The vomit machine lives on; norovirus can aerosolize during vomit events

I’ve been lucky to be close to some excellent projects, some of the stuff and knowledge created through these projects ends up mattering to food safety nerds – especially those who are making risk management decisions. Former NC State student Grace Tung-Thompson’s PhD project on vomit spray and norovirus is one of the most impactful. The work was carried out as part of the USDA NIFA-funded NoroCORE project led by my friend Lee-Ann Jaykus.VOMIT-BLOG-HEADER-698x393

I’ve talked to lots of Environmental Health Specialists, retailers and food service food safety folks about what Grace and fellow graduate student Dominic Libera put together and many respond with a weird level of enthusiasm for the barf project.

Mainly because a real question they struggle with is how far will virus particles travel from an up-chuck event – knowing this, and then cleaning and sanitizing helps limit the scope of a potential outbreak.  Grace’s work was published in PLOS ONE a while ago, we used it as a centerpiece for a Conference for Food Protection issue on vomit clean up in 2016 (which, maybe, could be included in the oft rumored 2017 Food Code) and the Daily Beast  covered the work today.

A couple of years ago, PhD student Grace Tung Thompson demonstrated something incredibly gross: When a person vomits, little tiny bits of their throw-up end up airborne. You could ingest them just by breathing air in the same room. As if that weren’t disconcerting enough, if the person got sick from a virus, there could be enough viruses in the air to get you sick, too. Just try not to think about that the next time the person in the row behind you throws up on an airplane.
So how do you get rid of airborne viruses? “There is no known technology that will eliminate norovirus if it’s in the air,” Jaykus said, “and there really aren’t a lot of technologies—safe technologies—that even are likely to work.” Her research team recently experimented with misting antiviral compounds into spaces as an alternative to disinfecting surfaces individually, and it worked, but not completely. This technique, known as fogging, can only be used in spaces that can be cleared out and contained, like bathrooms, for example. “I think we need that technology, and that technology is really, really important, but how the heck we’re going to develop it? I’m at a loss for words.”

From an individual perspective, the best you can do is get yourself far away from a vomiting incident; Jaykus recommends at least 100 feet. If you were in the middle of a meal at a restaurant and someone at the next table threw up, you’d probably be wise to stop eating, and to wash yourself and your clothes when you are able.

From the perspective of a restaurant owner, the best course of action is to do a really, really good job of the cleanup. Commercial vomit and fecal matter cleanup kits are catching on with bigger companies in the foodservice industry, says Jaykus. They provide personal protection, including disposable coveralls and respirator masks, in addition to the material required to pick up and wipe down the mess.

Storytelling has structure

Don’t just say people need to be educated. Figure out how to tell the risk story.

We’ve talked about storytelling a lot on barfblog. Doug and I published a couple of papers a few years ago on using narratives to impact food safety behaviors (here and here). Doug has always stressed the importance of not only being a good storyteller, but that there’s structure to a good story.

I just watched Don Schaffner give a talk on food safety risk assessment at the Dubai International Food Safety Conference and while some might consider it a dry concept, Don told two stories that exemplified how it all works.

A recent podcast name check caused me to check out Community and Rick and Morty creator Dan Harmon and his storytelling circle (right, exactly as shown, from an excellent old Wired article).

And there’s this classic from Kurt Vonnegut.

 

Eating broken glass sucks; Trader Joe’s salad recalled

Friend of barfblog and mentor Tanya MacLaurin told me a story when I was in grad school that I still use when telling folks about physical hazards.

It goes sorta like this (or this is the version I remember):

Tanya was running food services at Kansas State and had a really big event with donors and university administrators. She came into the kitchen and saw her staff picking something out of a couple of hundred of salads that were prepped and ready to go our for service. Someone had broken a fluorescent light that was situated over the staging area and everyone was scrambling to pick out the glass.

A great risk manager, Tanya shut down the coverup operation.

Glass removal by eyesight isn’t a great critical control point.

In related news, a supplier of Trader Joe’s salads is recalling a whole bunch of prepared salads due to glass contamination.

Green Cuisine, a San Fernando, Calif. establishment, is recalling approximately 36,854 pounds of chicken and turkey salad products that may be contaminated with extraneous materials, specifically hard silica and glass fragments, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The ready-to-eat chicken and turkey salads were produced from Nov. 4 – 15, 2017. The following products are subject to recall:

* 10.5-oz. clear plastic individual serving packages containing “TRADER JOE’S White Meat Chicken Salad with celery, carrots and green onions” with a “Use By” date of November 10 – 21, 2017.

* 11.0-oz. clear plastic individual serving packages containing “TRADER JOE’S CURRIED WHITE CHICKEN DELI SALAD with toasted cashews, green onion and a bit of honey” with a “Use By” date of November 10 – 21, 2017.

