Foodborne Disease Outbreak

Investigation Team Training:

Module 4 – Environmental
Health Investigation

Environmental health investigation 1

 Module Learning Objectives
At the end of this module, you will be able to
1. Discuss how contributing factors are related to the causative agent,
suspect food, and food processing method.
2. Compare an environmental health assessment with a HAACP plan review,
facility plan review, and regulatory inspection.
3. List types of activities included in an environmental health assessment.

4. Describe the likely role of local jurisdictions in a traceback investigation.

5. Diskusikan bagaimana faktor-faktor yang berkontribusi terkait dengan agen
penyebab, makanan yang dicurigai, dan metode pemrosesan makanan.
6. Bandingkan penilaian kesehatan lingkungan dengan tinjauan rencana
HAACP, tinjauan rencana fasilitas, dan inspeksi peraturan.
7. Daftar jenis kegiatan yang termasuk dalam penilaian kesehatan
lingkungan.
8. Jelaskan kemungkinan peran yurisdiksi lokal dalam investigasi traceback.

Environmental health investigation > Learning objectives 2

 Food System

Primary producers

Retailers

Distributors
Manufacturers

Point of service establishments

Environmental health investigation 3

 Food Establishments as Dynamic Systems
Perusahaan Makanan sebagai Sistem Dinamis

Hold Assemble Serve

Reheat Package
Underlying Factors
OUTPUT:
Foods and their properties
Final product
Food workers
Cool Equipment Store
Processes
Policies INPUTS:
- Raw foods
Cook Management Receive - Ingredients
Economics
- Chemicals
- Packing
Prep Store
materials
- Water

Environmental health investigation 4

 Contributing Factors-faktor kontribusi

Environmental health investigation 5

 Contributing Factors
• Factors that increase the risk of foodborne illnesses and repeatedly contribute to outbreaks
• Identification (and correction) of these factors facilitates prevention and control of foodborne
diseases
• Three major categories
– Contamination
– Survival
– Proliferation
• Faktor-faktor yang meningkatkan risiko penyakit bawaan makanan dan berulang kali
berkontribusi terhadap wabah
• Identifikasi (dan koreksi) faktor-faktor ini memfasilitasi pencegahan dan pengendalian penyakit
bawaan makanan
• Tiga kategori utama
• Kontaminasi
• Bertahan hidup
• Proliferasi

Environmental health investigation > Contributing factors 6

 Categories of Contributing Factors 
Contamination Survival=bertahanhidup Proliferation
Natural toxin Improper cooking or Improper refrigeration
Added poisonous heat processing Preparation too far in
substance Improper reheating advance of serving
Toxic container Inadequate Prolonged cold storage
acidification
Contaminated food Improper hot-holding
Insufficient thawing
eaten raw or lightly followed by
Insufficient acidification
cooked insufficient cooking Insufficiently low water
Unsafe sources activity
Cross-contamination Inadequate thawing of
Infected food worker frozen foods
Unclean equipment Anaerobic packaging
Poor storage Inadequate
practices fermentation

Environmental health investigation > Contributing factors 7

 Contributing Factors
• Presence alone may not be sufficient to cause illness
• A relationship exists between contributing factors, food vehicle, causative agent, and
processing methods
• Kehadiran saja mungkin tidak cukup untuk menyebabkan penyakit
• Ada hubungan antara faktor-faktor yang berkontribusi, kendaraan makanan, agen
penyebab, dan metode pengolahan

Environmental health investigation > Contributing factors 8

 Common Contributing Factors by
Causative Agent and Food
Situational Keys A-F (starting on page 80)

Environmental health investigation > Contributing factors 9

 Generalizations
Causative agent Common contributing factors

Spore formers and Cooling, reheating, hot holding, bare-

preformed toxins hand contact, room temperature
storage, cold holding
Viral infections Ill food worker, bare-hand contact,
inadequate handwashing, contaminated
raw products, contaminated surfaces
Bacterial infections Ill food worker, bare-hand contact,
inadequate handwashing, contaminated
raw product, cross-contamination,
inadequate cooking
Parasitic infections Contaminated raw products, source,
water, cross-contamination, inadequate
cooking > Contributing factors
Environmental health investigation 10
 Class Question 
Are the following likely to be contributing =Apakah yang berikut ini kemungkinan berkontribusi

factors for the outbreaks described?

