# 10 {#section .Chapter-#}

# Food Safety

10-1 Foodborne infections

10-1a *Campylobacter* species

10-1b *Escherichia coli* O157:H7

10-1c *Listeria monocytogenes*

10-1d *Salmonella* species

10-1e *Cyclospora cayetanensis*

10-1f Postdiarrheal hemolytic uremic syndrome

10-1g Congenital *Toxoplasma gondii*

10-2 Outbreaks of foodborne infections

10-2a *Escherichia coli* O157:H7

10-2b *Salmonella* serotype Enteritidis

10-3 Antimicrobial resistance of *Salmonella* species

Resistant from humans:

10-3a Fluoroquinolones

10-3b Third-generation cephalosporins

10-3c Gentamicin

10-3d Ampicillin

Resistant from cattle:

10-3e Fluoroquinolones

10-3f Third-generation cephalosporins

10-3g Gentamicin

10-3h Ampicillin

Resistant from broilers:

10-3i Fluoroquinolones

10-3j Third-generation cephalosporins

10-3k Gentamicin

10-3l Ampicillin

Resistant from swine:

10-3m Fluoroquinolones

10-3n Third-generation cephalosporins

10-3o Gentamicin

10-3p Ampicillin

10-4 Food allergy deaths

10-5 Consumer food safety practices

10-6 Safe food preparation practices in retail establishments

10-7 Organophosphate pesticide exposure

10-1. Reduce infections caused by key foodborne pathogens.

  ---------------------- ------------------------------------------------
  10-1a. *Campylobacter* 
  species.               

  **National Data        Foodborne Disease Active Surveillance Network
  Source**               (FoodNet), CDC, NCID, FDA, CFSAN, USDA, FSIS,
                         OPHS, and State agencies.

  **State Data Source**  State Health Department reports to CDC and sites
                         participating in FoodNet active surveillance.

  **Healthy People 2000  12.1 (Food and Drug Safety).
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           24.6 (1997) (selected sites---see Comments).

  **Numerator**          Number of culture-confirmed cases of illness
                         caused by *Campylobacter* species reported to
                         CDC.

  **Denominator**        Number of persons.

  **Population           Resident population (selected sites---see
  Targeted**             Comments).

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           FoodNet is a collaborative effort among CDC,
                         FDA, USDA, and participating State Health
                         Departments. This network collects
                         population-based surveillance data on
                         culture-confirmed cases of foodborne illnesses
                         from more than 300 participating clinical
                         laboratories.

                         In March 2000, the population at FoodNet sites
                         was 25.4 million persons (10 percent of the
                         resident population) for active surveillance of
                         bacterial pathogens. Baseline information for
                         bacterial infections is based on 1997 active
                         surveillance at FoodNet sites, which included
                         areas of California, Connecticut, Georgia,
                         Minnesota, Oregon, and New York. Since 1997,
                         additional counties or additional sites (New
                         York and Maryland in 1998, Tennessee in 2000,
                         and Colorado in 2001) have been added to the
                         network.

                         The data, received by CDC from the States, are
                         based on isolates from human case specimens. The
                         cause of the illness in many, but not all, of
                         the cases, is a contaminated food. The
                         denominator is from Internet site
                         http://www.census.gov/population/\
                         www/estimates/popest.html.

                         For more information on FoodNet from the
                         Internet, go to
                         http://www.cdc.gov/ncidod/dbmd/foodnet.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-1b. *Escherichia    
  coli* O157:H7.         

  **National Data        Foodborne Disease Active Surveillance Network
  Source**               (FoodNet), CDC, NCID, FDA, CFSAN, USDA, FSIS,
                         OPHS, and State agencies.

  **State Data Source**  State Health Department reports to CDC and sites
                         participating in FoodNet active surveillance.

  **Healthy People 2000  12.1 (Food and Drug Safety).
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           2.1 (1997) (selected sites---see Comments).

  **Numerator**          Number of culture-confirmed cases of illness
                         caused by *Escherichia coli* O157:H7 reported to
                         CDC.

  **Denominator**        Number of persons.

  **Population           Resident population (selected sites---see
  Targeted**             Comments).

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 10-1a for
                         more information.
  ---------------------- ------------------------------------------------

-   

  ---------------------- ------------------------------------------------
  10-1c. *Listeria       
  monocytogenes*.        

  **National Data        Foodborne Disease Active Surveillance Network
  Source**               (FoodNet), CDC, NCID, FDA, CFSAN, USDA, FSIS,
                         OPHS, and State agencies.

  **State Data Source**  State Health Department reports to CDC and sites
                         participating in FoodNet active surveillance.

  **Healthy People 2000  12.1 (Food and Drug Safety).
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           0.5 (1997) (selected sites---see Comments).

  **Numerator**          Number of culture-confirmed cases of illness
                         caused by *Listeria monocytogenes* reported to
                         CDC.

  **Denominator**        Number of persons.

  **Population           Resident population (selected sites---see
  Targeted**             Comments).

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 10-1a for
                         more information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 10-1d. *Salmonella* |                                                |
| species.            |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Foodborne Disease Active Surveillance Network  |
| Source**            | (FoodNet), CDC, NCID, FDA, CFSAN, USDA, FSIS,  |
|                     | OPHS, and State agencies.                      |
+---------------------+------------------------------------------------+
| **State Data        | State Health Department reports to CDC and     |
| Source**            | sites participating in FoodNet active          |
|                     | surveillance.                                  |
+---------------------+------------------------------------------------+
| ######              | 12.1 (Food and Drug Safety).                   |
|  Healthy People 200 |                                                |
| 0 Objective {#healt |                                                |
| hy-people-2000-obje |                                                |
| ctive .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 100,000 population.                   |
+---------------------+------------------------------------------------+
| **Baseline**        | 13.7 (1997) (selected sites---see Comments).   |
+---------------------+------------------------------------------------+
| ####                | Number of culture-confirmed cases of illness   |
| ## Numerator {#nume | caused by *Salmonella* species reported to     |
| rator .Heading6THP} | CDC.                                           |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons.                             |
+---------------------+------------------------------------------------+
| **Population        | Resident population (selected sites---see      |
| Targeted**          | Comments).                                     |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 10-1a for |
|                     | more information.                              |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  10-1e. (Developmental) 
  *Cyclospora            
  cayetanensis*.         

