Don't Eat Poop! A Food Safety Podcast

DEP E91
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Carolyn White: FDA and CDC have partnered to really look at norovirus. Norovirus has been targeted by healthy people 2030 is as one of the things we're trying to reduce, particularly when we see ill workers working in food establishments, right? That's been a big concern. Norovirus, it's a nasty bug. It spreads quickly.

Those, basically, your vomitous particles. can spread several feet. And it's not just ill food workers, but there's also that concern if we have a guest in the dining room who throws up. What's the policy and practice for that? How do we clean that up? It's not as simple as just throwing a little soap on it and calling it good, because now we've spread vomitous particles throughout the establishment, which increases the risk of your servers, your other guests also becoming ill.

And we've seen outbreaks where that's happened, where An ill guest vomits at one area of the restaurant, vomits throughout, their way outside the door. Other guests and employees of the establishment end up becoming ill. Which is why part of that model food code where we look at, do you have a policy on cleanup of vomiting and diarrheal incidents?

So whether it's an employee or a guest. Are we prepared with the knowledge and ability to clean up even that mess?

intro: Everybody's got to eat and nobody likes getting sick. That's why heroes toil in the shadows, keeping your food safe at all points, from the supply chain to the point of sale. Join industry veterans Francine L. Shaw and Matt Ragucci for a deep dive into food safety. It all boils down to one golden rule.

Don't. Eat poop. Don't eat poop.

Matt Regusci: Hello. Hello, Francine. We are at the Illinois Environmental Health Association conference. I finally got that right. You did.

Francine L Shaw: Last one of the second day and you finally got it right.

Matt Regusci: Yes. Yes. And it's the FDA conference and it's going very well. A lot of amazing speaker, great attendees.

And we are here with Carolyn White. So Carolyn, can you please introduce yourself and talk about what is it that you do and uh, how long you've been doing it? What are you doing here at this conference?

Carolyn White: Sure. So, as you said, my name is Carolyn White.

I'm a retail food specialist with FDA, currently in our Office of State and Cooperative Programs.

What does that mean? So, essentially, I am a liaison. I work with our state, local, tribal, and territorial health departments. And I provide technical assistance. I provide training. Anything related to a retail food program operating robustly, I let them know, I'm your girl. So, I work primarily with the states of Illinois, Indiana, and North Carolina.

There are 22 retail food specialists across the country, so we're each assigned a set number of states. That's the broad scale view of what we do.

Matt Regusci: Awesome. This is very interesting. You want to tell them what states do you cover?

Carolyn White: Yes, so I cover Illinois, Indiana, and North Carolina.

Matt Regusci: Illinois, Indiana, and North Carolina, because those are all very close to each other.

And you live where?

Carolyn White: I am based out of Kansas City, Missouri.

Matt Regusci: No rhyme or reason to this, I'm guessing, or is there a rhyme or reason?

Carolyn White: We do try. So we tend to have specialists semi close to their home base, but it doesn't always work out that way. So I know we've got two specialists based out of the Kansas City region.

So the other specialist who is in my area has Missouri and Kansas. So since those are already taken, I got to have the beautiful states of Illinois and Indiana. And I recently added North Carolina after a wonderful colleague retired.

Matt Regusci: Nice, got it. And so how long have you been working with the FDA?

Carolyn White: So I've been working with the FDA just over four years.

Matt Regusci: Perfect. And what were you doing before that?

Carolyn White: Before that, I worked at a large local health department. I started as an inspector, so started my career technically as an intern, then worked my way up and before I left, I was the training and grants manager and that was for the entire environmental public health program.

So not only focusing on food. That program handled everything from hotel inspections, child care, septic haulers, food trucks, noise, smoking ordinances, general EH, uh, and hopefully, uh, every once in a while a hoarding complaint, so we stayed busy.

Matt Regusci: Wow, okay. You are a reference, a resource, for the states that you cover for the FDA, so Illinois, Indiana, North Carolina.

But you're not just a resource, you've been there. So when people are calling you and asking you questions from the different state departments, you can kind of put your health inspector hat on and know what they're going through and provide the appropriate amount of advice. Is that kind of what you do?

Carolyn White: Absolutely. I think that's one of the strengths that a lot of our team has, is we've worked in these jobs, we've been at the local level. Many of our folks have been at the state level.