Contributing
factor
Bare-hand contact of lettuce in an out- break of shigellosis linked to a
salad bar

Refrigerator at 47 in an outbreak of hepatitis A virus linked to

a restaurant
Refrigerator at 47 in an outbreak of Staphylococcal
intoxication linked to potato salad

Cat in the kitchen of a restaurant prior to an outbreak of

norovirus=Kucing di dapur restoran sebelum wabah
norovirus

Environmental health investigation > Contributing factors 11

 Environmental Antecedents
• The root cause or circumstances that set the stage for contributing factors
to occur
• Include economic constraints, inadequate worker education, management
decisions, social and cultural beliefs
• Must be addressed to eliminate contributing
factors
• Akar penyebab atau keadaan yang mengatur panggung untuk faktor yang
berkontribusi terjadi
• Termasuk kendala ekonomi, pendidikan pekerja yang tidak memadai,
keputusan manajemen, kepercayaan sosial dan budaya
• Harus diatasi untuk menghilangkan faktor-faktor yang berkontribusi

Environmental health investigation > Contributing factors 12

 Example 
• Salmonellosis outbreak linked to potato salad
• Contributing factor: Potato salad contaminated because placed under thawing
chicken in refrigerator=Wabah salmonellosis terkait dengan salad kentang
• Faktor penyebab: Salad kentang terkontaminasi karena diletakkan di bawah ayam
yang dicairkan dalam lemari es

• Environmental antecedents: Economic issues led to hiring more part-time

workers who were less experienced, inadequate food worker education,
inadequate =Anteseden lingkungan: Masalah ekonomi menyebabkan
mempekerjakan lebih banyak pekerja paruh waktu yang kurang
berpengalaman, pendidikan pekerja makanan yang tidak memadai, tidak
memadai
• oversight and supervision=pengawasan dan pengawasan

Environmental health investigation > Contributing factors 13

 “When you have a foodborne outbreak,
more than one thing
went wrong.” Ketika Anda memiliki wabah
keracunan makanan, lebih dari satu hal yang
salah. "

Dr. Frank Bryan

Environmental health investigation > Contributing factors 14

 Environmental Health
Assessment

Environmental health investigation 15

 Environmental Health Assessment
• A systematic, detailed, science-based evaluation
• Focuses on factors that contributed to an outbreak
• Different from a
– Hazard Analysis and Critical Control Point (HACCP) risk assessment review
– Facility plan review
– Food establishment regulatory inspection

• Evaluasi sistematis, terperinci, berbasis sains

• Berfokus pada faktor-faktor yang berkontribusi terhadap wabah
• Berbeda dari a
• Ulasan Penilaian pengkajian Risiko Bahaya dan Titik Kontrol Kritis (HACCP)
• Ulasan rencana fasilitas
• Inspeksi peraturan perusahaan makanan

•  

Environmental health investigation > Env’t health assessment 16

 HACCP Risk Assessment Review
• Preemptive solutions to potential food safety problems in the future
• Undertaken before a problem occurs
• Focus
– Foods produced by establishment and related procedures
– Identification of potential food safety problems
– Control measures to mitigate potential problems
• Initiated by establishment

• Solusi pencegahan untuk masalah keamanan pangan potensial di masa depan

• Dilakukan sebelum masalah terjadi
• Fokus
• Makanan diproduksi oleh perusahaan dan prosedur terkait
• Identifikasi potensi masalah keamanan pangan
• Mengontrol langkah-langkah untuk mengurangi potensi masalah
• Diprakarsai oleh pendirian

