BBC News reports three cases of E. coli O157 have been confirmed and all pupils at Friarswood Primary School in Newcastle-under-Lyme are being tested. The Health Protection Agency (HPA) said the school had been closed.

Staffordshire County Council said it is believed the infection was brought into the school from an outside source. A thorough clean is now under way.

 Excerpts from an article in today’s U.S. Centers for Disease Control Morbidity and Mortality Weekly Report.

On April 20, 2010, the Colorado Department of Public Health and Environment (CDPHE) was notified by correctional authorities regarding three inmates with bloody diarrhea at a minimum-security correctional facility. The facility, which houses approximately 500 inmates, is a designated work center where inmates are employed or receive vocational training. Approximately 70 inmates work at an onsite dairy, which provides milk to all state-run correctional facilities in Colorado. CDPHE immediately began an investigation and was later assisted by the High Plains Intermountain Center for Agricultural Health and Safety at Colorado State University and by CDC. This report describes the results of the investigation, which determined that the illnesses were caused by Shiga toxin–producing Escherichia coli O111 (STEC O111) infections.

During April–July, 2010, 10 inmates at the facility received a diagnosis of laboratory-confirmed STEC O111 infection, and a retrospective prevalence study of 100 inmates found that, during March–April, 14 other inmates had experienced diarrheal illness suspected of being STEC O111 infection. Pulsed-field gel electrophoresis (PFGE) testing indicated that STEC O111 isolates from inmates matched STEC O111 isolates from cattle at the onsite dairy. An environmental investigation determined that inmates employed at the dairy might have acquired STEC O111 infection on the job or transported contaminated clothing or other items into the main correctional facility and kitchen, thereby exposing other inmates. To prevent similar outbreaks in correctional facilities, authorities should consult with public health officials to design and implement effective infection control measures.

CDPHE staff also inspected the correctional facility's kitchens and living areas and identified the following conditions conducive to STEC O111 transmission: poor adherence to standard food-service protocols and hygiene practices, including food handlers working while ill with diarrhea; inconsistent availability of hand soap throughout the facility; dairy employees wearing soiled work clothes into the kitchen and living areas; and transport of potentially fecally contaminated lunch coolers and water containers from the dairy into the kitchen.

CDPHE hypothesized that the outbreak was associated with environmental contamination and propagated by person-to-person transmission, possibly through food preparation. On learning of these results, the correctional facility immediately implemented the following public health recommendations: 1) prohibiting potentially contaminated material (e.g., lunch coolers, water containers, and work clothing from the dairy) in the kitchen area, 2) excluding from work all food handlers reporting diarrheal illness since April 1, 3) requiring food handlers with a confirmed STEC O111 test result to have two consecutive negative stool specimens before returning to work, and 4) limiting transfers of inmates to other facilities until they were cleared by the medical staff.

The complete report is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6109a1.htm?s_cid=mm6109a1_x

Following a spate of campylobacter outbreaks linked to chicken liver paté in the U.K., researchers at Aberdeen University found the bug in more than 80 per cent of packs of chicken liver paté bought from supermarkets and butchers during a two-year survey.

The Scotsman.com cites Dr Norval Strachan, the researcher in food safety and epidemiology who led the study, as saying the bug had been found in 81 per cent of raw chicken livers purchased from a typical range of supermarkets and butchers over a two-year period. “… last year 14 outbreaks of the bug in the UK were associated with consumers eating chicken or duck liver paté. By cooking the livers properly and ensuring good hygiene in the kitchen these episodes can be avoided. However, some celebrity chefs and many recipes advocate only partially cooking chicken liver to ensure that it is pink in the middle.”

Dr Jacqui McElhiney, policy adviser at the Food Standards Agency in Scotland, underlined the need for proper precautions to be taken to prevent the risk of food poisoning.

“Unfortunately, levels of campylobacter in raw chicken are high, so it’s really important that chefs thoroughly cook chicken livers fully to kill any bacteria, until there is no pinkness left in the centre, even if recipes call for them to be seared and left pink in the middle. “It’s the only way of ensuring the paté will be safe to serve.”

This is all sorta confusing: researchers found 80 per cent of raw chicken liver contaminated with campylobacter, but said they were looking at packs of chicken liver pate at supermarkets. But the food safety folks blame celebrity chefs? Do they make pre-packaged pate? Are consumers supposed to cook paté they buy pre-packaged at the supermarket? Guess they were talking about raw liver. So then what about the risk of cross-contamination. Maybe something is lost in translation; I speak Scottish as fluently as Australian.

And pinkness is a lousy indicator of whether any meat has been cooked to reduce dangerous bacteria such as campylobacter. So is piping hot.

