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1993 E. coli outbreak still driving food safety advances

After the deadly 1993 E. coli outbreak tied to Jack in the Box hamburgers,  the restaurant industry and government increased food safety education efforts.

In early 1993 most Americans had faith in the wholesomeness of the burgers they bought at restaurants and the government’s oversight of meat companies. Few considered eating out to be a potentially risky activity that could lead to illness or death, and even fewer had heard of the deadly pathogen E. coli O157:H7. By February of that year, all of that changed.

It’s been 20 years since a deadly foodborne illness outbreak at Jack in the Box grabbed headlines. That event, in which undercooked hamburgers tainted with E. coli O157:H7 killed four children and sickened about 700 people in western states, thrust food safety into the public consciousness and forced restaurant companies to rethink their food safety practices.

David Theno

“Certainly the Jack in the Box thing made a huge difference” and “catapulted things forward,” said David Theno, a food technology and microbiology consultant hired by the San Diego-based quick-service chain to shore up its quality-assurance initiatives even as details of the E. coli tragedy were unfolding.

In many ways considerable progress has been made. Restaurateurs today pay more attention to the meat products they receive from suppliers, and they are more vigilant about safe handling procedures at the unit level.  In addition, the U.S. Food and Drug Administration Model Food Code was revised after the 1993 outbreak, raising the minimum internal cooking temperature for ground beef from 140 degrees to 155 degrees Fahrenheit.

“Those two things — the increase in cooking temperatures and improved meat specifications and oversight — have, frankly, really changed the landscape for restaurants,” said Bill Marler of Seattle’s Marler Clark law firm, who represented many victims of the Jack in the Box outbreak. “We have not seen E. coli-related outbreaks linked to hamburger on the scale of Jack in the Box.”

Among other changes, the importance of hygiene and avoiding cross-contamination are now front-of-mind in most culinary workspaces, and more workers are trained in food safety protocols through such programs as the National Restaurant Association’s ServSafe, which said it certified its 5 millionth customer in 2012.

But while no one disputes that progress has been made since 1993, outbreaks have yet to be eradicated, consumer concern about food safety remains high, and lawmakers and critics continue to push for further reforms.

History lessons

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The Jack in the Box outbreak stemmed from questionable meat processing practices, some of which escaped federal regulatory scrutiny; the reported failure of the chain’s ground-beef supplier Vons Companies Inc. to meet contractual obligations related to product quality and bacteria-count reporting; and a lack of widespread knowledge about the dangers of E. coli O157:H7, which is not killed off in ground beef unless the meat is cooked to a minimum internal temperature of 155 degrees Fahrenheit.

The result: E. coli-contaminated hamburger patties were shipped to Jack in the Box restaurants in multiple markets, where, company officials later testified in Congressional hearings, employees unaware of the contamination cooked the patties only to 140 degrees Fahrenheit, as was the chain’s practice in accordance with Food Code guidelines at the time.

The chain’s failure to follow a months-old Washington regulation requiring burgers sold in the state to be cooked to an internal temperature of 155 degrees Fahrenheit was seen as having added to the outbreak’s toll, as three-fourths or more of the deaths and illnesses involved Washington residents.

The outbreak spurred modifications to slaughterhouse and meat processing operations and inspections, and additional product testing. It also pushed Jack in the Box into the role of food safety innovator as the chain fought to regain public trust, rebuild sales and return to profitability.

Bill Marler

“Not a day passes when we don’t think about the victims of the outbreak and their families who were impacted by the tragedy,” Brian Luscomb, Jack in the Box Inc. divisional vice president of corporate communications, said in a written statement in January. But, he added, “On a more macro level, we’re proud of the leadership role we’ve played in promoting more stringent food safety practices throughout the industry.”

Those learnings inspired Jeff Benedict’s 2011 book, “Poisoned: The True Story of the Deadly E. Coli Outbreak That Changed the Way Americans Eat,” which chronicles Marler’s efforts to win tens of millions of dollars in settlements for the victims and the efforts of Jack in the Box executives caught up in disaster to move forward.

Theno, the chain’s former senior vice president and chief product safety officer who now heads the Gray Dog Partners Inc. consultancy in Del Mar, Calif., said one positive development stemming from the outbreak was “the government taking a more proactive role in defining what is OK and what is not.”

“I’m not a fan of bigger government, but sometimes you have to set minimum standards and say, ‘This is what matters,’” he said.

Jack in the Box also proved “that we could put a HACCP [Hazard Analysis and Critical Control Point] system in restaurants,” Theno said. By making food safety one of the activities for which managers were measured and held accountable, “it became a higher priority and got managed better,” he said.

But perhaps most significant, said Joan McGlockton, the NRA’s vice president of industry affairs and food policy, is the advancement of  training in safe food handling through programs like ServSafe.

Growing knowledge of dangerous pathogens also has helped form food handling best practices, making restaurant meals safer, said Joseph Russell, a health official with the Flathead City-County Health Department in Montana and chair of the advisory committee on food safety for the National Association of County and City Health Officials, or NACCHO. Restaurant inspections conducted by the nation’s health departments also are among the frontline defenses against dangerous foods, he said.

Sarah Klein

Sarah Klein, senior staff attorney for the food safety program of the nonprofit Center for Science in the Public Interest in Washington, D.C., said she believes “restaurants have come to realize the role that they play in keeping consumers safe.”

“To the extent that restaurants are owned by large conglomerates or chains that are able to demand very high food safety standards of anyone who is selling into their chain, that is a real benefit to consumers — or can be a real benefit to consumers if the restaurant takes the step of requiring additional microbial testing, for example,” Klein said.