Environmental health investigation > Env’t health assessment 17

 Facility Plan Review
• Preemptive solutions to potential food safety problems in the future
• Undertaken before a problem occurs
• Focus
– Proposed structural plans and equipment at establishment
– Relation to intended procedures
– Functionality, durability, ease of cleaning
• Initiated by establishment

• Solusi pencegahan untuk masalah keamanan pangan potensial di masa depan

• Dilakukan sebelum masalah terjadi
• Fokus
• Usulan rencana dan peralatan struktural pada saat pendirian
• Kaitannya dengan prosedur yang dimaksudkan
• Fungsionalitas, daya tahan, kemudahan membersihkan
• Diprakarsai oleh pendirian

Environmental health investigation > Env’t health assessment 18

 Food Establishment Regulatory Inspection
• Addresses food safety problems occurring today
• Routinely scheduled inspections
• Focus
– Ongoing processes and procedures
– Leading causes of foodborne illness (risk-based approach)
• Initiated by regulatory authority
• Mengatasi masalah keamanan pangan yang terjadi saat ini
• Inspeksi terjadwal secara rutin
• Fokus
• Proses dan prosedur yang sedang berlangsung
• Penyebab utama penyakit bawaan makanan (pendekatan berbasis risiko)
• Diprakarsai oleh otoritas regulasi

Environmental health investigation > Env’t health assessment 19

 Environmental Health Assessment
• Addresses food safety issues that occurred in the past
• Occurs in response to a food safety problem
• Focuses on (and reconstructs) past events related to
– Implicated food(s)
– Prepared/served during outbreak period
• Outbreak investigation team initiates, guided by epidemiologic and laboratory
information
• Mengatasi masalah keamanan pangan yang terjadi di masa lalu
• Terjadi sebagai respons terhadap masalah keamanan pangan
• Berfokus pada (dan merekonstruksi) peristiwa masa lalu yang terkait dengan
• Makanan tersirat
• Disiapkan / disajikan selama periode wabah
• Inisiat tim investigasi KLB, dipandu oleh informasi epidemiologi dan
laboratorium

Environmental health investigation > Env’t health assessment 20

 Summary
HACCP/Facility Regulatory Env’t Health
Plan Review Inspection Assessment
When Before a food safety Regularly In response to specific
undertaken=ketik problem occurs=Sebelum problem=respon
masalah keamanan
scheduled-jadual
a dilakukan masalah spesifik
pangan terjadi rutin

Time focus Future Today Past

Focus of Areas where Ongoing Food safety
effort food safety processes problems related
problems could focusing on to implicated
occur common food during
problems outbreak period
Who Food Regulatory Outbreak inves-
initiates establishment agency tigation team

Environmental health investigation > Env’t health assessment 21

 Environmental Health Assessment
Objectives:
1. Reconstruct past events, focusing on implicated food(s)
2. Identify contributing factors
3. Identify environmental antecedents
4. Develop effective interventions
Tujuan:
1. Rekonstruksi peristiwa masa lalu, dengan fokus pada makanan yang terlibat
2. Identifikasi faktor-faktor yang berkontribusi
3. Identifikasi anteseden lingkungan
4. Kembangkan intervensi yang efektif

Environmental health investigation > Env’t health assessment 22

 Preparation for Assessment
• Examine available outbreak information
– Causative agent
– Onset of illness among cases
– Likely exposure dates/meals/foods

• Collect food establishment information

– Existing regulatory records
– Menus, recipes, product formulations
– Connection to chain of food establishments

• Review information on causative agent

– Reservoirs and previously identified vehicles
– Modes of transmission
– Likely contributing factors

• Periksa informasi wabah yang tersedia

• Agen penyebab
• Timbulnya penyakit di antara kasus-kasus
• Kemungkinan tanggal pajanan / makanan / makanan

• Kumpulkan informasi perusahaan makanan

• Catatan peraturan yang ada
• Menu, resep, formulasi produk
• Koneksi ke rantai perusahaan makanan

