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62Part Two/The FundamentalsAnother complicating factor is that agents of foodborne illness can be transmittedthrough water and through contact with infected farm animals and pets. Person-to-personcontact is another means by which an individual can become infected with the very samecausative agents that are attributed to foodborne illness. Surveillance has, however, greatlyimproved following a concerted effort on the part of the federal government to better trackand document the incidence of foodborne illness.During the mid- to late 1990s, there was a recognition on the part of the Clinton administration that oversight of food safety in the United States needed to be overhauled. Thisincluded better tracking of foodborne illness outbreaks to determine more accurately howwidespread the problem is. A better program would also provide the framework to assesswhether interventions were actually working. In 1997, the National Food Safety Initiative (NFSI) was launched. This initiative included a number of goals and triggered tracking programs for foodborne illness. One such program is the CDC’s Emerging Infectionsprogram, Foodborne Diseases Active Surveillance Network (FoodNet). The surveillanceprogram collects data on foodborne diseases at 10 U.S. sites. Each year the CDC releasesa report that describes preliminary surveillance data and compares them to previous data.Although accuracy and timeliness have improved as a result of the NFSI, a number ofsocial, economic, and political issues present ongoing challenges to ensuring that the U.S.food supply is indeed safe. These issues include: Advances in trade and transportation that have brought more food variety but newpathogens People eating a greater variety of food including raw seafood and more fresh produce An increase in the “at-risk” or “highly susceptible” populations comprising theelderly, very young children, and people with compromised immune systems More meals prepared and eaten outside of the home Changes in food preparation and handling practices Newly recognized microorganisms that cause foodborne illness Centralized, high-volume food processing and distribution The globalization of the food systemThese issues are further complicated by the complexities of the U.S. food regulatorysystem. For example, at least 12 federal agencies are charged with some oversight responsibility for at least 30 laws.In recognition of these challenges, the federal government has reinvigorated itscommitment to ensuring a safe food supply for Americans. Newly introduced legislationaddresses administrative and structural issues with our current system of laws and regulations. Issues include outdated laws, inadequate resources for inspection, suboptimalmanagement structures, and inadequate coordination across agencies at the federal, state,and local levels. On March 14, 2009, President Obama announced the formation of theFood Safety Working Group, a group specifically charged with advising the president onissues in food safety and how to correct them. As a result of this work, the Food SafetyModernization Act was signed into law on January 4, 2011. The intent of this legislationis to better protect public health by strengthening the U.S. food safety system. It provides the FDA, for example, with new enforcement authority for inspections, recalls, andtraceability.Costs Associated with Outbreaks of Foodborne IllnessIt is difficult to account for the total and true costs of foodborne illness, but the economicloss associated with foodborne disease outbreaks can be devastating and more broad thanmost foodservice directors realize. Medical care, lost business, and lawsuits against thefoodservice contribute most to the cost, but loss of income for victims and infected foodhandlers is also considerable. The social costs of pain and suffering are impossible to measure, not to mention the embarrassment and damage to the reputation of the foodservice. TheEconomic Research Service (ERS) is the division of the U.S. Department of Agriculture(USDA) that calculates the economic costs of foodborne illnesses outbreaks and estimatesM03 PAYN2754 13 SE C03.indd 621/12/15 10:59 AM

63Chapter 3/Food Safetythe loss at billions of dollars per year. To put this in perspective, the ERS estimates thatsalmonellosis (nontyphoidal) alone accounts for an economic loss in the billions of dollars.The Role of the Food ManagerKey Concept: The foodservice manager plays a leadership role in theprevention of foodborne illness.Food managers, especially those responsible for providing food to highly susceptible orat-risk populations, have a critical role in the prevention of foodborne illness. In effect,food managers and the employees they oversee are public health providers. It is theirjob to protect their customers from food that could become unsafe through mishandling.Foodservice managers need to instill a sense of professionalism and urgency about thepotential for foodborne illness. Foodservice managers themselves must be well educatedon the related topics of food microbiology, food law, risk analysis, HACCP, and standardoperating procedures. These are a few of the knowledge and skill requirements needed onthe part of the manager to design, implement, and manage an effective, comprehensive,and