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A Multidisciplinary Approach to Investigating Foodborne Illness Outbreaks June 26, 2019
Transcript of A Multidisciplinary Approach to Investigating Foodborne ... › uploads › card-images › ...A...
A Multidisciplinary Approach to Investigating Foodborne
Illness Outbreaks
June 26 2019
Overview
bull Seattle-King Countyrsquos Approach to Foodborne Illness Investigation bullQampA Session
Housekeeping Items
Throughout the presentation please use the QampA box to ask questions and the chat box to share your experiences The facilitator will pose your questions to the presenters
Recordingg
A link to the recorded webinar will be emailed to all participants This recording and past food safety sharing sessions can also be found the NACCHO website
httpswwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
PUBLIC HEALTH ndash SEATTLE amp KING COUNT Y FOODBORNE ILLNESS INVESTIGATION TEAM
June 26 2019
NACCHO Sharing Session
FOODBORNE ILLNESS OUTBREAK
INVESTIGATION OVERVIEW
Doug Dyer MS RS
Elysia Gonzales RN MPH
KING COUNTY WASHINGTON
SEATTLE
Environmental Health Food Program 65 staffCommunicable Disease Epidemiology 40 staffCommunications 8 staff
STAFF ndash BY THE NUMBERS
PREVIOUS SYSTEM
EPI
EH
COMMS
EPI
EH
COMMS
TEAM APPROACH
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Overview
bull Seattle-King Countyrsquos Approach to Foodborne Illness Investigation bullQampA Session
Housekeeping Items
Throughout the presentation please use the QampA box to ask questions and the chat box to share your experiences The facilitator will pose your questions to the presenters
Recordingg
A link to the recorded webinar will be emailed to all participants This recording and past food safety sharing sessions can also be found the NACCHO website
httpswwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
PUBLIC HEALTH ndash SEATTLE amp KING COUNT Y FOODBORNE ILLNESS INVESTIGATION TEAM
June 26 2019
NACCHO Sharing Session
FOODBORNE ILLNESS OUTBREAK
INVESTIGATION OVERVIEW
Doug Dyer MS RS
Elysia Gonzales RN MPH
KING COUNTY WASHINGTON
SEATTLE
Environmental Health Food Program 65 staffCommunicable Disease Epidemiology 40 staffCommunications 8 staff
STAFF ndash BY THE NUMBERS
PREVIOUS SYSTEM
EPI
EH
COMMS
EPI
EH
COMMS
TEAM APPROACH
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Housekeeping Items
Throughout the presentation please use the QampA box to ask questions and the chat box to share your experiences The facilitator will pose your questions to the presenters
Recordingg
A link to the recorded webinar will be emailed to all participants This recording and past food safety sharing sessions can also be found the NACCHO website
httpswwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
PUBLIC HEALTH ndash SEATTLE amp KING COUNT Y FOODBORNE ILLNESS INVESTIGATION TEAM
June 26 2019
NACCHO Sharing Session
FOODBORNE ILLNESS OUTBREAK
INVESTIGATION OVERVIEW
Doug Dyer MS RS
Elysia Gonzales RN MPH
KING COUNTY WASHINGTON
SEATTLE
Environmental Health Food Program 65 staffCommunicable Disease Epidemiology 40 staffCommunications 8 staff
STAFF ndash BY THE NUMBERS
PREVIOUS SYSTEM
EPI
EH
COMMS
EPI
EH
COMMS
TEAM APPROACH
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Recordingg
A link to the recorded webinar will be emailed to all participants This recording and past food safety sharing sessions can also be found the NACCHO website
httpswwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
PUBLIC HEALTH ndash SEATTLE amp KING COUNT Y FOODBORNE ILLNESS INVESTIGATION TEAM
June 26 2019
NACCHO Sharing Session
FOODBORNE ILLNESS OUTBREAK
INVESTIGATION OVERVIEW
Doug Dyer MS RS
Elysia Gonzales RN MPH
KING COUNTY WASHINGTON
SEATTLE
Environmental Health Food Program 65 staffCommunicable Disease Epidemiology 40 staffCommunications 8 staff
STAFF ndash BY THE NUMBERS
PREVIOUS SYSTEM
EPI
EH
COMMS
EPI
EH
COMMS
TEAM APPROACH
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
PUBLIC HEALTH ndash SEATTLE amp KING COUNT Y FOODBORNE ILLNESS INVESTIGATION TEAM
June 26 2019
NACCHO Sharing Session
FOODBORNE ILLNESS OUTBREAK
INVESTIGATION OVERVIEW
Doug Dyer MS RS
Elysia Gonzales RN MPH
KING COUNTY WASHINGTON
SEATTLE
Environmental Health Food Program 65 staffCommunicable Disease Epidemiology 40 staffCommunications 8 staff
STAFF ndash BY THE NUMBERS
PREVIOUS SYSTEM
EPI
EH
COMMS
EPI
EH
COMMS
TEAM APPROACH
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
KING COUNTY WASHINGTON
SEATTLE
Environmental Health Food Program 65 staffCommunicable Disease Epidemiology 40 staffCommunications 8 staff
STAFF ndash BY THE NUMBERS
PREVIOUS SYSTEM
EPI
EH
COMMS
EPI
EH
COMMS
TEAM APPROACH
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
SEATTLE
Environmental Health Food Program 65 staffCommunicable Disease Epidemiology 40 staffCommunications 8 staff
STAFF ndash BY THE NUMBERS
PREVIOUS SYSTEM
EPI
EH
COMMS
EPI
EH
COMMS
TEAM APPROACH
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Environmental Health Food Program 65 staffCommunicable Disease Epidemiology 40 staffCommunications 8 staff
