Food Safety

PSR NATIONAL SUMMARY

The Prevention Status Reports highlight—for all 50 states and the District of Columbia—the status of public health policies and practices designed to address 10 important public health problems and concerns. The three practices in this report are recommended by the Council to Improve Foodborne Outbreak Response and the US Food and Drug Administration (FDA) because scientific evidence supports their effectiveness in improving foodborne disease surveillance, detection, and prevention (1–3). These practices are

Increasing the speed of DNA fingerprinting using pulsed-field gel electrophoresis (PFGE) testing for all reported cases of Shiga toxin-producingEscherichia coli (E. coli) O157
Increasing the completeness of PFGE testing of Salmonella
Adopting provisions recommended in the FDA Food Code into state food safety regulations

Other strategies supported by scientific evidence include using trained staff and standardized questionnaires to interview persons with suspected foodborne illness as soon as possible after illness is reported and conducting environmental assessments as a routine component of foodborne disease outbreak investigations (1).

Speed of pulsed-field gel electrophoresis testing of reported E. coli O157 cases

The annual proportion of E. coli O157 PFGE patterns reported to CDC (i.e., uploaded into PulseNet, the CDC-coordinated national molecular subtyping network for foodborne disease surveillance) within four working days of receiving the isolate in the state or local public health PFGE lab. PFGE is a technique used to distinguish between strains of organisms at the DNA level.

Bar chart showing the number of states rated green, yellow, and red for speed of pulsed-field gel electrophoresis testing of reported E. coli O157 cases in the 2013 PSRs and 2015 PSRs, along with a table showing the rating scale. In 2013, of states with available data, 39 states rated green, 10 states rated yellow, and 1 state rated red. In 2015, of states with available data, 45 states rated green, 4 states rated yellow, and 1 state rated red. Green means that the percentage of annual reported cases tested within four days was greater than or equal to 90.0%. Yellow means that the percentage of annual reported cases tested within four days was 60.0% to 89.9%. Red means that the percentage of annual reported cases tested within four days was less than 60.0%. States with missing data are not included. (State count includes the District of Columbia.)

How These Ratings Were Determined
The speed of PFGE testing for reported E. coli O157 cases was determined by accessing the PulseNet national E. coli O157 database for calendar year 2014. Turnaround times were calculated per lab by subtracting the received date (receipt in the PFGE lab) from the upload date (upload to the PulseNet national database), excluding weekends and federal holidays. The percentage of samples tested within four days was calculated by dividing the number tested within four days (numerator) by the total number uploaded to the PulseNet national database (denominator). If the received date for a sample was missing, the sample was counted in the denominator but not the numerator, thus lowering the percentage.

The ratings reflect the extent to which each state tested E. coli O157 cases within four days as determined by the PulseNet database.

Completeness of pulsed-field gel electrophoresis testing of reported Salmonella cases

The annual proportion of Salmonella cases reported to CDC’s National Notifiable Diseases Surveillance System with PFGE patterns uploaded into PulseNet.

Bar chart showing the number of states rated green, yellow, and red for completeness of pulsed-field gel electrophoresis testing of reported Salmonella cases in the 2013 PSRs and 2015 PSRs, along with a table showing the rating scale. In 2013, of states with available data, 44 states rated green, 6 states rated yellow, and 1 state rated red. In 2015, of states with available data, 47 states rated green, 3 states rated yellow, and 1 state rated red. Green means that the percentage of annual reported cases tested by PFGE was greater than or equal to 90.0%. Yellow means that the percentage of annual reported cases tested by PFGE days was 60.0% to 89.9%. Red means that the percentage of annual reported cases tested by PFGE was less than 60.0%. States with missing data are not included. (State count includes the District of Columbia.)

How These Ratings Were Determined
The completeness of PFGE testing of reported Salmonella cases was determined by accessing the PulseNet national Salmonella database for calendar year 2014. The number of Salmonella entries per state was determined and used as the numerator. The denominator was the number of cases reported by each lab to the National Notifiable Diseases Surveillance System for calendar year 2014.

The ratings reflect the proportion of all Salmonella cases tested in each state as determined by the PulseNet database.

State adoption of selected foodborne disease-related provisions

Inclusion in the state’s food safety regulations of selected provisions contained in the 2013 FDA Food Code related to norovirus and other foodborne illnesses.

How These Ratings Were Determined
Publicly accessible state food code regulations were assessed for the presence of four selected provisions contained in the 2013 FDA Food Code (4):

Excluding ill food service staff from working until at least 24 hours after symptoms such as vomiting and diarrhea have ended (section 2-2 of the 2013 FDA Food Code)
Prohibiting bare hand contact with ready-to-eat food (section 3-301.11)
Requiring at least one employee in a food service establishment to be a certified food protection manager (sections 2-102.12 and 2-102.20)
Requiring food service employees to wash their hands (section 2-3)

The ratings reflect the number of provisions included in state food safety regulations.

**State count includes the District of Columbia.

References

Council to Improve Foodborne Outbreak Response. Guidelines for Foodborne Disease Outbreak Response . Second Edition. Atlanta, GA: Council of State and Territorial Epidemiologists; 2014.
Food and Drug Administration. Food Code: 2013 Recommendations of the United States Public Health Service Food and Drug Administration[PDF-7.2MB]. College Park, MD: US Department of Health and Human Services; 2013.
Council to Improve Foodborne Outbreak Response. Foodborne Illness Response Guidelines for Owners, Operators and Managers of Food Establishments . Washington, DC: National Association of County and City Health Officials; 2013.
CDC. State-Level Food Code Provisions. Unpublished data; Sep 2014.