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is FoodNet, a
                         collaborative effort among CDC, FDA, USDA, and
                         participating State Health Departments. Proposed
                         State data sources are the State Health
                         Department passive reporting to CDC and
                         participants in FoodNet active surveillance.
                         *Cyclospora cayetanensis* has only recently been
                         made a nationally notifiable disease and added
                         to Food Net surveillance. National estimates
                         will be based on active surveillance at FoodNet
                         sites. Final 1997 data for *Cyclospora
                         cayetanensis* were not available at the time of
                         publication. In 1998, the population at FoodNet
                         sites was 24.7 million persons for active
                         surveillance of *Cyclospora cayetanensis*.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-1f. (Developmental) 
  Postdiarrheal          
  hemolytic uremic       
  syndrome.              

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is FoodNet, a
                         collaborative effort among CDC, FDA, USDA, and
                         participating State Health Departments. Proposed
                         State data sources are the State Health
                         Department passive reporting to CDC and
                         participants in FoodNet active surveillance.
                         Postdiarrheal hemolytic uremic syndrome has only
                         recently been made a nationally notifiable
                         disease and added to FoodNet surveillance.
                         National estimates will be based on active
                         surveillance at FoodNet sites. Final 1997 data
                         for postdiarrheal hemolytic uremic syndrome were
                         not available at the time of publication.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-1g. (Developmental) 
  Congenital *Toxoplasma 
  gondii*.               

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national and State data source is the
                         National Notifiable Disease Surveillance System
                         (NNDSS), CDC, NCID.

                         As occurs with other parasitic diseases,
                         examination for toxoplasmosis is often not
                         available or is done infrequently. Efforts are
                         underway in the United States to make congenital
                         toxoplasmosis a nationally notifiable disease,
                         with serological data collection beginning in
                         calendar year 2000. Implementation will be done
                         in a stepwise fashion among the States.
                         Congenital toxoplasmosis data will include
                         neonates and their mothers.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

10-2. Reduce outbreaks of infections caused by key foodborne bacteria.

  ---------------------- ------------------------------------------------
  10-2a. *Escherichia    
  coli* O157:H7.         

  **National Data        Foodborne Disease Outbreak Surveillance System,
  Source**               CDC, NCID.

  **State Data Source**  State Health Department passive reports to CDC
                         and sites participating in FoodNet active
                         surveillance.

  **Healthy People 2000  Adapted from 12.2 (Food and Drug Safety).
  Objective**            

  **Measure**            Number.

  **Baseline**           22 (1997).

  **Numerator**          Number of outbreaks of infections caused by
                         *Escherichia coli* O157:H7 in the U.S. resident
                         population.

  **Denominator**        Not applicable.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A foodborne disease outbreak (FBDO) is defined
                         as the occurrence of two or more cases of a
                         similar illness resulting from the ingestion of
                         a common food. FBDOs are reported to CDC on a
                         standard reporting form. Outbreaks of known
                         etiology are those for which laboratory evidence
                         of a specific agent is obtained, and specified
                         criteria are met. Most reports are received from
                         State and local health departments; they also
                         may be received from Federal agencies and,
                         occasionally, from private physicians. Not
                         included in this surveillance system are FBDOs
                         on cruise ships; FBDOs if the food is eaten
                         outside United States, even if the illness
                         occurs within the United States; and if the
                         route of transmission from the contaminated food
                         to the infected person is indirect.

                         Many foods contain several ingredients, but only
                         one food-vehicle category is chosen for
                         categorizing each outbreak. Therefore, the
                         reported number of outbreaks attributed to a
                         particular food item may not include all the
                         reported outbreaks caused by that item. For
                         example, homemade ice cream containing milk and
                         eggs is listed under "ice cream" rather then
                         "milk" or "eggs." The category "Mexican food"
                         includes vehicles made from beef, cheese,
                         lettuce, and other ingredients.

                         For information on FoodNet, see Comments
                         provided with objective 10-1a.

                         This objective differs from Healthy People 2000
                         objective 12.2, which only tracked outbreaks
                         from *Salmonella* Enteritidis.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 10-2b. *Salmonella* |                                                |
| serotype            |                                                |
| Enteritidis.        |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Foodborne Disease Outbreak Surveillance        |
| Source**            | System, CDC, NCID.                             |
+---------------------+------------------------------------------------+
| **State Data        | State Health Department passive reports to CDC |
| Source**            | and sites participating in FoodNet active      |
|                     | surveillance.                                  |
+---------------------+------------------------------------------------+
| ###### H            | Adapted from 12.2 (Food and Drug Safety).      |
| ealthy People 2000  |                                                |
| Objective {#healthy |                                                |
| -people-2000-object |                                                |
| ive-1 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Number.                                        |
+---------------------+------------------------------------------------+
| **Baseline**        | 44 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of outbreaks of infections caused by    |
|                     | *Salmonella* serotype Enteritidis in the U.S.  |
|                     | resident population.                           |
+---------------------+------------------------------------------------+
| **Denominator**     | Not applicable.                                |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 10-2a for |
|                     | more information.                              |
+---------------------+------------------------------------------------+

10-3. Prevent an increase in the proportion of isolates of *Salmonella*
species, from humans and from animals at slaughter, that are resistant
to antimicrobial drugs.

