6.

FOOD SAFETY

Goal
Reduce the number of foodborne illnesses.

Terminology
Foodborne illness and foodborne disease: Broad terms that encompass infection and
intoxication caused by microbial or chemical contaminants in foods.

The Food Code: A book of recommendations of the Food and Drug Administration
(FDA) for adoption and use by state and local health departments, consisting of
requirements for safeguarding public health and ensuring food is unadulterated and
honestly presented to consumers. The Food Code is intended for use in achieving
compliance in food service, retail food stores or food vending operations.

Food industry: Producers (farmers, fishermen, ranchers), processors, storage,

warehousing and transport, and retail.

Retail food industry (as covered by the Food Code): Vending operations, grocery stores,
other retail food outlets, and food service in restaurants and institutions.

Foodborne disease outbreak: The occurrence of two or more cases of a similar illness
resulting from the ingestion of a common food.

Infective dose: The number of pathogenic microorganisms that will cause disease. This
number may vary depending on the status of the individual‘s immune system.

Pathogen: A microorganism that causes illness.

Emerging pathogen: An illness-causing microorganism previously unknown to be a

human pathogen, a foodborne pathogen not expected to occur in particular foods, or a
pathogen that is dramatically increasing in prevalence.

Overview
Foodborne illness in the future may be more serious due to:

a) An increase in people at risk, especially the elderly and immunocompromised

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b) Declining safe preparation practices
c) Increasingly diverse industry
d) Global food supply
e) Emerging pathogens

Historically, contamination of food was a major threat in the spread of infectious diseases
and foodborne illness. Kentucky’s food protection programs, developed during this
century, have reduced the risk of unsafe foods to consumers. State and local regulation of
food manufacturers, distributors, retail sales and restaurants has achieved dramatic
progress in protecting consumers from unsafe foods.

Raw agricultural food samples, for example, test higher than 98 percent within
established tolerance levels for pesticides permitted on products grown for food.
Approximately 94 percent of all food establishments are found to be in substantial
compliance with food laws at the time of routine unannounced inspections.

Nevertheless, outbreaks of foodborne illness still occur in Kentucky, posing a threat of

sickness or even death. These do not always trace back to food producers and handlers.
In at least some instances the cause is improper handling of foods by consumers or failure
of the governmental protective systems themselves.

Kentuckians are demanding a wider variety of food items and demanding them year
round, thus fueling an increasing global food supply. These concerns, along with society
consuming more foods away from home, a growing number of a susceptible population
(elderly), and an increase in known foodborne pathogens, all challenge the public health
official to ensure foods remain safe.

Despite high overall compliance rates, at least 6 percent of Kentucky retail food
establishments are found to have violations rated critical when inspected. Over 6
hundred thousand pounds of foods and a million pounds of milk have been removed from
channels annually, due to non-compliance with sanitation requirements or substandard
sanitary conditions. In addition, several million pounds of milk are diverted to lower
levels of usage due to substandard quality compliance.

Resolving such deficiencies calls for greater awareness by commercial food handlers of
code violations - their implications and potential consequences. Improving the overall
level of sanitary compliance will require the institution of a statewide designed program
of training and certification of industry management personnel, adopting Kentucky’s new
food code, and reinforced emphasis on surveillance and enforcement activities. Training
and education seminars are essential to keep the inspectors and persons involved with
food and milk production informed with current developments and happenings within
their industry.

Food Safety objectives for the year 2010 therefore emphasize continuing and
strengthening the ongoing maintenance functions as well as new measures that will
reinforce the existing programs.

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Progress Toward Year 2000 Objectives

12.1 To reduce by 25 percent infections caused by key foodborne pathogens.

12.2 To reduce outbreaks of infections due to Salmonella enteritidis to less than one
yearly.

Nationally, as of 1997, the incidence of disease caused by four key pathogens,

Salmonella spp., Campylobacter jejuni, Escherichia coli 0157:H7, and Listeria
monocytogenes, has decreased to levels below the year 2000 targets. Raw data
obtained from the Kentucky Division of Epidemiology does not differentiate
species of Salmonella and Campylobacter.

12.3. To increase to at least 75 percent the proportion of Kentucky households in which

basic food safety will be practiced.

Annual holiday food preparation guidelines are disseminated via state press
release, Food Safety Audio-Visual educational materials have been provided to all
local health departments; Food safety educational materials have been promoted
and handed out at the 1997 and 1998 State Fair; and safe food handling
instructions have been provided to all local health departments for dissemination
to the general public.

12.4. To implement a statewide retail food establishment standard (the new uniform
federal model “Unicode”) for uniform regulation of retail food establishments.

The Model FDA Food Code has not yet been implemented. Adoption is proposed
for the year 2000.

12.5. To teach food hygiene to children in all primary and secondary schools, and in
technical and appropriate professional schools.

School Food Safety Curriculum is being developed and should be ready for
introduction to schools during year 2000.

12.6. To provide a model food manager’s training and certification course which may
be reciprocally acceptable to all local health departments.

