The Centers for Disease Control and Prevention (CDC) has uncovered a new strain of E. coli that has been responsible for multiple outbreaks of foodborne illness over recent years, including those related to romaine lettuce and other leafy greens.

The REPEXH02 strain is believed to have first come to light at the end of 2015, with the agency noting that it was responsible for dozens of hospitalizations and many cases of hemolytic uremic syndrome (HUS), a serious issue that can often impede blood clotting in infected people and cause kidney failure.

A study by CDC researchers utilized whole genome sequencing to examine the DNA of a strain and track the bacteria that cause foodborne illness, which allowed them to determine whether outbreaks were caused by the same strain, and the link involved with others. The new strain consists of two clades with different geographic distributions, one of which has notable genomic features.  

E. coli O157:H7 is estimated to cause 63,000 domestically acquired foodborne illnesses and 20 deaths in the United States each year, according to the CDC. The agency found that 58% of recent E. coli-related illnesses were attributed to vegetable row crops, with the majority coming from leafy greens. In 2019, a large outbreak related to romaine lettuce from California’s Salinas Valley caused 167 cases and hospitalized 85 people from 27 states. In 2020, 40 infections occurred in 19 states, 20 people were hospitalized and four developed HUS. No further outbreaks from the strain have been associated with the strain.

The newly identified strain has a toxin type associated with more severe disease in those infected, according to the CDC. Still, additional study is needed to understand factors that contribute to the bacteria’s emergence and persistence in specific environments, the authors wrote.

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FDA, along with CDC and state and local partners, is investigating an outbreak of Listeria monocytogenes infections linked to enoki mushrooms. FDA has identified imported enoki mushrooms distributed by Utopia Foods, Inc. of Glendale, N.Y., as a likely source of illnesses in this outbreak. These mushrooms are long thin white mushrooms, usually sold in clusters. They are also known as enokitake, golden needle, futu, seafood, or lily mushrooms.

As of January 18, 2022, CDC reports three illnesses included in this outbreak. Two sick people reported eating the mushrooms or eating at restaurants with menu items containing them. One patient did not report eating the mushrooms but reported shopping at various Asian grocery stores.

Through ongoing sampling efforts, FDA and state partners have been collecting and testing samples of the mushrooms. An import sample of enoki mushrooms branded as Utopia Foods, Inc. was collected by FDA and was reported as being positive for L. monocytogenes. Whole genome sequencing analysis determined that the strain of Listeria found in this sample matches the strain of Listeria linked to two illnesses in this outbreak. FDA also detected an additional strain of L. monocytogenes in this sample, which is linked to one additional illness. Both strains are now included in this outbreak investigation.

As a result of this testing, Utopia Foods, Inc. voluntarily expanded their original recall (first issued on December 13, 2022) to include their 200g packages of enoki mushrooms, imported from China, with clear and blue plastic packages with clear markings of “best before 03/02/2023” or “best before 03.09.23.” These products were distributed between January 6 and January 13, 2023, in New York, New Jersey, and Connecticut, to wholesale companies for further distribution.

FDA is continuing its investigation to determine a potential source of contamination and whether any other products are contaminated or linked to illnesses. Additional information will be provided as it becomes available.

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With the end of 2022 upon us, data from the CDC showed that COVID-19 cases in the United States had been on the decline in recent months; however, cases are beginning to tick up over the past few weeks, which raises a question about the status of the pandemic: Is the pandemic (really) over?

Admittedly, many people in the U.S. have already returned to normal in their personal lives; few masks are seen in public these days and restaurant dining rooms are open. Supply chain concerns and personnel policy adjustments are still at the forefront of COVID-19 mitigation policies, but where does the food industry stand if another surge occurs? Are we better prepared than we were in March 2020? Are there new regulations or guidance to support risk mitigation? Will there be enforcement criteria going forward?

Nearly three years in, let’s look back at the food sector’s overall response and take a speculative peek into the future.

Current Data

Before evaluating the food sectors’ efforts to protect both employee and food safety, let’s see where we stand. According to CDC’s data tracker, 2022 started with the highest number of COVID-19 cases ever recorded in the pandemic in the U.S., reaching more than 5,000,000 cases per week. As of November 28, 2022, the weekly case count sits at just upward of 305,000, up slightly from an October 2022 low mark of 265,000, a number that hasn’t been seen since June 2020.

