On the evening of Friday, September 19, 2014 Diane Norman bought pizzas at Domino’s Pizza located at 2800 Milton Way in Milton, Washington.  She took the pizzas home for her family to consume. Michael Norman chose two slices of Canadian bacon and pineapple pizza and took a bite of one slice.  He swallowed and immediately felt something sharp in his throat.  He started to choke and dashed to the sink to drink water to help clear his throat. At this point he felt a sharp tearing at his throat and drank a glass of cranberry juice. His throat felt scratched and to relieve his pain he ate a slice of bread.  Although this action eliminated the feeling that food was lodged in his throat, Michael felt a dull pain in his stomach. Since he was no longer felt hungry, he did not eat any more pizza. Diane Norman froze the remaining leftover pizza. Sometime later she examined the frozen pizza slices and found a wire in a piece of the pizza she had saved.

Over the next few days Michael continued to feel a dull pain in his abdomen.  His doctor ordered x-rays which showed two metallic objects inside his abdomen.  A CT scan revealed that one of the metal objects had punctured his small intestines. After a failed attempt to remove the metal objects via endoscopy, Michael was rushed into surgery on September 27. It was then that surgeons removed two wires from Michael Norman’s intestines.

On September 30 Michael Norman filed a complaint with the Tacoma Pierce County Health Department.  In response to his complaint, TPCHD environmental health specialist, Christina Sherman, conducted an on-site investigation at the Domino’s in Milton.  Ms. Sherman reviewed the pizza making process with Domino’s employee, James Tyler. She noted that a wire brush was used to clean a wire rack inside the oven at the end of each day. Ms. Sherman also observed wear on some of the brush bristles. This wear was evident in photos of the brush taken by Ms. Sherman.

On October 8 Michael Johnson at TPCHD conducted a second on-site visit to Domino’s.  Mr. Johnson wrote in the inspection report:

“Observed a wire brush with food debris between the wires. Wires on the brush were bent and pointing in different directions and did not maintain its original design. Employee stated they had another brush that was used to clean the oven but was discarded last week. Person in charge stated the outside of the oven is cleaned every night and the inside of the oven is cleaned once a month using the brush.”

Ms. Johnson advised, “[E]quipment and utensils must be designed and construction to be durable and to retain their characteristic qualities under normal use conditions.”

The wire brush was discarded.

Of note is that other food safety violations were noted at Domino’s including inadequate handwashing facilities, improper cold holding and use of stem thermometers instead of digital thermometers.[1]

The facts of this case clearly link injuries experienced by Michael Norman to Domino’s pizza he consumed on September 19. Immediately after taking a bite of pizza he felt a sharp pain in his throat and started choking.  After experiencing several days of stomach pain x-rays were taken of his abdomen and revealed two metal wires in his intestines. Doctors performed emergency surgery and removed the wires.  Diane Norman found a metal wire in pizza leftover from the September 19 meal. Domino’s Pizza staff described how metal wire brushes were used to clean the pizza oven and public health investigators observed that wires on the brush at the Domino’s Pizza in Milton were bent.  A Tacoma Pierce County Health Department investigator took photos of the wire brush. These photos show obvious wear and tear of the brush.

Internal injuries from ingestion of wire grill-cleaning bristles are well documented. In a single hospital system 12 patients with injuries due to ingestion of wire bristles were reported between July 2009 and June 2012. The severity of injury ranged from puncture of the soft tissues of the neck, causing severe pain on swallowing, to perforation of the gastrointestinal tract requiring emergency surgery. (REF: Grand DJ, Egglin TK, Mayo-Smith WW. et al. Injuries from ingesting wire bristles dislodged from grill-cleaning brushes – Providence, Rhode Island, 2009-2012. J. Safety Res. 2012 Dec. 43(5-6):413-5.)  The Centers for Disease Control and Prevention (CDC) recommends actions to prevent these injuries by increasing awareness among consumers, manufacturers, retailers, and medical professionals to promote prevention, timely diagnosis and appropriate treatment. In an editorial published in the Morbidity and Mortality Weekly Report (MMWR), the agency suggests that awareness by manufacturers and retailers of the risk of ingesting wire bristles might encourage alteration of current products or development of safer ones. The CDC recommends those in the food services industry to “examine whether their patrons are at risk for this injury” and advises the “use of alternative grill-cleaning methods or products.”  (REF: Centers for Disease Control and Prevention, Injuries from ingestion of wire bristles from grill-cleaning brushes – Providence, Rhode Island, March 2011-June 2012. MMWR Morb Mortal Wkly Rep 2012 Jul 6;61(26):490-492.)