A theme that has been consistent throughout our department in regard to Food Safety is that We're all in this together.” That spirit is the piece of the puzzle that has made the Employee Health Achievers campaign such a success. The desire for the district's Food Safety program to go to another level required the dedication and support of staff in various facets of CDPH including not only Environmental Health, Administration, Epidemiology and the Health Director's office. The health district is voluntarily enrolled in the FDA Voluntary National Retail Food Regulatory Program Standards. In order to meet the requirements of Program Standard 9, the district conducted a Risk Factor Study of our food service establishments. Along with assessing specific risk factors for foodborne illness specified by the FDA, the following Employee Health related elements were also specified by the FDA for assessment:
1. Food employees exhibiting certain illness symptoms or conditions that require exclusion or restriction in the Food Code, ARE OBSERVED within the establishment during the data collection.
2. Are food employees and conditional employees informed of their responsibility to report to the person-in-charge illness SYMPTOMS as specified in Section 2201.11 of the Food Code?
3. Are food employees and conditional employees informed of their responsibility to report to the person-in-charge diagnosis with, or exposure to, the specific ILLNESSES specified in Section 2-201.11 of the Food Code?
4. Is management aware of its responsibility to NOTIFY THE REGULATORY AUTHORITY when a food employee is jaundiced or diagnosed with an illness due to a pathogen specified in Section 2-201.11 of the Food Code?
5. Is the management & employee health policy consistent with 2-201.12 of the Food Code for EXCLUDING AND RESTRICTING food employees and conditional employees on the basis of their health and activities as they relate to diseases that are transmitted through foods?
6. Is the management & employee health policy consistent with 2-201.13 of the Food Code for REMOVAL OF EXCLUSIONS AND RESTRICTIONS of food employees and conditional employees on the basis of their health and activities as they relate to diseases that are transmitted through foods?
7. Management has a copy of FDA Employee Health and Personal Hygiene Handbook OR cd database?
The results of the study were entered into a web-based system called FoodSHIELD. FoodSHIELD is a shared system by the nation's public health and food regulatory officials for communication, coordination, education, and training in the food and agriculture sectors. This secure system allows the local, state, and federal levels across the nation to work together. Experience as to what does and doesn't work well regarding various areas of food safety can be shared through the site and analysis of the data entered showed that over one-third of the facilities [which were randomly selected via a statistical program provided by FDA] were not in compliance with 6 out of the 7 elements listed above. Hence, the Employee Health Achievers (EHA) program evolved as an intervention strategy to improve compliance and reduce the possibility of non-compliance with Employee Health requirements being a contributor to cases of foodborne illness in the district.
Marketing of the EHA program involved persons in various parts of our community, industry and regulatory network. The program was introduced to local food service operators via: (1) emails that were sent to food service facilities within the health district; (2) district Environmental Health Specialists during routine field visits; (3) the CDPH Food Safety blog; (4) an email from our industry partners at the Georgia Restaurant Association; (5) in-person presentations to the Nutrition Services Department staff of the local school districts; and (6) the CDPH Food Safety Partnership Panel video presentation entitled The Risk Factor Challenge. The program has, also, been presented to (7) the Georgia public health districts via the 2018 District Food Standards Conference and (8) during the Fall 2019 meeting of the Georgia Food Safety Task Force. These elements will be highlighted below.
(1) Emails that were sent to food service facilities within the health district-- An email that summarized the results of the Risk Factor Study and the commencement of the Employee Health Achievers recognition program was sent out in September 2018 to district food service facilities which included a link to the Food Safety Partnership panel video on the topic and links to the STOP Alert placards, Employee Health RED Books link, link to Food Safety blog post regarding the campaign, and the online Employee Health Achievers quiz link. Additional emails (along with an EHA overview that was mailed with our annual service fee invoices) were sent out to provide status updates and EHA program availability information.
(2) District Environmental Health Specialists during routine field visits—Using the district designed STOP Alert placards, the Environmental Health Specialists, during routine inspections, walked the persons-in-charge through a review of the five necessary components of a compliant Employee Health policy (which are noted on the back side of the placard), and introduced them to the online tools that would prepare them to take the Employee Health Achievers quiz. A hard copy of the Employee Health RED Book was also issued to operators that did not already have the book or the online link. Depending on the predominant language spoken at the facility, a copy in Spanish was made available or a link to the CDPH website provided to access the information in other languages.