+---------------------+------------------------------------------------+
| 10-3a. *Salmonella* |                                                |
| from humans that    |                                                |
| are resistant to    |                                                |
| fluoroquinolones.   |                                                |
+---------------------+------------------------------------------------+
| ###### Na           | The National Antimicrobial Resistance          |
| tional Data Sources | Monitoring System: Enteric Bacteria-Salmonella |
|  {#national-data-so | (NARMS: Enteric Bacteria), NCID, CDC; FDA,     |
| urces .Heading6THP} | CVM; USDA, Agriculture Research Service (ARS); |
|                     | Foodborne Disease Active Surveillance Network  |
|                     | (FoodNet) FDA, CDC, and USDA, FSIS.            |
+---------------------+------------------------------------------------+
| **State Data        | Participating local and State health           |
| Sources**           | departments in 17 NARMS sites---see Comments.  |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 0 (1997).                                      |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of *Salmonella* species isolates that   |
|                     | are resistant to fluoroquinolones.             |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of *Salmonella* species isolates tested |
|                     | for resistance to fluoroquinolones.            |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | *Salmonella* species isolates from humans      |
|                     | (every 10th *Salmonella* species isolate from  |
|                     | each of 17 locations representing 32 percent   |
|                     | of the U.S. population), will be tested for    |
|                     | resistance to antimicrobial drugs.             |
+---------------------+------------------------------------------------+
|                     | The 17 NARMS sites (including the 8 FoodNet    |
|                     | sites) are participating local and State       |
|                     | health departments that include California,    |
|                     | Colorado, Connecticut, Florida, Georgia,       |
|                     | Kansas, Los Angeles County, Massachusetts,     |
|                     | Maryland, Minnesota, New Jersey, New York      |
|                     | City, New York State, Oregon, Tennessee,       |
|                     | Washington, and West Virginia. See Comments    |
|                     | provided with objective 10-1a for more         |
|                     | information on FoodNet.                        |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

-   

+---------------------+------------------------------------------------+
| 10-3b. *Salmonella* |                                                |
| from humans that    |                                                |
| are resistant to    |                                                |
| third-generation    |                                                |
| cephalosporins.     |                                                |
+---------------------+------------------------------------------------+
| **National Data     | The National Antimicrobial Resistance          |
| Sources**           | Monitoring System: Enteric Bacteria-Salmonella |
|                     | (NARMS: Enteric Bacteria), NCID, CDC; FDA,     |
|                     | CVM; USDA, ARS; Foodborne Disease Active       |
|                     | Surveillance Network (FoodNet) FDA, CDC, and   |
|                     | USDA, FSIS.                                    |
+---------------------+------------------------------------------------+
| #                   | Foodborne Disease Active Surveillance Network  |
| ##### State Data So | (FoodNet), FDA, CDC, and USDA, FSIS.           |
| urce {#state-data-s |                                                |
| ource .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 0 (1997).                                      |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of *Salmonella* species isolates that   |
|                     | are resistant to third-generation              |
|                     | cephalosporins.                                |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of *Salmonella* species isolates tested |
|                     | for resistance to third-generation             |
|                     | cephalosporins.                                |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 10-3a for |
|                     | more information.                              |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 10-3c. *Salmonella* |                                                |
| from humans that    |                                                |
| are resistant to    |                                                |
| gentamicin.         |                                                |
+---------------------+------------------------------------------------+
| **National Data     | The National Antimicrobial Resistance          |
| Sources**           | Monitoring System: Enteric Bacteria-Salmonella |
|                     | (NARMS: Enteric Bacteria), NCID, CDC; FDA,     |
|                     | CVM; USDA, ARS; Foodborne Disease Active       |
|                     | Surveillance Network (FoodNet), FDA, CDC, and  |
|                     | USDA, FSIS.                                    |
+---------------------+------------------------------------------------+
| ###                 | Foodborne Disease Active Surveillance Network  |
| ### State Data Sour | (FoodNet), CDC, FDA, USDA, and FSIS.           |
| ce {#state-data-sou |                                                |
| rce-1 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 3 (1997).                                      |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of *Salmonella* species isolates that   |
|                     | are resistant to gentamicin.                   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of *Salmonella* species isolates tested |
|                     | for resistance to gentamicin.                  |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 10-3a for |
|                     | more information.                              |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 10-3d. *Salmonella* |                                                |
| from humans that    |                                                |
| are resistant to    |                                                |
| ampicillin.         |                                                |
+---------------------+------------------------------------------------+
| **National Data     | The National Antimicrobial Resistance          |
| Sources**           | Monitoring System: Enteric Bacteria-Salmonella |
|                     | (NARMS: Enteric Bacteria), NCID, CDC; FDA,     |
|                     | CVM; USDA, ARS; Foodborne Disease Active       |
|                     | Surveillance Network (FoodNet), FDA, CDC, and  |
|                     | USDA, FSIS.                                    |
+---------------------+------------------------------------------------+
| ###                 | Foodborne Disease Active Surveillance Network  |
| ### State Data Sour | (FoodNet), CDC, FDA, USDA, and FSIS.           |
| ce {#state-data-sou |                                                |
| rce-2 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 18 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of *Salmonella* species isolates that   |
|                     | are resistant to ampicillin.                   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of *Salmonella* species isolates tested |
|                     | for resistance to ampicillin.                  |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 10-3a for |
|                     | more information.                              |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  10-3e. (Developmental) 
  *Salmonella* from      
  cattle at slaughter    
  that are resistant to  
  fluoroquinolones.      

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source for animals at
                         slaughter is the National Antimicrobial
                         Resistance Monitoring System: Enteric
                         Bacteria-Salmonella (NARMS: Enteric Bacteria),
                         supported by surveillance and research
                         activities of FDA, CDC, FSIS, ARS, and USDA,
                         Animal and Plant Health Inspection Service
                         (APHIS). Data are being collected, but were not
                         available at the time of publication.
                         *Salmonella* species isolates from animals at
                         slaughter (isolates from USDA, FSIS's Hazard
                         Analysis and Critical Control Point \[HACCP\]
                         and pathogen reduction program testing for
                         *Salmonella* species) are being tested for
                         resistance to antimicrobial drugs.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-3f. (Developmental) 
  *Salmonella* from      
  cattle at slaughter    
  that are resistant to  
  third-generation       
  cephalosporins.        

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-3g. (Developmental) 
  *Salmonella* from      
  cattle at slaughter    
  that are resistant to  
  gentamicin.            

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

-   

  ---------------------- ------------------------------------------------
  10-3h. (Developmental) 
  *Salmonella* from      
  cattle at slaughter    
  that are resistant to  
  ampicillin.            

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-3i. (Developmental) 
  *Salmonella* from      
  broilers at slaughter  
  that are resistant to  
  fluoroquinolones.      

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-3j. (Developmental) 
  *Salmonella* from      
  broilers at slaughter  
  that are resistant to  
  third-generation       
  cephalosporins.        

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-3k. (Developmental) 
  *Salmonella* from      
  broilers at slaughter  
  that are resistant to  
  gentamicin.            

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-3l. (Developmental) 
  *Salmonella* from      
  broilers at slaughter  
  that are resistant to  
  ampicillin.            