But, before the celebrations begin, it’s important to note the slight uptick in cases recently amid reports of new variants that appear to have increased vaccine immunity evasiveness. It should also be noted that a similar low point occurred in June 2021, when U.S. case counts dropped to as low as 82,000 per week, only to spike to more than a million per week by August 2021.

In the spring of 2020, COVID-19 hit the meat and poultry industry hard. Workers in close proximity to each other in poorly ventilated chilly rooms offered the perfect conditions in which the virus could thrive and spread. With absenteeism high, some companies actually incentivized workers with cash bonuses to continue working even if they were ill, a practice that was eventually stopped to prevent further spread of the disease. There were clear indications that these conditions contributed to community spread events in situations where workers often shared transportation and even lived together. According to CDC’s newsletter Morbidity and Mortality Weekly Report, among 23 states reporting COVID-19 outbreaks in meat and poultry processing facilities, 16,233 cases in 239 facilities occurred, including 86 (0.5%) COVID-19–related deaths.

Guidance for Industry

The World Health Organization (WHO) published an early guidance document that offered initial steps the food industry should take as the pandemic exploded. This was a general document that was not country specific, but at least offered industry a starting point.

This was quickly followed by a guidance issued by the Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency (CISA) on March 19, 2020, entitled “Guidance on the Essential Critical Infrastructure Workforce: Ensuring Community and National Resilience in COVID-19,” in which workers in the food and agriculture sector—agricultural production, food processing, distribution, retail and food service, and allied industries—were named as essential critical infrastructure workers (see “CISA Worker Risk Assessments,” below).

The agency’s National Infrastructure Protection Plan (NIPP) risk management framework, which has been in place since 2014, identifies 16 industry sectors as essential, including the food and agriculture sector, which is composed of an estimated 2.1 million farms, 935,000 restaurants, and more than 200,000 registered food manufacturing, processing, and storage facilities, accounting for roughly one-fifth of the nation’s economic activity. There are four other sectors applicable for food: water and wastewater, energy, transportation, and chemicals (pesticides). NIPP outlines the mitigation options for each sector using a matrix.

OSHA Steps In

In food facilities, COVID-19 response preparation was often assigned to food safety teams, staff who had a keen understanding of risk management but little or no public health knowledge. Although guidance was finally available, many scrambled to find accurate information for protocol development in the heat of an outbreak. This resulted in information and awareness gaps and poorly designed procedures such as the early attendance incentives, and it left workers to manage active disease cases identified during the workday.

Commonly implemented interventions included employee temperature screening at points of entry, control measures (universal face coverings), engineering controls (physical barriers), and infection prevention measures (additional hand hygiene stations). Adequate social distancing proved to be a real challenge for food producers, resulting in continued high case counts in some facilities.

In May 2020, OSHA released a COVID-19 planning guidance document based on traditional infection prevention and industrial hygiene practices. They encouraged plan managers to stay abreast of guidance from federal, state, local, tribal, and/or territorial health agencies, and to consider how to incorporate those recommendations and resources into workplace-specific response plans.

These plans should consider and address the level(s) of risk associated with various worksites and job tasks workers perform at those sites. OSHA divided job tasks into four risk exposure levels: very high, high, medium, and lower risk. The agency’s Occupational Risk Pyramid shows the four exposure risk levels to represent probable distribution of risk, with “very high” and “high” at the top of the pyramid, including workers primarily found in the healthcare field and those who come into direct contact with infected patients. Most U.S. food workers likely fall in the “medium” exposure risk level due to the high population density found in food facilities.

The publication of the OSHA guidance completed the fundamental information necessary to develop a comprehensive plan for preparation and response to a pandemic; however, it should be noted that these are guidance documents and therefore do not represent required actions under law. In the chaos of the early days of the pandemic, many didn’t know where to access CISA or OSHA documents, so there may still be implementation gaps that should be addressed. Enforcement activities remain unlikely unless actual regulations are proposed.

What Will Winter 2023 Bring?