So having that perspective and coming in into this role and saying, yes, I can tell you what the food code says. And I can also tell you what this looks like in practicality, like where we've seen this in real life, how I might've handled it at a previous jurisdiction, right?

So there's that twofold. You get the science and you also get the real life experience. I think that helps.

Francine L Shaw: 100 percent it helps when you know what it's like to have been there and then to be able to relate. It makes you more relatable.

Carolyn White: That's good. That's what we want. Again, we want our folks to, to see us as that resource, right?

We want to be approachable. We tell our states, right? We tell our health departments, reach out, call, email. We're available to you, kind of work for you, right? So that's the beauty of the role that we're in. And it's a very niche part of the agency. That's a really exciting role.

Matt Regusci: So when you're looking at, we're having the conversation about different states, different counties, different municipalities.

Having different rules around what they are being expected to do, regulations at which they're expected to do based upon where they are, or do you have to then put that hat on and start looking at how do you answer the question based upon what codes, what regulations they're under?

Carolyn White: So we do take that into consideration when we're giving technical assistance.

Most of the time we're looking at the current model food code because that is that based on the most current. science, the most current practices. We do have states that vary in their codes and we have those conversations of what does that look like with what the model code says versus what you maybe can enforce based on your rules and regulations.

So we do have to have those conversations.

Matt Regusci: Very cool. What's the day in life look like for you?

Carolyn White: Oh, it could be so varied. So for example, this week I'm here in lovely Chicago after spending the last year or so planning this seminar with my Illinois team. Next week I'll be in North Carolina for a meeting on retail program standards, followed by some restandardization field work with one of our locals.

And then the week after that we'll be in a different location for a workshop. We also teach and train local, regionalized and national workshops on a number of topics. So, it could be traveling throughout the week. I might be at home answering technical assistance questions, just depends on the date.

It's very varied, and it really depends on what my stakeholders need, which is always exciting.

Francine L Shaw: You know the food code probably, frontward, backward, upside down, I would imagine. If not, you've got, you can look at it, you know where to find it in the food code. So I know that very well. If I don't know the answer, I know where to find it in the food code.

Something that a lot of people aren't familiar with, and I realized this, I was working on a project a number of years ago. For a very large, well known company. And we're going through this and we're looking at it and they're like, to do what we have to do, we have to rewrite everything we've been given because they didn't take the annex into consideration, like in the back of the food code.

I think a lot of people don't know that that's important or that exists. Do you get into that frequently?

Carolyn White: So it's one of those fun things where, so the model food code itself is written in that statutory language that is easily adoptable by our state, local, tribal, and territorial jurisdictions. The annexes gives that background information, the public health reasons, it's the why.

Right? So the code gives the what, the annexes get into the why, the science, the reasons behind why we need to keep cold food at 41 or below, right? They're talking about preventing growth of pathogens and also gives a lot of model forms, a lot of guides. There's a ton of resources in the annexes. So it's not just the why, but it also gives some templates on the how to, which can also be beneficial not just for our regulatory partners, but for our industry partners.

Francine L Shaw: Yeah. Thank you. Because I'm thinking we just talked a lot about the food code, but the annex is something people don't talk about a lot. And I really think that sometimes in retail, I think a lot of people just, Oh, we just need to Last time I looked, the food code was like 800 and something pages long. I don't know how many pages there are right now.

Carolyn White: It's pretty hefty.

Francine L Shaw: Yeah. Yeah. Yeah. They think it's just extra pages and it's just not a lot of substance or importance there.

Carolyn White: It absolutely is.

And that's something we, we talk about with our SLTT partners. I say SLTT, it's State, Local, Tribal, and Territorial. Is that when we're having conversations during inspections in the field with our operators, right?

You have to give folks the why. I can tell you all day what I need you to do, but that doesn't mean we're going to have an operator buy into what we're saying. But if I can give you the why, if I can explain why I need you to have this in a certain way, why I need these temperatures to be controlled, why we don't want to have garlic and oil that we've made in house sitting at room temperature, because we'll create botulism and we'll kill somebody.

And sometimes we really need to just get into the why to get that buy in, right? And then we mentioned the other resources.