Food safety from here

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The American food supply is arguably among the safest in the world, yet the risk from consuming tainted meats, produce and seasonings remains. The federal Centers for Disease Control and Prevention in Atlanta estimates that each year roughly 48 million people get sick, 128,000 are hospitalized and 3,000 die from foodborne illnesses.

The CDC in late January reported that among the 766 foodborne-illness outbreaks reported in the United States during 2009 and 2010 with a known single setting where food was consumed, 48 percent were caused by food consumed in a restaurant or deli, and 21 percent were caused by food consumed in a private home. That figure was down from 868 such outbreaks in 2008, with 52 percent linked to restaurants and delis, the CDC said.

In January the FDA took more steps to reduce those figures by releasing the first of its proposed regulations for farming and food manufacturing under the federal Food Safety Modernization Act of 2011, a law intended to make government and business food safety initiatives more proactive.

While the proposed rules do not directly impact restaurants, they are intended to heighten food safety throughout the supply chain, reducing the risk that operators receive contaminated food products.

The first rule requires manufacturers to develop formal plans, such as the HACCP programs now used by the meat and seafood industries, and corrective strategies to guarantee the safety of their foods. The second calls for enforceable, science-based safety standards for the production and harvesting of produce.

Industry watchdogs embraced the proposed rules.

Joan McGlockton

“Food safety in restaurants depends on safe ingredients and food-safe practices in food preparation and service,” said the NRA’s McGlockton. “The enactment and now proposed regulations for implementation of FSMA is the single most important step in advancing food safety.”

But some remain skeptical. Rep. Rosa DeLauro, D-Conn., who helped pass the FSMA, said the bill is a step in the right direction, but more still needs to be done.

“If the Food Safety Modernization Act is sufficiently funded and implemented as Congress intended, we will see dramatic reductions in preventable foodborne illnesses,” DeLauro said. “But we still need an independent, single food safety agency to really affect food safety.  It makes no sense for food safety responsibilities to be scattered across more than a dozen federal agencies.”

Longtime observers Marler and Theno also said there is more operators can do, especially when it comes to produce.

The past decade has seen an uptick in contamination problems tied to fruits and vegetables. Among them was a 2003 Hepatitis A outbreak that killed three people, hospitalized 128 and sickened 565, linked to green onions from Mexico served by a Pennsylvania branch of the now-defunct Chi-Chi’s casual-dining chain, and a 2006 E. coli outbreak with more than 100 confirmed illnesses associated with lettuce from Taco Bell and Taco John’s restaurants.

Engaging suppliers

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According to Marler, some restaurant companies are taking longer than others to devise product specifications and standards for suppliers that will reduce the likelihood of receiving tainted produce or other products that don’t require a pathogen kill step, such as cooking, before they are served.

Though restaurant companies have increasingly drafted contracts that make suppliers liable for problems tied to their products and require additional insurance coverage for operators in product-liability cases, Marler said the confidence inspired by such clauses might be counterproductive.

“I think that restaurants may have gone a little bit too far in divorcing themselves from the supply chain,” he said. “They still need all of those contracts and accountability clauses, but they also need to engage their suppliers in some way.”

Marler said he also believes that restaurateurs would be better served by hiring their own inspectors to perform audits of supplier facilities, as opposed to requiring those suppliers to hire auditors and share inspection results.

“[Restaurateurs] should own the inspections that protect their consumers,” he said, adding that when auditors are paid by the supplier firms they are inspecting, “I think the incentives are wrong.”

“Let’s fix the produce thing,” Theno agreed. He added that emerging packaging and washing technologies appear to have the potential to greatly reduce or eliminate dangerous pathogens from some products in the years ahead.

But also key to restaurant food safety, Theno said, is dealing with the issues of food contamination from employees who work while ill or wash their hands improperly or not at all. “We have way too many human illness transmission problems,” he said.

“It’s not a lack of knowledge” that makes food safety elusive for some restaurant operators, “it’s a lack of leadership,” Theno maintained. “Where I have seen leadership really committed and hold people accountable, I have never seen a food safety system that was not well-thought-out and -run.”

CSPI attorney Klein said her organization believes food would be safer if more municipalities required restaurants to prominently post easily understood restaurant inspection results, such as the letter grades issued by Los Angeles County, New York City and North Carolina.

“By and large, consumers have no way of knowing how a restaurant is performing in terms of food safety because restaurant inspections are still largely hidden from public view,” she said. “That’s the sort of thing consumers should be able to see no matter what city they are dining in.”

Russell said that NACCHO, through a cooperative agreement with the FDA, this summer would study whether such postings correlate with improved inspection scores. He added that to help health departments better safeguard the public and more effectively impart best practices to restaurant management and employees, NACCHO, with a funding grant from the FDA, is overseeing an initiative in which health department officials with successful restaurant inspection programs mentor the staffs of other departments.

Meanwhile, the latest edition of the FDA Model Food Code, which is due out this year, recommends that local jurisdictions that follow its guidelines require all restaurants, retailers and foodservice institutions to hire unit-level certified food-protection managers. Both the NRA and National Council of Chain Restaurants have endorsed that idea.

Jack in the Box’s Luscomb explained, “We’re reminded every day of how critical our food safety programs are to the well-being of our guests — whether our restaurant employees are confirming grill temperatures or visually inspecting every beef patty we serve.” 

Contact Alan J. Liddle at [email protected].
Follow him on Twitter: @AJ_NRN.

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