Restaurateurs had their moment in the New York City political sun today, and wasted the opportunity with a barrage of complaints about the unfairness of restaurant inspections as well as the letter grades.

They could have said, most of us take food safety seriously, we’re proud of our establishments, so proud that we want to work with health types to make the system better, and we want to brag about our great food safety.

More representative of the 300 people who filled a City Council chamber today was Dimitri Kafchitsas, who heads a group of 1,000 restaurants in New York City: The average food-safety visit “feels like a criminal raid and not an inspection. There is a lack of sensitivity.”

More sensitivity and less in-your-face? In New York City?

NYC could have saved itself some grief by doing some significant consumer and food service research before launching the system and figuring out what kind of disclosure would work best for New Yorkers (we did this in New Zealand).

A major criticism from restaurateurs has been the city's imposition of significant fines for issues that they say have no bearing on food safety. Among them have been fines for inadequate lighting, employees' drinking beverages while on duty, leaky faucets, leaky faucets, broken tiles and open doors.

Risk-based, consistent inspections are a problem in every municipality and state. Work on it; improve the system. But don’t just whine.

The City's health commissioner Thomas Farley told the hearing (from a prepared statement), “I know that you will hear complaints today from some restaurant owners. But just imagine this scenario: Salmonella cases are up 14 percent; the number of restaurants with rodents has increased by 50 percent and viral videos of rats in kitchens dominate the web; and restaurant sales are plummeting.

What would happen? The Council would hold a hearing and demand to know why the Health Department wasn't doing its job. You would describe horror stories of constituents getting sick, and you would demand swift action. And you would be right, because my job is to protect the health of New Yorkers.

Fortunately, the opposite scenario is happening right now. Since restaurant grading began, salmonella cases are down 14 percent. The Department's website shows that 72 percent of restaurants have received the top grade for cleanliness. Restaurant sales are up almost 10% since grading began, increasing by $800 million. And 91 percent of New Yorkers say they support restaurant grading.”

Daniel E. Ho, a professor of law at Stanford and a visiting professor of law at Yale this spring, takes a stab at suggestions for improvement, writing in the New York Times this morning that the well-intentioned system is broken.

“Along with researchers at New York University, Stanford and Yale law schools, I have studied data from more than 500,000 inspections of more than 100,000 restaurants from the last few years in nine jurisdictions: Austin, Tex.; Catawba County, N.C.; Chicago; El Paso; Florida; Louisville, Ky.; New York City; San Diego; and Seattle. Our research examined the process for tallying violations and the consistency of inspections across repeat, unannounced visits to the same restaurant. In a critical dimension, New York performed the worst of the nine.
At their core, the inspections work similarly across the jurisdictions. From once to a few times a year, a health inspector shows up unannounced to tally health code violations, like failure to wash hands or to maintain food temperatures. If violations amount to a public health hazard, the restaurant may be shut down until they are resolved.

“Our examination found key deficiencies in New York’s inspection system.

First, the score a restaurant gets in New York says little about how it will perform in the future. Grades are based on a point system: in New York, 0 to 13 points yields an A, 14 to 27 points a B, and 28 or more points a C. In other jurisdictions, numerical scores substantively predict future scores. In San Diego, for example, prior scores account for roughly 25 percent of the variation in future scores. But New York is an outlier: Prior scores predict less than 2 percent of the variation in future scores. New York City’s posted restaurant grades therefore fail the most basic criterion: they communicate little about future cleanliness.

Why such inconsistency? Although the jurisdictions share broad similarities, the details of New York’s inspection process are far more complex. There are more inspectors (some 180, not all of whom necessarily specialize full time in restaurant inspections), more violations to score and far wider point ranges for each violation.

“While San Diego, for example, has a single violation for vermin, New York records separate violations for evidence of rats or live rats; evidence of mice or live mice; live roaches; and flies — each scored at 5, 6, 7, 8 or 28 points, depending on the evidence. Thirty “fresh mice droppings in one area” result in 6 points, but 31 droppings result in 7 points.

“To reduce imprecision, the city should apply the key insight of grading — simplification — not only for information consumers, but also for information producers — i.e., the inspectors. To increase efficiency, the city should abandon inspections for the purpose of resolving grades and instead redeploy those resources to focus on the worst offenders. It’s time for grade reform.”

OK. Get on with it. Restaurant managers, health types and consumers need to figure out how best to improve the system. But disclosure is here to stay.