• Tinjau informasi tentang agen penyebab

• Reservoir dan kendaraan yang diidentifikasi sebelumnya
• Mode transmisi
• Faktor yang mungkin berkontribusi
•  

Environmental health investigation > Env’t health assessment 23

 Site Visit 
Focus on implicated food and time period of outbreak
1.Manager interview
2.Facility walk through
3.Observation of operations
4.Collection of samples (food and environment)
5.Worker interviews
6.Collection of records (and other documents)
Fokus pada makanan yang terlibat dan periode waktu wabah
Wawancara manajer
Fasilitas berjalan
Pengamatan operasi
Koleksi sampel (makanan dan lingkungan)
Wawancara pekerja
Pengumpulan catatan (dan dokumen lainnya)
 

Environmental health investigation > Env’t health assessment 24

 1. Manager Interview
• Work to gain cooperation in investigation
• Assess management knowledge and attitude toward food safety
• Collect information about food workers who prepared the implicated food
• Review standard operating procedures
• Berusahalah untuk mendapatkan kerja sama dalam penyelidikan
• Menilai pengetahuan dan sikap manajemen terhadap keamanan pangan
• Kumpulkan informasi tentang pekerja makanan yang menyiapkan makanan
yang terlibat
• Tinjau prosedur operasi standar

Environmental health investigation > Env’t health assessment 25

 2. Facility Walk Through
• Get sense of general layout of facility and floor
design
• Walk through movement of implicated food
through facility
• Identify opportunities for occurrence of relevant
contributing factors

Environmental health investigation > Env’t health assessment 26

 Example Food Flow through Facility

Environmental health investigation > Env’t health assessment 27

 3. Observation of Operations
• Focus on implicated food and associated processes
• Attempt to reconstruct how food was prepared during period of
interest
• Take measurements
• Record observations on food preparation worksheet
• Draw flow diagram
• Fokus pada makanan yang terlibat dan proses terkait
• Mencoba merekonstruksi bagaimana makanan disiapkan selama
periode bunga
• Lakukan pengukuran
• Catat pengamatan pada lembar kerja persiapan makanan
• Gambar diagram alir

Environmental health investigation > Env’t health assessment 28

 Example Food Preparation Worksheet
FOOD PREPARATION REVIEW WORKSHEET
Complaint Number:
Establishment Name: _________________________________________________
Address: Phone Number:___________________
Date & Time of Suspect Meal: / : am pm
mo day yr

Date & Time Food Preparation: / : am pm

mo day yr
Person Interviewed: Name Position
Review: Observing Preparation Interviewing person who made food
__Other (specify)
                     
Suspect
DATE Food:
PROCESS ________________________________________________
AMOUNT TIME TEMP EQUIP- DEPTH OF HAND WORKER’S WORKER’S OTHER
OBSERVATION OF OF DAY OF MENT CONTAINER CONTACT NAME HEALTH INFO
FOOD FOOD USED OR FOOD WITH
THICKNESS FOOD
                   
 
Y Ill
N Well
   
Y Ill
N Well

Environmental health investigation > Env’t health assessment 29

 Example Flow Diagram Wooden cutting
board cleaned with
Celery stored under Celery and red
50 lbs. bag Washed and soapy cloth
thawing chicken pepper from
of potatoes chopped
grocery store
from
Farmer B Eggs in trays of 32 from
Eggs boiled Eggs Potatoes,
Farmer B, stored in walk-
for 10 min. sliced celery, red
in refrigerator
pepper, and
5 lbs. potatoes Potatoes boiled Potatoes Cubed potatoes eggs mixed
washed and in water until cooled and marinated in gently with
peeled tender cubed French dressing wood spoon
Knife used to cut other items
Same wooden spoon used
cleaned with soapy water at 4 cups of mayon-
to get mayonnaise and all
end of day naise added and
mixing
stirred into mixture
with wooden spoon
Stored in walk-in
Potato salad placed in Paprika
refrigerator at 4C Chopped parsley
resealable container sprinkled
(39 F) for up to 2 stirred into mixture
(cylindrical 8 in. x 14 in.) on top
days
Potatoes cooled and
Brand Z parsley washed and
Served directly from Paprika from chopped finely
container onto grocery store
customer’s plate with
Fresh parsley from
ice cream scoop
grocery store
Environmental health investigation > Env’t health assessment 30
 4. Collection of Samples
• Collect food, water, and environmental samples based on
suspicions about outbreak source
• Consult with laboratory on collection, storage, and transportation
procedures
• Collect as soon as possible and note condition (may store for testing
at later time)
• Kumpulkan sampel makanan, air, dan lingkungan berdasarkan
kecurigaan tentang sumber wabah
• Konsultasikan dengan laboratorium tentang prosedur pengumpulan,
penyimpanan, dan transportasi
• Kumpulkan sesegera mungkin dan catat kondisi (dapat disimpan
untuk pengujian di lain waktu)

