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Journal Of The American Dietetic Association

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1. What information would you need to acquire in order to establish the cause of the outbreak and how would you obtain this information?

2. How would you use this information to determine the nature and level of risk presented?

3. Write a letter to the proprietor to explain the findings of your completed investigation and to outline a suitable intervention?



1. Consumption of any contaminated foods or beverages can lead to a foodborne illness. The pathogenic organisms like virus, bacteria, fungi and parasites can cause different foodborne illness. Foodborne diseases are also caused by harmful chemicals or toxins produced by bacteria or fungi (Pierson 2012).

1.1 To establish the cause of an outbreak, some information is needed to be gathered. First of all the symptoms of the foodborne disease should be considered in order to identify the disease causing factors (Centers for Disease Control and Prevention (CDC) 2011). Secondly, it is important to know that what type of food had been consumed by the people suffering from the illness. It is required to detect the disease-causing factor. The hygiene of food processing system should be taken into consideration to identify the possible sources of any contamination. It may help to identify the type of the contaminating organism (Scharff 2010).

1.2 To obtain the above mentioned information related to the foodborne outbreak, some special inspection should be done. At first, the microbial analysis of the food sample and swab analysis of all food contact surfaces including the utensils are done. If any pathogenic strain is found then, it is isolated and confirmation test is done to assure the presence of that organism (Centers for Disease Control and Prevention (CDC) 2011). Chemical analysis of the food is also done to detect the presence of any toxic chemical. Next step is identifying the sources of the contamination by inspecting each step of the whole process starting from harvesting to processing. If any step is not performed correctly or the hygiene is not maintained, then contamination may occur. Medical tests of the food handlers are performed to detect if there are any of foodborne illnesses they are suffering from and the factors responsible for the disease (Panisello, Quantick and Knowles 1999).

2.  The nature of the foodborne illness and its severity is largely dependent on the type and the count of microorganism present in it. Some strains of microbes cause health hazard whether the others do not(Logan  2012).

A proper microbial analysis can determine the types and number of microorganism present in any sample. If the number of a particular species of microbe is present in excess of its permitted limit or if there is any pathogenic strain, then it can cause a health hazard and the type of disease and the level of risk can be determined accordingly (Mortimore and Wallace 1998).

There are several risk factors associated with the handling of food at each processing step and the inspection of each step of food handling is important to detect the errors of a food processing operation, which may help in determining the risk factor and its severity (Panisello, Quantick and Knowles 1999). The type of food material has a significant influence on the kinds of microbes that can grow on it (Centers for Disease Control and Prevention (CDC) 2011).

Different food items have a different nutritional composition and according to that, the microbial population varies. So, one can have an idea about the type of disease causing organism by knowing the type of food (Logan  2012).

The medical examination of the food handlers detects the type of pathogen by which a consumer might get affected and also determines the type and level of risk associated with it (Powell, Jacob and Chapman 2011).

3. To,

The proprietor

Flicks Restaurant, Belfast

Respected Sir/Madam,

                 Our team has investigated the case of the foodborne outbreak of Flicks Restaurant. Total three hundred cases of the foodborne outbreak have been reported by the people who had consumed the food of Flicks Restaurant. A pathogenic strain of E. coli (E. Coli O157) was found to be responsible for the outbreak. Some individuals suffered a mild gastrointestinal infection while the others have experienced a severe infection with bloody diarrhoea. In order to investigate the source of this pathogenic contamination, our team had an inspection of your restaurant and the staffs who work there.

