Header graphic for print
Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

Report on Outbreak of Salmonella Enteritidis at Casa Lopez in Athens County, Ohio – May, 2010

Screen shot 2010-10-23 at 6.09.44 PM.pngAthens City County Health Department has released its preliminary report on the Salmonella Enteritidis Outbreak that sickened 56 linked to Casa Lopez Mexican Restaurant. Of those case patients entered into the Ohio Disease Reporting System (ODRS), 47 reside in Athens County, including some with temporary Athens County Residence *83.93%, N=47) , 1 resides in Fairfield County, 1 in Franklin County, 3 in Meigs County, 1 in Morgan County, 1 in Stark County and 2 in Tuscarawas County. 33 of the case patients are females and 23 are male. Ages of case patients ranged from 5 years of age to 82 years of age, with a median age of 33.5 and mean age of 37.6. At least 7 (12.5%, N= 7) of the case patients were known to have been hospitalized due to the illness. Of those hospitalized, 4 were female and 3 were male. Of the case patients hospitalized, their ages ranged from 19 to 82, with a median age of 48 and a mean age of 47.3.

Screen shot 2010-10-23 at 5.59.56 PM.png

Here is my summary of the Summary:

The initial outbreak inspection occurred in the afternoon of May 5, 2010 after a reportedly busy lunch at the restaurant due to Cinco de Mayo celebration. The conditions during the busy lunch rush were speculated to be similar to the conditions at the restaurant during the reported exposure times the weekend before which was Ohio University Mom’s Weekend, contributing to an increase in the number of diners at local restaurants.

The Athens City-County Health Department (ACCHD) conducted the initial inspection of the entire facility on May 5, 2010. Four sanitarians conducted this inspection. Interviews with case patients initially implicated the chiles rellenos. The assistant manager explained their process of preparing the chiles rellenos and voluntarily removed this item from the menu. Critical violations were noted during this inspection and samples of the implicated menu item were taken.

Early in the investigation, a single menu item, chiles rellenos, drew attention as a source of the salmonella infections. This was based on the early case/control interviews and positive Salmonella test results from a leftover meal sample.

The ingredients of the chiles rellenos (along with the prep procedure and storage of the item) were carefully considered as possible sources of the bacterial contamination. A product in common with the Salmonella enteritidis outbreak in North Carolina, packaged pasteurized egg whites, was especially suspect due to the nature of the material (egg white) and the coincidence of the NC outbreak.

Lab test results of prepared chiles rellenos, samples of the unused pasteurized egg product from the local restaurant, the NC restaurant and the manufacturing facility did not support a hypothesis that the Salmonella originated from the pasteurized product.

Opportunities for cross contamination also were observed including improper use of single-use gloves, and the storage of raw animal products above uncovered chiles rellenos. Hot holding and cold holding conditions observed at the restaurant were conducive for the growth of bacteria. Microbiological testing supports the hypothesis of the common food source as well.

Actions taken to protect the public health included:

• Voluntary removal of the suspect menu item during investigation of the outbreak to reduce the risk of others consuming a possibly infectious ingredient;

• Provision of information to the public regarding general food safety measures to reduce the risk of acquiring salmonellosis and other food borne illnesses;

• Provision of education to the person in charge regarding the violations and measures necessary to correct them; and

• Repeat inspections to ensure that the violations were corrected and appropriate standards are being met to continue the food service operation.

Corrective action taken by the Athens City County Health Department was to make hand washing supplies available at all hand wash only sinks at all times, cover food products in storage to prevent contamination, observe date marking system, store raw animal products below or separate from ready to eat products, observe appropriate hot and cold holding, and properly use single-use gloves. Initially, on May 5, food safety booklets in Spanish were distributed to the staff of Casa Lopez and these were immediately read by each staff member. Regular inspections will continue at this food service establishment. Also a Level One Food Safety Training course will be given to the staff. These corrective measures have already been implemented.

Critical violations follow.

HOT HOLDING HAZARD:

• Hot holding shall be 135 degrees Fahrenheit or above. Discard any time/temperature controlled for safety food products which have been between 41-135 degrees Fahrenheit for four hours or more.

o Observed chiles rellenos holding at, 96.7 degrees Fahrenheit.