Environmental health investigation > Env’t health assessment 31

 5. Worker Interviews
• Interview in private
• Reconstruct preparation of implicated food during period of interest
• Note unusual circumstances during period of interest and
inconsistencies in the story
• Collect information about food worker hygiene and recent illnesses
• Wawancara secara pribadi
• Merekonstruksi persiapan makanan yang terlibat selama periode
bunga
• Catat keadaan yang tidak biasa selama periode minat dan
ketidakkonsistenan dalam cerita
• Kumpulkan informasi tentang kebersihan pekerja makanan dan
penyakit baru-baru ini

Environmental health investigation > Env’t health assessment 32

 6. Collection of Records
Collect and review
• Records that identify source of food or ingredients (e.g., receipts
and invoices)
• Worker logs or time cards
• Monitoring logs (e.g., temperatures in walk-in refrigerators)
• Kumpulkan dan ulas
• Catatan yang mengidentifikasi sumber makanan atau bahan-bahan
(mis., Kwitansi dan faktur)
• Log pekerja atau kartu waktu
• Log pemantauan (mis., Suhu di walk-in refrigerators)

Environmental health investigation > Env’t health assessment 33

 Group Exercise
Divide into groups by table.
1.Study the information provided on an outbreak of salmonellosis linked
to a restaurant at the end of the module.
2.Walk through the environmental health assessment of the restaurant,
answering the questions.
3.Do you see any contributing factors likely to be related to the
outbreak?
4.Bagilah menjadi beberapa kelompok berdasarkan tabel.
5.Pelajari informasi yang disediakan pada wabah salmonellosis terkait dengan restoran di
akhir modul.
6.Berjalan melalui penilaian kesehatan lingkungan restoran, menjawab pertanyaan.
7.Apakah Anda melihat ada faktor yang berkontribusi terkait dengan wabah?

Be prepared to share your thoughts with the

.
class Bersiaplah untuk membagikan pemikiran Anda
dengan kelas

Time: 15 minutes
Environmental health investigation 34
 Group Exercise (cont’d) 
An outbreak of gastrointestinal illness is linked to a local restaurant. Seven unrelated restaurant patrons are sick with abdominal pain, nausea, vomiting, and
diarrhea. Onset of illness among cases was January 22-24. Two ill patrons had stool specimens positive for Salmonella.

Question 1: You are responsible for undertaking

the environmental health assessment. How would
you prepare for the investigation?

Environmental health investigation 35

 Group Exercise (cont’d) 
The restaurant is known for its burgers but serves a variety of sandwiches and salads. Based on patient interviews, ill persons ate at the restaurant on January 20. All but one ate chicken salad; three ill persons had only chicken salad.
Restoran ini terkenal dengan burgernya tetapi menyajikan berbagai sandwich dan salad. Berdasarkan wawancara pasien, orang sakit makan di restoran pada 20 Januari. Semua orang makan salad ayam, tiga orang sakit hanya memiliki
salad ayam.

Question 2: What type of activities will you under-take at the facility?