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-3m. (Developmental) 
  *Salmonella* from      
  swine at slaughter     
  that are resistant to  
  fluoroquinolones.      

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-3n. (Developmental) 
  *Salmonella* from      
  swine at slaughter     
  that are resistant to  
  third-generation       
  cephalosporins.        

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-3o. (Developmental) 
  *Salmonella* from      
  swine at slaughter     
  that are resistant to  
  gentamicin.            

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-3p. (Developmental) 
  *Salmonella* from      
  swine at slaughter     
  that are resistant to  
  ampicillin.            

  **Comments**           See Comments provided with objective 10-3e for
                         more information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  10-4. (Developmental)  
  Reduce deaths from     
  anaphylaxis caused by  
  food allergies.        

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed data source is the mortality
                         component of the National Vital Statistics
                         System. The ICD-10 assigns a code to death from
                         food-induced anaphylaxis, although identifiers
                         have not been assigned for various food sources,
                         for example, peanuts, milk products, and eggs.
                         Codes have been assigned to anaphylactic shock
                         due to adverse food reaction in the ICD-9-CM for
                         nonfatal anaphylactic shock due to nonpoisonous
                         foods.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 10-5. Increase the  |                                                |
| proportion of       |                                                |
| consumers who       |                                                |
| follow key food     |                                                |
| safety practices.   |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Food Safety Survey (FSS), FDA, CFSAN, USDA,    |
| Source**            | and FSIS.                                      |
+---------------------+------------------------------------------------+
| **State Data        | See Comments.                                  |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 12.3 (Food and Drug Safety).      |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Weighted average percent.                      |
+---------------------+------------------------------------------------+
| **Baseline**        | 72 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | The sum of the average percents of consumers   |
|                     | who report they follow each of the four key    |
|                     | food safety practices: clean, separate, cook,  |
|                     | and chill.                                     |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of practices measured (four) among      |
|                     | persons aged 18 years and older who prepare    |
|                     | food (consumers).                              |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 Food Safety Survey:              |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | CLEAN                                          |
+---------------------+------------------------------------------------+
|                     | -   Before you begin preparing food, how often |
|                     |     do you wash your hands with soap? Would    |
|                     |     you say . . .                              |
|                     |                                                |
|                     |     1\) All of the time\*\                     |
|                     |     2) Most of the time\                       |
|                     |     3) Some of the time, or\                   |
|                     |     4) Rarely                                  |
+---------------------+------------------------------------------------+
|                     | -   After you have cracked open raw eggs, do   |
|                     |     you usually continue cooking, or do you    |
|                     |     first rinse your hands with water, wipe    |
|                     |     them, or wash them with soap?              |
|                     |                                                |
|                     |     1\) Continue cooking\                      |
|                     |     2) Rinse or wipe hands\                    |
|                     |     3) Wash with soap\*\                       |
|                     |     Open-ended code:\                          |
|                     |     4) Never handle raw eggs                   |
+---------------------+------------------------------------------------+
|                     | -   After handling raw meat or chicken, do you |
|                     |     usually continue cooking, or do you first  |
|                     |     rinse your hands with water, or wipe them, |
|                     |     or wash them with soap?                    |
|                     |                                                |
|                     |     1\) Continue cooking\                      |
|                     |     2) Rinse or wipe hands\                    |
|                     |     3) Wash with soap\*\                       |
|                     |     Open-ended code:\                          |
|                     |     4) Don't cut raw meat or chicken           |
+---------------------+------------------------------------------------+
|                     | -   After handling raw fish, do you usually    |
|                     |     continue cooking, or do you first rinse    |
|                     |     your hands with water, wipe them, or wash  |
|                     |     them with soap?                            |
|                     |                                                |
|                     |     1\) Continue cooking\                      |
|                     |     2) Rinse or wipe hands\                    |
|                     |     3) Wash with soap\*\                       |
|                     |     Open-ended code:\                          |
|                     |     4) Never handle raw fish                   |
+---------------------+------------------------------------------------+
|                     | SEPARATE                                       |
+---------------------+------------------------------------------------+
|                     | -   After you have used a cutting board or     |
|                     |     other surface for cutting [raw             |
|                     |     meat]{.underline} or                       |
|                     |     [chicken]{.underline}, do you use it [as   |
|                     |     it is]{.underline} for cutting other food  |
|                     |     to be eaten raw for the same meal, or do   |
|                     |     you first rinse it, or wipe it, or wash it |
|                     |     with soap?                                 |
|                     |                                                |
|                     |     1\) Use it as it is\                       |
|                     |     2) Rinse or wipe it\                       |
|                     |     3) Wash with soap\*\                       |
|                     |     Open-ended codes:\                         |
|                     |     4) Wash with bleach\*\                     |
|                     |     5) Use a different cutting board\*6) Don't |
|                     |     cut raw meat or poultry                    |
+---------------------+------------------------------------------------+
|                     | -   After cutting [raw fish]{.underline} or    |
|                     |     [shellfish]{.underline}, what do you do    |
|                     |     with the cutting board or surface? \[Do    |
|                     |     you use it [as it is]{.underline} for      |
|                     |     cutting food to be eaten raw for the same  |
|                     |     meal, or do you first rinse it, or wipe    |
|                     |     it, or wash it with soap?\] (NOTE:         |
|                     |     MATERIAL IN BRACKETS MAY NOT NEED TO BE    |
|                     |     READ).                                     |
|                     |                                                |
|                     |     1\) Use it as it is\                       |
|                     |     2) Rinse or wipe it\                       |
|                     |     3) Wash with soap\*\                       |
|                     |     Open-ended codes:\                         |
|                     |     4) Wash with bleach\*\                     |
|                     |     5) Use a different cutting board\*         |
+---------------------+------------------------------------------------+
|                     |                                                |
+---------------------+------------------------------------------------+
|                     | COOK\--PREFERENCE                              |
+---------------------+------------------------------------------------+
|                     | -   In your home, are hamburgers usually       |
|                     |     served\...(PROBE: IF DIFFERENT WAYS FOR    |
|                     |     DIFFERENT PEOPLE: What is the rarest       |
|                     |     degree of doneness hamburgers are served?) |
|                     |                                                |
|                     |     1\) Rare\                                  |
|                     |     2) Medium, or\                             |
|                     |     3) Well done?\*\                           |
|                     |     Open-ended code:\                          |
|                     |     4) Hamburgers are never served             |
+---------------------+------------------------------------------------+
|                     | -   If (2), When you say hamburgers are        |
|                     |     usually served \"medium,\" do you mean     |
|                     |     they are\...                               |
|                     |                                                |
|                     |     1\) Brown all the way through,\* or\       |
|                     |     2) Still have some pink in the middle?     |
+---------------------+------------------------------------------------+
|                     | -   In the past 12 months, did you eat any of  |
|                     |     the following foods that contain raw eggs? |
|                     |     (Did you eat. . .) (In the past 12 months, |
|                     |     did you eat . . .)                         |
|                     |                                                |
|                     |     a\) Raw, homemade cookie or cake batter?\  |
|                     |     b) Homemade frosting with raw egg?\        |
|                     |     c) Caesar salad with raw egg?\             |
|                     |     d) Chocolate mousse with raw egg?\         |
|                     |     e) Homemade eggnog?\                       |
|                     |     f) Homemade mayonnaise?\                   |
