National Voluntary Environmental Assessment
Information System
(NVEAIS)
David Nicholas, MPH
New York State Department of Health
Bureau of Community Environmental Health and Food Protection
David.nicholas@health.ny.gov
Original Presenters:
Carol Selman, MPH
Team Lead, Food Safety Team, Environmental Health Services Branch, Division of
Emergency and Environmental Health Services, NCEH
Kristin Delea, MPH, REHS
Health Scientist/Epidemiologist
National Center for Environmental Health
Environmental Health Services Branch
Overview

Background
 EHS-Net
 NVEAIS

Environmental Assessments: A systems approach to
foodborne illness outbreak investigations
 Systems Theory
 Contributing Factors
 Environmental Antecedents

NVEAIS – Data Collection
 Information the data can provide
 How can we use the data

Training/ E-learning
BACKGROUND
Environmental Health Specialist Network


EHS-Net (pronounced S-Net) is a collaborative forum of
environmental health specialists whose mission is to improve
environmental health practice.
These specialists collaborate with epidemiologists and
laboratorians to identify and prevent environmental factors
contributing to foodborne and waterborne illness outbreaks.
EHS-Net Background

Environmental Health Specialists Network
 Collaboration between:
• US Centers for Disease Control and Prevention
o National Center for Environmental Health
o Environmental Health Services Branch
• US Food and Drug Administration
o Center for Food Safety and Applied Nutrition
• US Department of Agriculture
• 8 sites
o California, Cerro Gordo Iowa, Minnesota, New York, New
York City, Rhode Island, San Mateo California and Tennessee
EHS-Net Background




EHS-Net work is based on a system theory.
EHS-Net assists state health departments in their efforts to
improve the practice of environmental health service programs.
EHS-Net conducts environmental assessments to determine why
an agent was present in the environment in such a way that the
host could be exposed.
EHS-Net works to
 Identify environmental antecedents (underlying factors) to illness
and disease outbreaks.
 Translate findings into improved prevention efforts using a systemsbased approach.
 Offer training opportunities to current and future environmental
health specialists.
 Strengthen collaboration among epidemiology, laboratory, and
environmental health programs.
NVEAIS Background

EHS-Net Foodborne Outbreak Study
 Objective: To identify contributing factors to foodborne illness
outbreaks in food-service facilities and to describe the characteristics,
policies and practices of those facilities.

What we learned
 No consensus on what a foodborne illness environmental assessment
was
 No standard methodology for conducting foodborne outbreak
environmental assessments
 Need for training on how to conduct a foodborne outbreak
environmental assessment using a systems approach
The Need to Improve Reporting of Environmental
Factors to Foodborne Illness Outbreaks

Environmental factor data are key to




To improve hazard surveillance .
To inform foodborne disease prevention policies
Understanding how and why outbreaks occur.
Preventing future outbreaks.

Limited environmental factor data are currently
reported to CDC’s existing National Outbreak
Reporting System (NORS).

Inspectors (environmental health specialists) need
training on collecting environmental factor data during
outbreak investigations.
8
The Need to Improve Reporting of Environmental
Factors to Foodborne Illness Outbreaks
Environmental factors
Contributing
factors
• Factors that caused the
outbreak
• How the outbreak
occurred
Environmental
antecedents
• Circumstances that led
to the contributing
factors
• Why the outbreak
occurred
9
The Need to Improve Reporting of Environmental
Factors to Foodborne Illness Outbreaks
Environmental
antecedents
• Worker in a
hurry
• Worker had not
been trained
on avoiding
cross
contamination
Contributing
factor
• Cross
contamination
• Worker used
same utensils
on raw ground
beef and salads
Outbreaks
• E. Coli
• Outbreak
caused by
salads eaten at
Restaurant A
NCEH/EEHS Activities to Improve Reporting of
Environmental Factors to Foodborne Illness Outbreaks

Developed
 National Voluntary Environmental
Assessment Information System (NVEAIS)
 e-Learning on Environmental Assessment of
Foodborne Illness Outbreaks


Launched in April 2014
Purpose
 NVEAIS: Discover environmental factors that
cause foodborne outbreaks to prevent next
one
 e-Learning: Improve competency in collecting
environmental factor data during foodborne
outbreak investigations
http://www.cdc.gov/nceh/ehs/NVEAIS/index.htm; http://www.cdc.gov/nceh/ehs/elearn/ea_fio/
NVEAIS Purpose

Identify factors that can be routinely monitored by
food control authorities to prevent or reduce the risk of
foodborne outbreaks
 Characterize food vehicles and monitor trends
 Identify and monitor contributing factors and environmental
antecedents
 Hypothesis generation
 Guide planning, implementation and evaluation of food safety
programs
Improving Surviellance
NATIONAL VOLUNTARY
ENVIRONMENTAL ASSESSMENT
INFORMAITON SYSTEM
Definition