* 10.25-oz. clear plastic individual serving packages containing “TRADER JOE’S TURKEY CRANBERRY APPLE SALAD TURKEY BREAST MEAT WITH SWEET DRIED CRANBERRIES, TANGY GREEN APPLES, PECANS AND SAGE” with a “Use By” date of November 10 – 21, 2017.

The products subject to recall bear establishment number “P-40299” inside the USDA mark of inspection. These items were shipped to retail locations in the following states: Arizona, California, Colorado, Idaho, Louisiana, New Mexico, Nevada, Oklahoma, Oregon, Texas, Utah and Washington.

Blaming consumers: Cruise ship edition

Jim Walker of Cruise Law News writes the Centers for Disease Control (CDC) reports that there was a gastrointestinal outbreak on the Crown Princess during its recent cruise, from October 25th to November 8, 2017. The Princess cruise ship departed Quebec, Canada on October 25th for a two-week cruise to Canadian and U.S. ports. The cruise ship arrived in Fort Lauderdale, Florida on November 8th and will begin its Caribbean season.

According to the CDC report, 184 passengers and 12 crew members became ill with gastro-like symptoms which included diarrhea.  

During the period from 2010 to the current date, Princess Cruises experienced the most outbreaks on its cruise ships calling on U.S. ports, according to the CDC. Princess reported twenty-one (21) cases to the CDC during this time period.

The Crown Princess alone has suffered through six (6) norovirus outbreaks since 2010 to the present. Before the current GI outbreak, the last norovirus outbreak on the Crown Princess was from January 3 – 18, 2016 and, before that, from October 18 to November 16, 2014. Earlier, there was a norovirus and e-coli outbreak from February 5 to 12, 2014. It also experienced back-to-back norovirus outbreaks from January 29 to February 4, 2012 and February 4 to February 9, 2012.

The cruise line with the second most outbreaks is Holland America Line with 18 cases of GI sicknesses reported to the CDC since 2010. HAL suffered norovirus outbreaks on the Nieuw Amsterdam, and two outbreaks each on the Voendam and the Noordam this year.  

So why is Princess Cruises far more prone to norovirus outbreaks than Carnival cruise lines, for example?

The cruise industry always blames the passengers for bringing the virus aboard, rather than its food handlers, or contaminated food or water. So are Princess Cruises customers the sickest and the least hygienic cruisers around? Are guests of HAL the second most unhygienic cruisers? Do they wash their hands the least of any cruisers? This seems like absurd arguments to make.

Whoever is to blame, the crew members, of course, always pay the price, by having to wipe and scrub and spray everything in sight for long 16+ hour days to try to disinfect a ship longer than three football fields.

Irrespective of the blame-game, don’t call us if you get sick on a cruise. Proving where the virus came from, or that the cruise line was negligent, is virtually impossible to prove, especially since the CDC conducts no epidemiological analysis and sometimes can’t even figure out whether the outbreak is due to norovirus, e-coli or something as exotic as Shigella sonnei or Cyclospora cayetanensis.

For example, The New Zealand Herald reports, a passenger on a cruise ship plagued with a vomiting and diarrhoea bug says he only learnt previous guests had been struck down with the same thing once they set sail.

Sydney man Walter Gibian and his wife Elisabeth left Sydney on October 30 on a 12-day Celebrity Solstice cruise travelling from Sydney to Auckland via the South Island so they could see New Zealand. Gibian had worked in New Zealand in 1980s and loved it so booked the cruise to see the East Coast.

The ship had left Melbourne when the captain announced to guests that passengers on an earlier cruise had norovirus and asked guests to take extra precautions including washing their hands regularly and using hand sanitiser.

any notification before they left and by this time it was too late to do anything about it as they were well on their way to New Zealand.

“It think people should be told and given the option that if you don’t like being exposed to this virus you are allowed to get off. But we found out when we were sea.”

Halfway into the 12-day cruise passengers started falling ill and Elisabeth came down with the bug on Saturday night. She was then isolated to her cabin for 48 hours.

“They (passengers) are sick all right. But of course the ship won’t tell us how many are sick, but my wife got sick on Saturday night. They are taking all sorts of precautions but it is still happening. They keep telling me, they are doing their utmost and they are doing their best but the fact is it is not effective.”

Food Safety Talk 138: Ominous noises

This special pre-halloween episode features ominous noises, and we are not talking about the pinging noise from Don’s email in the background.  The show opens with discussion not of noise, but of the sights and smells of fresh compost around Ben’s office.  After a brief digression into favorite TV, podcasts and fan feedback, the talk turns to recent food safety publications on cutting board safety and water bottle sanitation, followed by best Reduced Oxygen Packaging Handling practices from listener feedback. Next Ben gets real time inspiration and the guys do some back of the envelope risk assessment on home preparation of black garlic before a discussion raw camel milk and the risks of fake cures.  The show ends with a discussion of turkey eggs and Canadian Thanksgiving.