|                     |     g) Homemade ice cream with raw egg?\       |
|                     |     h) Shakes with raw egg?\                   |
|                     |     i) Homemade hollandaise sauce?             |
+---------------------+------------------------------------------------+
|                     | (NOTE TO INTERVIEWERS: COMMERCIAL FROZEN OR    |
|                     | REFRIGERATED COOKIE DOUGH IS PASTEURIZED; IT   |
|                     | DOES NOT CONTAIN RAW EGGS EVEN BEFORE IT IS    |
|                     | BAKED. COMMERCIAL CAKE AND COOKIE MIXES        |
|                     | USUALLY CALL FOR ADDING RAW EGGS, SO THEY      |
|                     | COUNT AS EATING RAW EGGS.)                     |
+---------------------+------------------------------------------------+
|                     | -   In the past 12 months, which of the        |
|                     |     following [raw]{.underline} foods did you  |
|                     |     eat?                                       |
|                     |                                                |
|                     |     a\) Raw oysters\                           |
|                     |     b) Sushi, ceviche (se - VEE - chay), or    |
|                     |     other raw fish                             |
+---------------------+------------------------------------------------+
|                     | COOK\--IMPLEMENTATION                          |
+---------------------+------------------------------------------------+
|                     | -   Thinking of your usual habits over the     |
|                     |     past year, when you prepare the following  |
|                     |     foods, how often do you use a thermometer? |
+---------------------+------------------------------------------------+
|                     | a\) Roasts or other large pieces of meat\--how |
|                     | often do you use a thermometer when you cook   |
|                     | roasts? Would you say. . .                     |
|                     |                                                |
|                     | 1\) Always\*\                                  |
|                     | 2) Often\*\                                    |
|                     | 3) Sometimes,\* or\                            |
|                     | 4) Never\                                      |
|                     | Open-ended code:\                              |
|                     | 5) Never cook the food                         |
+---------------------+------------------------------------------------+
|                     | b\) Chicken parts, such as breasts or          |
|                     | legs\--how often do you use a thermometer when |
|                     | you cook chicken parts? Would you say. . .     |
|                     |                                                |
|                     | > *1) Always\*\                                |
|                     | > 2) Often\*\                                  |
|                     | > 3) Sometimes,\* or\                          |
|                     | > 4) Never\                                    |
|                     | > *Open-ended code:\                           |
|                     | > *5) Never cook the food*                     |
+---------------------+------------------------------------------------+
|                     | c\) How about hamburgers\--how often do you    |
|                     | use a thermometer when you cook hamburgers?    |
|                     | Would you say. . .                             |
|                     |                                                |
|                     | 1\) Always\*\                                  |
|                     | 2) Often\*\                                    |
|                     | 3) Sometimes,\* or\                            |
|                     | 4) Never\                                      |
|                     | Open-ended code:\                              |
|                     | 5) Never cook the food                         |
+---------------------+------------------------------------------------+
|                     | CHILL                                          |
+---------------------+------------------------------------------------+
|                     | -   If you cook a large pot of soup, stew, or  |
|                     |     other food with meat or chicken and want   |
|                     |     to save it for the next day, when do you   |
|                     |     put the food in the refrigerator? Would it |
|                     |     be (READ 1-3) . . .                        |
|                     |                                                |
|                     |     1\) Immediately\*\                         |
|                     |     2) After first cooling it at room          |
|                     |     temperature, or\                           |
|                     |     3) After first cooling it in cold          |
|                     |     water?\*\                                  |
|                     |     Open-ended codes:\                         |
|                     |     4) Do not cook such foods\                 |
|                     |     5) Would not refrigerate it                |
+---------------------+------------------------------------------------+
|                     | -   If (2): For about how long would you let   |
|                     |     it cool at room temperature? (DO NOT READ  |
|                     |     LIST)                                      |
|                     |                                                |
|                     |     1\) Less than 2 hours\*\                   |
|                     |     2) 2 hours or more                         |
+---------------------+------------------------------------------------+
|                     | -   How about if the soup or stew contains     |
|                     |     fish or shellfish instead of meat or       |
|                     |     chicken. If you want to save it for the    |
|                     |     next day, when do you put the food in the  |
|                     |     refrigerator? Would it be (READ 1-3) . . . |
|                     |                                                |
|                     |     1\) Immediately\*\                         |
|                     |     2) After first cooling it at room          |
|                     |     temperature, or\                           |
|                     |     3) After first cooling it in cold          |
|                     |     water?\*\                                  |
|                     |     Open-ended codes:\                         |
|                     |     4) Do not cook such foods\                 |
|                     |     5) Would not refrigerate it                |
+---------------------+------------------------------------------------+
|                     | -   If (2): For about how long would you let   |
|                     |     it cool at room temperature? (DO NOT READ  |
|                     |     LIST)                                      |
|                     |                                                |
|                     |     1\) Less than 2 hours\*\                   |
|                     |     2) 2 hours or more                         |
|                     |                                                |
|                     |     \*Response is coded as safe.               |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The key food safety practices are the four     |
|                     | Fight BAC™ Campaign messages: 1) clean: wash   |
|                     | hands and surfaces often; 2) separate: don't   |
|                     | cross-contaminate; 3) cook: cook to proper     |
|                     | temperatures; and 4) chill: refrigerate        |
|                     | promptly.                                      |
+---------------------+------------------------------------------------+
|                     | Calculating the estimate for this objective is |
|                     | a three-step process. First, the percent of    |
|                     | consumers who have a safe response for each    |
|                     | measure of each practice in which they have    |
|                     | the opportunity to engage is calculated (the   |
|                     | safe responses are indicated with an asterisk  |
|                     | in the questionnaire above). The percents for  |
|                     | all items that measure each practice are       |
|                     | averaged to obtain an average percent who      |
|                     | follow each of the four recommendations. These |
|                     | four average percents are summed and divided   |
|                     | by 4 to obtain the estimate.                   |
+---------------------+------------------------------------------------+
|                     | For all practice estimates, the base is the    |
|                     | number of people who engage in the behavior    |
|                     | and who answered the question. For example,    |
|                     | people who did not cook meat or poultry were   |
|                     | excluded from the sample base of the questions |
|                     | about meat or poultry; people who did not cook |
|                     | fish were excluded from the practice questions |
|                     | about fish. The total base (excluding          |
|                     | nonresponses) was used for the question on     |
|                     | hand washing before preparing food and for the |
|                     | questions on consumption of raw foods.         |
+---------------------+------------------------------------------------+
|                     | The FSS is based on 30-minute telephone        |
|                     | interviews with consumers to determine food    |
|                     | safety knowledge, concern level, food handling |
|                     | practices, perception of risk, and consumption |
|                     | of potentially hazardous foods by consumers.   |
|                     | The FSS is not a regularly scheduled survey.   |
|                     | Previous surveys have been conducted in 1988   |
|                     | (3,200 people surveyed), 1993 (1,620 people    |
|                     | surveyed), and 1998 (2,001 people surveyed).   |
|                     | Because FSS is part of the Food Safety         |
|                     | Initiative, more frequent data collection is   |
|                     | anticipated in the future. A fourth collection |
|                     | is tentatively scheduled for 2001.             |
+---------------------+------------------------------------------------+
|                     | A proposed State data source is the Behavioral |
|                     | Risk Factor Surveillance System (BRFSS). In    |
|                     | the past, the BRFSS has included an optional   |
|                     | food safety module that has questions that are |
|                     | similar but not identical to FSS questions on  |
|                     | hand washing and cutting surfaces. It has also |
|                     | included a question about eating hamburgers    |
