Suspect Food-borne Illness; Community Food-borne Illness

Policy

Category: Control of Infectious Diseases
Subject: Suspect Food-borne Illness; Community Food-borne Illness
Division: N/A 
Policy Number: CA.82.01.115
Effective Date: April 13, 2012

POLICY STATEMENT

It is the policy of Wellington-Dufferin-Guelph Public Health to investigate suspect food-borne illness in the community within 24 hours of receiving notification from the general public, physician, hospital, or laboratory isolation of organisms.

Response to suspect food-borne illness will take place at one of 3 different priority levels – Low Priority, Medium Priority, and High Priority.  A response may require involvement of both General Program Inspectors and Control of Infectious Diseases (CID) team members.

SCOPE

This policy applies to all Public Health Nurses and Public Health Inspectors working in the Health Protection Division.

DEFINITIONS

General Program Inspector (GP-PHI) – a Public Health Inspector whose normal duties include inspection of food premises and food service at special events.

CID Team Member – a Public Health Inspector (PHI) whose normal duties involve inspection of institutions and food related preparation and service within institutions, or a Public Health Nurse (CID PHN)  whose normal duties involve liaison with institutions (Long-Term Care Homes, Nursing Homes, Rest Homes, Retirement Homes, Hospitals).

Low Priority: Suspect Food-borne Illness – a single reported case of food-borne illness from a restaurant or special event with no confirmation of causative organism from stool samples or no samples submitted.

Medium Priority: Community Food-borne Outbreak – two or more food poisoning reports or lab confirmed cases other than the ones indicated in the High Priority section.

High Priority: Community Food-borne Outbreak – two or more lab confirmed cases of Botulism, Cyclosporiasis, Hepatitis A, Listeriosis, Salmonellosis, Shigellosis, Verotoxin producing E. coli, or Yersiniosis.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.82.02.115  Suspect Food-borne Illness; Community Food-borne Illness

APPROVED BY

Rob Thompson   


Procedure

Category: Control of Infectious Diseases
Subject: Suspect Food-borne Illness - Community Food-borne Illness
Division: N/A
Procedure Number: CA.82.02.115
Effective Date: April 13, 2012

PROCEDURE

Suspect Food-borne Illness -
Low Priority

Community Food-borne Outbreak - Medium Priority

Community Food-borne Outbreak -
High Priority

Definition: A single reported case of food-borne illness from a restaurant or special event with no confirmation of causative organism from stool samples or no samples submitted.

Case information will be recorded in Hedgehog CSR and assigned to the area Inspector whose premise is implicated. The CID team will also be notified and the CID(F)20 Suspect Food-borne Complaint form completed. An inspection of the premises will be made by the area inspector while the CID team member will interview the client and complete the Suspect Food-borne Complaint form.

Definition: 2 or more food poisoning reports or lab confirmed cases other than the ones indicated in the High Priority section.

Case information will be recorded in Hedgehog CSR and assigned to the area inspector whose premise is implicated. The CID team will also be notified and the Suspect Food-borne Complaint form completed.  An inspection of the premises will be made by the area Inspector while the CID team member will interview the client and complete the Suspect Food-borne Complaint form.

Definition: 2 or more lab confirmed cases of Botulism, Cyclosporiasis, Hepatitis A, Listeriosis, Salmonellosis, Shigellosis, Verotoxin producing E. Coli, or Yersiniosis.

Case information will be recorded in CSR and assigned to the area Inspector whose premise is implicated. The CID team will also be notified and the Suspect Food-borne Complaint form completed.  An inspection of the premises will be made by the area Inspector while the CID team member will interview the client and complete the Suspect Food-borne Complaint form.

The area Inspector will conduct a follow-up inspection within 24 hours and provide the CID team with a copy of the inspection report.

A CID team member will follow up within 24 hours.

The area Inspector will be consulted and a joint inspection may be made if warranted.

A CID team member will follow-up immediately.

The area Inspector will be consulted and a joint inspection may be made if warranted.

The completed Suspect Food-borne Complaint form and report(s) will be filed by a CID team member after review and approval by management.

A CID team member will ensure a copy of the Suspect Food-borne Complaint form will be scanned into the notes/documents section of the electronic Hedgehog file for the implicated premise.

A CID team member will enter the outbreak information in SharePoint in the CID Management folder under the tab Suspect Food-borne Illness.

The area Inspector will ensure that the CSR is closed at the conclusion of the investigation.