A model Food Safety Training Video with participant manual has been developed
and presented to all local health department retail food inspectors for use in
training food managers. However, a model statewide mandatory training package
has not yet been implemented. Progress has been made towards introduction of a
statewide program in that twelve (12) local health departments have adopted
mandatory food protection manager certification rules by local ordinance that

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 apply to approximately 46 percent of the state’s retail food establishment
managers. Mandatory food protection manager certification could be
implemented during year 2000.

12.7. To maintain at 100 percent ongoing inspectional surveillance by local health

departments of all retail food operations including institutional food operations.

On target

12.8. To maintain at 100 percent ongoing annual inspectional surveillance carried out
by state and local health departments for all establishments which process,
manufacture, store, and distribute foods, and for food salvage establishments, and
for growers of raw agriculture products under the authority of state food laws and
regulations.

Statewide surveillance of the food-manufacturing program is on going as planned.

12.9. To maintain an ongoing fish product monitoring program with sampling to

determine tissue contaminant residue levels for fish taken from Kentucky’s
streams and lakes.

On target

12.10. To continue annual issuance of consumer fish consumption advisories based on

data obtained from cooperating state and federal regulatory agencies for fish
tissue residue contaminant levels.

On target

12.11. To continue the ongoing program to sample and test food for pesticide residuals
and other toxic chemicals.

On target

12.12. To continue a program to collect and require laboratory testing for

microbiological and chemical contaminants and quality of food.

On target

12.13. To increase to 100 percent public health environmentalist registration within

twelve months after employment.

On target

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12.14. To achieve a 100 percent sanitary compliance level by all Grade A milk sheds
(dairy farms), Grade A plants and receiving/transfer stations, and 90 percent
compliance by manufacturing milk sheds and plants.

In 1998 there was 90 percent compliance for all

12.15. To reduce to no more than 2.5 million pounds the amount of milk that must be
destroyed because of adulteration or substandard quality.

3,980,258 pounds had to be destroyed in 1999.

12.16. To reduce to no more than 1 million pounds the amount of Grade A milk that
must be diverted to manufactured milk products because of failure to meet prime
quality (Grade A) standards.

876,161 pounds were diverted in 1999.

12.17. To reduce to less than 1,500 the number of notices issued for noncompliance to
milk producers.

1,795 notices were issued in 1999.

12.18. To decrease to less than 500, the number of suspensions of milk producers’
permits because of noncompliance.

In 1999 570 permits were suspended.

2010 Objectives
6.1 (Developmental) Reduce the proportion of infections caused by bacteria,
parasites, and key foodborne pathogens. Reduce the yearly outbreaks of
infections due to Salmonella serotype Enteritidis and Escherichia coli
O157:H7.

Potential Data Source: Kentucky Reportable Disease Surveillance

Implementation Strategy:

• Incorporate the use of a revised foodborne illness surveillance investigation

collection form and the Kentucky reportable disease form, which would
enable the Department, through the communicable disease reporting system,
to collect data for food related illness stemming from bacteria and parasites.
• Pursue the addition of Toxoplasma gondii to the list of food related illness to
be reported and investigated.

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 • Improve the method of collecting and reporting data for foodborne bacteria
and foodborne parasites.
• Urge use of radiation pasteurization to reduce the level of bacterial
contamination in meat.

6.1a. (Developmental) Reduce foodborne infections caused by the parasitic

pathogens Cryptosporidium parvum and Cyclospora cayetanensis, hepatitis A
virus, and Norwalk virus.

6.1.b. (Developmental) Reduce the incidence of postdiarrheal hemolytic uremic

syndrome.

Potential Data Source: Kentucky Reportable Disease Surveillance

Implementation Strategy:

• Add Cryptosporidium, Cyclospora, and Norwalk virus to the Kentucky

Reportable Disease reporting system.
• Adopt the FDA Food Code.
• Implement the Primary Education Food Safety Curriculum.
• Implement the Food Protection Manager Certification for retail food
managers.
• Make available educational food safety materials at public gatherings.

6.2 (Developmental) Reduce the number of deaths from Listeria monocytogenes

and Vibrio vulnificus annually.

Potential Data Source: Kentucky Reportable Disease Surveillance

Implementation Strategy:

• Add Vibrio vulnificus to the reportable disease listing in Kentucky.

• Implement similar steps as those listed under Objectives 6.1 and 6.1a.

6.3 (Developmental) Reduce foodborne infections caused by antimicrobial-

resistant bacterial pathogens of the species Salmonella, Campylobacter, and
Escherichia coli in humans and the prevalence of resistant pathogens
collected from animals.

Potential Data Source: Kentucky Reportable Disease Surveillance

Implementation Strategy: Add the listed organisms to the reportable disease

listing in Kentucky.

6.4 (Developmental) Make food-induced anaphylaxis death a reportable

condition.

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 Because allergens are present in a variety of foods, and because even trace
amounts of these allergens can induce anaphylaxis, education and clear ingredient
information are critical to the management of food allergy.