Environmental health investigation 36

 Group Exercise (cont’d) 
Question 3: Given the causative agent (Salmonella), implicated food (chicken salad), and setting (food service establishment), what contributory factors will you be looking for? makanan
yang terlibat (salad ayam), dan pengaturan (pendirian layanan makanan), faktor kontribusi apa yang akan Anda cari?

The manager tells you two employees (Willard and Anita) usually make the salad. Making the chicken salad is a 2-day
process. You interview the employees to reconstruct how the salad was made.

Environmental health investigation 37

 Group Exercise (cont’d) 
Question 4: Draw a flow diagram for preparing the chicken.

Environmental health investigation 38

 Group Exercise (cont’d)
Question 5: These photos were taken as you ob-served the salad being made. Do any concern you?

1 2 3

4 5 6

Environmental health investigation 39

 Develop Effective Interventions
• Immediate control measures
– Hold – Embargo
– Seize – Closure
– Cease/desist – Worker exclusion
– License sanctions or restrictions
– Menu limitation – Recalls
• Long term strategies to prevent recurrence
– HACCP plan
– Risk control plans
– Training
– Menu/supplier/recipe modifications

Environmental health investigation > Env’t health assessment 40

 Traceback Investigation

Environmental health investigation 41

 Traceback Investigations
• Process used to determine the production and distribution chain of an implicated food
• Purpose:
– Identify product so that it can be removed from further consumption
– Determine likely origin of food safety problem
– Strengthen epidemiologic associations between food and illness
• Formal regulatory traceback vs. informational traceback
• Proses yang digunakan untuk menentukan rantai produksi dan distribusi makanan
yang terlibat
• Tujuan:
• Identifikasi produk sehingga dapat dihapus dari konsumsi lebih lanjut
• Tentukan kemungkinan asal masalah keamanan pangan
• Perkuat hubungan epidemiologis antara makanan dan penyakit
• Traceback regulasi formal vs traceback informasi

Environmental health investigation > Traceback investigation 42

 Results of Traceback Investigations 
POINT OF SERVICE DISBUTORS/ PRODUCERS/
CASES
ESTABLISHMENTS IMPORTERS PROCESSORS

Grocery Domestic
Store A Producer A
Case #1
Distributor A Domestic
Restaurant A
Producer B

Case #2-4, Distributor B Distributor D Domestic

Cafeteria X
6, 8 Producer C

Case #5, 7,
Restaurant B Importer X
13-17

Case #7, Foreign

Deli A
9-12 Producer A
Distributor C

Environmental health investigation > Traceback investigation 43

 Role of Local Health Departments
• Undertake scientifically sound investigations to
– Implicate specific food item
– Rule out end user contamination
• Interview cases for product details and where they purchased the food (e.g.,
receipts)
• Collect paperwork (e.g., receipts, invoices, shipping documents) from retail
food establishments
– Melakukan investigasi ilmiah yang masuk akal untuk
– Implikasi item makanan tertentu
– Singkirkan kontaminasi pengguna akhir
– Wawancara kasus untuk detail produk dan di mana mereka membeli
makanan (mis., Tanda terima)
– Mengumpulkan dokumen (mis., Kwitansi, faktur, dokumen pengiriman)
dari perusahaan makanan eceran

Environmental health investigation > Traceback investigation 44

 Traceforward Investigations
Once source of outbreak identified:
•Process used to trace distribution of all implicated lots of food from the
original source (not just foods eaten by known cases)
•Purpose
– Support recall efforts
– Support further case-finding
– Test hypothesis about source
telah sumber wabah diidentifikasi:
Proses yang digunakan untuk melacak distribusi semua banyak makanan yang terlibat dari
sumber aslinya (bukan hanya makanan yang dimakan oleh kasing yang diketahui)
Tujuan
Mendukung upaya penarikan
Mendukung penemuan kasus lebih lanjut
Uji hipotesis tentang sumber

Environmental health investigation > Traceback investigation 45

 Example 

Grocery Domestic
Store A Producer A
Case #1
Distributor A Domestic
Restaurant A
Producer B
Case #2

