performance indicators for foodborne disease programs · 2017-11-13 · of states’ foodborne...

CHAPTER

Surveillance and outbreak response are major components

of states’ foodborne investigation capacity and are essential

for preventing and controlling foodborne illness. Multiple

entities—almost 3000 local health departments, more than 50 state

and territorial health departments, and several federal agencies—

interact in a complex system covering surveillance to detect and

respond to enteric and other foodborne diseases.

The occurrence of large and multistate foodborne disease outbreaks

and concerns about bioterrorism have increased the need to rapidly

detect and distinguish between outbreaks of foodborne disease

and possible intentional contamination. Evaluating the timeliness

and effectiveness of foodborne disease surveillance is a major step

toward assessing and improving U.S. capacity for foodborne disease

surveillance and outbreak response. Since the original publication

of the Guidelines, there has been a great increase in the evidence

base for establishing performance measures. These are reflected in

the performance measures included in this chapter, for which target

ranges are being developed.

8

Performance Indicators for

Foodborne Disease Programs

CIFOR | Council to Improve Foodborne Outbreak Response206P

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CDC’s Public Health Emergency Preparedness Goals established a general framework and a few specific performance measures relevant to foodborne disease surveillance. CDC’s

Foodborne Diseases Centers for Outbreak Response Enhancement (FoodCORE) has developed a series of performance metrics that cover a range of outbreak detection and response activities. These are designed

to demonstrate successes and identify gaps in the detection, investigation, and control of enteric disease outbreaks. Thus, progress is being made towards the development of comprehensive national performance standards, measures, and models for public health agencies to follow to ensure foodborne illness surveillance and outbreak detection and response systems work at maximum efficiency.

The CIFOR Guidelines for Foodborne Disease Outbreak Response were intended to serve as a comprehensive source of information on foodborne disease investigation and control for state and local health departments. The Guidelines included measurable indicators of effective surveillance for enteric diseases and for response to outbreaks by state and local public health officials. The performance indicators were intended to be used by agencies to evaluate the performance of their foodborne disease surveillance and control programs. However, the Guidelines stopped short of providing specific targets for individual metrics, to avoid their use as a score card that could be compared between agencies.

Since the development of the Guidelines, there has been more emphasis placed on performance, accountability and transparency by public health agencies. Therefore, there is a need for the development of target values that will help state and local public health agencies demonstrate their performance and effectiveness for foodborne disease surveillance and outbreak control activities. Given the distributed public health system with multiple independent jurisdictions, having performance targets will also provide a framework for communicating model practices for surveillance activities and create clear expectations for performance that will increase the likelihood of compliance.

The use of standardized performance criteria and metrics serves several functions:

• They promote a common understanding of the key elements of foodborne disease surveillance and control activities across local, state, and federal public health agencies;

• They facilitate training of food program staff in the use and interpretation of the performance criteria; and

• They allow for the aggregation of data at state, regional, or national levels to evaluate program effectiveness and to identify specific needs for improvement and additional resource investment.

The indicators were not intended as performance standards. Where specific performance standards exist (e.g., PulseNet turnaround times, Draft Voluntary National Retail Food Regulatory Program Standards), meeting the performance standard was adopted as a performance indicator. The development of performance standards depends on the availability of specific indicators such as these to provide a basis for program evaluation. Defining the level of performance expected from foodborne disease surveillance and control programs exceeds the scope of these Guidelines, However, the body of evidence needed to do so is growing, as reflected in the performance measures

8.0. Introduction

8.1. Purpose and Intended Use

2014 | Guidelines for Foodborne Disease Outbreak Response 207P

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included in this chapter for which target ranges are being developed. Thus, this chapter increases the range of performance measures that may be useful for future public health agency evaluation and certification programs.

The aggregation of data at state, regional, or national levels is intended to provide a comprehensive overview of foodborne disease surveillance and control programs, rather than a system for ranking them.

8.1. Purpose and Intended Use

8.2. Performance Indicators

This chapter contains tables organized to highlight major performance indicators by program function. The roles and responsibilities of foodborne disease surveillance and control programs vary by state according to state law. Individual agencies that wish to evaluate their programs using these indicators should select indicators and metrics that best reflect their activities, regardless of where they fall in the document’s table structure.

Foodborne Disease Program Objectives and Indicators

Table 8.1. Objectives of foodborne disease surveillance program

Table 8.2. Short-term objectives, indicators, subindicators, and metrics

Table 8.3. Intermediate objectives, indicators, subindicators, and metrics

Table 8.4. Long-term objectives, indicators, subindicators, and metrics

A total of 16 performance indicators were selected for the development of target ranges based on their importance and feasibility of implementation (Table 8-5). These include metrics for epidemiology, laboratory, and environmental health programs. Most of the selected performance measures focus on the state level. Several are applicable to both state and local programs and a few are primarily focused on local agencies. For each of the performance measures, a description is provided that describes the performance measure, relevant definitions, an assessment of the feasibility of measuring performance of the metric, and detailed methods for measurement.

Target ranges for these performance measures are being developed under direction of the CIFOR Performance Indicators Work Group, and will be maintained separately on the CIFOR website. This will allow for the target ranges to be modified as needed, based on the availability of resources and the performance of the system.

Foodborne Disease Program Objectives and Indicators

Table 8.1. Objectives of foodborne disease surveillance program

SHORT-TERM OBJECTIVES INTERMEDIATE OBJECTIVES LONG-TERM OBJECTIVES

Detect foodborne disease events of public health importance.

Respond to events in a timely manner.

Intervene when appropriate to prevent illness.

Determine etiology, vehicle, and contribut-ing factors of foodborne disease outbreaks.

Monitor trends to identify emerging food-borne diseases and food-safety problems.

Increase knowledge of foodborne disease causes and abatement strategies.

Prevent future outbreaks.

Reduce incidence of foodborne illness.

Increase health of the general population.


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8


Det

ect f

oodb

orne

di

seas

e ev

ents

of

pub

lic h

ealth

im

porta

nce.

8.2.

1.Fo

odbo

rne

com

plai

nts

inve

stig

ated

PR

OC

ESS

• P

rogr

am m

aint

ains

logs

or d

atab

ases

for a

ll co

mpl

aint

or

refe

rral r

epor

ts fr

om o

ther

sou

rces

alle

ging

food

-rela

ted

illne

ss, i

njur

y, or

inte

ntio

nal f

ood

cont

amin

atio

n. T

he fi

nal

disp

ositi

on fo

r eac

h co

mpl

aint

is re

cord

ed in

the

log

or

data

base

and

file

d in

or l

inke

d to

the

esta

blish

men

t rec

ord

for r

etrie

val p

urpo

ses

(Dra

ft Vo

lunt

ary

Nat

iona

l Ret

ail F

ood

Regu

lato

ry P

rogr

am S

tand

ards

, sta

ndar

d 5,

par

t 1.d

).•

Dem

ogra

phic

info

rmat

ion

obta

ined

• F

ood

hist

ory

obta

ined

OU

TCO

ME

• D

ispos

ition

, act

ion,

or f

ollo

w-u

p on

com

plai

nt o

r ref

erra

l re

port

alle

ging

food

-rela

ted

illne

ss o

r inj

ury

with

in 2

4 ho

urs

• O

utbr

eak

dete

cted

PR

OC

ESS

• D

raft

Volu

ntar

y N

atio

nal R

etai

l Foo

d Re

gula

tory

Pr

ogra

m S

tand

ard

5, p

art 1

.d, m

et, y

es/n

o•

% o

f com

plai

nts

for w

hich

com

plet

e de

mog

raph

ic in

form

atio

n w

as a

vaila

ble

• %

of c

ompl

aint

s fo

r whi

ch fo

od h

istor

y w

as

obta

ined

OU

TCO

ME

• N

o. c

ompl

aint

s re

ceiv

ed. R

ate

of c

ompl

aint

s re

ceiv

ed p

er 1

00,0

00 p

opul

atio

n in

juris

dict

ion.