So, the guides. This week we've talked a lot about employee health policy and preventing workers from working when they're ill. We have some model guides and forms that you can use as a starting point, that's our industry folks, that's our regulatory folks, to implement some of these things to start having that conversation to help build out those policies, which you One, gets us a starting point.

Two, they're free. We all like free stuff. And three, creates this opportunity for that uniformity and, and consistency across the board. Because that's one of our national goals is uniformity and consistency in the inspectional approach even when we have different food code adoption practices throughout the country.

I'll also note that uniform adoption of the most current model food code, it's one of our national strategies. That's something that we are striving for. We work with our states and our locals to try to encourage that food code adoption process.

Francine L Shaw: And a couple of things. I talk all the time about there's a difference between training and education.

They're two different things. Education is the why. Training is showing how, education is explaining why. And that's so important. I was talking to somebody yesterday morning, I was waiting to get coffee and I was speaking to somebody that was waiting behind me about that very thing. So it's so important.

That's a great thing that you do, and it's so important that people understand that.

Another thing is that people don't understand that some of those forms exist, and there's a lot of, the corporations have these forms. They write the policies, they write the procedures, and they give them to their, to operations.

They have them in place. I just wrote an article, I think it was for QA Magazine, in that I was talking about the employees not working when they're sick, that portion of knowing when employees shouldn't be at work. And if you don't know where to start the FDA food code. You guys have the, it's the FDA form, is it one, there's like A, B, and C or something I believe.

I have to look it up now. I used to know it like the back of my hand, but I'm not that involved in the day to day of this at this point. You're familiar with what I'm talking about.

Carolyn White: I am. Yes.

We do have some model forms related to employee health policy, the reporting agreements, something we also have launched this year and we're incredibly proud of it.

It's the employee health policy tool. And what that does is it is a PDF based application that can be used by either our regulators or our industry partners. And it has really taken, it's put an app form and it breaks down the exclusions and restrictions of chapter two of the food code, which is incredibly lengthy, has a lot of pieces to it.

So it really allows you to click through and go, if my employee comes to me as an operator, if I'm a manager, my employee says, I have diarrhea today, it tells you what we need to do next, right? What is the expectation? When can I return to work? If I have an employee with a diagnosis of one of the big six, when can they come to work?

And the app has put all of that into plain language, easily usable, it's again, it's free and available, all you need is a, you can use it on your phone, on your tablet, on your computer, if you have a reader application on a device, and you can open up and use it, and it's incredibly user friendly, and again, available and free for a resource.

Francine L Shaw: Exclusions and restrictions is what I was looking for, and it just was not coming to my head right then, and I don't know why.

Matt Regusci: So you don't advise frontline employees at a restaurant when they have diarrhea to go serve food. That is not good.

Carolyn White: Absolutely not. Absolutely not. And that's and that's something we have to get comfortable with, right?

Matt Regusci: Because we our podcast is Don't Eat Poop.

Carolyn White: Exactly. Because if we're working with diarrhea, odds are decent. We might. So, yeah. Fecal oral, right? A hundred percent. All, all of those are fecal oral pathogens. That is how we get there.

Francine L Shaw: Right. I can remember that, but not exclusions and restrictions. That just slipped my mind.

Matt Regusci: So, uh, when you're, I have so many questions, but one of them is, what do you see the most in terms of retail when it comes to an outbreak? Is it norovirus is one of the top?

Carolyn White: Norovirus is and has remained one of the top. We've done, FDA and CDC have partnered to really look at norovirus. Norovirus has been targeted by healthy people.

2030 is one of the things we're trying to reduce, particularly when we see ill workers working in food establishments, right? That's been a big concern. Norovirus, it's a nasty bug. It spreads quickly. Those basically your vomitous particles can spread several feet. And it's not just ill food workers, but there's also that concern if we have a guest in the dining room who throws up.

What's the policy and practice for that? How do we clean that up? It's not as simple as just throwing a little soap on it and calling it good because now we've spread vomitous particles throughout the establishment, which increases the risk of your servers, your other guests also becoming ill. And we've seen outbreaks where that's happened, where An ill guest vomits at one area of the restaurant, vomits throughout their way outside the door.