Evidence is emerging that the Northern Hemisphere is on course for a surge of cases this winter; the question is, how large will it be? Scientists believe new immune-evading strains of the Omicron variant, behavior changes, and waning immunity could result in more COVID-19 infections.

With newer and more contagious variants of the disease emerging, a new phase of the pandemic response is likely at hand. Although largely unchanged from the August 2020 version 4.0 release, the 4.1 version of the CISA guidance encourages industry to use its recommendations to update or develop a response plan to further reduce the frequency and severity of the virus’s impact in the event of another surge in cases.

Currently, more than 400,000 cases are reported globally every day, or roughly 2.8 million per week. This is not an insignificant number. Nine of 12 countries with the highest per capita case counts are in Europe, and the U.S. often follows, after a brief lag. These cases aren’t equally distributed, so a review of certain countries or regions provides the most accurate data to try to predict future spikes, although it still amounts to looking into a muddy crystal ball.

European Union data is the most worrisome at present. Increasing cases, along with shifting dominance in variants and subvariants, could be a prediction for the U.S. Michael T. Osterholm, PhD, MPH, director of the Center for Disease Research and Policy (CIDRAP) at the University of Minnesota in Minneapolis, was appointed to (then) President-elect Biden’s 13-member Transition COVID-19 advisory board. He reports an increase from 1.1 million cases per week in early September 2022 to 1.9 million cases per week in the four-week period from September through October 11, 2022, in the EU, as reported by WHO. The WHO/EU consists of 53 countries, 37 of which reported increasing cases; 14 reported rates increasing at greater than 20% over the prior two weeks.

According to data for this period, reviewed by Dr. Osterholm, Germany reported fewer than 30,000 cases per day, a number that increased to 105,000 cases per day, and was at or near hospital capacity, during this four-week period in the fall of 2022. France reported increases from 17,000 to 56,000 per day over the same period, and both countries reported that 80% to 90% of cases were attributed to the BA.5 variant. Austria reported 4,000 per day, increasing to 14,000 cases per day, with hospitalizations increasing from 1,100 to 2,400 during the same period. Italy’s cases doubled, from 20,000 to 40,000.

While most countries have shifted to a more sustainable mode of pandemic response measures, China continues to utilize a strict zero COVID-19 policy, including the use of complete lockdowns. This policy resulted in a two-month lockdown of Shanghai earlier this year and a more recent shutdown in Guangzhou that impacted 19 million people. Several protests began in late November, as people across China have grown weary of these severe measures.

Yum China, the Shanghai-based company that owns the KFC, Pizza Hut, and Taco Bell chains in China, re­ports the challenges resulting from the continued shutdowns. “In October, approximately 1,400 of our stores were either temporarily closed or offered only takeaway and delivery services,” the company said on November 1, 2022.

On the other end of the spectrum, Taiwan recorded relatively few COVID-19 cases until the highly infectious Omicron variant and its sub-variants began spreading in January 2022. Despite reporting more than 6.5 million infections since then, more than 99.5% of cases have been mild or asymptomatic, according to Taiwan’s health authorities. This may be due to the high level of vaccination uptake; four out of five people in the country have received the vaccine and at least one booster. Quarantine requirements have been lifted for inbound travelers, and pre-entry testing is no longer needed. Japan and Hong Kong have also relaxed COVID-19 border restrictions to boost struggling tourism.

In mid-August 2022, an effort called the COVID-19 Scenario Modeling Hub laid out several scenarios for the U.S. over the upcoming months. After surges caused by the BA.5 Omicron variant, resulting in high levels of immunity in the population, the models suggest that the U.S. could be in for a relatively quiet season at the end of 2022, as long as vaccine booster campaigns are robust and new variants don’t emerge.

Even with a new variant, a big surge in U.S. cases isn’t certain. More than a month into fall, hospitalizations were declining slightly, in line with projections, says Justin Lessler, PhD, an infectious disease epidemiologist at the University of North Carolina at Chapel Hill, who leads the modeling effort. But other factors on the horizon could spell trouble. As of November 28, U.S. cases and hospitalizations are ticking up in key areas.