• N

o. o

utbr

eaks

det

ecte

d as

a re

sult

of

food

born

e ill

ness

com

plai

nts.

Rat

e of

out

brea

ks

dete

cted

per

100

,000

pop

ulat

ion

in ju

risdi

ctio

n,

and

per 1

,000

com

plai

nts

rece

ived

.

Det

ect f

oodb

orne

di

seas

e ev

ents

of

pub

lic h

ealth

im

porta

nce.

8.2.

2.Re

porte

d ca

ses

with

spe

cifie

d fo

odbo

rne

illne

sses

in

terv

iew

ed

PR

OC

ESS

• D

emog

raph

ic in

form

atio

n ob

tain

ed

• Ex

posu

re h

istor

y ob

tain

ed

• C

ase

onse

t dat

e ob

tain

ed

• D

ate

of re

port

docu

men

ted

• C

ase

repo

rt m

aint

aine

d in

sea

rcha

ble

data

base

PR

OC

ESS

• %

of r

epor

ted

case

s fo

r whi

ch c

ompl

ete

dem

ogra

phic

info

rmat

ion

was

ava

ilabl

e

• %

of r

epor

ted

case

s w

ith a

ttem

pted

inte

rvie

w

• %

of c

onfir

med

cas

es w

ith e

xpos

ure

hist

ory

obta

ined

% o

f rep

orte

d ca

ses

for

whi

ch o

nset

da

te w

as a

vaila

ble

• %

of r

epor

ted

case

s fo

r whi

ch re

port

date

was

av

aila

ble

• S

earc

habl

e da

taba

se m

aint

aine

d, y

es/n

o

Foo

db

orn

e D

isea

se P

rog

ram

Ob

ject

ives

and

Ind

icat

ors

Tab

le 8

.2.

Shor

t-te

rm o

bje

ctiv

es, i

ndic

ator

s, s

ubin

dic

ator

s, a

nd m

etri

cs

SHO

RT-T

ERM

O

BJEC

TIVE

SIN

DIC

ATO

R SU

BIN

DIC

ATO

RM

ETRI

CS


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CE

IND

ICA

TO

RS

FO

R

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OD

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ISE

AS

E P

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Det

ect f

oodb

orne

di

seas

e ev

ents

of

pub

lic h

ealth

im

porta

nce.

8.2.

2.Re

porte

d ca

ses

with

spe

cifie

d fo

odbo

rne

illne

sses

in

terv

iew

ed

OU

TCO

ME

• In

terv

al fr

om re

ceip

t of r

epor

t to

inte

rvie

w o

f cas

e

• N

eed

for p

ublic

hea

lth in

terv

entio

n id

entifi

ed (e

.g.,

excl

usio

n of

wor

kers

, con

duct

of i

nves

tigat

ion)

OU

TCO

ME

• M

edia

n no

. day

s fro

m re

ceip

t of r

epor

t to

inte

rvie

w o

f cas

e

• %

of c

ases

for w

hich

an

inte

rven

tion

was

id

entifi

ed o

r rul

ed o

ut

Det

ect f

oodb

orne

di

seas

e ev

ents

of

pub

lic h

ealth

im

porta

nce.

8.2.

3.Is

olat

es o

r cu

lture

-in

depe

nden

t di

agno

stic

test

(C

IDT)

-pos

itive

sp

ecim

ens

of s

peci

fied

food

born

e pa

thog

ens

subm

itted

to

PHL

PR

OC

ESS

• S

tool

col

lect

ion

date

obt

aine

d

• D

ate

of c

linic

al la

bora

tory

find

ing

obta

ined

• D

ate

of s

ubm

issio

n to

PH

L do

cum

ente

d

• D

ate

of s

erot

ypin

g do

cum

ente

d

• D

ate

of s

ubty

ping

by

PFG

E do

cum

ente

d

• Is

olat

e/C

IDT-

posit

ive

spec

imen

repo

rt m

aint

aine

d in

se

arch

able

dat

abas

e

OU

TCO

ME

• N

o. re

porte

d ca

ses

for w

hich

isol

ate

or C

IDT-

posit

ive

spec

imen

sub

mitt

ed to

PH

L

• N

o. d

ays

from

clin

ical

labo

rato

ry fi

ndin

g to

sub

miss

ion

of

isola

te o

r CID

T-po

sitiv

e sp

ecim

en to

PH

L

• N

o. d

ays

from

rece

ipt o

f iso

late

by

PHL

to s

ubty

ping

resu

lts

• S

ubty

pe-c

lust

ers

iden

tified

• %

of p

ulse

d fie

ld g

el e

lect

roph

ores

is (P

FGE)

sub

typi

ng

data

resu

lts fo

r E. c

oli O

157:

H7

and

List

eria

sub

mitt

ed

to th

e Pu

lseN

et n

atio

nal d

atab

ase

with

in fo

ur w

orki

ng

days

of r

ecei

ving

isol

ate

at th

e PF

GE

labo

rato

ry (C

DC

pr

epar

edne

ss g

oal)

PR

OC

ESS

• %

of c

ases

for w

hich

sto

ol c

olle

ctio

n da

te w

as

av

aila

ble

• %

of i

nves

tigat

ed c

ases

for w

hich

dat

e of

clin

ical

labo

rato

ry fi

ndin

g w

as a

vaila

ble

• %

of c

ases

for w

hich

dat

e of

sam

ple

subm

issio

n

to

PH

L w

as a

vaila

ble

• %

of c

ases

for w

hich

PFG

E su

btyp

ing

date

was

avai

labl

e

• Se

arch

able

dat

abas

e m

aint

aine

d, y

es/n

o

OU

TCO

ME

• %

of c

ases

for w

hich

isol

ates

wer

e su

bmitt

ed to

PHL

• M

edia

n no

. day

s fro

m re

port

of c

linic

al fi

ndin

gs

to

rece

ipt o

f iso

late

at P

HL

• M

edia

n no

. day

s fro

m re

ceip

t of s

peci

men

to

se

roty

ping

or s

ubty

ping

resu

lts

• N

o. s

ubty

pe c

lust

ers

iden

tified

• C

DC

pre

pare

dnes

s go

al m

et, y

es/n

o


ER

FO

RM

AN

CE

IN

DIC

AT

OR

S F

OR

F

OO

DB

OR

NE

DIS

EA

SE

PR

OG

RA

MS

8

Foo

db

orn

e D

isea

se P

rog

ram

Ob

ject

ives

and

Ind

icat

ors

Tab

le 8

.2.

Shor

t-te

rm o

bje

ctiv

es, i

ndic

ator

s, s

ubin

dic

ator

s, a

nd m

etri

csC

ontin

ued

SHO

RT-T

ERM

O

BJEC

TIVE

SIN

DIC

ATO

R SU

BIN

DIC

ATO

RM

ETRI

CS

Resp

ond

to e

vent

s in

a ti

mel

y m

anne

r.8.