Episode 138 can be found here and on iTunes.

Here are show notes so you can follow along at home:

Jumped the shark: Food safety culture

It’s a shame when one of your children jumps the shark.

Not my actual children, there are all unique and different, and I love their takes on life.

Ideas are not biological beings.

Food ​safety culture in a business is how everyone (owners, managers, employees) thinks and acts in their daily job to make sure that the food they make or serve is safe. It’s about having pride in producing safe food every time, recognising that a good quality product must be safe to eat. Food safety is your top priority.

A strong food safety cu​lture comes from people understanding the importance of making safe food and committing to doing whatever it takes, every time. It starts at the top but needs everyone’s support across the business.

Food Standards Australia New Zealand (FSANZ) says it has developed some easy-to-use tools and resources to help businesses and regulators work together to improve food safety culture, through a 3-step process:

Step 1: Know where your business stands

Step 2: Do something to make a difference

Step 3: Follow through for a long-lasting impact

Food safety is not simple, and nothing is easy.

How does FSANZ know their tools are easy to use? Have they done surveys, personal interviews?

Unlikely.

It’s one of those catch phrases which means, be suspicious.

I’ve always told my daughters, anyone who says trust me is untrustworthy.

Food safety is like anything else, especially hockey: put in the hours, get it right.

Food Safety Talk 137: Grandma makes the best pickles

Don and Ben talk High Sierra and bricking a MacBook Air, Gord Downie of the Tragically Hip, State Fair judging, pH test strips, mail order food safety and cold brewed canned coffee. They also do some listener feedback on food safe issues related to brewing beer.

Episode 137 can be found here and on iTunes.

Show notes so you can follow along at home:

Baltimore proposes inspection disclosure

My little boy turned 2 yesterday and my family and I went all out to make this a memorable event. He’s into Paw Patrol (cartoon about dogs who rescue) and so the house was littered with Paw Patrol posters, napkins, plates, everything and dad’s wallet was depleted.
Worth it when I saw the look on his face.
I was in charge of picking up cake and food for the evenings’ BBQ from a local grocery store. In Manitoba (Canada) there is no on-site disclosure system to inform me how the place fared on their latest health inspection but I have done enough of them in my time to understand what to look for when I am shopping/dining and I ask questions, it’s the food safety in me. I observe behaviors; it gives me a more comprehensive picture of a food establishment’s culture. The City of Baltimore is proposing that restaurants post their latest inspection report to increase public transparency. Anything to better inform the public on food safety is better than nothing. I am curious to see if patrons will actually read the report and accurately assess the risk.