STAFF ndash BY THE NUMBERS
PREVIOUS SYSTEM
EPI
EH
COMMS
EPI
EH
COMMS
TEAM APPROACH
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
PREVIOUS SYSTEM
EPI
EH
COMMS
EPI
EH
COMMS
TEAM APPROACH
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
TEAM APPROACH
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
EH Members in Training
7 staff
EH Experienced Members10 staff
EH Food Program Leads
12 staff
Responsibilities
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Provide technical advice and support Partner with
restaurant investigator in the field
Back-up to experienced members
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
EH Members in Training
7 staff
EH Experienced Members 10 staff
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Epi Food Program Leads
12 staff
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
EH Members in Training
EH Experienced
Members
EH Food Program
Leads
Comms Foodborne Lead
Epi Foodborne Liaison Lead
Senior Foodborne Technical Lead
Lead Roles
FOODBORNE ILLNESS INVESTIGATION TEAM (FIIT)
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Small group with expertise Increases investigation consistency amp
effectivenessClear rolesresponsibilitiesFIIT members are Capable to perform many roles as neededReady to deploy Mentors
WHY HAVE A FIIT
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
OUTBREAK INVESTIGATION
PROCESS
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Reports received
Plan Approach
Investigation request
Team prep call
Field investigation
Team field call
Team disclosure meeting
Public disclosure
Follow-up steps
After action
INVESTIGATION PROCESS
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
1 RECEIVE REPORTS
Salmonella
Epi
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
2 PLAN APPROACH
Epi
EH
Comms Lab
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
2 TEAM PREP
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator (as needed)
Comms
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
ORGANISM-SPECIFIC RESOURCE GUIDE
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
VOMITING AND DIARRHEA CLEANUP
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
ENVIRONMENTAL ASSESSMENT FORM
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
2 TOOLKIT ESSENTIALS
Planning checklist Guides prep for field investigation (before during after)
Organism-specific resource guide Guide to tailor investigation into CFrsquos for typical foodborne pathogens
Resources for operators Includes chlorine concentrations for noro FDA illness policy forms
Employee illness screening forms Self-report form in multiple languages
Environmental Assessment (EA) Form WArsquos modified version of the CDC NEARS form
Sampling kits Specimen kits and cooler for use if indicated
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
3 FIELD INVESTIGATION REQUEST
EH
Submits standardized request form
Epi
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
INVESTIGATION REQUEST FORM
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
4 TEAM PREP CALL
Epi EH
Field team included EH Restaurant
InvestigatorEH FIIT
InvestigatorEpi
Investigator
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
5 FIELD INVESTIGATION
SAM amp ELLAS DINER
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
5 FIELD INVESTIGATION ROLES
bull Explains process to person in charge at restaurant
bull NEARS form databull Diffuses tension bull Collects samples
(if indicated)
EH FIIT INVESTIGATOR
bull Conducts routine inspection with focus on contributing factors for Salmonella
EH RESTAURANT INVESTIGATOR
EPI INVESTIGATOR
bull Screens staff for illness
bull Observational data
bull Assists EH investigators
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
6 TEAM FIELD CALL
Field investigation team
EH Restaurant Investigator
EH FIIT Investigator
Epi Investigator
EH Epi leads
Review field findingsAnswer questions from
restaurant managementMake decisions on
immediate interventionsDiscuss sample collection
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
7 TEAM DISCLOSURE MEETING
ReviewFindings from Epi
EH and LabStrength of evidence Interventions and
remaining stepsNeed for disclosureNeed for blog
EH + Epi + Comms
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
8 PUBLIC DISCLOSURE
wwwkingcountygovoutbreak
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
8 PUBLIC EXPECTATIONS FOR TRANSPARENCY
Health officials who investigated the outbreak did not inform the public I find that completely unequivocally wrong said Bill Marler a food safety litigator in Seattle They have a responsibility to the public
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Investigation led by King County and cluster was
CONFIRMED FBD outbreak with lab evidence confirming the outbreak etiology
PROBABLE FBD outbreak with observational evidence and contributing factors without lab evidence
SUSPECT [possible] Group of cases linked by time or place without strong evidence linking to a common food
8 WHICH OUTBREAKS TO DISCLOSE
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