2.4.

Food

born

e ou

tbre

aks

inve

stig

ated

PR

OC

ESS

• C

ases

inte

rvie

wed

to d

eter

min

e ill

ness

and

exp

osur

e hi

stor

ies

• S

tool

sam

ples

obt

aine

d fro

m c

ases

• C

ontro

ls (n

on-il

l per

sons

) int

ervi

ewed

to d

eter

min

e ex

posu

re h

istor

ies

• E

nviro

nmen

tal h

ealth

ass

essm

ent o

f est

ablis

hmen

t co

nduc

ted,

whe

re a

ppro

pria

te

• F

ood

flow

doc

umen

ted

• F

ood

wor

kers

inte

rvie

wed

• S

tool

sam

ples

obt

aine

d fro

m fo

od h

andl

ers

• F

ood

or e

nviro

nmen

tal s

ampl

es o

btai

ned

OU

TCO

ME

• N

o. d

ays

from

ons

et o

f sym

ptom

s to

initi

atio

n of

out

brea

k in

vest

igat

ion

• N

o. d

ays

from

col

lect

ion

of s

tool

sam

ples

to c

onfir

med

cu

lture

resu

lts

• N

o. d

ays

from

col

lect

ion

of e

nviro

nmen

tal o

r foo

d sa

mpl

es

to c

onfir

med

cul

ture

resu

lt

• F

oodb

orne

dise

ase

outb

reak

sou

rce

iden

tified

PR

OC

ESS

• %

of o

utbr

eak

inve

stig

atio

ns w

ith e

xpos

ure

asse

ssm

ents

con

duct

ed.%

of o

utbr

eak

inve

stig

atio

ns w

ith c

linic

al s

peci

men

s co

llect

ed

and

subm

itted

to P

HL

from

2 o

r mor

e pe

ople

%

of o

utbr

eak

inve

stig

atio

ns w

here

spe

cim

ens

wer

e te

sted

for a

spe

cifie

d se

t of p

oten

tial

agen

ts a

t PH

L

• %

of o

utbr

eak

inve

stig

atio

ns w

ith >

10 il

l peo

ple

whe

re a

n an

alyt

ic s

tudy

was

con

duct

ed. %

of

inve

stig

atio

ns in

whi

ch a

n es

tabl

ishm

ent w

as

inve

stig

ated

, if a

ppro

pria

te

• %

of e

nviro

nmen

tal i

nves

tigat

ions

that

incl

uded

a

food

flow

, int

ervi

ews

of fo

od w

orke

rs,

colle

ctio

n of

sto

ol s

ampl

es fr

om fo

od h

andl

ers,

co

llect

ion

of fo

od o

r env

ironm

enta

l sam

ples

OU

TCO

ME

• N

o. fo

odbo

rne

outb

reak

s re

porte

d, a

ll ag

ents

. Ra

te o

f out

brea

ks re

porte

d / 1

00,0

00 p

opul

atio

n.

• M

edia

n no

. day

s fro

m o

nset

of s

ympt

oms

of

first

/inde

x ca

se to

out

brea

k in

vest

igat

ion

• M

edia

n no

. day

s fro

m s

ubm

issio

n of

sto

ol

sam

ples

to re

ceip

t of r

esul

ts

• M

edia

n no

. day

s fro

m s

ubm

issio

n of

food

or

envi

ronm

enta

l sam

ples

to re

ceip

t of r

esul

ts

• %

of f

oodb

orne

dise

ase

outb

reak

s fo

r whi

ch a

so

urce

was

iden

tified

• %

of o

utbr

eaks

whe

re N

ORS

form

com

plet

ed



ER

FO

RM

AN

CE

IND

ICA

TO

RS

FO

R

FO

OD

BO

RN

E D

ISE

AS

E P

RO

GR

AM

S8

Resp

ond

to e

vent

s in

a ti

mel

y m

anne

r.8.

2.4.

Food

born

e ou

tbre

aks

inve

stig

ated

PR

OC

ESS

• C

ases

inte

rvie

wed

to d

eter

min

e ill

ness

and

exp

osur

e hi

stor

ies

• S

tool

sam

ples

obt

aine

d fro

m c

ases

• C

ontro

ls (n

on-il

l per

sons

) int

ervi

ewed

to d

eter

min

e ex

posu

re h

istor

ies

• E

nviro

nmen

tal h

ealth

ass

essm

ent o

f est

ablis

hmen

t co

nduc

ted,

whe

re a

ppro

pria

te

• F

ood

flow

doc

umen

ted

• F

ood

wor

kers

inte

rvie

wed

• S

tool

sam

ples

obt

aine

d fro

m fo

od h

andl

ers

• F

ood

or e

nviro

nmen

tal s

ampl

es o

btai

ned

OU

TCO

ME

• N

o. d

ays

from

ons

et o

f sym

ptom

s to

initi

atio

n of

out

brea

k in

vest

igat

ion

• N

o. d

ays

from

col

lect

ion

of s

tool

sam

ples

to c

onfir

med

cu

lture

resu

lts

• N

o. d

ays

from

col

lect

ion

of e

nviro

nmen

tal o

r foo

d sa

mpl

es

to c

onfir

med

cul

ture

resu

lt

• F

oodb

orne

dise

ase

outb

reak

sou

rce

iden

tified

PR

OC

ESS

• %

of o

utbr

eak

inve

stig

atio

ns w

ith e

xpos

ure

asse

ssm

ents

con

duct

ed.%

of o

utbr

eak

inve

stig

atio

ns w

ith c

linic

al s

peci

men

s co

llect

ed

and

subm

itted

to P

HL

from

2 o

r mor

e pe

ople

%

of o

utbr

eak

inve

stig

atio

ns w

here

spe

cim

ens

wer

e te

sted

for a

spe

cifie

d se

t of p

oten

tial

agen

ts a

t PH

L

• %

of o

utbr

eak

inve

stig

atio

ns w

ith >

10 il

l peo

ple

whe

re a

n an

alyt

ic s

tudy

was

con

duct

ed. %

of

inve

stig

atio

ns in

whi

ch a

n es

tabl

ishm

ent w

as

inve

stig

ated

, if a

ppro

pria

te

• %

of e

nviro

nmen

tal i

nves

tigat

ions

that

incl

uded

a

food

flow

, int

ervi

ews

of fo

od w

orke

rs,

colle

ctio

n of

sto

ol s

ampl

es fr

om fo

od h

andl

ers,

co

llect

ion

of fo

od o

r env

ironm

enta

l sam

ples

OU

TCO

ME

• N

o. fo

odbo

rne

outb

reak

s re

porte

d, a

ll ag

ents

. Ra

te o

f out

brea

ks re

porte

d / 1

00,0

00 p

opul

atio

n.

• M

edia

n no

. day

s fro

m o

nset

of s

ympt

oms

of

first

/inde

x ca

se to

out

brea

k in

vest

igat

ion

• M

edia

n no

. day

s fro

m s

ubm

issio

n of

sto

ol

sam

ples

to re

ceip

t of r

esul

ts

• M

edia

n no

. day

s fro

m s

ubm

issio

n of

food

or

envi

ronm

enta

l sam

ples

to re

ceip

t of r

esul

ts

• %

of f

oodb

orne

dise

ase

outb

reak

s fo

r whi

ch a

so

urce

was

iden

tified

• %

of o

utbr

eaks

whe

re N

ORS

form

com

plet

ed

Resp

ond

to e

vent

s in

a ti

mel

y m

anne

r.8.

