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Communicable and Environmental Disease Services

EHS-Net

Once a program under the FoodNet umbrella, the Environmental Health Specialist Network (EHS-Net) is a sister program to FoodNet. EHS-Net is a network of environmental health specialists and epidemiologists collaborating and exchanging ideas with laboratories, state food protection programs, the Environmental Health Branch of the National Center of Environmental Health at CDC, the Food and Drug Administration, and FoodNet.

The purpose of EHS-Net is to assist state health departments in their efforts to improve the practice of environmental health service programs. This will be accomplished by: Identifying environmental antecedents (underlying factors) to illness and disease outbreaks; translating findings into improved prevention efforts using a systems-based approach; offering training opportunities to current and future environmental health specialists; and strengthening the relations among epidemiology, laboratory, and environmental health programs.  

As we expand the scope of EHS-Net from food safety programs to other environmental health issues we hope to recruit more states into the network.

Currently, members of EHS-Net are gathering information from food-service establishments to learn more about food-handling practices and how they relate to foodborne illness. The objectives of this project are to determine:

  • What causes foodborne outbreaks ?
  • Cross-contamination
  • Inadequate cooking
  • Improper food-holding temperatures
  • Other factors
  • Why foodborne outbreaks occur ?
  • Inadequate worker knowledge
  • Poor sanitation practices
  • Improper use of equipment
  • Other factors

Outbreak/non-outbreak restaurant inspection study:

The Tennessee site is actively participating in analysis of data from the first cycle of the “outbreak/non-outbreak” restaurant inspection study and preparing for cycle 2. This study seeks to compare various aspects of restaurants that have been implicated in a foodborne outbreak with those restaurants that have been outbreak-free for some time.

National Antimicrobial Resistance Monitoring System (NARMS) retail food survey: The retail food study is an ongoing study whose objective is to determine the burden of microbial contamination of retail meat products and their potential contribution to foodborne illnesses. The National Antimicrobial Resistance Monitoring System (NARMS) Retail Food Survey is a cooperative project involving the USDA, FoodNet, and 10 state-based FoodNet partners.

Environmentalists at participating sites purchase uncooked meat products from retail grocery stores in their areas each month. In Tennessee the Tennessee Department of Health State Laboratory tests the samples for contamination. The laboratory also carries out testing for Campylobacter, Salmonella, Enterococcus, E. coli, and C. difficile using standardized methods and procedures.

Tomato handling practices study:

The Tennessee EHS-Net site is participating in development of the study of tomato handling practices, regulations, and policies in foodservice establishments. Recent large outbreaks have highlighted the importance of better understanding the range of current practices, identifying potential areas for modification, determining models of best practice, and assessing system modifications, which can facilitate positive change. Data collection for this study is scheduled for 2006.

Complaint systems project:

This working group was formed to develop a list of the model criteria of a foodborne illness complaint system. The group has completed this model and is currently in the process of developing tools that incorporate the model criteria, which may be used by food protection agencies abroad. These tools include a standard foodborne illness complaint data collection form to be used by agencies that lack computer capabilities to manage complaints. Additionally, the workgroup is developing a computerized database to capture real-time reports of complaint calls received by participating agencies. This new database will allow early detection of outbreaks and restaurant-specific problems, and facilitate tracking of resources and trends in complaint responses within participating food protection agencies.

The project has developed the complaint system with in-kind support from Nashville/Davidson Metropolitan Health Department’s IT division that will serve as a pilot-project for expansion to other rural and metropolitan jurisdictions in the state within the next two years. The EHS-Net working group is gathering data on similar systems from other jurisdictions, and planning to develop models and guidelines for complaint-data system development in other states.

Value of the inspection program:

This study is in its infancy, with the official hypothesis and study design still in development. The workgroup has met several times to discuss the direction of the study that will attempt to link contributing factors associated with foodborne outbreaks to specific, related items on state inspection forms that preceded the outbreak.

Denominator determination:

Tennessee EHS-Net staff worked to determine the “denominator” number of restaurants in the surveillance area in preparation for the first cycle of the Outbreak/Non-outbreak Inspection Study. Understanding the categorization of establishment types (i.e. prep. serve, cook serve, complex, quick serve, regular sit down, etc.) is paramount to understanding business trends within the state, and results from this study will provide accurate assessment of the numbers of permitted establishments.

Improved reporting of contributing factors in the Electronic Foodborne Outbreak Reporting System (EFORS):

 This FoodNet/EHS-Net working group looking at existing EFORS data to ascertain the completeness and reliability of “contributing factor” information associated with outbreak investigations. The working group has been instrumental in acquiring this dataset and coordinating efforts to use existing data to develop methods for improving the completeness and usefulness of these data. Within the state, EHS-Net working to formalize communication between environmentalists and epidemiologists involved in outbreak investigations to ensure that all parties have appropriate input into reports submitted via EFORS.

EHS-net information system:

The EHS-net has developed this information system to support data collection activities in food safety programs, available to local, state, tribal and federal environmental health service programs.

Foodborne terrorism tabletop exercise:

Tennessee EHS-net staff led a working group in planning, developing, and executing the first tabletop exercise for the Tennessee Food Safety Taskforce. This exercise was designed to enable participants to demonstrate and evaluate the response capabilities, communication, resources, data, coordination, and organizational elements involved in a food security emergency response.

For more information, contact the EHS-Net Coordinator at (615) 741-7206 or visit the CDC website at: http://www.cdc.gov/nceh/ehs/EHSNet/highlights.htm.