In 1993, 623 people in the western U.S. fell ill with a little-known bacteria called E. coli O157:H7. Ultimately, four children would die from their infections; many others suffered long-term medical complications. The bug was later traced to undercooked hamburger served at Jack in the Box restaurants. This outbreak thrust foodborne illness onto the national stage as a real and present threat, sparking a sea change in the way Americans and the government treat this issue. To commemorate the 20th anniversary of the 1993 Jack in the Box outbreak, Food Safety News has produced a series of retrospective stories chronicling the outbreak itself and how food safety in America has changed since that time. Michael Taylor had been the USDA’s new Food Safety and Inspection Service Administrator for just six weeks when he took to the podium at the American Meat Institute’s annual convention in San Francisco on September 29, 1994, and changed the beef industry forever. Taylor was appointed to the job less than two years after the most devastating foodborne illness outbreak the U.S. had ever seen: The 1993 Jack in the Box E. coli outbreak. Memories of that tragedy — in which tainted hamburger meat sickened hundreds and killed four children — set the tone for the speech. Every point in the beef chain, from slaughterhouse to marketplace, Taylor said, required scrutiny to protect consumers from dangerous microbes. And then, in two sentences, he effectively established a new safety standard for the entire industry: “To clarify an important legal point, we consider raw ground beef that is contaminated with E. coli O157:H7 to be adulterated within the meaning of the Federal Meat Inspection Act,” he said. “We are prepared to use the Act’s enforcement tools, as necessary, to exclude adulterated product from commerce.” Until Taylor’s announcement, the term “adulterant” had been restricted to things like harmful chemicals or foreign objects. Now, for the first time, a microorganism in the gut of a cow would become an illegal substance if it made it into the ground beef. Some industry leaders viewed the announcement as government playing catch-up. Companies were already experimenting with new prevention methods. No one wanted to be the next Jack in the Box, but many thought declaring the pathogen an adulterant was going too far. The industry sued, but ultimately the declaration stood. E. coli in ground beef was illegal, plain and simple. Between the efforts of industry leaders and the baseline government regulations, action inspired by the Jack in the Box outbreak have resulted in major reductions in E. coli O157:H7 infections in the past 20 years. According to FSIS estimates, since peaking in 2001, the presence of E. coli O157:H7 in U.S. ground beef has declined by approximately 80 percent. Looking at U.S. Centers for Disease Control (CDC) data, that corresponds with an estimated 40 percent decline in overall E. coli infections during the same time, despite E. coli rates rising among other food commodities, such as spinach and lettuce. Out of nine major foodborne pathogens, E. coli O157:H7 was the only one driven below the U.S. government’s 2010 National Health Objective of less than 10 reported infections for every 1 million citizens (it infects around 9.8). By comparison, Salmonella — commonly found on poultry and not considered an adulterant — infects 165, an infection rate more than 15 times greater. Today, beef industry leaders will say there’s still progress to be made, and E. coli victims would agree, but the zero-tolerance policy toward E. coli has inspired two decades of innovations that continue to drive infection rates lower. “Before the Jack in the Box outbreak, beef plants were simply in the beef business. Microbial control was more of a shelf-life consideration than a contamination issue,” said Dave Theno, Ph.D., the man hired to take over the company’s safety system after the outbreak. “But I can tell you that today, at major corporations, food safety is a topic that gets brought up at every board meeting.” A company reacts In January 1993, Dave Theno knew more about E. coli in beef than anyone else in America, a distinction that likely put him in the running for most knowledgeable in the world. By 1988, he was working with a select group of beef producers concerned that the bug was poised to cause the industry some headaches down the road. In 1982, an unnamed fast food chain sickened at least 47 people in Oregon and Michigan with E. coli O157:H7. The bacterium almost was unheard-of in the medical field. At the time, public health agencies never released the name of the restaurant chain, but today the outbreak is known to have been caused by McDonald’s hamburgers. Other isolated outbreaks had cropped up in the interim decade, but many in the industry explained them as “one-offs,” Theno explained. Up until 1993, major players in the beef and fast food industry — including Jack in the Box CEO Robert Nugent — had still never heard of E. coli. “The more I looked into E. coli, the more I realized it was perhaps a bigger issue than we thought it was at the time,” Theno told Food Safety News. “But I just wasn’t fast enough. When it did finally blow up, it was catastrophic.” When the outbreak hit, Nugent brought Theno on as a consultant to help Jack in the Box deal with the fallout, and eventually hired him as the company’s vice president of technical services. Nugent tasked Theno with ensuring the company never had another outbreak. That task resulted in sweeping changes to the company’s operations which have since set new standards across the entire fast food