integrated food safety program. Figure 3.1 provides a more comprehensive list of theknowledge expectations for the foodservice manager or person in charge.Areas of knowledge for the Foodservice Manager: Federal, state, and local laws and regulations that pertain to a specific foodservice operationRelationship between the prevention of foodborne disease and the personal hygieneof a foodservice workerMeans to prevent transmission of foodborne disease by a food worker who has adisease or medical condition that may cause foodborne diseaseSymptoms associated with the diseases that are transmitted through foodRelationship between maintaining the time and temperature of potentiallyhazardous food and the prevention of foodborne illnessInherent hazards associated with potentially hazardous foodsMinimum end-point temperatures for the safe cooking of potentially hazardous foodsRequired temperatures and times for safe and proper storage, hot holding, cooling,and reheating of potentially hazardous foodsRelationship between prevention of foodborne illness and management of crosscontamination, bare hand contact with ready to eat food and handwashingProcedures for proper care, cleaning, and sanitation of equipment and facilities inthe prevention of foodborne illnessMajor food allergens and symptoms of allergic reactionsFigure 3.1Foundation knowledgeon food safety for the foodservicemanager.Source: Adapted from the 2013 Food Code.Causes of Foodborne IllnessInvestigations of foodborne illness outbreaks indicate that contaminated food in itself doesnot explain why people get sick. In fact, the CDC identifies the following as the five mostcommon risk factors that cause foodborne illness: Purchasing food from unsafe sourcesFailing to cook food correctlyHolding food at incorrect temperaturesUsing contaminated equipmentPracticing poor personal hygieneThe food manager needs to understand the contaminants and the operational failuresthat result in foodborne illness in order to design and implement effective preventive measures in the foodservice facility.M03 PAYN2754 13 SE C03.indd 631/12/15 10:59 AM

64Part Two/The FundamentalsKey Concept: Pathological hazards are inherent to some foods and cancause disease if allowed to grow.Hazards Inherent to Food: Forms of Food ContaminationHazardA biological, chemical, or physical property that may cause an unacceptableconsumer health riskPathogenA disease-causing microorganismTime/temperature control forsafety (TCS) foodFoods that are more likely than othersto be implicated in an outbreak of foodborne illnessCodeA collection of regulationsAny biological, chemical, or physical property of food that affects a person’s health iscalled a hazard. The biological pathogens or disease-causing pathogens include bacteria,viruses, parasites, and fungi (yeasts and molds). Illness resulting from live disease-causingor pathogenic microorganisms is called infection. Illness caused by eating toxins producedby microorganisms is called intoxication. Growth of pathogenic microorganisms in foods oron food contact surfaces increases the likelihood of either of these types of illness. Certainconditions support the survival and growth of harmful microorganisms. It is the responsibilityof the foodservice manager to recognize these hazards and conditions, then implement procedures that will prevent them from becoming a food safety threat. This is challenging becausemicroorganisms differ among food items and how they behave under various environmentalconditions.Most bacteria grow best in low-acid food; a few grow in acid food. Some grow best ifsugar is present in the food, others if proteins are present. Some need oxygen for growth,and others thrive in its absence. The temperature most favorable for growth of pathogenicbacteria is body temperature, about 98 F; temperatures below 41 F inhibit their growtheither totally or markedly, and temperatures above 130 F for a period of time are lethal tovegetative cells of pathogenic microorganisms. The federal government defines the temperature range of 41 F to 135 F as the temperature danger zone, and all food handling inthis range should be minimized.The time required for growth and multiplication depends on the other environmentalconditions present and the type of food being processed. Fungi require nutrients, oxygen,and time to grow. They are usually the dominant microorganisms only in foods that are toodry, acidic, or sugary for optimal growth by bacteria. Viruses and protozoa do not reproduce in foods and thus only cause infections.Any food can be a vehicle for foodborne illness, but some are more likely to be involved than others. These foods are termed time/temperature control for safety (TCS)foods. According to the 2013 FDA Food Code:1. “Time/temperature control for safety food” means a food that requires time/temperature control for safety (TCS) to limit pathogenic microorganism growth ortoxin formation.2. “Time/temperature control for safety food” includes:An animal food that is raw or heat-treated; a plant food that is heat-treated or consists of raw seed spouts, cut melons, cut leafy greens, cut tomatoes or mixturesof cut tomatoes that are not modified in a way so that they are unable to supportpathogenic microorganism growth or toxin formation, or garlic-in-oil mixturesthat are not modified in a way so