|                     | that are pink in the middle, but no question   |
|                     | about using a food thermometer to judge when   |
|                     | hamburgers are done. It has no question about  |
|                     | chilling foods. The food safety module has     |
|                     | been available since 1995. In that year, five  |
|                     | States included the module in their BRFSS.     |
|                     | Additional States have used the module in      |
|                     | subsequent years, but the number of States     |
|                     | collecting the food safety data remains low.   |
+---------------------+------------------------------------------------+
|                     | Note: According to a USDA study on premature   |
|                     | browning, more than 25 percent of ground beef  |
|                     | patties turn brown before reaching a safe      |
|                     | internal temperature (160 degrees F).**^1^**   |
|                     | Information from the CDC links eating          |
|                     | undercooked, pink ground beef with a higher    |
|                     | risk of illness.**^2^** Therefore, consumers   |
|                     | should not eat ground beef patties unless a    |
|                     | food thermometer is used to verify the         |
|                     | temperature.**^3,\ 4,\ 5,\ 6^**                |
+---------------------+------------------------------------------------+
|                     | This objective differs from Healthy People     |
|                     | 2000 objective 12.3, which tracked             |
|                     | refrigerating perishable foods, washing        |
|                     | cutting boards with soap, and washing utensils |
|                     | with soap as individual behaviors, instead of  |
|                     | tracking the four key food safety practices    |
|                     | combined.                                      |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 10-6.               |                                                |
| (Developmental)     |                                                |
| Improve food        |                                                |
| employee behaviors  |                                                |
| and food            |                                                |
| preparation         |                                                |
| practices that      |                                                |
| directly relate to  |                                                |
| foodborne illnesses |                                                |
| in retail food      |                                                |
| establishments.     |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication.          |
+---------------------+------------------------------------------------+
|                     | The expected national data source for this     |
|                     | objective is the Retail Food Database of       |
|                     | Foodborne Illness Risk Factors, FDA, and       |
|                     | CFSAN. The expected State data source will     |
|                     | result from FDA/State cooperation in           |
|                     | inspections.                                   |
+---------------------+------------------------------------------------+
|                     | The expected numerator will be the sum of the  |
|                     | number of data elements (food employee         |
|                     | behaviors and food preparation practices)      |
|                     | directly related to foodborne illness risk     |
|                     | that are observed to be in compliance during   |
|                     | FDA inspections of institutions, restaurants,  |
|                     | and retail stores.                             |
+---------------------+------------------------------------------------+
|                     | The expected denominator will be the sum of    |
|                     | the number of data elements (food employee     |
|                     | behaviors and food preparation practices)      |
|                     | directly related to foodborne illness risk     |
|                     | that were observable (in or out of compliance) |
|                     | during FDA inspections of institutions,        |
|                     | restaurants, and retail stores.                |
+---------------------+------------------------------------------------+
|                     | Forty-six questions, listed below from the FDA |
|                     | Retail Food Database of Foodborne Illness Risk |
|                     | Factors, will be used to obtain the data. The  |
|                     | questions selected are critical items in the   |
|                     | Food Code that directly relate to each risk    |
|                     | factor group. The form was drafted for the     |
|                     | specific purpose of collecting data regarding  |
|                     | the occurrence at the retail level of          |
|                     | CDC-identified risk factors associated with    |
|                     | foodborne illness outbreaks. It was/is not     |
|                     | intended to serve as a comprehensive, Food     |
|                     | Code-based inspection form for food            |
|                     | establishment inspections.                     |
+---------------------+------------------------------------------------+
|                     | This ongoing data collection focuses on known  |
|                     | risk factors for foodborne illness in          |
|                     | institutions (elementary schools, hospitals,   |
|                     | and nursing homes), restaurants (fast-food and |
|                     | full service), and retail stores (deli         |
|                     | departments, meat and poultry departments,     |
|                     | produce departments, and seafood departments   |
|                     | of grocery stores). The following              |
|                     | in-compliance indicators were under            |
|                     | observation: proper holding temperatures,      |
|                     | adequate cooking, good personal hygiene, clean |
|                     | equipment, and foods from safe sources.        |
+---------------------+------------------------------------------------+
|                     |                                                |
+---------------------+------------------------------------------------+
|                     |                                                |
+---------------------+------------------------------------------------+
|                     |                                                |
+---------------------+------------------------------------------------+
|                     |                                                |
+---------------------+------------------------------------------------+
|                     | RISK FACTOR: FOODS FROM UNSAFE SOURCE          |
+---------------------+------------------------------------------------+
|                     | -   Approved Source                            |
|                     |                                                |
|                     |     A. All food from Regulated Food Processing |
|                     |     Plants/No home prepared / canned foods.\   |
|                     |     B. All shellfish from National Shellfish   |
|                     |     Sanitation Program (NSSP) listed sources.  |
|                     |     No recreationally caught shellfish         |
|                     |     received or sold.\                         |
|                     |     C. Game, wild mushrooms harvested with     |
|                     |     approval of Regulatory Authority.          |
+---------------------+------------------------------------------------+
|                     | -   Receiving/Condition                        |
|                     |                                                |
|                     |     A. Food received at proper                 |
|                     |     temperatures/protected from contamination  |
|                     |     during transportation and receiving/food   |
|                     |     is safe, unadulterated.                    |
+---------------------+------------------------------------------------+
|                     | -   Records                                    |
|                     |                                                |
|                     |     A. Shell stock tags/labels retained for 90 |
|                     |     days from the date the container is        |
|                     |     emptied.\                                  |
|                     |     B. As required, written documentation of   |
|                     |     parasite destruction maintained for fish   |
|                     |     products.\                                 |
|                     |     C. CCP monitoring records maintained in    |
|                     |     accordance with HACCP plan when required.  |
+---------------------+------------------------------------------------+
|                     | RISK FACTOR: INADEQUATE COOKING                |
+---------------------+------------------------------------------------+
|                     | -   Proper Cooking Temperature per potentially |
|                     |     hazardous food (PHF)                       |
|                     |                                                |
|                     |     A. Raw eggs broken for immediate service   |
|                     |     cooked to 145° F for 15 seconds, eggs not  |
|                     |     prepared for immediate service cooked to   |
|                     |     155° F for 15 seconds.\                    |
|                     |     B. Comminuted fish, meats, game animals    |
|                     |     155° F for 15 seconds.\                    |
|                     |     C. Beef roasts, including formed roasts,   |
|                     |     are cooked to 130° F for 121 minutes or as |
|                     |     chart specified and according to oven      |
|                     |     parameters per chart.\                     |
|                     |     D. Poultry; stuffed fish, meat, pasta,     |
|                     |     poultry, stuffed ratites, or stuffing      |
|                     |     containing fish, meat, poultry or ratites  |
|                     |     cooked to 165° F for 15 seconds.\          |
|                     |     E. Wild game animals cooked to 165° F for  |
|                     |     15 seconds.\                               |
|                     |     F. Raw animal foods cooked in microwave    |
|                     |     are rotated, stirred, covered, and heated  |
|                     |     to 165° F. Food is allowed to stand        |
|                     |     covered for 2 minutes after cooking.\      |
|                     |     G. Pork, ratites, injected meats are       |
|                     |     cooked to 155° F for 15 seconds\           |
|                     |     H. All other PHF cooked to 145° F for 15   |
