Environmental Health Specialists' Self-Reported Foodborne Illness Outbreak Investigation Practices
Selman, Carol A., Green, Laura R., Journal of Environmental Health
For the years 1993 to 1997, an annual average of 550 foodborne illness outbreaks was reported in the United States (Olsen, MacKinon, Goulding, Bean, & Slutsker, 2000). More than 40 percent of these outbreaks were attributed to food service establishments. Environmental health specialists along with epidemiologists and laboratorians in federal, state, and local public health agencies are typically involved in investigations of foodborne illness outbreaks. These investigations are important food safety activities because they can identify the pathogens that caused an outbreak and the circumstances that led to the introduction or proliferation of those pathogens (i.e., contributing factors such as improper holding temperatures and worker bare-hand contact with food). Knowledge of the pathogens and contributing factors associated with outbreaks can increase understanding of the causes of, and prevention strategies for, outbreaks. (Jones et al., 2004).
The quality and effectiveness of foodborne illness outbreak investigations have, however, been criticized (Bryan, 2002; Food and Drug Administration, 2001; Jones et al., 2004). Some have contended that investigations often yield inadequate information concerning the etiology and contributing factors of foodborne illness outbreaks. Contributing factors were identified in only 57 percent of outbreaks reported to the Centers for Disease Control and Prevention (CDC) (Olsen, MacKinon, Goulding, Bean, & Slutsker, 2000). This inadequacy may result, at least in part, from specialists' ineffective outbreak investigation practices and from barriers encountered during investigations (Bryan, 2002; Ehiri & Morris, 1994; Jones et al., 2004).
The Environmental Health Specialists Network (EHS-Net) wished to gain a better understanding of specialists' foodborne illness outbreak investigation practices and consequently spearheaded the study reported here. EHS-Net is a collaborative project focused on food and water safety research and includes epidemiologists and environmental health specialists from CDC, the Food and Drug Administration (FDA), the U.S. Department of Agriculture (USDA), the U.S. Environmental Protection Agency (U.S. EPA), and nine state public health agencies. Currently, EHS-Net includes California, Connecticut, Georgia, Iowa, Minnesota, New York, Oregon, Rhode Island, and Tennessee; before 2005, Colorado was an EHS-Net state and Iowa and Rhode Island were not.
In 2004, EHS-Net convened six focus groups of specialists who worked in state or local public health departments in EHS-Net states. The groups met through telephone conference calls, a cost-effective method of collecting data from participants who are geographically dispersed. This method has been found to generate as much information as the use of face-to-face focus groups (Silverman, 2003).
To enroll participants, study recruiters telephoned specialists randomly selected from public lists to request their participation in the study. Eligible participants had spent at least 30 percent of their time conducting restaurant inspections and had worked in their current positions for at least six months. To minimize the possibility that participants might know one another, only two participants from any state and only one participant from any agency were scheduled in a group together. Each group session lasted approximately two hours, and participants received a $60 incentive for their participation.
During the focus group meetings, participants discussed various topics associated with their restaurant food safety activities. This paper covers only the discussions of participants' investigation practices for foodborne illness outbreaks, the methods they used to identify contributing factors, their success in identifying contributing factors, and the difficulties they faced when conducting investigations. The meetings were audio taped, the transcripts of the audiotapes were reviewed, and common themes among responses were identified. …