Note:  If Norovirus is occurring in the community and there is only one sporadic case being reported that implicates a regularly inspected food premise, the CID team member will interview the client and attempt to obtain a stool specimen. If no specimen is obtained and the CID team member suspects the illness may be due to community- acquired Norovirus, the case information can be documented and no site inspection made by the GP-PHI.  If more than one suspect food-borne illness case is linked to the same establishment in a short period of time an immediate inspection of the food premises must be made by the assigned PHI.

The completed Suspect Food-borne Complaint form and report(s) will be filed by a CID team member after review and approval by management.

A CID team member will ensure a copy of the Suspect Food-borne Complaint form will be scanned into the notes/documents section of the electronic Hedgehog file for the implicated premise.

A CID team member will enter the outbreak information in SharePoint in the CID Management folder under the tab Suspect Food-borne Illness.

The GP Inspector will ensure that the CSR is closed at the conclusion of the investigation.

The completed Suspect Food-borne Complaint form and report(s) will be filed by a CID team member after review and approval by management.

A CID team member will ensure a copy of the Suspect Food-borne Complaint form will be scanned into the notes/documents section of the electronic Hedgehog file for the implicated premise.

A CID team member will enter the outbreak information in SharePoint in the CID Management folder under the tab Suspect Food-borne Illness.

The GP Inspector will ensure that the CSR is closed at the conclusion of the investigation.

Suspect Food-borne Illness – Low Priority

Receiving Information:

1. A WDGPH staff member receives the suspect food-borne complaint. Information pertaining to the complaint will be recorded as a CSR in Hedgehog and assigned to the appropriate GP-PHI, if known. The following information must be recorded:
name, address, and phone number of complainant;
location of suspect meal; and
suspect food items.

Request Stool Samples:

2. Information about the complaint will also be provided to a CID team member who will complete the HPDCD(F)27 Food-borne Illness Complaint form.

3. A CID team member should request the complainant(s) submit a stool sample. It is important to obtain samples as quickly as possible after onset of illness.

4. A CID team member will provide Enteric Outbreak Kits (EOK) to all identified symptomatic cases and make arrangements for pick-up or drop-off of samples and delivery to the Public Health Lab.

5. The CID team member will assess whether to use the 2-vial (Food poisoning Kit) or 3-vial Stool Sample kit (EOK). Food poisoning kits are used for bacteria and viruses, while the EOK’s are used for bacteria, viruses, and parasites.

6. The CID team member will ensure the bar code and the name of the patient is written on each vial.

7. Any Suspect Food-borne Complaint report(s) received on a week-end or holiday by an on call CID team member must be started immediately if the report is about a person who is:

  • hospitalized;
  • under the age of 5;
  • an elderly person living at home; or
  • a resident of a long-term care home.

8. For any other situation, the CID team member on call can forward the information to the appropriate CID team member on the following workday.

Interview Ill People:

9. The assigned CID team member will contact and interview the ill person(s) and review 72-hour food history prior to symptom onset and other risk exposures. 

Inspection of Food Premises or Special Event:

10. The CID team member will consult with the area PHI and provide him/her with enough information to conduct an inspection.

11. The area PHI will conduct an inspection of the food premises within 24 hours of receiving the report.

12. The GP-PHI should conduct a Hazard Analysis Critical Control Point (HACCP) audit on the suspected food item(s) and collect the appropriate food samples.

13. If Norovirus is occurring in the community and there is only one sporadic case being reported, the CID team member will interview the client and attempt to obtain a stool specimen. If no specimen is obtained, and the CID team member suspects the client’s illness may be due to community acquired Norovirus, the case information shall be recorded on the Suspect Food-borne Complaint form and no site inspection needs to be done.  If more than one suspect food-borne illness is linked to the same establishment in a short period of time an immediate inspection of the premises must be made by the GP-PHI.

14. The CID team member will contact the complainant to advise him/her of the results of the investigation and HACCP audit.

15. The CID team member responsible for follow-up will enter the information regarding the investigation in SharePoint (“CID Management 2011” folder, “Suspect Food-borne Illness” tab).

16. The completed Suspect Food-borne Complaint form will be reviewed by management and filed.

17. A CID team member will store an electronic copy of the Suspect Food-borne Complaint form in the notes/documents section of Hedgehog for the premises being implicated.

18. The area PHI assigned shall ensure the CSR is closed out when the investigation is completed. 

Community Foodborne Illness Outbreak - Medium or High Priority

Receiving Information:

1. If the GP-PHI receives a Suspect Food-borne Complaint report on two or more cases linked to the same establishment, exposure, or special event, the GP-PHI must immediately contact the CID Team.