2.5.

Cas

e cl

uste

rs

inve

stig

ated

PR

OC

ESS

• C

ases

inte

rvie

wed

to d

eter

min

e ex

posu

re h

istor

ies

• A

naly

tic e

pide

mio

logi

c st

udy

cond

ucte

d fo

r Sal

mon

ella

an

d ST

EC c

lust

ers

with

>5

case

s

OU

TCO

ME

• N

o. d

ays

from

clu

ster

reco

gniti

on to

com

plet

ion

of

inte

rvie

ws

of c

ases

and

con

trols

• C

lust

er s

ourc

e id

entifi

ed

PR

OC

ESS

• %

of i

nves

tigat

ed c

lust

ers

with

rout

ine

inte

rvie

w

of c

ases

to d

eter

min

e ex

posu

re h

istor

y•

Onc

e a

mul

tista

te fo

odbo

rne

outb

reak

ha

s be

en d

ecla

red

by C

DC

, sta

te h

ealth

de

partm

ents

in c

onju

nctio

n w

ith th

eir l

ocal

he

alth

dep

artm

ents

com

plet

e or

clo

seou

t 80

% o

f int

ervi

ews

with

in 4

8 ho

urs

usin

g th

e ‘o

utbr

eak

desig

nate

d’ q

uest

ionn

aire

% o

f Sa

lmon

ella

and

STE

C c

lust

ers

with

> 5

cas

es

whe

re a

n an

alyt

ic e

pide

mio

logi

c st

udy

was

co

nduc

ted.

OU

TCO

ME

• M

edia

n no

. day

s fro

m id

entifi

catio

n of

a c

lust

er

to c

lose

out

of i

nves

tigat

ion-

rela

ted

inte

rvie

ws

% o

f clu

ster

s in

whi

ch a

sou

rce

was

iden

tified

Inte

rven

e w

hen

appr

opria

te to

pr

even

t illn

ess.

8.2.

7.Ill

or i

nfec

ted

food

han

dler

s id

entifi

ed a

nd e

xclu

ded

OU

TCO

ME

• %

of o

utbr

eak

inve

stig

atio

ns w

ith e

xclu

sion

of

an il

l per

son(

s) fr

om h

igh

risk

setti

ng•

Med

ian

no. d

ays

from

initi

atio

n of

inve

stig

atio

n to

impl

emen

tatio

n of

inte

rven

tion

8.2.

8.D

efici

ent f

ood-

hand

ling

prac

tice

iden

tified

and

cor

rect

edO

UTC

OM

E•

% o

f out

brea

k in

vest

igat

ions

with

rem

edia

tion

or c

losu

re o

f an

esta

blish

men

t lin

ked

to il

lnes

s•

Med

ian

no. d

ays

from

initi

atio

n of

inve

stig

atio

n to

impl

emen

tatio

n of

inte

rven

tion

8.2.

9.A

dviso

ry is

sued

abo

ut o

utbr

eak

and

impl

icat

ed s

ourc

eO

UTC

OM

E•

Med

ian

no. d

ays

from

initi

atio

n of

inve

stig

atio

n

to

impl

emen

tatio

n of

inte

rven

tion



ER

FO

RM

AN

CE

IN

DIC

AT

OR

S F

OR

F

OO

DB

OR

NE

DIS

EA

SE

PR

OG

RA

MS

8

Foo

db

orn

e D

isea

se P

rog

ram

Ob

ject

ives

and

Ind

icat

ors

Tab

le 8

.2.

Shor

t-te

rm o

bje

ctiv

es, i

ndic

ator

s, s

ubin

dic

ator

s, a

nd m

etri

cs

Con

tinue

d

SHO

RT-T

ERM

O

BJEC

TIVE

SIN

DIC

ATO

R SU

BIN

DIC

ATO

RM

ETRI

CS

Inte

rven

e w

hen

appr

opria

te to

pr

even

t illn

ess.

8.2.

10.

Con

tam

inat

ed fo

od re

calle

d an

d re

mov

ed fr

om m

arke

tpla

ceO

UTC

OM

E•

Med

ian

no. d

ays

from

initi

atio

n of

inve

stig

atio

n

to

impl

emen

tatio

n of

inte

rven

tion

Resp

ond

to e

vent

s in

a ti

mel

y m

anne

r, an

d in

terv

ene

whe

n ap

prop

riate

to

pre

vent

illn

ess.

8.2.

11.

Afte

r-act

ion

revi

ews

of o

utbr

eak

inve

stig

atio

ns c

ondu

cted

with

in a

mea

n of

60

days

afte

r inv

estig

atio

n en

ds (C

DC

pre

pare

dnes

s go

al)

PR

OC

ESS

• C

DC

pre

pare

dnes

s go

al m

et, y

es/n

o

8.2.

12.

Staf

f tra

ined

on

the

agen

cy’s

outb

reak

resp

onse

pro

toco

lP

RO

CE

SS•

% o

f sta

ff lik

ely

to b

e in

volv

ed in

an

outb

reak

inve

stig

atio

n th

at h

ave

rece

ived

trai

ning

8.2.

13.

Con

tact

list

s of

indi

vidu

als

or o

rgan

izatio

ns k

ey to

food

born

e di

seas

e ou

tbre

ak

inve

stig

atio

ns c

reat

ed a

nd re

gula

rly u

pdat

ed

PR

OC

ESS

• C

onta

ct li

st c

reat

ed, y

es/n

o•

Inte

rval

s be

twee

n up

date

s

8.2. Performance Indicators8.2. Performance Indicators

Tab

le 8

.3.

Inte

rmed

iate

ob

ject

ives

, ind

icat

ors,

sub

ind

icat

ors,

and

met

rics

INTE

RMED

IATE

O

BJEC

TIVE

IND

ICAT

OR

SUBI

ND

ICAT

OR

MET

RIC

S

Det

erm

ine

etio

logy

, veh

icle

, an

d co

ntrib

utin

g fa

ctor

s of

fo

odbo

rne

dise

ase

outb

reak

s.

8.3.

1.Et

iolo

gy o

f ou

tbre

ak

iden

tified

PR

OC

ESS

• C

linic

al c

hara

cter

istic

s of

out

brea

k ch

arac

teriz

ed

• St

ool s

ampl

es c

olle

cted

and

test

ed fo

r lik

ely

agen

ts

• Fo

od a

nd e

nviro

nmen

tal s

ampl

es c

olle

cted

and

test

ed

fo

r lik

ely

agen

ts

OU

TCO

ME

• Et

iolo

gy o

f out

brea

k id

entifi

ed

PR

OC

ESS

• %

of o

utbr

eaks

for w

hich

clin

ical

cha

ract

erist

ics

wer

e de

scrib

ed•

% o

f out

brea

ks fo

r whi

ch a

t lea

st 1

sto

ol s

ampl

e

was

test

ed fo

r lik

ely

agen

ts•

% o

f out

brea

ks fo

r whi

ch fo

od o

r env

ironm

enta

l

sam

ples

wer

e te

sted

for l

ikel

y ag

ents

OU

TCO

ME

• %

of o

utbr

eaks

for w

hich

etio

logy

was

iden

tified

an

d re

porte

d to

NO

RS


ER

FO

RM

AN

CE

IND

ICA

TO

RS

FO

R

FO

OD

BO

RN

E D

ISE

AS

E P

RO

GR

AM

S8

8.2. Performance Indicators8.2. Performance Indicators

8.3.