 While proceeding with the investigation of this case, our team had to perform some experiments. At first, the sampling of the food items was done followed by swab analysis of all food contact surfaces including the utensils. Among them, it was found that four food samples had an excess microbial count but none of them were E. coli positive. However, when the faecal samples of all food handlers were tested, two of them were found to have a positive result with E. coliO157. One of them was noted to have enteric symptoms with severe diarrhoea on 28th September 2012 while working in the restaurant. It was informed that the garnishing of a meal with chopped parsley was done on that day by the staff suffering from diarrhoea. Researchers have found that exposure of chopped parsley can be a potential source of foodborne illness. The people who consumed chicken and gourmet burger also suffered from the disease. A lot of issues related to the hygiene of the restaurant have been noted. The major problem is that there are no Hazard Analysis and Critical Control Point (HACCP) documentation on the premises. Poor structure of cleaning and storage of equipment and lack of hand washing soap, wash basins and hand drying facilities are another issues related to food safety. The storage conditions of the food are also not properly maintained. The result of the microbial analysis shows no pathogenic organism but a higher number of total plate count, which indicates that the food was not refrigerated and kept for a long time in this condition. The lettuce had a fungal contamination also resulting from inadequate storage and cleanliness. Some other issues related to cross contamination like storing the processed foods and raw materials together were noticed.

 After our investigation, the above questions related to food safety have been put forward. We would request you to take some measures to deal with these issues. The primary step against these issues is the proper implementation of HACCP (Hazard Analysis and Critical Control Point). The risks that are to be controlled can be associated with three main factors. The first one is the raw material and water used for the preparation of food. The second one is the condition of the environment where the food is exposed and lastly the health and hygiene of the food handlers (BaÅŸ, Ersun and Kıvanç 2006).


 From the receiving of raw materials to the serving of prepared food, every step should be inspected properly as contamination can occur at any stage. At the receiving, the appearance, flavour, texture and other physical properties of the raw material should be checked. Then those are cleaned properly prior to use or store. If they need to be stored, then the storage temperature should be low. Before the preparation of food the working platform and the equipment should be sanitized. Cooking has to be done at the proper temperature and then it is served to the consumer with no delay. The food should be held hot until it is served. Some particular food items like raw fruits, vegetables, fish, meat, milk etc. are very prone to microbial contamination, and they should be handled more carefully. The water used for cleaning or cooking purpose should be treated and free form microbes and harmful chemicals (Youn and Sneed 2003).

 The next factor of concern is the environment to which the food gets exposed. All the food contact surfaces including the refrigerator should be clean and sanitized. The microbial count of the air is also be maintained for complete hygiene. The equipments should be washed and sanitised after every use (Mortimore and Wallace 1998).

There are some certain rules to be followed by every personnel, who are directly involved in food handling operation. If an individual is suffering from some illness, he or she should not enter the processing area. Those who are having an open wound, they should not be allowed to handle food items. Every personnel entering the processing area should be properly dressed in head cover, gloves, apron and shoe cover. Individual should not have any jewellery like ring, bangles, watch etc. Everyone should have their hand washed properly before touching any food item or food contact surface, after using toilet and after every absence from the processing area. Eating, drinking or smoking should be prohibited in the processing area. Every individual related to a food handling operation should be given a proper training about the foodborne illness and the precautionary measures (Baş, Ersun, and Kıvanc 2006).

The implementation of HACCP (Hazard Analysis and Critical Control Point) can be an effective solution to this problem. HACCP is basically a risk management and control system. It has been designed to identify, evaluate and control the hazards related to the food supply chain of any food processing organization (Mortimore and Wallace 1998). The implementation of HACCP is followed by seven steps: to perform a hazard analysis by inspecting each step properly, setting up the critical control points in order o control the hazards, determining the critical limits for each of the contaminants, to establish a monitoring procedure for the critical control points (CCP), developing corrective actions if an operation does not work correctly, setting up verification processes, documenting of the whole process (Robert, Barrett and Sneed 2005). HACCP (Hazard Analysis and Critical Control Point) is basically a quality assurance programme that is set up to provide an approach to control and identify the factors associated with risk. An HACCP team should be formed for proper inspection of the whole process (Soriano, Rico and Manes 2002). In a restaurant, the control points for the microbial hazards are cleaning of raw materials and cooking. So these two processes are done properly. The time and temperature during cooking is maintained carefully depending on the type of food as it is the critical control point for microbial contamination. The implementation of the above HACCP principles needs a proper designing of the processing area (Robert, Barrett and Sneed 2005).

