Environmental Antecedents of Foodborne Illness Outbreaks, United States, 2017-2019

Foodborne outbreak investigations often provide data for public health officials to determine how the environment contributed to the outbreak and on how to prevent future outbreaks. State and local health departments are responsible for investigating foodborne illness outbreaks in their jurisdictions and reporting the data to national-level surveillance systems, including information from the environmental assessment. This assessment is designed to describe how the environment contributed to the outbreak and identifies factors that contributed to the outbreak and environmental antecedents to the outbreak. Environmental antecedents, also referred to as root causes, are specific reasons that allow biological or chemical agents to contaminate, survive, or grow in food. From 2017 to 2019, 24 jurisdictions reported 1,430 antecedents from 393 outbreaks to the National Environmental Assessment Reporting System. The most reported antecedents were lack of oversight of employees/enforcement of policies (89.1%), lack of training of employees on specific processes (74.0%), and lack of a food safety culture/attitude towards food safety (57.5%). These findings highlight the critical role that employees play in restaurant food safety and are heavily influenced by restaurant management, who can exercise active managerial control to manage these antecedents. Identifying antecedents during investigations is essential for understanding the outbreak's root cause and implementing sustainable corrective actions to stop the immediate outbreak and future outbreaks.