Filion, K. and Powell, D.A. 2011. Designing a national restaurant inspection disclosure system for New Zealand
. Journal of Food Protection 74(11): 1869-1874
.
http://www.ingentaconnect.com/content/iafp/jfp/2011/00000074/00000011/art00010
The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated. Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant's inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.

Filion, K. and Powell, D.A. 2009. The use of restaurant inspection disclosure systems as a means of communicating food safety information. Journal of Foodservice 20: 287-297.
The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments. Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.

Twin Trees Too, a popular Syracuse, New York restaurant, will be undergoing a serious cleaning over the next 18 hours, as the number of customers with norovirus is now up to 70.

The health department says there’s no evidence the bug is still being spread, but as a precaution, the restaurant is voluntarily closing for the first half of the day on Wednesday so Serve-Pro can come in and do a thorough cleaning.

The Onondaga County Health Department suspects the norovirus – or stomach bug – was spread in the restaurant sometime around the last weekend of February and was likely caused by sick employees preparing food.

While the restaurant is well known for its pies, it may have been some other foods that were contaminated.

"The investigation is still pending, but we do think that it’s more likely to be related to a salad or antipasto than to the pizza at this time,” said Onondaga County Health Commissioner, Dr. Cynthia Morrow.

I’m all for restaurant inspection disclosure but all against bogus evidence to win rhetorical points in the public arena.

The night before a hearing on the public display of letter grades, New York City mayor Michael “Lenny” Bloomberg told collected journos that salmonella is down more than 13 percent over the first full year of restaurant inspection disclosure because of improved food sanitary practices by restaurants striving to achieve better grades.

The mayor — speaking with the health commissioner, Dr. Thomas A. Farley, and Deputy Mayor Linda I. Gibbs — announced that “New Yorkers overwhelmingly support the grading system,” citing a recent survey by Baruch College at the City University of New York. It showed that 91 percent of New Yorkers approve of restaurant grading and 88 percent consider letter grades when dining, according to a telephone survey conducted in January and February.

Surveys don’t mean much.

Dr. Farley said salmonella infections were significantly reduced in New York City, but remained unchanged in the rest of New York State, Connecticut and New Jersey.

He added that the city’s restaurants had made significant improvements in sanitary practices, since more than 72 percent of them earned A grades, up from 65 percent a year ago.

The same compliance results have been seen around North America and elsewhere in the 13 years I’ve been involved and long before that; it’s cute that NYC is catching up.

Mr. Bloomberg said, “Restaurant grades have been good for public health and good for the economy,” adding that “New York City is known for its great restaurants and now it will be known for food safety, too.”

Hang on there, Lenny. There’s lots of caveats with inspection and disclosure. The available evidence – which is extensively documented on barfblog.com but even I’m getting tired of writing about it – is a draw at best. Links to reductions in foodborne illness are speculation, bordering on false-hope.

Disclosure is good. Leave the self–aggrandizement and rhetoric to pro athletes and lawyers.

The mayor also announced a new free mobile app for iPhones, IPads and IPod Touch devices called “ABCEatsNYC,” which lets New Yorkers check letter grades from any street corner in the five boroughs. The app is listed under the title “NYC Restaurant Grading” at the iPhone App Store, and can be downloaded after searching for mobile devices.

Michael J. Fox is a great Canadian.

Last weekend we took the family to Myrtle Beach, land of golf, outlet malls and lazy rivers. After hitting a kids museum, a pizza arcade and the Ripley's Aquarium I asked Jack, our three-year-old, where he wanted to eat dinner and he emphatically replied 'Chick-Fil-A' because of the playground. No wonder I dream about the place.

Being a food safety nerd,  we do a bunch of handwashing after visiting the play area and before jumping into our meals. A friend of mine who runs one told me the staff also disinfect the whole room using a bunch of different sanitizers every night. Not risk elimination, but definitely reduction.

According to USA Today, a mother of four has embarked on a national crusade to reduce illness risks associated restaurant playgrounds, including suggesting regulations on sanitation.

Arizona's most populous county is looking at new regulations to safeguard restaurant play areas after one mother here discovered unsanitary conditions when her 3-year-old wanted to play at a nearby McDonald's.Maricopa County health officials are looking at expanding their oversight of restaurant cleanliness to playgrounds."This is a giant step in the right direction," said Erin Carr-Jordan, 37, a mother of four with a doctorate in developmental psychology who lives in this Phoenix suburb.The proposal would require sanitizing of those areas after every shift, detailed cleaning protocols, permanent signs encouraging children's hand washing before meals and immediate closure of the play areas "when vomiting and/or fecal accidents occur."But getting those changes into law isn't a sure thing. The approval process takes months, the county supervisor she is working with leaves office at the end of the year and a candidate for another supervisor's seat is president of the Arizona Restaurant Association.

