Environmental health professionals are embracing informatics as a tool to improve the health of populations across the nation. It is essential to ensure the public has access to environmental health-related data, such as restaurant and recreational water inspections, to help make informed decisions about health and safety. While many environmental health programs across the country share their data using online platforms, this practice is not universal and the timeliness, ease of access, and extent of data sharing vary across programs. | | The Centers for Disease Control and Prevention partnered with the Public Health Informatics Institute to better understand how environmental health programs collect and share data. This month's column highlights the information gathered from key informants to provide insight into data standardization.

Environmental health programs collect data (e.g., inspection results) that might not be routinely analyzed for trends or used to inform timely public health decision-making. State, tribal, local, and territorial health departments and environmental health programs, however, can lack resources, time, or the experience to collect, analyze, and visualize EH data. Leveraging the use of informatics by standardizing data collection, sharing, and utilization can support innovative approaches to improving EH practice. | | The Centers for Disease Control and Prevention (CDC) Water, Food, and Environmental Health Services Branch supports the work of EH informatics through collaborative activities that | | promote timely public data and information sharing to detect and address existing or potential exposures to EH hazards, | support best practices for the innovative use of existing data and electronic information to design interventions to protect public health, and | identify environmental and health outcome indicators to assess the need for and impact of EH services. | This month's column explores designing an open data standard to improve health and safety in aquatic facilities, as well as leveraging informatics to improve environmental health practice and innovation.

PROBLEM/CONDITION: State and local public health departments report hundreds of foodborne illness outbreaks each year to CDC and are primarily responsible for investigations of these outbreaks. Typically, investigations involve epidemiology, laboratory, and environmental health components. Health departments voluntarily report epidemiologic and laboratory data from their foodborne illness outbreak investigations to CDC through the Foodborne Disease Outbreak Surveillance System (FDOSS); however, minimal environmental health data from outbreak investigations are reported to FDOSS. PERIOD COVERED: 2014-2016. DESCRIPTION OF SYSTEM: In 2014, CDC launched the National Environmental Assessment Reporting System (NEARS) to complement FDOSS surveillance and to use these data to enhance prevention efforts. State and local health departments voluntarily report data from their foodborne illness outbreak investigations of retail food establishments. These data include characteristics of foodborne illness outbreaks (e.g., agent), characteristics of establishments with outbreaks (e.g., number of meals served daily), food safety policies and practices of these establishments (e.g., glove use policies), and characteristics of outbreak investigations (e.g., timeliness of investigation activities). NEARS is the only available data source that includes characteristics of retail establishments with foodborne illness outbreaks. RESULTS: During 2014-2016, a total of 16 state and local public health departments reported data to NEARS on 404 foodborne illness outbreaks at retail establishments. The majority of outbreaks with a suspected or confirmed agent were caused by norovirus (61.1%). The majority of outbreaks with identified contributing factors had at least one factor associated with food contamination by a worker who was ill or infectious (58.6%). Almost half (47.4%) of establishments with outbreaks had a written policy excluding ill workers from handling food or working. Approximately one third (27.7%) had a written disposable glove use policy. Paid sick leave was available for at least one worker in 38.3% of establishments. For most establishments with outbreaks (68.7%), environmental health investigators initiated their component of the investigation soon after learning about the outbreak (i.e., the same day) and completed their component in one or two visits to the establishment (75.0%). However, in certain instances, contacting the establishment and completing the environmental health component of the investigation occurred much later (>8 days). INTERPRETATION: Most outbreaks reported to NEARS were caused by norovirus, and contamination of food by workers who were ill or infectious contributed to more than half of outbreaks with contributing factors; these findings are consistent with findings from other national outbreak data sets and highlight the role of workers in foodborne illness outbreaks. The relative lack of written policies for ill workers and glove use and paid sick leave for workers in establishments with outbreaks indicates gaps in food safety practices that might have a role in outbreak prevention. The environmental health component of the investigation for most outbreaks was initiated quickly, yet the longer initiation timeframe for certain outbreaks suggests the need for improvement. PUBLIC HEALTH ACTION: Retail establishments can reduce viral foodborne illness outbreaks by protecting food from contamination through proper hand hygiene and excluding workers who are ill or infectious from working. NEARS data can help prioritize training and interventions for state and local food safety programs and the retail food establishment industry by identifying gaps in food safety policies and practices and types of establishments vulnerable to outbreaks. Improvement of certain outbreak investigation practices (e.g., delayed initiation of environmental health investigations) can accelerate identification of the agent and implementation of interventions. Future analysis comparing establishments with and without outbreaks will contribute knowledge about how establishments' characteristics and food safety policies and practices relate to foodborne illness outbreaks and provide information to develop effective prevention approaches.

Foodborne illness is a significant public health problem in the U.S. Annually, more than 800 foodborne illness outbreaks are reported to the Centers for Disease Control and Prevention (CDC) and most of these occur in retail food service establishments (e.g., restaurants). State and local health department investigations of outbreaks collect information valuable in preventing future outbreaks. Of particular value are the data collected during environmental assessments. Environmental assessments are focused on identifying the environmental causes of outbreaks (also known as contributing factors and environmental antecedents). Findings from environmental assessments can be used to recommend effective interventions that stop ongoing foodborne illness outbreaks and prevent future outbreaks. | | CDC developed the Environmental Assessment Training Series (EATS) to provide much needed training on environmental assessments for food safety officials, CDC’s goal was to provide free online training that uses cutting edge e-learning technology to improve competency with conducting environmental assessments as part of foodborne illness outbreak investigations. This month’s column highlights the EATS training program and its benefits.

NEHA strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we feature a column from the Environmental Health Services Branch (EHSB) of the Centers for Disease Control and Prevention (CDC) in every issue of the Journal. In these columns, EHSB and guest authors share insights and information about environmental health programs, trends, issues, and resources. The conclusions in this article are those of the author(s) and do not necessarily represent the views of CDC. Erik Coleman is a health scientist in informatics with EHSB.

Information on the factors that cause or amplify foodborne illness outbreaks (contributing factors), such as ill workers or cross-contamination of food by workers, is critical to outbreak prevention. However, only about half of foodborne illness outbreaks reported to the United States' Centers for Disease Control and Prevention (CDC) have an identified contributing factor, and data on outbreak characteristics that promote contributing factor identification are limited. To address these gaps, we analyzed data from 297 single-setting outbreaks reported to CDC's new outbreak surveillance system, which collects data from the environmental health component of outbreak investigations (often called environmental assessments), to identify outbreak characteristics associated with contributing factor identification. These analyses showed that outbreak contributing factors were more often identified when an outbreak etiologic agent had been identified, when the outbreak establishment prepared all meals on location and served more than 150 meals a day, when investigators contacted the establishment to schedule the environmental assessment within a day of the establishment being linked with an outbreak, and when multiple establishment visits were made to complete the environmental assessment. These findings suggest that contributing factor identification is influenced by multiple outbreak characteristics, and that timely and comprehensive environmental assessments are important to contributing factor identification. They also highlight the need for strong environmental health and food safety programs that have the capacity to complete such environmental assessments during outbreak investigations.

Food-related illnesses affect tens of millions of people and kill thousands in the U.S. each year. They also cause billions of dollars in health care–related and industry costs annually. As a result, the Centers for Disease Control and Prevention (CDC) have identified reducing food-borne diseases as a “winnable battle (CDC, 2013).” To address this issue, in April 2014 CDC’s National Center for Environmental Health launched two food safety tools that are transforming how environmental health workers conduct foodborne illness environmental assessments as part of an outbreak response and how they report these data to prevent future outbreaks.