Parts of North America are also seeing the rise of other Omicron sublineages. One such variant, BA.2.12.1, also has the capacity to evade antibodies triggered by a previous Omicron infection and vaccination, according to a study by virologist David Ho, MD, at Columbia University in New York City. The emergence of these strains suggests that the Omicron lineage is continuing to make gains by eroding immunity, says Dr. Ho. “It’s pretty clear that there are a few holes in Omicron that are gradually being filled up by these new subvariants.”

If SARS-CoV-2 continues along this path, its evolution could come to resemble that of other respiratory infections, such as influenza. In this scenario, immune-evading mutations in circulating variants, such as Omicron, could combine with dips in population-wide immunity to become the key drivers of periodic waves of infection.

Scientists say we could see more surprises from SARS-CoV-2. For instance, the Delta variant hasn’t completely vanished and, as global immunity to Omicron and its expanding family increases, a Delta descendant could mount a comeback. Whatever their source, new variants seem to emerge roughly every six months, and scientists wonder whether this is the structure that future COVID-19 outbreaks will settle into.

While we can’t predict the future with something as unpredictable as COVID-19, the virus is clearly not over yet. But we now have the experience and tools to develop response plans that can reduce or prevent large-scale outbreaks within food facilities. These plans will require maintenance and continued vigilance until the day comes that we can declare the pandemic finished—until the next one pops up.

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Six U.S. children and one child in Mexico have died and approximately 180 other youths have been inflicted with hepatitis, according to the Centers for Disease Control and Prevention. The cause of the hepatitis outbreak remains a mystery.

These occurrences of the liver disease, which stretch back at least seven months, have impacted children in 36 U.S. states and territories. “The illness in many of these patients is severe, and the extent of the injury to the liver can be quite extensive,” Umesh Parashar, chief of the viral gastroenteritis branch at CDC’s Division of Viral Diseases, said in a statement. “And so, this is clearly a severe disease that we’re taking very carefully for that reason, and the proportion of these, despite treatment, do unfortunately die.”

As of May 23, 15 of the children reported to have a connection to the investigation have required a liver transplant, according to the agency. Additionally, there have been no reported deaths since February 2022, and the proportion of patients requiring liver transplants has gone down from 15% to 9% since May 5.

Jay Butler, deputy director for infectious diseases at CDC, notes that, of the 180 number being reported, not all cases are recent, and some may not even be linked to the current investigation, but no firm answers are available at this time.

Currently, there is no epidemiological link between the cases. “No common exposures or other patterns had been discovered,” Butler says, noting that CDC has run lab tests to examine the virus genome and other potential pathogens, such as SARS-CoV-2. Furthermore, the agency says that testing ruled out some of the viruses that commonly cause hepatitis.

“It’s important to note that severe hepatitis in children remains rare,” the agency said in a press release. “However, we encourage parents and caregivers to be aware of the symptoms of hepatitis—particularly jaundice, which is a yellowing of the skin or eyes—and to contact their child’s healthcare provider with any concern.”

Some good news is that the majority of the children who were infected during the hepatitis outbreak have since fully recovered. CDC is continuing the investigation.

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The Centers for Disease Control and Prevention (CDC) has launched the Center for Forecasting and Outbreak Analytics (CFA). CFA seeks to enhance the nation’s ability to use data, models, and analytics to enable timely, effective decision-making in response to public health threats for CDC and its public health partners.

CFA’s work will be focused into three main pillars: to predict, inform, and innovate. CFA has begun to build an outbreak analytics team that includes experts across several disciplines to develop faster, richer evidence to predict trends and guide decision making during emergencies. CFA is hiring expert communicators to regularly share insights with federal, state, and local partners and the public, and will also continue to advance the state of the science of outbreak data, models, and analytics to improve the nation’s ability to respond to health emergencies.

Planning for CFA began in August 2021, with the initial funding of $200 million from the American Rescue Plan Act. So far, CDC has awarded $26 million in funding to academic institutions and federal partners to advance modeling and forecasting methodology.

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FDA and CDC, in collaboration with state and local partners, are investigating a multistate outbreak of Listeria monocytogenes infections. According to the CDC, as of December 21, 2021, 10 people infected with the outbreak strain of Listeria monocytogenes have been reported from eight states, with ten hospitalizations and one death. Illnesses started on dates ranging from July 26, 2016 to October 19, 2021.