|                     |     seconds.                                   |
+---------------------+------------------------------------------------+
|                     | -   Rapid Reheating for Hot Holding            |
|                     |                                                |
|                     |     A. PHF are rapidly reheated to 165° F for  |
|                     |     15 seconds.\                               |
|                     |     B. Food reheated in a microwave is heated  |
|                     |     to 165° F or higher\                       |
|                     |     C. Commercially processed ready-to-eat     |
|                     |     food, if reheated, held at 140° F or       |
|                     |     above.\                                    |
|                     |     D. Remaining unsliced portions of beef     |
|                     |     roasts are reheated for hot holding using  |
|                     |     minimum oven parameters.                   |
+---------------------+------------------------------------------------+
|                     | RISK FACTOR: IMPROPER HOLDING                  |
+---------------------+------------------------------------------------+
|                     | -   Proper Cooling Procedures (Note any        |
|                     |     temperature above 41° F)                   |
|                     |                                                |
|                     |     A. Cooked PHF is cooled from 140° F to 70° |
|                     |     F within 2 hours and from 70° F to 41° F   |
|                     |     or below within 4 hours.\                  |
|                     |     B. Cooked PHF is cooled from 140° F to 70° |
|                     |     F within 2 hours and from 70° F to 45° F   |
|                     |     or below within 4 hours.\                  |
|                     |     C. PHF (from ambient ingredients) is       |
|                     |     cooled to 41° F or below within 4 hours.\  |
|                     |     D. PHF (from ambient ingredients) is       |
|                     |     cooled to 45° F or below within 4 hours.\  |
|                     |     E. Foods received at a temperature         |
|                     |     according to Law are cooled to 41° F       |
|                     |     within 4 hours.\                           |
|                     |     F. Foods received at a temperature         |
|                     |     according to Law are cooled to 45° F       |
|                     |     within 4 hours.                            |
+---------------------+------------------------------------------------+
|                     | -   Cold Hold (41° F/45° F)                    |
|                     |                                                |
|                     |     A. PHF is maintained at 41° F or below,    |
|                     |     except during preparation, cooking, or     |
|                     |     cooling or when time is used as a public   |
|                     |     health control.\                           |
|                     |     B. PHF is maintained at 45° F or below,    |
|                     |     except during preparation, cooking, or     |
|                     |     cooling or when time is used as a public   |
|                     |     health control.                            |
+---------------------+------------------------------------------------+
|                     | -   Hot Hold (140° F)                          |
|                     |                                                |
|                     |     A. PHF is maintained at 140° F or above,   |
|                     |     except during preparation, cooking, or     |
|                     |     cooling or when time is used as a public   |
|                     |     health control.\                           |
|                     |     B. Roasts are held at a temperature of     |
|                     |     130° F or above.                           |
+---------------------+------------------------------------------------+
|                     | -   Time                                       |
|                     |                                                |
|                     |     A. Ready-to-eat PHF held for more than 24  |
|                     |     hours is data marked as required (prepared |
|                     |     on-site).\                                 |
|                     |     B. Ready to eat PHF, held at 45° F for 4   |
|                     |     days or 41° F for 7 days and discarded as  |
|                     |     required.\                                 |
|                     |     C. Commercially prepared ready-to-eat PHF  |
|                     |     is date marked as required.\               |
|                     |     D. When only time is used as a public      |
|                     |     health control, food is cooked and served  |
|                     |     within 4 hours as required.                |
+---------------------+------------------------------------------------+
|                     |                                                |
+---------------------+------------------------------------------------+
|                     |                                                |
+---------------------+------------------------------------------------+
|                     |                                                |
+---------------------+------------------------------------------------+
|                     | RISK FACTOR: CONTAMINATED EQUIPMENT            |
+---------------------+------------------------------------------------+
|                     | -   Separation/Segregation/Protection          |
|                     |                                                |
|                     |     A. Food is protected from cross            |
|                     |     contamination by separating raw animal     |
|                     |     foods from raw, ready-to-eat food and by   |
|                     |     separating raw animal foods from cooked,   |
|                     |     ready-to-eat food.\                        |
|                     |     B. Raw animal foods are separated from     |
|                     |     each other during storage, preparation,    |
|                     |     holding, and display.\                     |
|                     |     C. Food is protected from environmental    |
|                     |     contamination.\                            |
|                     |     D. After being served or sold to a         |
|                     |     consumer, food is not re-served.           |
+---------------------+------------------------------------------------+
|                     | -   Food Contact Surfaces                      |
+---------------------+------------------------------------------------+
|                     | A. Food contact surfaces and utensils are      |
|                     | clean to sight and touch and sanitized before  |
|                     | use.                                           |
+---------------------+------------------------------------------------+
|                     | RISK FACTOR: POOR PERSONAL HYGIENE             |
+---------------------+------------------------------------------------+
|                     | -   Proper, Adequate Handwashing               |
|                     |                                                |
|                     |     A. Hands are clean and properly washed     |
|                     |     when and as required.                      |
+---------------------+------------------------------------------------+
|                     | -   Good Hygienic Practices                    |
|                     |                                                |
|                     |     A. Food employees eat, drink, and use      |
|                     |     tobacco only in designated areas/do not    |
|                     |     use a utensil more than once to taste food |
|                     |     that is sold or served/do not handle or    |
|                     |     care for animals present. Food employees   |
|                     |     experiencing persistent sneezing,          |
|                     |     coughing, or runny nose do not work with   |
|                     |     exposed food, clean equipment, utensils,   |
|                     |     linens, unwrapped single-service, or       |
|                     |     single-use articles.                       |
+---------------------+------------------------------------------------+
|                     | -   Prevention of Contamination From Hands     |
|                     |                                                |
|                     |     A. Employees do not contact exposed,       |
|                     |     ready-to-eat food with their bare hands.   |
+---------------------+------------------------------------------------+
|                     | -   Handwash Facilities                        |
|                     |                                                |
|                     |     A. Handwash facilities conveniently        |
|                     |     located and accessible for employees.\     |
|                     |     B. Handwash facilities supplied with hand  |
|                     |     cleanser/sanitary towels/hand-drying       |
|                     |     devices.                                   |
+---------------------+------------------------------------------------+
|                     | RISK FACTOR: OTHER                             |
+---------------------+------------------------------------------------+
|                     | -   CHEMICAL                                   |
|                     |                                                |
|                     |     A. No unapproved food or color additives.  |
|                     |     Sulfites are not applied to fresh fruits   |
|                     |     and vegetables intended for raw            |
|                     |     consumption.\                              |
|                     |     B. Poisonous or toxic materials,           |
|                     |     chemicals, lubricants, pesticides,         |
|                     |     medicines, first aid supplies, and other   |
|                     |     personal care items properly identified,   |
|                     |     stored, and used.\                         |
|                     |     C. Poisonous or toxic materials held for   |
|                     |     retail sale are properly stored.           |
+---------------------+------------------------------------------------+
|                     | The expected baseline data were collected by   |
|                     | Retail Food Specialists (FDA, Office of        |
|                     | Regulatory Affairs) through their field        |
|                     | inspections conducted in 1998--99. Additional  |
|                     | national benchmark data will be obtained       |
|                     | during FDA/State inspection activities and FDA |
|                     | specialists' audits of programs to include     |
|                     | incorporation of Food Code interventions.      |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  10-7. (Developmental)  
  Reduce human exposure  
  to organophosphate     
  pesticides from food.  