Environmental Assessment
 The component of an outbreak investigation that fully
describes how the environment contributed to the
introduction and or transmission of agents that cause
illness. Environment is everything external to the host,
including air, food, water, animals, plants, climate, etc as
well as people, social and built environments.
• All aspects of the external environment can be listed as
variables that, in relation to transmission, are neutral,
conducive or protective.
• From this description contributing factors and
environmental antecedents to an outbreak can be
determined.
 NOT an inspection
Foodborne Outbreak Environmental Assessment




Conducted as part of the foodborne illness outbreak
team
A reconstruction of past events in the context of the
outbreak investigation
Taking a systems approach
Inputs - Are the items which feed into the
system

Process - Are the steps and methods to which
the inputs are subjected

Internal System Variables - Are the
factors that exert positive, negative and neutral
influences on all other aspects of the system


Outputs - The immediate results of the system
Outcomes -What happens as a result of the
outputs

External Feedback to System
Contributing Factor Definition

The factors likely to be conducive to the contamination
and survival of the etiologic agent or suspected agent
and/or to its growth or proliferation.
 Contamination Factors
• Toxic substance part of the tissue , Contaminated raw product, Crosscontamination of ingredients, Bare-hand contact by a food
handler/worker/preparer who is suspected to be infectious
 Proliferation Factors
• Improper cold holding due to malfunctioning refrigeration equipment,
Improper hot holding due to improper procedure or protocol, Prolonged
cold storage
 Survival Factors
• Insufficient time and/or temperature during cooking/heat processing,
Insufficient time and/or temperature during reheating

Contributing factors are NOT food code violations
Environmental Antecedents Definition

Root causes

Supporting factor(s) to the contamination, survival or
increase of biological or chemical agents in food

They may be related to







People
Equipment
Process
Food
Economics
Behavior
Other circumstances
Environmental Antecedents
Environmental Antecedents Related
to Food System Variables
People
Food
• Location of hand wash
sinks
Equipment
• Availability of supplies for
hand wash sinks
• TrainingProcesses
• Supervision
• Water available for hand
wash sinks
• Availability of a supply of
gloves
Economics
Environmental Antecedents Related
to Food System Variables
Equipment
People
•
•
•
•
•
•
Design
Construction
Cleanability
Maintenance
Food
Placement
Installation
Processes
Economics
Environmental Antecedents Related
to Food System Variables
Equipment
•
•
•
Handling after kill step
People
No kill step where kill
step is required
Multiple- step
processes
Food
Processes
Economics
Environmental Antecedents Related
to Food System Variables
Equipment
•
•
•
•
People
Food
Source
pH Processes
Water activity (Aw)
Viscosity
Economics
Environmental Antecedents Related
to Food System Variables
Equipment
• Shifting food trends
• Profit margins
People
• Operational costs such
as
• Cost of food
• Cost of equipment
• Cost of facilities
Food
• Cost of staffing and
training
Processes
Economics
The Food Establishment System
Customer
Health
Ingredients
Organisms
Receive
Chemicals
Final Food
Item
Serve
Customer
Satisfaction
Profit
Store
Internal System Variables
People
Assemble
Processes
Equipment
External Feedback to System
Prep
Hold
Food
Economics
Cook
Reheat
Cool
Example

Thorough understanding of
the problem
 On the ground assessment by
Environmental Health
Specialist or Environmental
Engineer

Identification of underlying
causes of problems (not
just symptoms)
 Contributing Factors
 Environmental Antecedents
DATA COLLECTION
Data Collection

Data collection for FBIO environmental assessments
 Standardized data collection instrument to report information FBIO
environmental assessments
 Validated questions
 Identifying contributing factors
 Understanding how selected environmental antecedents are related
to contributing factors, vehicles, and agents

Is not a form or template for conducting a FBIO
environmental assessment
Data Collection Tool

Part I
General Characterization of Outbreak

Part II
Establishment Description

Part III
Manager Interview

Part IV
Establishment – Observation

Part V
Food Vehicle

Part VI
Sampling

Part VII
Contributing Factors (CF)

Part VIII
National Outbreak Reporting System (NORS)
INFORMATION THE DATA CAN
PROVIDE
Food Processing

Characterization of the establishment (Part II)
 81.6 % Complex
 15.6 % Cook / Serve
 2.9 % Prep / Serve

Characterization of suspect food preparation (Part V)
 25.3 % Complex
 27.2 % Cook / Serve
 47.5 % Prep / Serve

31.2% served raw or undercooked animal products
(Part I)
 Of these, 61% did not have a customer advisory
Part – III Establishment Characteristics