As a part of routine sampling, the Michigan Department of Agriculture and Rural Development collected a product sample of Fresh Express Sweet Hearts salad mix with a Use-By-Date of December 8, 2021, for testing. The sample tested positive for Listeria monocytogenes and subsequent whole genome sequencing (WGS) analysis determined that the Listeria monocytogenes present in the samples matches the strain that has caused illnesses in this outbreak.

In response to the sample results and the ongoing outbreak investigation, Fresh Express voluntarily ceased production at its Streamwood, Ill., facility and initiated a recall of certain varieties of its branded and private label salad products produced at the facility and distributed across 19 states. The recall includes all use-by dates of fresh salad items with product codes Z324 through Z350. Product codes are located on the front of the packages below the use-by date. No other Fresh Express products are subject to recall. A full list of recalled products is available on FDA’s website.

This is an ongoing investigation and additional information will be provided as it becomes available.

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CDC released a report in late July revealing that 16 people in 12 states have been infected with the same strain of E. coli. The agency believes the outbreak is related to contaminated cake mix.

FDA is in the midst of a trackback investigation to see if it can identify a common brand or production facility linked to these cases. Officials have started product testing in relation to the illnesses.

Although no source has been identified as of yet, the early investigation has found that a majority of those experiencing the effects have recently eaten or tasted raw cake batter—though the varieties and brands were diverse. Therefore, there has been no recall of any products.

The cases date back to March 2021 and include people in Oregon, Washington, Utah, Nebraska, Iowa, Illinois, Indiana, Michigan, Ohio, Virginia, South Carolina, and Massachusetts.

So far, seven people have been hospitalized and one has developed hemolytic uremic syndrome, a serious kidney problem. No deaths have been reported. It’s believed that the outbreak is larger than just the 16 cases, but milder cases are often not reported as people tend not to seek help for what they perceive as a run-of-the-mill stomach bug.

The investigation remains ongoing.

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While the Trump Administration’s record $4.8-trillion proposed budget for Fiscal 2021 calls for steep cuts to many domestic programs, funding for food safety would survive at FDA and USDA but fare poorly at CDC. While the budget is unlikely to be approved, given congressional opposition and established spending caps, the document offers a look into the White House’s fiscal priorities.

The proposed budget for FDA, presented to Congress in February, would give that agency a discretionary budget of $3.29 billion, an increase of $25 million (less than 1 percent) over the current year’s funding.

FDA’s budget, which begins Oct. 1, allocates $1.5 billion for food safety programs, an increase of $33 million (2.2 percent). This total includes $1.4 billion in budget authority (a $5 million increase) and $28 million in user fees for imported foods and recalls. FDA is proposing a new “food product innovation” user fee of $28 million, which will need congressional approval.

To support its smarter food safety initiative, FDA will add $2 million for new technologies to enhance track and trace capabilities; $1 million more to improve detection and response to foodborne illness; and $8 million more to implement agency-wide artificial intelligence (AI) capabilities.

“In relative terms, we are pleased that the administration’s commitment to FDA remains strong, even while many other worthwhile agencies are proposed for cuts,” said Steven Grossman, deputy executive director of the Alliance for a Stronger FDA, in a statement.

Facing an agency-wide 9 percent reduction, the Centers for Disease Control and Prevention (CDC) would not fare as well as FDA. CDC’s food safety activities would be cut by $9 million (14 percent) to $54 million in Fiscal 2021.

While USDA’s overall budget would be cut by $1.9 billion (8 percent) to $21.8 billion, food safety programs would hold their own or increase slightly. Discretionary funding for USDA’s Food Safety and Inspection Service (FSIS) would increase by $38 million (3.6 percent) to $1.1 billion. Additionally, FSIS will propose a new user fee starting in 2022 to cover costs associated with all federal, state, and international food inspections for meat, poultry, and egg products.

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As of February 14, 2020, a novel coronavirus (2019-nCoV) has inflicted more than 60,000 people in China and around the globe. The U.S. Center for Disease Control and Prevention’s most recent Morbidity and Mortality Weekly Report, released on Feb. 7, says that as of Feb. 4, in addition to the cases confirmed in China, more than 150 others from 23 additional counties have been confirmed to have the novel virus. As of February 13, CDC has confirmed 15 cases of the viral infection in the U.S.