COLD HOLDING HAZARD:

• Cold holding shall be 41 degrees Fahrenheit or below.

o Observed food products in the walk-in cooler cold holding at between 43.4-49.3 degrees Fahrenheit including chiles rellenos at 46.0 degrees Fahrenheit.

o Observed food products cold holding at 51-53 degrees Fahrenheit in the preparation table.

o Observed food products cold holding at 43 degrees Fahrenheit in the small cold holding table. .

o Observed food products cold holding at 45 degrees in the double door reach in cooler.

CROSS CONTAMINATION HAZARD:

• If used, single-use gloves shall be used for only one task such as working with ready-to-eat food or with raw animal food, used for no other purpose, and discarded when damaged or soiled, or when interruptions occur in the operation.

o Observed food preparation employee wash hands, put on gloves, handle raw steak, and then, with the same gloves, handle ready to eat vegetables, tortillas, and utensils, posing a cross-contamination hazard.

• Raw animal products shall be stored below or separate from ready to eat food products.

o Observed raw animal products being stored above ready to eat food products in the walk-in freezer.

• All food products shall be covered while in storage in order to prevent contamination.

o Observed food products uncovered in storage, including chiles rellenos in walk-in freezer.

• Hand washing supplies must be available at all times at all hand wash sinks.

o Soap was not available at the hand wash only sink located near the bathroom.

DATE MARKING HAZARD:

• All potentially hazardous food products open from the original container and kept over 24 hours must be date marked with the seven day expiration date.

o Did not observe date marking on any food products in storage.

Critical violations were either corrected, food items discarded, or maintenance was scheduled.

The ACCHD conducted follow-up Inspections on May 6, 7, 12, and 17 by at least two sanitarians. During these inspections, more samples of menu items and ingredients were taken for testing and all violations noted were either corrected or food items were discarded.

Critical violations observed on May 6, 2010 follow.

COLD HOLDING HAZARD:

• Cold holding shall be 41 degrees Fahrenheit or below.

o Observed the large prep table holding potentially hazardous food products at 47.1-49.3 degrees Fahrenheit.

o Potentially hazardous foods were holding at 46-47degrees Fahrenheit in the walk in cooler.

Critical violations observed on May 7, 2010 follow.

HOT HOLDING HAZARD:

• Hot holding shall be 135 degrees Fahrenheit or above. Discard any time/temperature controlled for safety food products which have been between 41-135 degrees Fahrenheit for four hours or more.

o The rice mixture was not placed on the steam table and was holding at 127 degrees Fahrenheit.

COLD HOLDING HAZARD:

• Cold holding shall be 41 degrees Fahrenheit or below.

o Cold holding temperatures in the walk in cooler are 48 to 62.3 degrees Fahrenheit in the walk in cooler.

o Double door reach in refrigerator cold holding temperature is also elevated to 42.5 degrees Fahrenheit.

o Double refrigerator temperature was not holding cold enough with temperature of milk at 43 degrees Fahrenheit.

CROSS CONTAMINATION HAZARD:

• Hand washing supplies must be available at all times at all hand wash sinks.

o No towels were found in the employees restroom sink.

On May 12, 2010, critical violations were as follows.

COLD HOLDING HAZARD:

• Cold holding shall be 41 degrees Fahrenheit or below.

o Double refrigerator temperature was not holding cold enough with temperature of milk at 43 degrees Fahrenheit.

  • Roy Costa

    A clear example of obvious and gross food safety deficiencies that were overlooked. All were easily avoidable if someone was paying attention. Its almost ludicrous to comment on this. Ohio does not have mandatory food manger training, and has just implemented employee level (level 1). Untrained workers over their heads with production for a larger then normal event can be disasterous.
    “Mexican style” has gone on my list of most-risky, along with buffet food and catered food.
    Now, if you want to see something explosive, have a big catered event, go Mexican-style, use a place that has no trained employees and no trained managers, and serve it buffet style. Then watch the fireworks.