Distributor B Distributor C Domestic

Case #3-6 Cafeteria X
Producer C

Case
Restaurant B Importer X
#8-17

Foreign
Producer A

Environmental health investigation > Traceback investigation 46

 Example
Grocery
Cases
Store B

Grocery
Domestic Domestic
Store A
Case #1 Producer E Producer D
Distributor A
Restaurant A
Case #2

Distributor B Distributor C Domestic

Case #3-6 Cafeteria X
Producer C

Case
Restaurant B Distributor E
#8-17

Grocery Domestic
Cases
Store C Producer F
Processor A

Cases
Deli A

Environmental health investigation > Traceforward investigation 47

 Salmonella Typhimurium and Peanut Butter
• Cluster of S. Typhimurium detected by PulseNet
• Studies implicate peanut butter sold to institutions and peanut butter crackers
• Outbreak traced to one plant
• Initial recall of specific lots of peanut butter expanded to include all peanuts
and peanut products from implicated plant
• FDA performs traceforward
• Ultimately 3,900 products recalled from several hundred
companies
• Cluster S. Typhimurium terdeteksi oleh PulseNet
• Studi melibatkan selai kacang yang dijual ke institusi dan biskuit selai kacang
• Wabah ditelusuri ke satu pabrik
• Penarikan awal dari banyak selai kacang spesifik diperluas untuk mencakup
semua kacang dan produk kacang dari tanaman yang terlibat
• FDA melakukan penelusuran ke depan
• Akhirnya 3.900 produk ditarik dari beberapa ratus perusahaan

Environmental health investigation > Traceforward investigation 48

 Quick Quiz

Environmental health investigation 49

 Quick Quiz
1. Which of the following statements is true about
contributing factors.
A. An outbreak will occur if a contributing factor
is present.
B. The three major categories of contributing
factors are contamination, survival (lack of
inactivation), and proliferation.
C. Contributing factors in an outbreak depend
on the causative agent but not the food
vehicle or processing method.
D. Correction of the contributing factor will
correct the food safety problem and prevent
it from occurring again.

Environmental health investigation 50

 Quick Quiz
2. An environmental health assessment of a food establishment undertaken during an outbreak
investigation is similar to a regulatory inspection except it focuses on the past.
Penilaian kesehatan lingkungan dari perusahaan makanan yang dilakukan selama penyelidikan
wabah mirip dengan inspeksi peraturan kecuali berfokus pada masa lalu.

A. True
B. False

Environmental health investigation 51

 Quick Quiz
3. To prepare for an environmental health
assessment, the investigator might consult
which of the following?
A. Team epidemiologist
B. Laboratory staff
C. Regulatory inspector for facility
D. All of the above

Environmental health investigation 52

 Quick Quiz
4. All of the following activities might be performed during an environmental health assessment of
the implicated facility in an outbreak EXCEPT
5. Semua kegiatan berikut dapat dilakukan selama penilaian kesehatan lingkungan dari fasilitas
yang terlibat dalam wabah KECUALI

A. Interview of the manager of the implicated

facility
B. Walk through of the facility
C. Collection of information from ill food
workers
D. Observation of all food preparation
processes undertaken at the facility

Environmental health investigation 53

 Quick Quiz
5. Staff from local health departments are likely to be responsible for all of the
following activities during a traceback investigation EXCEPT
A. Interview of cases for product details
B. Determining whether contamination at the food service facility is the
source of the outbreak
C. Collection of paperwork from the implicated food establishment
D. Detailed analysis of receipts and invoices

E. Staf dari departemen kesehatan setempat cenderung bertanggung

jawab atas semua kegiatan berikut selama penyelidikan traceback
KECUALI
1. Wawancara kasus untuk detail produk
2. Menentukan apakah kontaminasi di fasilitas layanan makanan adalah
sumber wabah
3. Koleksi dokumen dari perusahaan makanan yang terlibat
4. Analisis terperinci dari kwitansi dan faktur

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