This latest update from the CDC says that there is little evidence to suggest animals or animal products imported from China pose a risk for spreading 2019-nCoV; the virus is spread from person-to-person contact, and not from food or water.

Food Safety Best Practices

While food safety concerns regarding the virus are minimal, the World Health Organization (WHO) said we are in a “window of opportunity” to stop the new coronavirus from becoming a broader global crisis, and that food safety is one area that people should be looking to.

To prevent the spread of the disease, WHO suggests that basic food safety measures be followed by the public: They advise people to wash their hands frequently, avoid consumption of raw or undercooked animal products, and take on good food safety practices, such as never reusing the same chopping boards and knives that were used on raw meat.

Amesh A. Adalja, MD, FIDSA, senior scholar for Johns Hopkins Center for Health Security and a board-certified infectious disease physician noted that, although the virus is spreading chiefly in a respiratory droplet manner, there are reports of diarrhea and vomiting in patients. “This is important for food handlers as fecal-oral transmission is likely possible,” he tells Food Quality & Safety. “It is essential that hand washing before food preparation and requisite general food preparation safety protocols be followed.”

Still, he doesn’t feel that people should be worried about food safety with respect to this outbreak, explaining that food producers should discuss what is known and what is unknown about the virus with their employees and stress safe food preparation methods as part of day-to-day operations.

Mark Flanagan, CEO of Shield Safety Group, told Food Quality & Safety that, while there’s still very limited risk from this novel coronavirus in the Western world, good food hygiene practices are always recommended. “[This] is particularly important, as the virus is zoonotic, rumored to have originated through wild ‘game’ meat, although we are still awaiting scientific clarification on this,” he said. “Basic food hygiene principles need to be thoroughly followed now more than ever.”

This is a rapidly evolving story and FQ&S will update information as it becomes available.

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Effective July 1, California will require all employees who handle food in restaurants to earn a California Food Handlers Card. This legislation, modeled on successful programs in other states, will affect more than 1.4 million food industry jobs.

Senate Bill 602, sponsored by state Sen. Alex Padilla and signed into law in September by Gov. Arnold Schwarzenegger, is intended to benefit food facilities and their employees, boost consumer confidence, and significantly improve food safety. Similar programs have been successfully implemented in Oregon, Washington, Arizona, Texas, and Florida. A recent study of a similar program in Florida found that it lowered cases of foodborne illnesses by an average of 7% per year, a total of 79% since the program’s inception 10 years ago.

Local food safety regulatory authorities will be responsible for ensuring that food facilities meet their obligations under the law. This will include ensuring that employees possess a valid food handler card and that records are being maintained and are available to regulatory authorities upon request. The expansion of certification to all food handlers may have national implications, because other states may enact similar legislation. The national trend among regulatory agencies is to require that each retail food facility employ at least one certified food safety manager.

The California Restaurant Association (CRA) hailed the bill as “lawmaking at its best, as all stakeholders were at the table working toward a shared goal of ensuring food safety.”

When the law goes into effect, all California food facility employees who handle food will be required to obtain a California Food Handlers Card after training for and passing a test within 30 days of hire, or no later than July 1 for current employees. With more than 90,000 food and beverage facilities operating in California, the CRA estimates that food and drink sales reached an estimated $58 billion in 2010. SB 602 requires that all food facility employees be trained and certified in proper food handling practices, an aggressive effort to reduce the incidence of foodborne illnesses and hospitalizations in the state.

The food handler certification examination will test the handler’s knowledge of CDC food safety risk factors such as:

• Foodborne illness principles, including definitions;
• The relationship between time and temperature in foodborne illnesses;
• The relationship between personal hygiene and food safety;
• Methods of preventing food contamination in all stages of food handling;
• Procedures for cleaning and sanitizing equipment and utensils;
• Problems and solutions for facility and equipment design, layout, and construction; and
• Problems and solutions associated with temperature control, cross contamination, housekeeping, and maintenance.