Other guests and employees of the establishment end up becoming ill, which is why part of that model food code where we look at, do you have a policy on cleanup of vomiting and diarrheal incidents? So whether it's an employee or a guest, are we prepared with the knowledge and ability To clean up even that mess, to prevent folks from becoming.

Matt Regusci: Wow.

Francine L Shaw: And they're supposed to all have policies and procedures on cleanup.

Carolyn White: In the model food code, we do see and we do expect. Recommend. It is a requirement in the model food code if you've adopted it, that you do have to have that, that written policy.

Francine L Shaw: Yes. And it takes so few particles.

Carolyn White: It's not very many.

Francine L Shaw: It's 18, I think, particles of gas to make somebody sick.

Matt Regusci: I like how we're talking about particles. Basically, we're talking about vomit spray. We're thinking like a shotgun. It's like particles are like just pieces of little vomit vapor flying through the air.

Carolyn White: If you want to see a great visual representation, there is a video on YouTube called Vomiting Larry.

And there was a scientist who did the experiment showing Was that Leanne? Did that, So double check me on that. But yeah, if you just Google that in YouTube, you'll see not only do they create a dummy that vomited the particulate, but they actually used a glow in the dark medium so you could see the spray under a black light.

And then they showed the person cleaning up the vomit and how much contamination ended up being on the individual doing the cleaning to really demonstrate how important it is to ensure you're protecting yourself if you're cleaning that up, because if it's on your face and your hands, now all of a sudden, You could have infected yourself just by cleaning someone's puke.

Matt Regusci: Yummy.

Francine L Shaw: Now you and all 12 children, your in laws and the wife, they're all sick.

Matt Regusci: That's how it happens. That's why it's like a cascading event in my house where somebody gets norovirus and then it's, we have it for seven days because that stuff is everywhere.

Carolyn White: I took it home for Christmas one year. My parents were not amused.

Francine L Shaw: I bet not. The gift, it just keeps on giving. It did. My son's children just started school, like my, my, like in the last couple of years, my granddaughter's in the equivalent of K 4 this year. And it's like, God bless them. Ever since my grandson went to pre K 4, they're just constantly, somebody is ill. And it's just.

For the first few years when your kids start school, it's just non stop. It's like, I'm just keep remembering when he and his sister first started school. It's like, we'd never been sick so much in our lives. And that's just.

Matt Regusci: Yeah. Story of my life, Francine. Thank you. Story of my life. All these children.

So you work with the State Departments of Territories and all that. Where does it come into play in like a crisis situation? Do you deal with that at all with like epidemiology? There may be a national outbreak that's happening and you're getting data that may be important for the State Departments and vice versa, State Departments is getting data that may be interesting.

More important for you to then pass on, like how does that type of a thing work?

Carolyn White: Gotcha, so within my role as a Retail Food Specialist, often a liaison between if someone, so we're not doing the investigation itself if there's an interstate outbreak, there's another part of the agency that handles that, but because we have the direct contact with the local health department, with the state health department, at the retail level, right, so we end up being the bridge.

To connect the pieces together, because we maintain those relationships and those contacts, the retail level. So, we're a part of that, but we're not necessarily boots on the ground doing that investigation work.

Matt Regusci: So, they would be calling you and be like, who do we connect with for this particular issue?

Carolyn White: Yep. Or, I might have a health department reach out, hey, we've had this pop up, and if we see it could possibly be related, we send that up the chain to the state liaison, where does this go? So. Most of the time it's really just communication and ensuring that the right people are being connected to the right folks.

Francine L Shaw: So what can we do better with, so like the Boar's Head outbreak is supply chain and it's a catastrophe of massive proportions, but it affects retail. The product was sent into retail and if retail doesn't handle this properly, it could go on for months anyway, just because of the nature of the illness.

But if they don't handle the product properly, granted it should have all been sent back from retail. But, if they don't clean their slices properly, if they did not thoroughly clean out the delis as they should have, that could create all kinds of cross contamination issues. Odds are, and you don't have to comment on this, I'm going to say what I'm going to say.

Odds are they did not all do that. It's the nature of the beast. I've worked in the industry. We hope they did. But the odds of them all tearing down all the slicers and emptying out all their delis and washing, rinsing, and sanitizing all of their equipment as thoroughly as they should have probably did not happen a hundred percent.