Potential Data Source: Reports to the Division of Epidemiology and Health

Planning

Implementation Strategy:

• Ensure that these food related deaths are reported to and investigated by the
Division of Epidemiology and Health Planning.

6.5 (Developmental) Increase the proportion of consumers who practice each of the
four critical food handling behaviors:

1) Clean: wash hands after touching raw meat or poultry

2) Separate: clean and sanitize cutting board or use a different board after cutting
raw meat or poultry
3) Cook hamburgers thoroughly
4) Chill: refrigerate promptly

6.5a. (Developmental) Maintain and keep current food safety curriculum for
teaching students throughout Kentucky.

Potential Data Sources: Surveys listed below

Implementation Strategy:

• Continue to provide food safety educational handout materials for distribution

at fairs, special public events, church and civic groups.
• Provide to all local health departments food safety video training and
educational materials for use in educating the general public.
• Surveys to measure progress will be commenced at the 1999 Kentucky State
Fair and will be conducted for the same purpose by local health departments
at local public gatherings.
• Inform the public that the Food Safety Branch has developed a Web Site for
information and educational purposes that consumers may access.

6.6 (Developmental) Reduce the occurrences of the following factors in retail food
establishments: improper holding temperatures, inadequate cooking, poor
personal hygiene, contaminated equipment, and foods from unsafe sources.

Potential Data Source: Retail food establishment inspection data

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 Implementation Strategy: Conduct training in the use of the Food Code by retail
food handlers.

6.7. (Developmental) Assess the effect of changes in pesticide residue tolerances

mandated by the Food Quality Protection Act.

Potential Data Source: Office of Pesticide Programs, Environmental Protection

Agency.

Implementation Strategy: Monitor the reassessment of the effect of changes in

pesticide residue tolerances mandated by the Food Quality Protection Act.

6.8. Increase to at least 75 percent the proportion of households in which

principal food preparers routinely refrain from leaving perishable food out
of the refrigerator for over 2 hours and clean and sanitize cutting boards and
utensils after contact with raw meat and poultry.

Baseline: For refrigeration of perishable foods, 70 percent; for cleaning and

sanitizing cutting boards, 66 percent; and for cleaning and sanitizing utensils, 55
percent, in 1988.

Data Sources: Conduct surveys to measure progress at the Kentucky State Fair.
Local health departments conduct surveys for the same purpose at local public
gatherings.

Implementation Strategy:

• Provide food safety educational handout materials for distribution at fairs,

special public events, church and civic groups meetings.
• Provide food safety video training and educational materials to all local health
departments for use in educating the general public.

6.9. Carry out the provisions of the FDA FOOD CODE, to be adopted by the
Department for Public Health, for regulation of food safety in all retail food
establishments.

Data Source: Department for Public Health Surveillance

Implementation Strategy:

• Maintain the mandated surveillance level necessary to achieve safe food

handling establishments.
• Carry out a statewide food protection manager certification program.
• Utilize the science-based provisions of the Model FDA Food Code.

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6.10. Maintain raw agricultural produce pesticide sampling and monitoring
(approximately 200 samples annually) program for produce grown in
Kentucky.

Data Source: Department for Public Health testing

Implementation Strategy:

• Maintain the raw agricultural produce pesticide sampling and monitoring

program for testing produce grown for sale.
• Collect random samples of fresh fruits and vegetables grown for retail sale.
• Analyze the samples.
• Report results from the analysis.

6.11. Maintain fish tissue contaminant residue sampling (approximately 20 samples

annually) and testing for edible fish species listed in Kentucky’s annual fish
consumption advisory publication.

Data Source: Fish samples which are collected from state fish processors and
analyzed for pesticide and chemical residues in accordance with EPA established
limits.

Implementation Strategy: Maintain the fish-sampling objective of testing edible

fish tissue in fish harvested from the state’s waterways that are subject to fish
consumption advisories.

6.12. Maintain inspection surveillance (approximately 1,000 inspections annually)

and enforcement under the authority of KRS 217.005 to 217.285 for
Kentucky’s approximately 1200 food manufacturing and storage firms.

Data Source: Department for Public Health Surveillance inspection surveillance.

Implementation Strategy:

• Maintain the mandated surveillance level necessary to achieve safe food

handling in the state’s food manufacturing and storage establishments which
consists of:
• Routine inspection surveillance.
• Collection of food samples to determine wholesomeness of foods.
• Review of food product labels to determine the status of misbranded foods.

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Contributors

• Guy Delius, Manager, Food Safety Branch, Department for Public Health, Cabinet
for Health Services, Chapter Coordinator
• Michael Auslander, DVM, MSPH, Department for Public Health
• Edward Crews, Drug Control Branch, Department for Public Health
• Peggy Dixon, RN, Division of Epidemiology & Health Planning, Department for
Public Health
• John Draper, Food Safety Branch, Department for Public Health
• Morris Strevels, Manager, Milk Safety Branch, Department for Public Health
• Anita Travis, Food Safety Branch, Department for Public Health

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