Every step included in the flow of food from farm to table has some responsibility related to food safety. HACCP is an effective food safety management tool to ensure the safety associated with each step. Implementation of HACCP can be a profitable option for any organization. Although the primary target of implementing HACCP is to ensure the safety of food, there are also other benefits that can be acquired by the implementation of HACCP (Mortimore and Wallace 1998). An HACCP certified organization increases the confidence of consumers. By reducing the loss of any product or rework, it minimizes the cost of production. By implementing HACCP, the whole process becomes quite simplified because of the record keeping and documentation of each and every detail of a process. A consistent good quality of the food is maintained which increases the customer satisfaction (Soriano, Rico and Manes 2002).

By developing and implementing a food safety management system like HACCP voluntarily you can play a protective role to ensure the safety of the food served in your restaurant. Rather than preventing a foodborne illness after its occurrence, it can be avoided by taking the mentioned step to reduce, prevent and eliminate the hazards that can cause someone to fall ill (Robert, Barrett and Sneed 2005). So, for the betterment of the service of your restaurant, we suggest you to implement the above mentioned food safety management system which will result in a considerable decrease in foodborne diseases and will be profitable for your organization with an increase in customer satisfaction.

Thank you

With regards



BaÅŸ, M., Ersun, A.Åž. and Kıvanç, G., 2006. Implementation of HACCP and prerequisite programs in food businesses in Turkey. Food Control, 17(2), pp.118-126.

Centers for Disease Control and Prevention (CDC), 2011. CDC estimates of foodborne illness in the United States. Retrieved March, 23, p.2011.

Khandke, S.S. and Mayes, T., 1998. HACCP implementation: a practical guide to the implementation of the HACCP plan. Food control, 9(2), pp.103-109.

Logan, N.A., 2012. Bacillus and relatives in foodborne illness. Journal of applied microbiology, 112(3), pp.417-429.

Mortimore, S. and Wallace, C., 1998. An introduction to HACCP. In HACCP(pp. 1-11). Springer US.

Mortimore, S. and Wallace, C., 2013. HACCP: A practical approach. Springer Science & Business Media.

Panisello, P.J., Quantick, P.C. and Knowles, M.J., 1999. Towards the implementation of HACCP: results of a UK regional survey. Food control,10(2), pp.87-98.

Pierson, M.D., 2012. HACCP: principles and applications. Springer Science & Business Media.

Powell, D.A., Jacob, C.J. and Chapman, B.J., 2011. Enhancing food safety culture to reduce rates of foodborne illness. Food Control, 22(6), pp.817-822.

Roberts, K.R., Barrett, B. and Sneed, J., 2005. Status of prerequisite and HACCP program implementation in Iowa and Kansas restaurants: Sanitarians' perspective. Food protection trends, 25(9), pp.694-700.

Scallan, E., Hoekstra, R.M., Angulo, F.J., Tauxe, R.V., Widdowson, M.A., Roy, S.L., Jones, J.L. and Griffin, P.M., 2011. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis, 17(1).

Scallan, E., Griffin, P.M., Angulo, F.J., Tauxe, R.V. and Hoekstra, R.M., 2011. Foodborne illness acquired in the United States—unspecified agents.Emerging infectious diseases, 17(1), p.16.

Scharff, R.L., 2010. Health-related costs from foodborne illness in the United States.

Seward, S., 2000. Application of HACCP in food service. Irish Journal of Agricultural and Food Research, pp.221-227.

Soriano, J.M., Rico, H., Molto, J.C. and Manes, J., 2002. Effect of introduction of HACCP on the microbiological quality of some restaurant meals. Food Control, 13(4), pp.253-261.

Youn, S. and Sneed, J., 2003. Implementation of HACCP and prerequisite programs in school foodservice. Journal of the American Dietetic Association, 103(1), pp.55-60.

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