Training, Exemptions, and Enforcement

The food handler law requires workers to participate in a training course and pass an examination to be certified. The law stipulates that companies that are certified in other states and adhere to the 2001 food code will be allowed to run their own in-house training programs; such companies must provide satisfactory evidence to the local enforcement officer of an approved out-of-state training program. Yum Brands and Disney are examples of food facilities that may qualify for in-house training by virtue of their adherence to these provisions. The new law stipulates that any in-house training course and examination must be designed to be completed in approximately 2½ hours during normal working hours and at no cost to employees. Employees may opt to take the training through an approved association or third party program, however.

The law also stipulates that one training course must be available to all employees at a cost of no more than $15 to ensure affordability and prevent hardship. Once the $15 option is established, employees may opt for subsequent training courses that may cost more. Employers are not required to pay for any time and expense incurred by employees while participating in training and testing unless a food facility provides in-house training and testing during normal working hours.

The law also requires that all employees have access to an examination costing no more than $60, including the certificate. Again, employees can choose to take subsequent examinations, which may be more expensive, from other companies. The assessment exam must consist of at least 40 questions, and a minimum score of 70 percent will be required for employees to receive the certificate/food handler card. The exam may be taken online or at an approved facility. Unlike the current ANSI/CFP certified food manager online or manual examinations, which require that the applicant be proctored at an approved testing center, the new law for handlers does not require proctoring.

The newly formed SB 602 workgroup has not yet resolved the important issue of who will be approved as trainers.

Local enforcement officials will be responsible for ensuring that food facilities meet their obligations under the law, including making sure that employees possess a valid food handler card and that the food facility is maintaining records that can be provided to local enforcement officers upon request. Failure to comply may result in administrative action that includes but is not limited to issuance of an infraction. Before implementation of SB 602 is possible, many clarifications are needed, especially with regard to enforcement.

The law exempts some food handlers but generally applies to all food facilities with the exception of those that are temporary. Individuals already holding a valid manager’s food safety certification are exempt. Current facilities and handlers exempt from the new law include:

• Food handlers with current cards from Riverside, San Bernardino, and San Diego counties;
• Food facilities with collective bargaining agreements with their food handlers; and
• Food handlers employed by certified farmers markets; commissaries; grocery stores, except for separately owned food facilities; licensed health care facilities; mobile support units; public and private school cafeterias; restricted food service facilities; and retail stores where a majority of sales are from a pharmacy.

The Ultimate Goal

Proactive prevention training is the key to reducing foodborne illnesses. It can be accomplished by minimizing the foodborne illness risk factors in a food facility. The ultimate responsibility to produce and process safe foods lies with the management and employees. Regulatory authorities generally only inspect a food facility several times a year, and each inspection provides only a snapshot of the facility at the time of inspection. Without proper and timely training, food facility operators may commit food safety errors that could lead to foodborne illness.

Four key concepts of food safety training that the California law is intended to address include the following:

• Hands are a critical transmitter of disease.
• High temperature kills. The final cook temperature is your critical control point.
• It is critical to eliminate cross contamination, especially from hands, equipment, dripping foods, and work surfaces.
• It is vital to minimize exposure to the temperature danger zone (41 to 135 degrees Fahrenheit), a concept that relates to short preparation times, monitored cooling, and thawing foods.

Improved training and education is critical, because history has proven that many food facilities that have received approved food safety training still failed to pass inspection and were forced to close. While the current training proposals only address English- and Spanish-speaking food handlers, some experts assert that training and education must be adapted to more food handlers’ languages and cultures—and that the availability of additional languages for this exam must therefore be addressed. Major barriers to learning and practicing food safety are literacy, cultural differences, socioeconomic standards, diverse skill levels, motivation of employees, lack of interest, and operators’ lack of time and feedback. Despite knowledge of food safety practices, many food handlers do not practice food safety behaviors regularly. Management must emphasize food safety as a priority even when burdened with more pressing tasks. Effective food safety instructors will be important to the food handling card-training program’s success.

George Nakamura, a food safety consultant with DeltaTRAK of Pleasanton, Calif., has more than 40 years of experience supervising and evaluating sanitation and environmental health programs and personnel. He has conducted safety and quality assurance audits for companies like Brinker International, Darden Restaurants, Burger King, Clorox, Baskin Robbins, U.S. Foodservice, California Grocers Association, and others. He also served as the chairman of the National Environmental Health Association’s Food Safety and Protection section for more than 18 years.

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