How can we do a better job of spreading the awareness and making them understand the importance of that being handled as efficiently and effectively as it must be in order to make sure that it doesn't happen and to make everybody, 'cause odds are your national chains, most of them did it fairly effectively.

Matt Regusci: Yeah. Odds are that they're going to most of them because if this pops up, again, there's a genetic strain that's gonna be linked directly to them. So the, the national chains and international chains, odds are they're going to be very diligent to make sure that everything goes well. But what about like the mom and pop delis?

Francine L Shaw: Because my husband, out on the road, there's a deli that he stops at regularly, and all they use is boar's head. That's all they use. Now, what are the odds that facility out in the middle of literally nowhere understands the importance of doing what they need to do?

Carolyn White: I think it speaks to a couple of things.

I think it speaks first to the value and the impact that our local regulatory programs have.

So your county health inspector, your city health inspector, your state inspector, I think it really speaks to the importance of the work that they are doing because they are doing routine inspections and we are getting into facilities and providing that education, right?

So. You hear the word regulator and, and folks automatically assume it's someone here just to dropping the hammer, but that's really not what your retail food inspector is here to do. It's here to be a resource and a guide and to work with their operators, right, to ensure that we're using those best food safety practices.

And from our industry partners, right, for our industry stakeholders, I think it really talks about, we talk a lot about food safety management systems and are we putting in a culture of food safety into our establishment, whether you have a 4 million budget or a 40 budget, right? The importance of that food safety culture.

If you look at the results of our national risk factor studies that we've done over the years, when you have folks providing managerial control, to put it in plain terms, when you have a manager who cares and is involved in those day to day operations and doing things the right way, employees follow suit.

So we want to see the behavior modeled with our operators. We want to ensure that our inspectors are able to get into our facilities and provide that education. I think a lot of times we see that there's a disconnect and not understanding the value of the resource. That your local health department really is, especially when it comes to environmental health and food protection for your facilities if you're paying a permit fee.

You're paying to have them be your resource. Use them. If you have questions on how to do things safely, or if you need help making sure that your policies make sense based on your food code, call your health department, call your food protection program. They are there. They're going to help you. It's easier to provide education and training, right, than it is to come in and Well, now we've done things incorrectly and we need to readjust, right?

But being proactive, I would say, and building that relationship. I think the relationship and the rapport is the most important thing because we have the same goal.

Francine L Shaw: I 100 percent agree. And I didn't say this. I don't know if you were in our session this morning or not, but one of the things that I talked about when I first started doing these inspections, one of the things that I did was I started holding at the community center.

monthly sessions for anybody that wanted to attend about food safety and the whys and ask whatever questions that you want to ask, like free of charge, just come and let's talk. And that did wonders for the rapport and building those relationships. And that's what we needed. I didn't, even know I was perceived as the enemy initially, by the time I left three years later, we had come a long way.

And there were a lot of. good, solid relationships that had been built.

Matt Regusci: So that's really cool. That's, and that's going to what you're talking about being a resource. And that's super cool. I didn't really think about it like that because I don't really know that world very well. The retail inspection world as well.

And I always think of. Like, on the supply chain side, the auditor, people aren't calling the auditor and asking the auditor on the supply chain side. They're coming in, they're getting a certificate, and the auditor's being very regimented. But I love what you're talking about, the health inspector really being a resource there.

And every single health inspector that we've talked to, it really truly is the case. They're educators first, and then they're a coach second, and then a cop reluctantly third.

Carolyn White: And most of our folks. live in the communities that they're serving, right? So it's not just a job. This is where I live. This is my community.

These are folks that I work with, but these are also places that I eat at, right? This is where my children also eat. So again, we have the same goal. As a regulator, as a former regular, I guess I'll say, I want my restaurants busy and functional and operating, and I want lots of them, right? And I want folks having great business practices and serving food, serving a ton of it, but serving it safely.

And I don't know a single operator out there who doesn't want the same thing. We want to be busy. We want to make money, but we want to serve food and serve it safely.

Francine L Shaw: And they want the health inspector to eat at their restaurant because there is no better advertisement in the world than when an off duty health inspector is eating at your restaurant.

You don't eat there when you're working.

Carolyn White: No, absolutely not.

Francine L Shaw: But when you're not working and you're eating in their restaurant, there is no better advertisement in the world.