(3) The CDPH Food Safety blog—For approximately five years, the CDPH Center for Environmental Health has provided a Food Safety blog that has over 1000 followers. A post introducing the Employee Health Achievers campaign was made at its commencement and periodically posts have been used to highlight the EHA campaign's progress and to introduce it to new managers and followers of the blog. Since the blog is accessed by not only food service operators but by consumers and regulatory officials as well, it has served as a good way to keep each group informed.
(4) Presentations to the Nutrition Services Department staff of the local school districts—A presentation was given to the Cobb County Schools Nutrition Services staff and to the Marietta City Schools Nutrition Services staff. The Cobb County Schools system is one of the largest school systems in the state of Georgia and the majority of their schools have been listed on our website as having achieved the designation of Employee Health Achievers. The EHA program has been highly supported by the leadership of the Cobb County Schools Nutrition Services department.
(5) An email from our industry partners at the Georgia Restaurant Association-- After receiving a presentation on the EHA campaign, the Georgia Restaurant Association sent out a blast email to its members as well as other food service facility owners (which included many restaurant chain operators) that they had in their database for the Cobb and Douglas area to advertise the opportunity to participate and gain recognition for this achievement.
(6) CDPH Food Safety Partnership Panel video presentation entitled The Risk Factor Challenge—The Food Safety Partnership Panel videos enhance food safety practices beyond regulatory requirements and strengthens our partnership with the food service industry and community. Each episode's panel consists of 4 panelists [one or more representatives from the food service industry, a consumer that resides within the community, and an Environmental Health manager, who serves as the host]. Any person in Cobb or Douglas that falls into the category of a food service operator, regulator, or consumer may be considered for panel participation. This particular video emphasized the need to improve upon the results observed during the Risk Factor Study via the implementation of intervention strategies with an added emphasis on Employee Health and the EHA campaign.
(7) The Georgia public health districts via the 2018 District Food Standards Conference- The CDPH Center for Environmental Health was asked to provide a presentation on the Fisk Factor Study and Employee Health Achievers program at the 2018 District Food Standards Conference so that all of the district Food Program Standards from across the state of Georgia could understand the program components and take the information back to their respective districts and use it as they desire.
(8) Presentation during the Fall 2019 meeting of the Georgia Food Safety Task Force. The Georgia Food Safety Task Force is comprised of representatives from not only district level Food Safety officials but those from the State and Federal levels, including Epidemiologists, Environmentalists, State Laboratory representatives, USDA and FDA field representatives, and consultants, along with academia, food service industry representatives and consumer representatives. The presentation at the task force meeting was how the Georgia Restaurant Association was officially introduced to the EHA campaign.
Regarding challenges, the biggest challenges have been the initial determination of how much information needed to be tracked per project participant, how often to track it, and how much time was needed to monitor and send out the certificates and other means of recognition. However, after the first couple of months, it was determined that updates to the website and certificates would only occur once a month. To help ensure that operators in all areas of the Cobb & Douglas community were being informed in person about the project, the field inspectors maintained a log of facilities that they introduced to the campaign within their district. Another challenge that has occurred during this period has been a larger turn over in food inspection staff and the amount of food service management turnover. The good thing regarding the training experience in this area for new staff is that the protocol for Employee Health Achievers introduction has become a part of the protocol for routine inspections which is made simple by use of the STOP Alert placards that provide a quick summary. The end result has made the efforts worthwhile.
After exposure to the program, EHA Learners will be able to:
1) understand and demonstrate how having specific protocols and controls in place can minimize the potential for food workers to work while sick and reduce the potential of a foodborne illness outbreak.
2) understand the importance of timely communication with the health authority and that the health authority is a resource when developing an effective employee health compliance program.
3) access and use additional resources available to assist with employee health compliance and outbreak prevention and response
4) respond effectively to Employee Health related information provided by food workers.
Recipients of the information provided during the EHA campaign benefit even if they don't commit to taking the quiz due to the way the requirements for Employee Health compliance is simplified.
No capital costs were incurred while developing or implementing the Partnership Panel video introducing the program. Douglas Communications does not charge the department for the filming nor editing of the Partnership panel videos. They also host them on their local channel and allow them to be freely shared with Cobb County's Communication Department for airing. The panel video containing the EHA overview is also available on the CDPH website upon demand. In addition, the AFDO small projects grant that funded the production of the hard copies of the Employee Health RED Books-- as well as the special paper for printing the certificates and STOP Alert placards-- is competitively available to local health departments across the US that have enrolled in the FDA Retail Food Program Standards.