2.Ve

hicl

e of

ou

tbre

ak

iden

tified

PR

OC

ESS

• Su

itabl

e ep

idem

iolo

gic

stud

y co

nduc

ted

to id

entif

y ve

hicl

e

• In

form

atio

nal t

race

back

con

duct

ed to

sub

type

exp

osur

e

hi

stor

ies

• Re

gula

tory

trac

ebac

k co

nduc

ted

to c

onfir

m p

rodu

ctio

n

so

urce

of i

mpl

icat

ed fo

od v

ehic

le

• Is

olat

es fr

om c

ase

spec

imen

s an

d po

tent

ial v

ehic

les

subt

yped

OU

TCO

ME

• Ve

hicl

e of

out

brea

k id

entifi

ed

PR

OC

ESS

• %

of o

utbr

eaks

for w

hich

epi

dem

iolo

gic

stud

y w

as c

ondu

cted

to id

entif

y a

vehi

cle

• %

of o

utbr

eaks

for w

hich

info

rmat

iona

l tra

ceba

ck w

as c

ondu

cted

to h

elp

eluc

idat

e ex

posu

re h

istor

ies

• %

of o

utbr

eaks

for w

hich

regu

lato

ry tr

aceb

ack

was

con

duct

ed to

con

firm

pro

duct

ion

sour

ce o

f im

plic

ated

food

veh

icle

• %

of o

utbr

eaks

for w

hich

sub

typi

ng o

f iso

late

s fro

m c

ases

and

pot

entia

l veh

icle

s w

as

cond

ucte

d

OU

TCO

ME

• %

of o

utbr

eaks

for w

hich

a v

ehic

le w

as

iden

tified

and

repo

rted

to N

ORS

Det

erm

ine

etio

logy

, veh

icle

, an

d co

ntrib

utin

g fa

ctor

s of

fo

odbo

rne

dise

ase

outb

reak

s.

8.3.

3.C

ontri

butin

g fa

ctor

s id

entifi

ed

PR

OC

ESS

• Pr

epar

atio

n of

impl

icat

ed fo

od it

ems

revi

ewed

• Fo

od-p

repa

ratio

n re

view

gui

ded

by id

entifi

catio

n of

susp

ecte

d ag

ent

• Po

ssib

le c

ontri

butin

g fa

ctor

s to

the

illne

ss, i

njur

y, or

in

tent

iona

l foo

d co

ntam

inat

ion

iden

tified

in e

ach

on-s

ite

inve

stig

atio

n re

port

OU

TCO

ME

• C

ontri

butin

g fa

ctor

s id

entifi

ed

PR

OC

ESS

• %

of o

utbr

eak

inve

stig

atio

ns w

ith li

nk to

a

rest

aura

nt/fo

od e

stab

lishm

ent w

here

an

on-

site

envi

ronm

enta

l hea

lth a

sses

smen

t was

co

nduc

ted

• %

of o

utbr

eaks

for w

hich

food

-pre

para

tion

flow

w

as re

view

ed fo

r im

plic

ated

food

item

• %

of o

utbr

eaks

for w

hich

food

-pre

para

tion

flow

w

as re

view

ed, w

ith s

peci

fic a

gent

sus

pect

ed

• D

raft

Volu

ntar

y N

atio

nal R

etai

l Foo

d Re

gula

tory

Pr

ogra

m S

tand

ard

5, p

art 2

.a, m

et, y

es/n

o

OU

TCO

ME

• %

of o

utbr

eaks

for w

hich

con

tribu

ting

fact

ors

wer

e id

entifi

ed a

nd re

porte

d to

NO

RS


ER

FO

RM

AN

CE

IN

DIC

AT

OR

S F

OR

F

OO

DB

OR

NE

DIS

EA

SE

PR

OG

RA

MS

8

Foo

db

orn

e D

isea

se P

rog

ram

Ob

ject

ives

and

Ind

icat

ors

Tab

le 8

.3.

Inte

rmed

iate

ob

ject

ives

, ind

icat

ors,

sub

ind

icat

ors,

and

met

rics

Con

tinue

d

INTE

RMED

IATE

O

BJEC

TIVE

IND

ICAT

OR

SUBI

ND

ICAT

OR

MET

RIC

S

Mon

itor t

rend

s to

id

entif

y em

ergi

ng

food

born

e di

seas

es a

nd fo

od-

safe

ty p

robl

ems.

PR

OC

ESS

• A

t lea

st a

nnua

lly, d

ata

in c

ompl

aint

log

or d

atab

ase

and

illne

ss a

nd in

jury

in

vest

igat

ions

revi

ewed

to id

entif

y tre

nds

and

poss

ible

con

tribu

ting

fact

ors

mos

t lik

ely

to c

ause

illn

ess

or in

jury

. The

se re

view

s m

ay s

ugge

st a

nee

d fo

r fu

rther

inve

stig

atio

ns a

nd s

teps

for i

llnes

s pr

even

tion

(Dra

ft Vo

lunt

ary

Nat

iona

l Re

tail

Food

Reg

ulat

ory

Prog

ram

Sta

ndar

ds, s

tand

ard

5, p

art 7

.a)

• R

outin

e re

view

of c

ases

of r

epor

ted

food

born

e di

seas

es fo

r tre

nds

in

emer

ging

food

born

e di

seas

es•

Rou

tine

revi

ew o

f out

brea

k in

vest

igat

ion

findi

ngs

for t

rend

s

PR

OC

ESS

• D

raft

Volu

ntar

y N

atio

nal R

etai

l Foo

d Re

gula

tory

Pr

ogra

m S

tand

ard

5, p

art 7

.a, m

et, y

es/n

o

• A

naly

sis o

f foo

dbor

ne d

iseas

e ca

se re

ports

, yes

/no

• A

naly

sis o

f out

brea

k re

ports

, yes

/no

Incr

ease

kn

owle

dge

of fo

odbo

rne

dise

ase

caus

es

and

abat

emen

t st

rate

gies

.

Inco

rpor

atio

n of

resu

lts o

f out

brea

k in

vest

igat

ion

sum

mar

ies

into

food

-saf

ety

train

ing

activ

ities

• Tr

aini

ng a

ctiv

ities

upd

ated

ann

ually

, yes

/no

• %

of s

taff

that

rece

ive

train

ing

rela

ted

to

fo

odbo

rne

dise

ase

outb

reak

inve

stig

atio

ns



ER

FO

RM

AN

CE

IND

ICA

TO

RS

FO

R

FO

OD

BO

RN

E D

ISE

AS

E P

RO

GR

AM

S8

Redu

ce in

cide

nce

of fo

odbo

rne

illne

ss.

8.4.

2.

Tren

ds in

no.

co

nfirm

ed

food

born

e ou

tbre

aks

OU

TCO

ME

• N

o. o

utbr

eaks

repo

rted

to in

divi

dual

sta

te h

ealth

de

partm

ents

• O

utbr

eaks

per

mill

ion

popu

latio

n

• O

utbr

eaks

per

100

0 re

porte

d ca

ses

of s

peci

fied

food

born

e di

seas

e ag

ents

• O

utbr

eaks

in re

stau

rant

s pe

r 100

0 re

stau

rant

s

• N

o. o

utbr

eaks

repo

rted

to e

FORS

OU

TCO

ME

• %

of o

utbr

eaks

repo

rted

to s

tate

hea

lth

de

partm

ent b

y ye

ar a

nd ty

pe o

f age

nt,

co

mpa

red

over

tim

e

Redu

ce in

cide

nce

of fo

odbo

rne

illne

ss.