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the Total
                         Diet Study, FDA, to determine the levels of
                         chemical contaminants, including organophosphate
                         pesticides, present in foods. There will be
                         continuous quarterly data collection for the
                         Total Diet Study during the next 10 years.

                         The current food consumption estimates, needed
                         for the human exposure baseline calculation, are
                         10 years old. During FY 2000, FDA will be
                         updating food consumption data collection and
                         will then be able to calculate a baseline for
                         human exposure to selected organophosphate
                         pesticides from food.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

## References

1\. U.S. Department of Agriculture (USDA). *FSIS/ARS Study: Premature
Browning of Cooked Ground Beef.* Washington, DC: Food Safety and
Inspection Service (FSIS), 1998.

2\. Mead, P.S.; Finelli, L.; Lambert-Fair, M.A.; et al. Risk factors for
sporadic infection with *Escherichia coli* O157:H7. *Archives of
Internal Medicine* 157:204-208, 1997.

3\. USDA. *FSIS Key Facts Thermometer Use for Cooking Ground Beef
Patties.* Washington, DC: FSIS, 1998.

4\. USDA. *Color of Cooked Ground Beef as It Relates to Doneness,
Technical Information.* Washington, DC: FSIS, 1998.

5\. USDA. *Thermy™: Use a Food Thermometer*. Washington, DC: FSIS, 2000.

6\. USDA. *Kitchen Thermometers*. Washington, DC: FSIS, Revised April
2000.