn't communism, it's common sense," health board member Brad Brumm said after the meeting.

Supervisor Ann Day said common sense will lead people to carry hand sanitizer in a purse or pocket if they want to wash up.