Carr-Jordan is getting support from the county's public-health director, Dr. Robert England (not to be confused with Robert Englund - ben).
"It's just common sense. You don't want to facilitate something that's going to make kids' hands filthy dirty right before they handle food," England said. "But we also don't want to do anything that discourages physical activity. For some, this is the best playground equipment available."
England said he hasn't read the proposed health-code changes but would support "reasonable" play-equipment-cleanliness requirements.The Arizona Restaurant Association would prefer advisory, not mandatory, cleaning standards for play areas."Our restaurants do everything in their power to make sure these locations are clean," said Sherry Gillespie, the association's government relations manager.

The mother's outrage started about a year ago when Carr-Jordan's son asked to go on the slide at a Tempe, Ariz., McDonald's."I saw filth and grime coupled with clumps of dirt, matted hair and rotting food. The entire structure was riddled with swear words and gang signs," she said.
The Arizona Restaurant Association would prefer advisory, not mandatory, cleaning standards for play areas.

"Our restaurants do everything in their power to make sure these locations are clean," said Sherry Gillespie, the association's government relations manager.

While I'm not a fan of regulation just because, Gillespie's comments sound like 'just trust us' to me. Everything in their power is pretty empty, if there are cleaning and sanitizing guidelines that folks are following, tell people what they are. My Chick-Fil-A friend showed me what he does and that was good enough for me.

British athletes are being told not to shake hands at the 2012 Olympics in London, a good idea considering that one-in-five hospitals – hospitals with sick people where everyone is supposed to religiously wash hands – in Australia suck at handwashing.

The Australian government on Tuesday released data on the MyHospitals website about how often staff at 233 public hospitals clean their hands, against an interim benchmark of 70 per cent.

It is the first time such information has been made publicly available.

The figures show that about half of the country's major public hospitals are above the benchmark, while just over 30 per cent were similar to the current standard.

Around 19 per cent were below the benchmark.

The data are based on audits of hand hygiene moments - when there is a perceived or actual risk of pathogen transmission from one surface to another via someone's hands - in public hospitals between July and October last year.

Meanwhile, Dr Ian McCurdie, the British Olympic Association (BOA) chief medical officer, told the Daily Mail that a mild bug which can knock athletes off their stride could be picked up in the "quite stressful environment" of the Games.

When asked whether this means shaking hands should be off-limits, he said, “I think, within reason, yes.

“I think that is not such a bad thing to advise. The difficulty is when you have got some reception and you have got a line of about 20 people you have never met before who you have got to shake hands with.

'Within reason if you do and have to shake hands with people, so long as you understand that regular handwashing and/or also using hand foam can help reduce the risk - that would be a good point.'”

The advice is part of a detailed package of health and resilience issues which the BOA has looked at ahead of the Games.

 Why is meat inspected?

Why does it have to be overseen by veterinarians?

Does inspection result in fewer sick people?

Do inspectors have pathogen-seeking goggles?

The Washington Post reports this morning that every day, inspectors in white hats and coats take up positions at every one of the nation’s slaughterhouses, eyeballing the hanging carcasses of cows and chickens as they shuttle past on elevated rails, looking for bruises, tumors and signs of contamination.

It’s essentially the way U.S. Department of Agriculture food safety inspectors have done their jobs for a century.

But why? Today’s meat inspection seems grounded in repetition and historical precedent rather than science.

In 1184, city leaders in Toulouse, France, introduced some of the first documented measures to oversee the sale of meat: profit for butchers was limited to eight per cent; the partnership between two butchers was forbidden; and, selling the meat of sick animals was forbidden unless the buyer was warned.

By 1394, the Toulouse charter on butchering contained 60 articles, 19 of which were devoted to health and safety.


As outlined by Madeleine Ferrières, a professor of social history at the University of Avignon, in her 2002 book, Sacred Cow, Mad Cow: A History of Food Fears, the goal of regulations at butcher shops -- the forerunners of today's slaughterhouse -- was to safeguard consumers and increase tax revenues.

Primarily increase tax revenues.

Animals from the surrounding countryside were consolidated at a single spot -- the evolving slaughterhouse, originally inside city walls -- so taxes could be more easily gathered, and so animals could be physically examined for signs of disease.

It's no different today: slaughterhouses are common collection points to examine animals for signs of disease and to collect various levies.

Bernard Vallat, Director General of the World Organisation for Animal Health (OIE), said a couple of years ago that veterinary legislation is the foundation of any efficient animal health policy.