Facilities
 91% restaurants
• Independent
68%
 Median meals/day 240
 Busiest on weekends
 In 50% food handler to kitchen manager ratio ≤ 4:1
Part III- Busiest Day
UNSURE / MONDAY TUESDAY
WEDNESDAY
MISSING
SUNDAY
THURSDAY
SATURDAY
FRIDAY
Disposable Gloves
Yes
No
Glove Policy*
193 (79.1)
48 (19.7)
3 (1.2)
Glove Supply**
198 (81.1)
41 (16.8)
5 (0.4)
Glove Use**
159 (65.2)
72 (29.5)
13 (5.3)
*Part III
**Part IV
Missing
Part V- Suspected Food Vehicles in
Foodborne Disease Outbreaks
TRAINING
The Need for Training

In 2001 Selman and Green surveyed local and state
Environmental Health Specialists (EHS) and found
 EHS focus on pathogens during outbreaks instead of contributing
factors and their environmental antecedents
 A lack of communication between epidemiologist and EHS was found
to be a barrier to EHS active engagement in foodborne illness
outbreak environmental assessments
 Local EHS staff require training because they are not involved in
outbreaks often enough to attain competency in environmental
assessments
 EHS were in need of a basic training in how to conduct foodborne
illness outbreak environmental assessments
Selman, CA and Green, LR (2001). Environmental health specialists’ self-reported foodborne illness outbreak
investigation practices. Journal of Environmental Health, 20(6),16-21.
Using Environmental Assessments to
Investigate Illness Outbreaks

Environmental Health Specialists are accustomed to
look for violation of regulations
 not contributing factors and their environmental antecedents
 Performing an environmental assessment (EA) requires a different
mindset than other environmental food safety activities

No two outbreaks are alike
 No single ‘checklist’ applies to all environmental assessments


Conducting an EA requires a complex set of knowledge
and skills including the ability to apply ‘critical
thinking’
Training must promote development of competency in
the field and not just the acquisition of knowledge
Goal of this Training Effort

Use cutting-edge e-learning technologies to develop
competency with Foodborne Illness Outbreak
Environmental Assessments and deliver training free of
charge over the Internet to enhance global food safety
Incorporation of ‘Gaming’

Each virtual learning experience scenarios is framed as
a forensic investigation mystery of an outbreak

Participants decide




Who to interview
What topics to interview about
Which actions to take
What observations to perform and samples to collect

At end, learners must identify contributing factors and
environmental antecedents

Actions and conclusions are tracked and evaluated

Learners receive individual feedback on results
Accompany the Worker
The Cognitive Domain

Involves knowledge and the development of
intellectual skills

Includes 6 categories of behavior
 Knowledge (recall data or information)
 Comprehension (understanding the meaning)
 Application (use a concept in a new situation)
 Analysis (separate materials into component parts)
 Synthesis (build a pattern from diverse elements)
 Evaluation (make judgments)
Analysis of Learner Performance

Learner receives individualized feedback on:
 Interview effectiveness
• Did the learner choose the correct questions?
 Interview efficiency
• Did the learner choose the questions in the correct order?
 Observational skills
• Did the learner find all the important embedded clues in the
environment?
 Critical thinking
• Did the learner correctly identify contributing factors and environmental
antecedents
E-Learning on Environmental Assessments of Foodborne Illness Outbreaks
VIRTUAL WORLD TRAINING
Promotional Video

https://www.youtube.com/watch?v=77w9aVeROiA&ind
ex=1&list=PLvrp9iOILTQaRWTguYiBvPlVB7R-88Wbq
PARTICIPATING IN THE TRAINING
Information

www.cdc.gov/nceh/ehs
 Provides information about e-Learning on
Environmental Assessments of Foodborne Illness
Outbreaks and NVEAIS
 Registration information
 Complete the registration
 Take the pre-test
Important Websites
•
More information on CDC EHS-Net:
– http://www.cdc.gov/nceh/ehs/EHSNet/
•
Information on National Voluntary Environmental Assessment Information System
(NVEAIS):
– http://www.cdc.gov/nceh/ehs/NVEAIS/index.htm
•
Additional information on e-Learning:
– http://www.cdc.gov/nceh/ehs/eLearn/EA_FIO/index.htm
•
Register for the e-Learning course at:
– https://ehseleafio.cdc.gov/
•
National Outbreak Reporting System (NORS) Guidance:
– http://www.cdc.gov/nors/pdf/NORS_Guidance_20130219_508c.pdf
•
National Outbreak Reporting System (NORS) Form:
– http://www.cdc.gov/nors/pdf/NORS_CDC_5213.pdf
Acknowledgements
• Centers for Disease Control and Prevention
–
–
–
–
Carol Selman
Kristin Delea
Erik Coleman
Laura Brown
• EHS-Net Site Partners
• Local Health Departments
Thank You!
Questions
David C. Nicholas, MPH
NYSDOH BCEHFP
Ph:518-402-7600
Email: David.nicholas@health.ny.gov
The findings and conclusions in this report are those of the authors and do not necessarily
represent the views of the Centers for Disease Control and Prevention (CDC).