8 TIMING OF DISCLOSURE
Disclose while investigation is ongoing if Risk to the public still exists Public can take action to protect their health Severe outcomes seen Case finding is needed Need to prevent or interrupt misinformation High profile concerns (media or political) Novel vehicle identified
Otherwise disclose once investigation is complete
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Follow-up site visit(s) by EH
Work with WA DOH Lab on testing specimens
Work with local state and federal partners
Update public disclosure with final outcomes
Complete report forms (NEARSNORS)
9 FOLLOW-UP STEPS
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
10 AFTER ACTION REVIEW
What was supposed to
happen
What actually happened
What worked amp what was
challenging
What can be improved next
time
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
BENEFITS OF TEAM APPROACH
Many perspectives
More effective amp efficient
Delineates roles
Builds expertise Increases trust
Increased cultural competency
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
CHALLENGES OF TEAM APPROACH
Filling absences
Every investigationis unique
Maintaining experience Too many cooks in the kitchen
Balancing thoroughness with efficiency
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
LESSONS LEARNED
Hold after action debriefsMaintain equal partnerships not hierarchicalQuarterly FIIT meetings and frequent trainingsTable top exercises Case reviews
Disclosure process is time intensive but effectivePH leads by speaking first reducing misinformationDecreased media calls
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
LESSONS LEARNED
Identify points-of-contact for each program Include Epi investigator in EH field visitsShare data across programsTeam approach requires broad engagementMake time for process improvement activitiesDevelop consistent tools internally and
externally
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Elysia Gonzales Epidemiology Foodborne Disease Program Manager elysiagonzaleskingcountygov
Doug Dyer Environmental Health Senior Technical Leadddyerkingcountygov
Ki Straughn Environmental Health Services Supervisor kstraughnkingcountygov
Kate Cole Communications Specialistkacolekingcountygov
THANK YOU
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Council to Improve Foodborne Outbreak Response (CIFOR) wwwciforus FDA Retail Program Standard 5 - Foodborne I l lness and Food Defense
Preparedness and Response wwwfdagovmedia86813download Epi-Ready Team Training wwwnehaorgprofessional-
developmenteducation-and-trainingepi-ready -team-training CDC Integrated Food Safety Centers of Excellence (COE)
wwwcdcgovfoodsafetycenterspdfscoe-factsheetpdf Council of State and Territorial Epidemiologists (CSTE)
wwwcsteorgpageWebinarLibrary Rapid Response Teams (RRTs) wwwfdagovfederal-state-local-tr ibal-
and-territorial -of ficialsnational- integrated-food-safety -system-ifss-programs-and-init iativesrapid-response-teams-rr ts
USDAFSIS wwwfsisusdagovwpsportalfsistopicsrecalls-and-public-health-aler tsaudience-public-healthresources-for
National Environmental Assessment Reporting System (NEARS)wwwcdcgovncehehsnearsindexhtm
CDC National Outbreak Reporting System (NORS)wwwcdcgovnorsresourceshtml
RESOURCES
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
QampA Session
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
Thank you for your participation in todayrsquos sharing session
For more information about NACCHOrsquos Food Safety and Infectious Disease Programs contact
bull Amy Chang(achangnacchoorg)bull Erin Laird (elairdnacchoorg)
NACCHO Food Safety Webpagehttpwwwnacchoorgprogramsenvironmental-healthhazardsfood-safety
NACCHO Infectious Disease Webpagehttpswwwnacchoorgprogramscommunity-healthinfectious-disease
- A Multidisciplinary Approach to Investigating Foodborne Illness OutbreaksJune 26 2019
- Overview
- Housekeeping Items
- Recordingg
- Foodborne illness outbreak investigation overview
- King county washington
- Seattle
- Staff ndash by the numbers
- Previous system
- Team approach
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Foodborne illness investigation team (FIIT)
- Why Have a FIIT
- Outbreak investigation process
- Investigation Process
- 1 Receive reportS
- 2 PLAN APPROACH
- 2 TEAM PREP
- 2 Toolkit essentials
- 2 Toolkit essentials
- Organism-specific resource guide
- 2 Toolkit essentials
- Vomiting and Diarrhea cleanup
- 2 Toolkit essentials
- 2 Toolkit essentials
- Environmental Assessment Form
- 2 Toolkit essentials
- 3 FIELD investigation REQUEST
- Investigation request form
- 4 TEAM Prep call
- 5 Field Investigation
- 5 Field investigation roles
- 6 TEAM FIELD CALL
- 7 TEAM DISCLOSURE MEETING
- 8 PUBLIC disclosure
- 8 Public Expectations for Transparency
- 8 Which outbreaks to disclose
- 8 Timing of disclosure
- 9 FOLLOW-UP steps
- 10 AFTER ACTION REVIEW
- Benefits of team approach
- Challenges of team approach
- Lessons learned
- Lessons learned
- Thank you
- Resources
- QampA Session
- Thank you for your participation in todayrsquos sharing session
-
