Module 4 – Group Exercise: Undertaking an Environmental Health Assessment of a Restaurant associated with an Outbreak of Salmonellosis

Divide into groups by table.

  1. Study the information provided on an outbreak of salmonellosis linked to a restaurant.
  2. Walk through the environmental health assessment of the restaurant, answering the questions below.
  3. Do you see any contributing factors likely to be related to the outbreak?

An outbreak of gastrointestinal illness is linked to a local restaurant. Seven unrelated restaurant patrons are sick with abdominal pain, nausea, vomiting, and diarrhea. Onset of illness among cases was January 22-24. Two ill patrons had stool specimens positive for Salmonella.

Question 1: You are responsible for undertaking the environmental health assessment associated with this outbreak. How would you prepare yourself for the investigation?

The restaurant is known for its burgers but serves a variety of sandwiches and salads. Based on patient interviews by the public health nurse, ill persons ate at the restaurant on January 20. All but one ate chicken salad. Three ill persons had only chicken salad.

Question 2: What type of activities will you undertake at the facility as part of the environmental health assessment?

Question 3: Given the causative agent (Salmonella), implicated food (chicken salad), and setting (food service establishment), what contributory factors will you be looking for?

The manager tells you two employees (Willard and Anita) usually make the salad. Making the chicken salad is a 2-day process. You interview the employees to reconstruct how the salad was made.

Day 1 (Preparation of chicken): Refrigerated, whole chickens are washed, trimmed, and placed in a clean and sanitized tub for transport to the cooking area. The chickensare placed on rotisserie spindles, 5 chickens to a spindle. The chickens are cooked until the chicken’s internal temperature reaches at least 165° F for 15 seconds which usually takes about 1.5 hours. The chickens are removed from spindles to cool in shallow cooling pans. After about an hour, the chicken is warm to the touch and is deboned and diced. The diced chicken is placed into a shallow pan (4-inches deep) and is covered with plastic wrap, leaving a vent for warm air to dissipate. The pan is placed in the walk-in refrigerator.

Question 4: Draw a flow diagram for preparing the chicken.


Day 2 (Salad assembly): Pre-chilled salad ingredients, including nuts, celery, and grapes, are washed, chopped, and placed in a bowl. Chopped ingredients are mixed with pre-chilled mayonnaise. The salad is placed onto a servingplatter, covered with plastic wrap, and placed in the walk-in refrigerator.

Question 5: You then watch Willard and Anita make the salad. These photos were taken as you observed the salad being made. Do any concern you? Do you see any factors likely contributing to the outbreak of salmonellosis?

Group Exercise: Undertaking an Environmental Health Assessment of a Restaurant – p. 1