8.4.

3.

Tren

ds in

in

cide

nce

of s

peci

fied

food

born

e ill

ness

es

OU

TCO

ME

• S

tate

wid

e an

nual

sum

mar

ies

of re

porte

d fo

odbo

rne

dise

ases

with

tren

d an

alys

is

• F

oodN

et tr

end

anal

yses

Incr

ease

hea

lth o

f po

pula

tion.

Beyo

nd s

cope

of

pro

ject

Tab

le 8

.4.

Long

-ter

m o

bje

ctiv

es, i

ndic

ator

s, s

ubin

dic

ator

s, a

nd m

etri

cs

LON

G-T

ERM

O

BJEC

TIVE

IND

ICAT

OR

SUBI

ND

ICAT

OR

MET

RIC

S

Prev

ent f

utur

e ou

tbre

aks.

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Performance Measures for Program Evaluation

A total of 16 performance indicators were selected for the development of target ranges based on their importance and feasibility of implementation (Table 8-5). These include metrics for epidemiology, laboratory, and environmental health programs. Most of the selected performance measures focus on the state level. Several are applicable to both state and local programs and a few are primarily focused on local agencies. For each of the performance measures, a description

is provided that describes the performance measure, relevant definitions, an assessment of the feasibility of measuring performance of the metric, and detailed methods for measurement.

Target ranges for these performance measures are being developed under direction of the CIFOR Performance Indicators Work Group, and will be maintained separately on the CIFOR website. This will allow for the target ranges to be modified as needed, based on the availability of resources and the performance of the system.



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Table 8.5. CIFOR performance measures chosen for target range development

CIFOR PERFORMANCE MEASURE MEASUREMENT METHODS PERFORMANCE

1. Foodborne illness complaint reporting system:

Metric: Agency maintains logs or databases for all complaints or referral reports from other sources alleging food-related illness, food-related injury or intentional food contamination, and routinely reviews data to identify clusters of illnesses requiring investigation.

Definitions: Foodborne illness complaint: A report of illness experienced by one or more persons following exposure to a specific event or establishment.Foodborne illness complaint log: A paper registry of complaints that records information about the complaint and specific establishment.Foodborne illness complaint database: An electronic database that records information about the complaint and specific establishment in a searchable format.

Feasibility: This metric is associated with CIFOR Indicator 8.2.1 “Foodborne complaints investigated.” FDA’s Draft Voluntary National Retail Food Regulatory Program Standards, Standard 5, Part 1.d calls for programs to maintain logs or databases for all complaint or referral reports from other sources alleging food-related illness, injury, or intentional food contamination.

Determine if an agency has any complaint system in place and if it is used to review foodborne illness complaints.

Determine if an agency has an electronic database that can be systematically reviewed to link complaints.

Complaint system is: (select one)Electronic database:System to log complaints:

Not applicable:



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Table 8.5. CIFOR performance measures chosen for target range development Continued


2. Outbreaks detected from complaints:

Metric: Outbreaks detected from complaints: Number outbreaks detected as a result of foodborne illness complaints. Rate of outbreaks detected per 1,000 complaints received.

Definitions: Outbreak detected from a complaint: A foodborne illness outbreak that was detected as a result of a foodborne illness complaint investigation.Foodborne illness outbreak: The occurrence of two or more similar illnesses resulting from ingestion of a common food.Foodborne illness complaint: A report of illness experienced by one or more persons following exposure to a specific event or establishment.

Feasibility: This metric is associated with CIFOR Indicator 8.2.1 “Foodborne complaints investigated.” It provides a consistent expectation for the use of complaint data system. Reporting numbers will allow simple comparisons from year to year for the agency, and reporting rates will allow for comparisons across agencies.

Determine the number of foodborne illness complaints that were received during the year. This will be the denominator for the metric.

Determine the number of foodborne illness outbreaks that were detected as a result of a foodborne illness complaint investigation during the year. This will be the numerator for the metric.

Divide the numerator by the denominator and multiply by 1,000. This will convert the observed numbers into a standardized rate.

Denominator (No. complaints) =

___________________

Numerator (No. outbreaks detected from complaints) =

___________________

Rate (Num./Denom. x 1000)=

___________________



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3. Foodborne illness outbreak rate:

Metric: Number foodborne outbreaks reported, all agents. Rate of outbreaks reported / 1,000,000 population.

Definitions: Foodborne illness outbreak: The occurrence of two or more similar illnesses resulting from ingestion of a common food.Foodborne illness outbreak rate: The number of confirmed foodborne illness outbreaks within a jurisdiction during a year, divided by the population of the jurisdiction x 1,000,000.

Feasibility: This metric is associated with CIFOR Indicator 8.2.4 “Foodborne outbreaks investigated.” It aggregates FoodCORE metrics for outbreak investigations across all pathogens. Reporting foodborne outbreaks is part of PHEP Performance Measure 13.3 Outbreak Investigation Reports. Reporting numbers will allow simple comparisons from year to year for the agency, and reporting rates will allow for comparisons across agencies.

Determine the population of the jurisdiction. This will be the denominator for the metric.

Determine the number of foodborne illness outbreaks that were reported during the year. This will be the numerator for the metric.

Divide the numerator by the denominator and multiply by 1,000,000. This will convert the observed numbers into a standardized rate.

Denominator (Population) =

___________________

Numerator(No. foodborne outbreaks reported) =

___________________

Rate (Num./Denom. x 1,000,000) =

___________________



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4. Confirmed cases with exposure history obtained:

Metric: Number and % of confirmed cases with exposure history obtained.

Definitions: Confirmed case: Case reported to local or state health department by clinical laboratory with confirmed Salmonella, Shiga toxin-producing E. coli (STEC) or Listeria infection.Exposure history: An interview (of any format) that assesses exposures prior to onset of illness. The assessment should go beyond assessment of high risk settings and prevention education to ascertain food consumption/preference or other exposure data. For STEC this should include disease-specific data elements identified by CSTE and for Listeria it should include completing the Listeria case form.

Feasibility: This metric is associated with CIFOR Indicator 8.2.2 “Reported cases with specified foodborne illness interviewed.” It is consistent with FoodCORE common metrics for Salmonella, STEC, and Listeria. Reporting numbers will allow simple comparisons from year to year for the agency, and reporting rates will allow for comparisons across agencies.

Determine the number of confirmed cases reported. This will be the denominator for the metric.

Determine the number of confirmed cases with exposure history obtained. This will be the numerator for the metric.

Divide the numerator by the denominator and multiply by 100. This will convert the observed numbers into a standardized rate.

Measure and report separately for confirmed Salmonella, E. coli (STEC) and Listeria cases.

Denominator (No. confirmed cases) = A. SalmonellaB. E. coli (STEC)C. Listeria

Numerator (No. cases with exposure history) =A. SalmonellaB. E. coli (STEC)C. Listeria

Rate (Num./Denom. x 100) =A. SalmonellaB. E. coli (STEC)C. Listeria



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5. I solate/CIDT-positive clinical specimen submissions to PHL:

Metric: Isolate/CIDT-positive clinical specimen submissions to public health laboratory (PHL): Number and % of isolates from confirmed cases and clinical specimens from patients diagnosed by culture independent diagnostic test (CIDT), submitted to PHL.