”Veterinary legislation is a critical infrastructure element for all countries. In many OIE Member countries, the veterinary legislation has not been updated for many years and is obsolete or inadequate in structure and content for the challenges facing veterinary services in today's world. Dr Vallat said that it is important that the veterinary services have the authority to enter livestock premises and other establishments and take the actions needed for early detection, reporting and rapid and effective management of any animal diseases as soon as they are detected. Such actions include the capacity to seize animals and products, to impose standstills, quarantine, testing and other procedures; to control animals and products at frontiers; and to require the destruction and safe disposal of animals and all articles considered to present a risk of disease transmission and to public health. These activities represent the core activities of veterinary services in the field of animal health control and veterinary public health and the legislation must provide the necessary authority as a minimum.”

That’s an attempt to answer the why-inspect-meat question, but it won’t be found in the Post story.

The Post story does explain that in some large slaughterhouses, USDA inspectors must regularly shave slices off the surface of different pieces of meat and send them to labs to test for E. coli.

But science has done little to thin the ranks of traditional inspectors. The law requires that they be present whenever animals are slaughtered and that they visit meat processing plants at least once a day. The USDA has more than 7,500 people doing the job.

The USDA launched an initiative in 1997 that would have shifted some responsibility for identifying carcass defects on slaughter lines to food company employees so that inspectors could focus more on microbial contaminations, USDA officials said. But a year later, the American Federation of Government Employees, some federal inspectors and a public-interest group sued to block the plan, alleging that it scrapped the carcass-by-carcass inspections required by the 1906 law.

As a result of the court battle, the USDA was forced to keep at least one inspector on each slaughter line.

Richard Raymond, a former USDA undersecretary of food safety, tried another approach in 2005. He worked to reallocate the time inspectors spend in meat processing plants based on the facilities’ safety record and the risk posed by the foods processed: Ground-beef plants, for example, would get more attention than a canned-ham operation.

But after two years of discussion with the food industry, consumer groups and unions, Congress barred the USDA from using funds to pursue the initiative. Raymond said he suspects that unions, fearful for their members’ jobs, blocked the effort.

In Canada, the years following the 2008 listeria-in-Maple-Leaf-deli-meat outbreak that killed 23, the federal inspectors' union has had the public discussion volume set to shrill.

Canadian union president Bob Kingston said in the past few days (months, years) that any cuts to Canadian Food Inspection Agency inspector staffing would “be devastating.”

He doesn’t say why.

Would more federal government inspectors have prevented the Maple Leaf mess? No. Do Canadian inspectors possess Superman-style listeria detection goggles? No. Do more inspectors make food safer? No.

In January, the USDA unveiled a proposal that would keep one inspector on each poultry slaughter line while the rest focused on what the agency considers higher risks, such as testing poultry for pathogens. Much of the responsibility for spotting obvious problems with the carcasses would fall to the plant’s employees.

The voluntary proposal would save taxpayers more than $90 million over three years, lower production costs for the industry by $257 million a year and better protect the public against contaminants, USDA officials say.

But these days, the bulk of what Americans eat — seafood, vegetables, fruit, dairy products, shelled eggs and almost everything except meat and poultry — is regulated by the Food and Drug Administration. And the FDA inspects the plants it oversees on average about once a decade.

These radically different approaches are a legacy from a time when animal products were thought to be inherently risky and other food products safe. But in the past few years, the high-profile and deadly outbreaks of foodborne illness linked to spinach, peanuts and cantaloupe have put the lie to that assumption.

The FDA’s approach is partly by necessity: The agency lacks the money to marshal more inspectors.

But it also reflects a different philosophy about how to address threats to the nation’s food supply: an approach based on where the risk is greatest.

“We have two extremes in the inspection programs,” said Michael Doyle, a nationally known microbiologist who directs the Center for Food Safety at the University of Georgia. “Neither system is working very well. They both need to be updated and upgraded.”

At the USDA, tight federal budgets and scientific advances over the past century make the case for new ways to manage risk, one that relies less on basic observation by an army of inspectors. But bureaucratic politics and union power have blunted these initiatives.

“I’m sure the resources can be allocated better,” said Michael Batz, a University of Florida researcher who studied the risks posed by different foods. “But each agency has a mandate. USDA, because of its mandate, has very little discretion about how it can use its resources. FDA has a broader mission, but, I think it’s fair to say, not enough resources.”

Regardless of whether local, state or federal, inspection are present to hold producers accountable, as part of a tax collection scheme, or to make food safer, the best slaughterhouses, processors, retailers and restaurants will go above and beyond the minimal standards of government.

And stop whining about it.

Because none of this chatter among the, err, chatting classes means fewer people are barfing from the food they consume.