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2003 Model Practice Application (Public)

Application Name: 2003 Model Practice Application (Public) : Maricopa County Environmental Services Department : Utilization of Food Sample Results to Improve Food Safety
Applicant Name: Mr. John Kolman
Practice Title
Utilization of Food Sample Results to Improve Food Safety
Submitting LHD/Agency/Organization
Maricopa County Environmental Health Division


Starting in April 2002, the Foodborne Illness Program of the Maricopa County Environmental Services Department, Environmental Health Division began using food sample results from alleged foodborne illness complaints to verify how procedural changes in food preparation can lower the microbial load on prepared food, thus reducing the risk factors associated with food borne illness. By linking food samples taken prior to and after procedural changes within the food service establishment, the Foodborne Illness Program has shown a 92 percent reduction in the microbial load of these food items. This reduction is directly related to one or more procedural changes made at the facility.

This program was directly aimed at food establishment owners/operators who have been involved in foodborne illness complaints/outbreaks, and it has made a direct impact on any establishment that has registered high bacterial counts on prepared foods.

Responsiveness and Innovation
For the last few years, Maricopa County's Foodborne Illness Program operated in one standard format, which was not optimal:
  • Food borne illness complaints were received and complaints were investigated (if deemed necessary).

  • The inspector wrote a conclusion based on the investigation.

  • Implicated foods were sampled for bacterial analysis (if found mistreated).

  • The investigation was closed.
Generally, the inspector's final investigative report and conclusion written prior to receiving the sample results. Occasionally, an inspector would follow up on the investigation, using the sample results as an aid, and note any procedural change made as a result of the investigation. However, these situations were far and few between.

What appeared to be occurring was a disconnection between foodborne illness investigations and the day-to-day inspection program. Unless the inspectors made the effort, they were rarely informed of sample results at all. These samples played no part in foodborne illness investigations other than as a side note that was entered by the Foodborne Illness Coordinator up to a month after the investigation was closed. Even worse, many of the food samples were coming back positive, with high bacterial counts for various indicators (APC, Total coliform, E.coli).

By implementing the new program, the link between the Foodborne Illness Program and the routine inspection program has been dramatically strengthened. The sample results play an important role in the investigative findings and are now being used to help create lasting change within many establishments. The inspection staff has responded enthusiastically as they are now able to show that a problem exists, and they are better equipped to overcome challenges from individual operators.

Agency Community Roles
The function of the Environmental Health Division is to reduce the risk of foodborne illness for Maricopa County citizens and visitors. This program is doing that by changing existing internal procedures and fully using all the tools and information available to the inspection staff. This program has created a link between foodborne illness complaints and the day-to-day inspection program. By implementing these new procedures, food safety has been increased without additional staffing and at very minimal cost. The program has also helped to improve the relationship with the inspection staff and food establishment owners/operators. It has even created a partnership with the Arizona State Laboratory.

With inspectors able to provide tangible evidence that procedural changes are needed, many owners/operators are open to inspector suggestions and then create lasting change within their own facilities. In addition, the Arizona State Laboratory, which questioned the need to run samples in the past, has become very proactive and is interested in what changes are occurring as a result of their sample results.

Costs and Expenditures
The cost to implement this program has been minimal. All staffing and computer requirements exist. The only new cost has been to mail an informational letter to the food service establishments.

The sustainability of the program is high. The Environmental Health Division of Maricopa County is a fee-based program funded by permit fees collected from the establishments within its jurisdiction. With this fee structure in place, the staff members and computer equipment required to maintain the program will be funded.

Outcome Process Evaluation
In April 2002, the Foodborne Illness Coordinator implemented a new program that requires inspectors to re-inspect and re-sample at establishments where food samples were obtained that tested positive for bacterial indicators. The procedure is as follows:
  • At any establishment where a foodborne illness investigation is required, the coordinator requires that the inspector inform him when and what samples are taken and any procedural problems that were identified. This information is immediately entered into an Excel spreadsheet for coordination. In addition, paperwork is required to be filled out in a uniform manner to alleviate problems with misinformation and confusion.

  • After three days, the coordinator calls the Arizona State Laboratory to obtain samples results. If the results are positive for the indicator organisms (or any other organism that was tested - i.e. Salmonella), the coordinator sends a letter to the establishment informing the owner the food samples obtained did not meet the recommended criteria. The food service facility is directed to call their inspector to establish a time for a training inspection or other meeting to identify the problems in their preparation steps and corrective action(s). This training inspection or meeting occurs within ten days of the initial investigation.

  • Once procedural changes have been implemented and verified, the inspector will re-sample the food item(s) to verify if the procedural change has reduced the microbial load on food. The second sample is taken within one month of the initial investigation.

  • For facilities that do not respond to the informational letter, the inspector will re-inspect as required under the Maricopa County Environmental Health Code and follow the same procedures for re-sampling.

  • The coordinator updates the final report for the alleged foodborne illness, listing the sample results and procedural changes.

Lessons Learned
As a direct result of this program the following results have been observed and lessons learned:
  • The inspection staff has developed a better understanding of the foodborne illness program.

  • The investigations are becoming more important in the overall inspection program; they are not considered a separate function as in the past.

  • Offering documented proof that the microbial load on a certain food item is above the suggested limit has helped to open communication with food service operators. The sample results are tangible and operators are more willing to change food preparation practices when they are able to see the food is not "clean."

  • By using the initial sample results and then re-sampling after procedures have changed, the inspector can show the operator that the food is safer and lower the risk factors associated with foodborne illness.

    From these results, the inspectors are noticing lasting change within establishments. They not finding the same violations three months down the road during the next routine inspection. One unexpected reward from the program is an improved relationship with the Arizona State Laboratory. In the past, the state lab has been somewhat adversarial, questioning the need to run certain samples and only accepting the samples on certain days and times. With the new program, they have become very open, wanting to know what procedural changes have occurred at the establishments in question, and they will take the samples at all times. The relationship has greatly improved, and they are working as a partner in this program.

Key Elements Replication
This program utilizes one staff member, the Foodborne Illness Coordinator, to collect, store, and retrieve data and the computer programs of Excel, Word, and Microsoft Outlook. Excel is used to maintain a listing of food samples and associated results. The spreadsheet also lists the incorrect procedure(s) identified during the investigation. Word and Outlook are used to write to the food service establishments and maintain internal communications with inspection staff.