Definitions: Isolate: Primary isolates of Salmonella, Shiga toxin-producing E. coli (STEC) or Listeria, limited to first or representative isolate or sample for each case. PHL: State or local public health laboratory designated to serve as a reference laboratory for confirmation and subtyping of isolates for jurisdiction.

Feasibility: This metric is associated with CIFOR Indicator 8.2.3 “Isolates of specified foodborne pathogens submitted to PHL.” It is consistent with FoodCORE common metrics for Salmonella, STEC, and Listeria. Reporting numbers will allow simple comparisons from year to year for the agency, and reporting rates will allow for comparisons across agencies.

Determine the number of confirmed cases reported. This will be the denominator for the metric.

Determine the number of isolates and clinical specimens from patients diagnosed by culture independent diagnostic test (CIDT), submitted to the PHL. This will be the numerator for the metric.


Measure and report separately for confirmed Salmonella, E. coli (STEC), and Listeria cases.

Denominator (No. confirmed cases) = A. SalmonellaB. E. coli (STEC)C. Listeria

Numerator (No. isolates/ CIDT-positive clinical specimens submitted) =A. SalmonellaB. E. coli (STEC)C. Listeria

Rate (Num./Denom. x 100) =A. SalmonellaB. E. coli (STEC)C. Listeria



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6. PFGE subtyping of isolates:

Metric: Number and % of isolates with PFGE information.

Definitions: Isolate: Primary isolates of Salmonella, Shiga toxin-producing E. coli (STEC), or Listeria, limited to first or representative isolate or sample for each case. PFGE: Pulsed-field gel electrophoresis.

Feasibility: This metric is associated with CIFOR Indicator 8.2.3 “Isolates of specified foodborne pathogens submitted to PHL.” It is consistent with FoodCORE common metrics for Salmonella, STEC, and Listeria. Reporting numbers will allow simple comparisons from year to year for the agency, and reporting rates will allow for comparisons across agencies.

Determine the number of isolates submitted to the PHL. This will be the denominator for the metric.

Determine the number of isolates with PFGE information. This will be the numerator for the metric.



Denominator (No. isolates submitted) = A. SalmonellaB. E. coli (STEC)C. Listeria

Numerator (No. isolates with PFGE information) =A. SalmonellaB. E. coli (STEC)C. Listeria

Rate (Num./Denom. x 100)=A. SalmonellaB. E. coli (STEC)C. Listeria



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7. Isolate/CIDT-positive clinical specimen submission interval:

Metric: Median number days from collection of clinical specimen to receipt of isolate or clinical specimen from a patient diagnosed by CIDT, at PHL.

Definitions: Isolate: Primary isolates of Salmonella, Shiga toxin-producing E. coli (STEC), or Listeria, limited to first or representative isolate or sample for each case. CIDT-positive clinical specimen: Clinical specimens forwarded to PHL for confirmation and isolation from patients diagnosed with Salmonella, Shiga toxin-producing E. coli (STEC) or Listeria by culture independent diagnostic test (CIDT). Isolate/CIDT-positive clinical specimen submission interval: The number of days from collection of the clinical specimen to receipt of the isolate or clinical specimen from a patient diagnosed by CIDT, at the PHL.

Feasibility: This metric is associated with CIFOR Indicator 8.2.3 “Isolates of specified foodborne pathogens submitted to PHL.” It is consistent with FoodCORE common metrics for Salmonella and STEC. Median values likely reflect consistent general practices within the jurisdiction. Reporting median values will allow for comparisons across years within the agency and across agencies.

For each isolate or clinical specimen from a patient diagnosed by culture independent diagnostic test (CIDT), determine the date of specimen collection and the date of receipt at the PHL.

Determine the number of calendar days between these dates, which is the isolate/CIDT-positive clinical specimen submission interval. Analyze the distribution of all known isolate/CIDT-positive clinical specimen submission intervals for the year.

Report the median value for isolates/CIDT-positive clinical specimens with known isolate/CIDT-positive clinical specimen submission intervals. Determine the percentages of isolates/CIDT-positive clinical specimens with missing information for which an isolate submission interval cannot be determined.


% of isolates/CIDT-positive clinical specimens with missing information:A. SalmonellaB. E. coli (STEC)C. Listeria

Median interval for isolates/CIDT-positive clinical specimens with known isolates/CIDT-positive clinical specimen submission intervals:A. SalmonellaB. E. coli (STEC)C. Listeria



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8. Isolate subtyping interval:

Metric: Median number days from receipt of isolate to availability of PFGE subtyping results.

Definitions: Isolate: Primary isolates of Salmonella, Shiga toxin-producing E. coli (STEC), or Listeria, limited to first or representative isolate or sample for each case. Isolate subtyping interval: The number of days from receipt of the isolate at the PFGE laboratory to availability of PFGE subtyping results.

Feasibility: This metric is associated with CIFOR Indicator 8.2.3 “Isolates of specified foodborne pathogens submitted to PHL.” It is consistent with FoodCORE common metrics for Salmonella and STEC. Median values likely reflect consistent general practices within the jurisdiction. Reporting median values will allow for comparisons across years within the agency and across agencies.

For each isolate, determine the date of receipt at the PFGE laboratory and the date of upload to PulseNet.

Determine the number of calendar days between these dates, which is the isolate subtyping interval. Analyze the distribution of all known isolate subtyping intervals for the year.

Determine the percentages of isolates with missing information for which an isolate subtyping interval cannot be determined.

Report the median value for isolates with known isolate subtyping intervals.


% of isolates with missing information:A. SalmonellaB. E. coli (STEC)C. Listeria

Median interval for isolates with known isolate subtyping intervals:A. SalmonellaB. E. coli (STEC)C. Listeria



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CIFOR PERFORMANCE MEASURE MEASUREMENT METHODS

PERFORMANCE

9. PHEP E. coli O157 and Listeria subtyping interval:

Metric: PHEP E. coli O157 and Listeria subtyping interval: % of PFGE subtyping data results for E. coli O157:H7 and Listeria submitted to the PulseNet national database within four working days of isolate receipt at the PFGE laboratory.

Definitions: PHEP: Public Health Emergency Preparedness Cooperative Agreement. PHEP specifies performance measures regarding public health surveillance and investigation of specified agents.

Feasibility: This metric is associated with CIFOR Indicator 8.2.3 “Isolates of specified foodborne pathogens submitted to PHL,” but entirely incorporates existing PHEP performance measures for PFGE subtyping of E. coli O157:H7 (PHEP 12.14) and L. monocytogenes (PHEP 12.15).

Determine the number of isolates submitted to the public health laboratory.

Determine the number of isolates for which PFGE subtyping was performed. This will be the denominator for the metric.

Determine the number of number of primary patterns from subtyped isolates uploaded to PulseNet.

Determine the number of results from PFGE subtyped isolates that were submitted to PulseNet within four working days of receipt at the PFGE laboratory. This will be the numerator for the metric.

Divide the numerator by the denominator and multiply by 100.

Denominator (No. isolates subtyped by PFGE) =

___________________

Numerator (No. isolates subtyped within 4 days) =

___________________

Rate (Num./Denom. x 100) =

___________________



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10. Outbreak clinical specimen collections:

Metric: Outbreak clinical specimen collections: Number and % of outbreak investigations with clinical specimens collected and submitted to PHL from two or more people.