Baltimore Sun reports

At least once every year each of Baltimore City’s approximately 5,700 restaurants and eateries must pass a health department inspection in order to stay in business. Those checks are essential not only to ensure that minimum standards of cleanliness are observed in food preparation and service but also to prevent the spread of serious foodborne illnesses such as Norovirus and Salmonella. Yet until recently the public had virtually no way of knowing when a restaurant failed to pass muster or the reasons officials shut it down. Baltimore needs to make the process more transparent so that citizens can be more confident making up their own minds about where and what to eat.
A bill last year sponsored by City Councilman Brandon Scott would have required health department officials to assign a letter grade to restaurant inspection reports and display the results in a prominent place. Many other cities, including New York, have adopted similar grading systems over the initial objections of restaurateurs who argued consumers would confuse it for an endorsement of some restaurants over others. That appears not to have happened in the Big Apple, where the restaurant industry is still booming. Yet Mr. Scott’s initiative ultimately failed in the council, even though the debate did convince Health Commissioner Dr. Leana Wen to post restaurant inspection reports on her department’s website.
Now Mr. Scott is back this year with a new proposal that would require restaurants to post their latest health inspection reports in plain view outside their shops. Unlike his earlier effort, this one wouldn’t require inspectors to give restaurants a letter grade. We appreciate restaurants’ objection to such a system but also the value an easy-to-understand rating would have for diners. Though it may be unlikely that potential patrons would be as inclined (or equipped) to judge the contents of an entire inspection report as they would a simple letter grade, posting them would still represent a vast improvement in transparency. Diners could look up a restaurant’s inspection report on the Internet, but they’re much more likely to consider the issue of food safety if reports are posted in plain sight.
“We need to join the rest of the civilized world on this issue,” Mr. Scott says. “The city inspection reports are already on line, and there are only a handful of major cities that don’t require restaurants to show their health department reports on site. In Baltimore, for some reason, we’ve been slow to do that.”
The federal government estimates that about 1 in 6 Americans are sickened by a foodborne illness each year, which adds up to about 48 million cases nationally. Though the American food supply is considered one of the safest in the world, foodborne illness account for an estimated 128,000 hospitalizations and 3,000 deaths every year. Young children, the elderly and people with weakened immune systems are at greatest risk for contracting such diseases, but they can strike anyone of any age with deadly effect.
That’s why we urge the City Council to revisit Mr. Scott’s proposed legislation with the aim of helping consumers judge for themselves whether the food they are offered is safe to eat. Some restaurant owners object that posting inspection reports prominently on site could confuse diners who may not know how to interpret the results or who may become alarmed by a reported problem that appears to be more serious than it really is. But that’s a cause to educate the public, not to hide important information. If a report prompts consumers to ask questions about a particular food safety issue, it’s probably something the restaurant owner ought to be paying more attention to anyway.
Would any requirement that establishments post their inspection reports in a prominent place make customers less likely to patronize a particular restaurant or eatery? We doubt that any of the city’s top-tier dining places would see much, if any, change in consumer attitudes, not least because they’ve spent years developing reputations for excellence in all aspects of their business, including food safety and cleanliness. It’s the smaller, more informal neighborhood establishments that are most likely to feel the effects of a change in the law, but they’re also the most likely to be cited for health code violations. By encouraging them to strive for a clean bill of health every time Mr. Scott’s proposed legislation would give them more than enough incentive to offer fare that is not only tasty but safe to eat as well.
As for the criticism this proposal is bound to receive that restaurant inspections are a minor issue compared to Baltimore’s epidemic of violence, we would note that Brandon Scott is the last city official who could be accused of paying insufficient attention to the crime rate. On the contrary, no member of the council has been so consistently at the forefront of efforts to develop strategies for improving public safety and for ensuring accountability. He’s allowed to do more than one thing at a time. In fact, the taxpayers who pay his salary should expect it.

Nacho cheese botulism was likely linked to retail practices

Lots of folks must like to eat gas station food; even the nacho cheese and nacho combos. I figure they are good sellers since so much retail space is dedicated to the snack. Earlier this year, according to a memo from the California Department of Public Health, ten people became ill with botulism after eating nacho cheese from Valley Oak Food and Fuel gas station in Walnut Grove, CA.

The memo highlights three notable things that came out of the investigation:

  • The 5 pound bag of nacho cheese collected at the retail location on May 5, 2017 was being used past the “Best By” date.
  • Records were not being maintained by the gas station employees indicating when the bag of nacho cheese was originally added to the warming unit.
  • The plastic tool designed to open the bags of cheese (provided with the nacho cheese warming and dispensing unit) was not being used by employees.

So the cheese was in the dispenser for a while, no one knows how long, and folks were using some other means to open the bag. Maybe some utensil with some soil ended up inserting bot spores deep into the anaerobic cheese bag.

 

Chicken sashimi is risky; and gross

A year ago I was in Japan for a few days and my hosts took me for sashimi every night. I think they thought it was funny taking a food safety nerd for a bunch of raw seafood. I did my best to be polite and steered towards more cooked foods. And lots of rice.

Earlier today Sara Miller at Live Science and I exchanged emails about chicken sashimi, a food that has been popular on twitter over the past couple of days. The same food that was linked to 800+ illnesses in the spring of 2016. Even Japanese public health folks were urging against eating it.

It’s not uncommon to find raw foods on a restaurant menu — think sushi or steak tartare — but if you see uncooked poultry as an option the next time you’re dining out, you may want to opt for something else.

Several restaurants in the United States are serving up a raw chicken dish that’s referred to as either chicken sashimi or chicken tartare, according to Food & Wine Magazine. Though the “specialty” hasn’t caught on much in the U.S., it’s more widely available in Japan.

Eating chicken sashimi puts a person at a “pretty high risk” of getting an infection caused by Campylobacter or Salmonella, two types of bacteria that cause food poisoning, said Ben Chapman, a food safety specialist and an associate professor at North Carolina State University.

Chapman noted that eating raw chicken is different from eating raw fish, which can be found in sushi dishes. With raw fish, the germs that are most likely to make a person sick are parasites, and these parasites can be killed by freezing the fish, he said. Salmonella, on the other hand, “isn’t going to be affected by freezing.”

Chicken sashimi is sometimes prepared by boiling or searing the chicken for no more than 10 seconds, according to Food & Wine Magazine.

But these preparations probably only kill off the germs on the surface of the chicken, Chapman said. “But even that I’m not sure about,” he added. In addition, when a chicken is deboned, other germs can get into the inside of the chicken, he said.