that they are unable to support pathogenic microorganism growth or toxin formation.Simply put, TCS are those foods that favor rapid growth of microorganisms. The conditions that favor rapid growth can be remembered by the acronym FAT-TOM: food, acid,time, temperature, oxygen, and moisture.Foodborne Illness and Applied MicrobiologyMicroorganisms play a number of important roles in our food supply both harmful and beneficial. Probiotics, for example, are increasingly recognized for their positive implicationsfor digestive health. Spoilage microorganisms on the other hand cause foods to deterioratein appearance and texture leading to waste. Pathogens are disease-causing microorganismsand are the focus of food safety programs in foodservice operations. The food manager needsM03 PAYN2754 13 SE C03.indd 641/12/15 10:59 AM

65Chapter 3/Food Safetyto understand the types of pathogens, the diseases they cause, the foods implicated, and,most importantly of all, the preventive measures that must be implemented throughout thefoodservice operation.There are three types of diseases that can be caused by the pathogens attributed tooutbreaks of foodborne illness. The first is infection that results from the ingestion of livepathogens. These pathogens colonize and cause damage to the intestinal tract throughan invasive process. Another type of illness is intoxication. In this case, the pathogensproduce a toxin in the food that is subsequently ingested. These toxins then cause illness.Finally, there is what is referred to as toxicoinfection. This illness is caused when livepathogens are ingested, which produce a toxin in the digestive tract that makes theindividual ill.These illnesses are caused by four types of pathogens that contribute to foodborneillness: bacteria, parasites, viruses, and fungi (yeasts and molds). According to the CDC,there are 31 known pathogens that cause foodborne illness but they account for only20 percent of the outbreaks. The other 80 percent are caused by “unspecified agents,”meaning that there are insufficient data to identify the specific microorganism. Regardless, it is clear from CDC data that there are major pathogens that account for much ofthe foodborne illness confirmed in the United States each year. These include bacteriasuch as Salmonella spp., Toxoplasma gondi, Listeria monocytogenes, Campylobactor spp.,Clostridium perfringens, and E. coli. Viruses including Norovirus and Hepatitis A are ofparticular concern because of their prevalence and link to poor personal hygiene. The primary preventative measures will depend on the pathogen and the food source. Table 3.2summarizes the six pathogens that, collectively, cause the most illnesses, hospitalizations,and deaths. Complete details on all confirmed outbreaks, contributing pathogens, implicatedfoods, and venues can be found on the CDC Web site.Table 3.2InfectionAn illness that results from the ingestionof live pathogensIntoxicationIn this illness, the pathogens producea toxin in the food that is subsequentlyingestedToxicoinfectionThis illness is caused when live pathogens are ingested, which produce a toxinin the digestive tract that makes theindividual illMajor foodborne pathogenic isteriamonocytogenesNorovirus (NorwalkVirus)Campylobacter spp.ClostridiumperfringensE. coli O157:H7DiseaseBacterial infectionBacterial infectionViral infectionBacterial fectionCommon foodsourcesPoultryRaw meatReady-to-eat foodPoultryMeatEggsUnpasteurized dairyproductsShellfish from contaminated waterWater contaminated with thebacteriaPoultryGround beef (rawand undercooked)Dairy productsProduceReady-to-eat food,such as deli meats,hot dogs, and softcheesesMeatsStews and graviesDishes made withmeat and poultry,such as stews andgraviesContaminatedproduceOnset/incubation 6 to 48 hours12 hours to severaldaysUp to 2 days3 to 5 days8 to 22 hours12 to 72 hoursSymptomsMiscarriage in pregnant inal crampsNauseaFeverSevere abdominalpainAbdominalcrampsKidney failureAbdominal crampsVomiting24 hoursUp to 8 daysDiarrheaAbdominal crampsVomitingFeverSepsis, pneumonia, meningitis innewbornsHeadachesDuration1 to 4 daysDepends on severityand treatment1 to 3 days1 to 4 daysSource: The Bad Bug Book (second edition): Foodborne Pathogenic Microorganisms and Natural Toxins handbook. U.S. Food and Drug Administration.M03 PAYN2754 13 SE C03.indd 6501/12/15 6:36 PM

66Part Two/The FundamentalsFigure 3.2Food handlers as asource of foodborne pathogens.Open cuts,sores & boils,via handsSaliva fromrespiratory tractvia coughingand/or sneezingFood is prepared.Food is consumedIllness resultsCommunicable diseaseAn illness that is transmitted from oneperson to another through direct orindirect meansInfected eyes,ears; transientskin microbesIntestinaltract via handscontaminatedwith fecesThe routes of transmission for pathogens are diagrammed in Figure 3.2. It should benoted that human wastes, particularly fecal material, are especially hazardous. An individualwho has used the toilet is certain to have contaminated hands. If careful and thorough handwashing is ignored, the worker’s hands can be a dangerous “tool” in the kitchen. Standardsof personal hygiene are presented later in this chapter.Carriers are an important source of infection or intoxication-causing microorganismsin foods. A carrier is a person who, without symptoms of a communicable