2. The GP-PHI will collect the information using CSR and forward the information to the CID team.

Declare Outbreak and Priority Level:

3. The assigned CID team member will contact and interview the ill client(s) and review the 72-hour food history prior to onset of symptoms and other exposure risk factors. If the person(s) is positive with a reportable disease, the CID team member will complete the HPDCD(F)40 Enteric Disease Worksheet.

4. The CID Team will conduct a risk assessment and if an outbreak is declared, management will be notified.  The assigned CID team member will obtain an outbreak number and enter all known information in iPHIS.

5. Outbreak information will be recorded on iPHIS as soon as possible. Outbreak information must be updated daily by the assigned CID team member.

Obtain Information (Initial Inspection):

6. The assigned CID team member and area Inspector will do an inspection at the establishment or special event within the time indicated by the priority rating.

7. The CID team member must collect the following information:

  • list of all foods served at the suspect meal; and
  • list of all persons attending the meal, if possible.

8. The CID team will review surveillance data from emergency departments, schools, and daycare centres to help determine the scope of the outbreak.

Notify the Public Health Lab:

9. The assigned CID team member will notify the lab by completing the Ministry of Health Outbreak Notification Report and faxing it to the Public Health Lab.

10. If the outbreak involves more than 10 people, phone the Public Health Lab to advise them of the anticipated number of samples being sent.

Food Sampling:

11. The GP-PHI will collect all available food samples from the suspect meal or collect similar foods that were eaten/served in the last 72 hours. Collect 200 grams as a minimum. Ask for the original containers and packages to be saved if possible.

12. Use aseptic technique (see Food Handling Procedure Sheet) when collecting food. Place the food in labeled sterile, whirl-pack bags and refrigerate immediately.

13. Complete the Ministry of Health and Long Term Care HPDCD(F)45 Food Bacteriology Form and include the outbreak number. Ensure all food is securely packaged and properly labelled. Arrange for transport of the samples to the Public Health Lab.

Prepare Outbreak Questionnaire:

14. Using the information obtained in Steps 4 and 8, the CID team and the Public Health Epidemiologist will develop a HPDCD(F)1 Food History Questionnaire.

Interviews Using Questionnaire:

15. The CID team member will use the questionnaire developed in Step 14 to interview all persons that attended the event, regardless if they were ill or not.

16. WGPH management will assign the appropriate number of staff to be used for conducting interviews of all people present at the suspect meal.

17. All completed questionnaires will be returned to the assigned CID team member. Information will be inputted into the outbreak database system for analysis with assistance from the Health Analytics Team.

18. If people to be interviewed live outside the Wellington-Dufferin-Guelph geographic area, CID will contact the health unit in that area and give WDGPH the option of doing the interview using our questionnaire or having a WDGPH CID team member do the interview.

Summarizing Data:

19. The data summarized from the interviews is to be reviewed by the CID team and WDGPH Epidemiologist.  They will prepare:

  • a food attack rate table;
  • an epi curve;
  • a mean incubation period; and
  • a list of the most common symptoms.

20. The information from Step 19 as well as the results from the stool and food samples is to be reviewed with the Manager.

Follow-up Inspection (HACCP Audit):

21. The assigned CID team member and the GP-PHI will conduct a HACCP audit of the most likely suspect foods identified from the Food Attack Rate Table.

22. Following completion of the investigation, the assigned CID team member and GP-PHI should meet with the establishment owner or special event coordinator to discuss the results of the investigation.  Recommendations for preventing future outbreaks should be made at this time. 

23. If the suspected source of infection is the home of the client, explain the need for proper food preparation techniques, handling, storage and personal hygiene.

Outbreak Report:

24. All information related to the community food-borne illness investigation will be included in an outbreak report with the file identified by the outbreak number.

25. The assigned CID team member will enter the information in iPHIS, send an iPHIS outbreak summary referral to the Manager for review, and close the iPHIS file.

26. The assigned CID team member will file the completed report in the Outbreak filing cabinet.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy:  CA.82.01.115  Suspect Food-borne Illness; Community Food-borne Illness
CID(F)20 Suspect Food-borne Complaint
HPDCD(F)27 Food-borne Illness Complaint form
HPDCD(F)40 Enteric Disease Worksheet.
HPDCD(F)45 Food Bacteriology Form
HPDCD(F)1 Food History Questionnaire

APPROVED BY

Rob Thompson