Definitions: Foodborne illness outbreak: The occurrence of two or more similar illnesses resulting from ingestion of a common food.

Feasibility: This metric is associated with CIFOR Indicator 8.2.4 “Foodborne outbreaks investigated.” It extends FoodCORE metrics to investigations for all pathogens.

Determine the number of foodborne illness outbreaks that were investigated. This will be the denominator for the metric.

Determine the number of outbreaks for which clinical specimens were collected and submitted to the PHL from two or more people. This will be the numerator for the metric.


Denominator (No. outbreaks) =

___________________

Numerator (No. outbreaks with clinical specimens collected) =

___________________


___________________



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11. Cluster investigation interval:

Metric: Median number days from initiation of investigation to identification of source.

Definitions: Cluster: Two or more isolates with a matching molecular subtype pattern identified in a period of two weeks.Cluster investigation interval: The number of days from the initiation of an investigation to the identification of source, for clusters with a source identified.Initiation of an investigation: Steps taken to investigate the possible source of a cluster of cases after it is determined that they may represent a common source outbreak. This goes beyond routine follow-up of individual cases.

Feasibility: This metric is associated with CIFOR Indicator 8.2.5 “Case clusters investigated.” It aggregates FoodCORE metrics for investigations across all pathogens.

Determine the number of clusters that were detected by the public health laboratory.

Determine the number and % of clusters where a source was identified.

For each cluster for which a source was identified, determine the date at which the investigation was initiated and the date at which the source was identified.

Determine the number of calendar days between these dates, which is the cluster investigation interval. Analyze the distribution of all known cluster investigation intervals for the year.

Report the median value for investigations with known cluster investigation intervals.

Percentage of clusters with source identified:

___________________

Median interval for cluster with known investigation intervals:

___________________



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12. Complaint investigation interval:

Metric: Median number days from initiation of investigation to implementation of intervention.

Definitions: Foodborne illness complaint: A report of illness experienced by one or more persons following exposure to a specific event or establishment. Complaint investigation interval: The number of days from the initiation of an investigation to the initial intervention. Initiation of an investigation: Steps taken to investigate the possible source of a complaint after it is determined that it may represent a common source outbreak. This goes beyond routine follow-up of individual complaints. Intervention: A public health action taken to control an identified hazard.

Feasibility: This metric is associated with CIFOR Indicator 8.2.1 “Foodborne complaints investigated.” It aggregates FoodCORE metrics for investigations across all pathogens.

Determine the number of foodborne illness complaints that were investigated.

Determine the number and percentage of foodborne complaint investigations that led to an intervention.

For each complaint investigation that led to an intervention, determine the date at which the investigation was initiated and the date at which an intervention was initiated.

Determine the number of calendar days between these dates, which is the complaint investigation interval. Analyze the distribution of all complaint investigation intervals for the year.

Report the median value for complaint investigation intervals.

% of complaint investigations with interventions:

___________________

Median interval for complaints with known isolate investigation intervals:

___________________



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13. Cluster source identification:

Metric: Number and % of clusters with more than five cases in which a source was identified.

Definitions: Cluster: Two or more isolates with a matching molecular subtype pattern identified in a period of two weeks. Cluster source identification: The number of identified clusters for which a specific food transmission setting, meal, food item or ingredient was identified, leading the cluster to be considered an outbreak.

Feasibility: This metric is associated with CIFOR Indicator 8.2.5 “Case clusters investigated.”

Determine the number of clusters that include five or more cases. This will be the denominator for the metric.

Determine the number of clusters for which a source was identified that include five or more cases. This will be the numerator for the metric.


Denominator (No. clusters with ≥ 5 cases) =

___________________

Numerator (No. clusters with ≥ 5 cases with source identified) =

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___________________



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14. Outbreak etiology reported to NORS:

Metric: Number and % of outbreaks for which etiology was identified and reported to NORS.

Definitions: Foodborne illness outbreak: The occurrence of two or more similar illnesses resulting from ingestion of a common food.NORS form: National Outbreak Reporting System, Foodborne Disease Outbreaks and Enteric Disease Outbreaks Transmitted by Contact with Persons, Animals, or Environmental Sources, or by an Unknown Mode; NORS Form (CDC 52.13 Form).Etiology identified: For most etiologic agents CDC considers an outbreak to have a confirmed etiology if there are two or more lab-confirmed cases (MMWR 2000, Vol. 49/SS-1, App. B). Etiology may be suspected based on characteristic combinations of clinical symptoms, incubation periods, and duration of illness. Feasibility: This metric is associated with CIFOR Indicator 8.3.1 “Etiology of outbreak identified.” This metric will require improved investigation and documentation by many agencies.

Determine the number of foodborne outbreaks that were investigated. This will be the denominator for the metric.

Determine the number of outbreaks for which an etiology was identified and reported to NORS. This will be the numerator for the metric.



___________________

Numerator (No. with etiology reported to NORS) =

___________________


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15. Outbreak vehicle reported to NORS:

Metric: Number and % of outbreaks for which a vehicle was identified and reported to NORS.

Definitions: Foodborne illness outbreak: The occurrence of two or more similar illnesses resulting from ingestion of a common food.NORS form: National Outbreak Reporting System, Foodborne Disease Outbreaks and Enteric Disease Outbreaks Transmitted by Contact with Persons, Animals, or Environmental Sources, or by an Unknown Mode; NORS Form (CDC 52.13 Form).Vehicle identified: A specific food item or ingredient was confirmed or suspected to be the source of the outbreak based on one of the following: (1) Statistical evidence from epidemiological investigation, (2) Laboratory evidence (e.g., identification of agent in food), (3) Compelling supportive information, (4) Other data (e.g., same phage type found on farm that supplied eggs), (5) Specific evidence lacking but prior experience makes it a likely source. Feasibility: This metric is associated with CIFOR Indicator 8.3.2 “Vehicle of outbreak identified.” This metric will require improved investigation and documentation by many agencies.


Determine the number of outbreaks for which a vehicle was identified and reported to NORS. This will be the numerator for the metric.



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Numerator (No. with vehicle reported to NORS) =

___________________


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16. Outbreak contributing factor reported to NORS:

Metric: Number and % of outbreaks for which contributing factors were identified and reported to NORS.

Definitions: Foodborne illness outbreak: The occurrence of two or more similar illnesses resulting from ingestion of a common food.NORS form: National Outbreak Reporting System, Foodborne Disease Outbreaks and Enteric Disease Outbreaks Transmitted by Contact with Persons, Animals, or Environmental Sources, or by an Unknown Mode; NORS Form (CDC 52.13 Form).Contributing factor identified: Contributing factors (CFs) are defined as the food safety practices and behaviors which most likely contributed to a foodborne illness outbreak.A CF should be identified only if the investigator has strong evidence that it actually occurred in the investigated outbreak; just because a factor has been cited in similar outbreaks in the past does not mean it was involved in the investigated outbreak. Feasibility: This metric is associated with CIFOR Indicator 8.3.3 “Contributing factor identified.” This metric will require improved investigation and documentation by many agencies.


Determine the number of outbreaks for which a contributing factor was identified and reported to NORS. This will be the numerator for the metric.



___________________

Numerator (No. with contributing factors reported to NORS) =

___________________


___________________


performance indicators for foodborne disease programs · 2017-11-13 · of states’ foodborne...

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