disease, harbors and gives off from his or her body the specific pathogen of a disease, usually withoutbeing aware of it. Hepatitis A and Norovirus are examples of viruses that can be “carried”without notice and are both major contributors to the incidence of foodborne illness. Aninfected person is one in whose body the specific pathogens of a disease are lodged andhave produced symptoms of illness. Thus, others may be aware of the possible danger ofcontamination. Consumers can become infected by ingesting water, milk, or other foodproducts that have been contaminated with the fecal material of an infected person, animal, or carrier. Still another path of infection is drinking raw milk drawn from cows withinfected udders.An infectious disorder of the respiratory system such as a common cold can be spreadby the droplet spray of infected discharges of coughing and sneezing without safeguard.An indirect route of infection spread through respiratory discharges is the used handkerchief, or the contaminated hand, and the subsequent handling of food or plates and cups inserving a patron.KEY CONCEPT: Physical and chemical hazards, including allergens, posethreats to food safety.Foodborne illnessIllness that results from ingesting foodscontaining live microorganismsAccidentAn unintentional incident that results ininjury, loss, or damage to propertyM03 PAYN2754 13 SE C03.indd 66Chemical and Physical ContaminantsAccidental Chemical Contamination. Microbial causes of foodborne illness are common, but disease and illness can also be caused by chemical contaminants in food. This typeof foodborne illness results from eating food to which toxic chemicals have been added,usually by accident.1/12/15 10:59 AM

Chapter 3/Food Safety67Chemical poisoning may result from contamination of food with foodservice chemicalssuch as cleaning and sanitizing compounds, excessive use of additives and preservatives,or contamination of food with toxic metals. The foodservice manager is responsible forimplementing the necessary precautions to ensure that food is protected from these hazards.Minimum precautions include proper labeling and storage of all chemicals and frequent in- service training for employees on the hazards associated with the improper use of chemicals.Physical Hazards. Physical hazards account for the third category of causes that contributeto outbreaks of foodborne illness. These, as the name suggests, include material or foreign contaminants that are accidentally or intentionally introduced into foods. Examples include metalshavings from cans, glass from service ware, and staples from packing materials. Compared topathogenic microbes, physical hazards are rarely a cause of foodborne illness or injury.Food AllergensA Contaminant of Growing ConcernNaturally occurring allergens in some foods are a form of food contamination that increasingly influence the design of food safety programming in foodservice operations.The food manager needs to be well versed on the incidence, common food vehicles, symptoms, regulatory guidelines and preventive practices in order to design an AllergenRisk Reduction Program that will protect guests who are sensitive to food allergens.According to Food Allergy Research and Education—FARE (formerly known asFood Allergen and Anaphylaxis Network—FAAN), 90 percent of food allergies are causedby eight common foods; collectively referred to as “the big 8.” These include milk, eggs,fish, shellfish (including lobster, shrimp, and crab), wheat, soy, peanuts, and tree nutssuch as almonds, walnuts, and pecan. Food safety programs must minimally address these common foods but it is important to note that many other foods can cause allergic reactions. Other food ingredients may cause adverse, but nonallergic, reactions. These includefood intolerances such as lactose in dairy products and food sensitivities including MSG.Symptoms of allergic reactions vary from mild to life-threatening. Most serious isanaphylaxis, a severe allergic reaction that can cause death. Less serious symptoms includenausea, shortness of breath, hives, swelling, vomiting, diarrhea, and/or abdominal pain.It is estimated that 11 million Americans suffer from food allergies and that 30,000individuals are hospitalized each year. As many as 200 deaths are attributed to foodallergies. The incidence of allergic reactions linked to food does appear to be on the rise.In fact, it is estimated that there was an 18 percent increase between the years 1997 and2007. Peanut allergies are believed to have tripled during this same time period.From a regulatory perspective, there are a number of federal laws that address food allergens and allergies throughout the food system. Laws that are particularly influential includethe Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004, the Americanswith Disabilities Act (ADA) of 1990, and, most recently, the Food Safety ModernizationAct (FSMA) of 2011. FALCPA mandates that ingredient lists on packaged food clearlyidentify the food sou

128,000 hospitalizations and 3,000 deaths related to foodborne illness on an annual basis. Underreporting and underestimating the true incidence is a reflection of the complexity of tracking foodborne illness. Keeping track, or surveillance, of foodborne illness is complicated. Symptoms among victims vary widely.