Matt Regusci: And I ran a Starbucks in our health inspector was that Starbucks. So I understand exactly what you're talking about. I was, I walked in, I was like, yeah, good.

My milk temperature is the right temperature.

Francine L Shaw: Yeah. Cause my God, if there's anybody that knows where not to eat, it is your health inspector.

Matt Regusci: And he would always get a latte too. So I was like, good. Yeah. Go for the highest risk one too.

Francine L Shaw: He had this one Chinese restaurant, God bless him. He was amazing. And it was a phenomenal restaurant.

And when I would go in, I would eat there. And whenever I would go in to eat, like when I was done or when I wasn't working, he would come rushing to the door and he'd open the door and he would want to give me like, not like part of the fun of eating Chinese is the chopsticks and the paper and that. And he'd come rushing out with like, he'd open the door and he'd give me like a regular plate and if I know, no special treatment.

And I'm like, no, I want the regular, the regular utensils. If you're going to treat me special, I can't eat here. It was so sweet.

Matt Regusci: So you have any crazy stories for us?

Carolyn White: Here's the thing. The best part about retail food is, and when you get into with. When you get to an event like this, we have the best stories.

So if you start asking folks, like, you can ask, what's the craziest thing you've seen? What's the funniest thing that happened? What's the nastiest? And you'll watch their face. There's a story for every single one of those categories. That's a separate category. It is. But you can just show the success story of, we had this happen.

I watched a mouse jump on the back of this guy and he screamed. But then we were able to resolve the issue and now it's, we're operating in a safe and clean manner. It's just the success stories that come with that are also incredible. But, oh, you learn if you start going out with a lot of folks in retail food that there's never a conversation that's off limits.

So you say it's don't eat poop. Well, we'll talk about not eating poop at the dinner table in the restaurant. Yes, we do. Sometimes you have to be self aware. And if you start grossing out the table next door, you may need to take it down a couple of notches. But, oh, we see all kinds of fun things.

Francine L Shaw: I've always said that you need to be really careful if you off, if you agree to go out to eat with a group of health inspectors or people that are in environmental health, because there's nothing we won't talk about.

Matt Regusci: Yeah, but I'm perfectly fine with them picking the restaurant.

Carolyn White: Well, yeah. And watch the odds are is by some miracle of circumstance, you'll get sat facing the kitchen.

Francine L Shaw: And we notice everything. Yeah. Not even intentionally. You just notice. We were in the airport in Mexico years ago, my husband and I was sitting there and I'm looking at the ceiling.

And this is from operations, not from being a health inspector. My husband's like, what are you doing? And I'm like, why? He said, what are you doing? I'm like, I can tell you how many burnout light bulbs they have. And that's from working in operations. I was sitting there not even realizing, counting the burnout light bulbs from just working in operations.

Like, why aren't you replacing the light bulbs in this airport?

Matt Regusci: Very cool. Very cool.

Well, is there anything else you would like to talk about before we give you some advice?

Carolyn White: I just, I appreciate the opportunity. Anytime we can talk about our state, local, tribal, and territorial health departments, the ag departments, the folks doing retail food, you hear them called the boots on the ground, and I can't stress enough how important.

They are not just to my work, but really just to retail food safety. And so anytime I can highlight the amazing work that they are doing, because you have some folks in your communities doing incredible work and it is a thankless job, right? Like we're never everyone's favorite person. No one's happy to see the health inspector, right?

So, so building those relationships and really seeing that as a resource and shifting that idea. of oh no the health inspector's here. Oh the health inspector's here. I can't wait to show you what we've done next. So anytime I can come and talk about the amazing work these folks do, it just it gets me excited because they are doing the most incredible work and I will say it's one of those programs that impacts every single person in their community.

Everyone has to eat. Yes. Everyone eats.

Francine L Shaw: Absolutely. We're less appreciated than the dentist.

Carolyn White: Boy, that is so true.

Francine L Shaw: That's what I used to say. I'm way less appreciated than the dentist and I just never thought I'd ever feel that way.

Matt Regusci: Well, we so appreciate your time and thank you so much for joining us and we just have some advice.

Don't eat poop. Would never dream of it. Thank you so much.

Carolyn White: Thank you.