industry — and beyond. In essence, Theno introduced to Jack in the Box a systematic approach to food safety known as Hazard Analysis and Critical Control Points, or HACCP (pronounced “hassip”). HACCP was originally developed by NASA and the Pillsbury Company in the 60s in an effort to ensure food for the space program would have the least possible chance of sickening astronauts. Theno had already introduced HACCP to poultry operations at Foster Farms in the 80s to successfully drive down the company’s Salmonella contamination rate to minuscule numbers. He intended to do the same thing to E. coli. Theno’s plan targeted four major components of the business: Suppliers, transportation, restaurant staff, and corporate infrastructure. Jack in the Box now required random E. coli sampling of all beef supplies. The company went from having no microbial testing at all to conducting a random test every 15 minutes. When certain plants had consistent E. coli problems, they simply got dropped as a supplier. The company graphed the amount of E. coli coming into its system over time, and found that each time he food safety team cut out a bad supplier, the data showed a steep drop in E. coli levels. “The graph looked like a staircase,” Theno said. “That tells you the burden those people were adding to the system. Through this process, we made it to the point where we had a 2.5-year stretch where we tested every 15 minutes without a single positive sample.” Jack in the Box had a checklist for slaughterhouses: Proper ways to skin the animals, wash the carcasses, and, most importantly, remove the organs without rupturing the intestines. The vast majority of E. coli contamination occurs when contaminated feces comes in on the cattle’s hides, or when intestines are ruptured during evisceration. During transportation, patties were to be strictly held at safe temperatures from plant to burger grill, at which point they’d be heated to an internal temperature of 155 degrees by employees versed in food safety training. Corporate incentives were structured around food safety priorities. And, for the record, the company has not had an outbreak since 1993. “Many people said we couldn’t do what we did,” Theno said. “Any time you try to make changes there are always naysayers, but the reality is that you can do things better and you can make a difference.” An industry adjusts The beef industry, represented by organizations such as the National Cattlemen’s Beef Association (NCBA) and the American Meat Institute (AMI), has invested almost $30 million in beef safety research since the Jack in the Box outbreak. Around 95 percent of that research has focused on E. coli, said James Reagan, Ph.D., senior vice president of research, education and innovation at the NCBA. After 1993, companies started experimenting with a myriad of prevention methods: Organic acid rinses, hot water baths — anything that could kill any organism on the surface it hit. By 1995, the USDA had approved of an intervention known as steam pasteurization, a “get-out-of-jail-free card,” as Theno jokingly described it. Developed by engineer Craig Wilson of Frigoscandia Equipment and Excel Fresh Meats CEO Jerry Leising, steam pasteurization was designed to kill even the pathogens that might escape the interventions that relied on liquid rinses. Wilson’s son went to school with Brianne Kiner, the severely sickened girl who received the largest settlement of the personal injury lawsuits that followed the outbreaks. His engineering team was based out of Bellevue, Wash., a community directly hit by the outbreak. While Frigoscandia primarily focused on refrigeration technology, Wilson and others were inspired to capitalize on their beef industry ties to help fight the threat of E. coli. Following USDA approval, steam pasteurization systems became a staple at the plants of many of the major beef processors such as Tyson and Cargill. The systems kill pathogens on beef by running carcasses through a clamshell enclosure that blasts hot steam. “No intervention is a one-hundred percent guarantee, but we’ve definitely kept kids safer,” Wilson told Food Safety News. In 1998, Wilson left Frigoscandia to become the vice president of food safety and technology for Costco. He eventually established a company standard that all beef sold at Costco stores must come from plants that use steam pasteurization or an equally effective intervention. But from 1993 to 2001, E. coli contamination rates continued to rise. Finally, in summer 2002, an E. coli O157:H7 outbreak sparked a recall of 18.6 million pounds of ground beef processed by ConAgra Foods in Colorado. That was when Reagan at NCBA, Theno and other industry leaders decided enough was enough. They established an annual food safety summit for the industry, where major beef companies would attend to share their best food safety information for the benefit of all. When beef gets people sick, it hurts the whole industry’s image, Reagan said. “We could no longer look at safety being an economic advantage. It had to become a non-competitive issue,” Reagan said. “We got these companies to come together and say ‘This is what we’ve learned. This is what’s working. Here’s our data.’ All of a sudden you’ve got guys from Tyson and Cargill and JBS — guys who would never normally talk to each other — sharing data.” And the summits weren’t just for the big players. Small-scale beef producers have access to the same information, and they have access to expert consultants to get their safety systems up to speed. After the summits became a hit and companies began collaborating on safety practices, Theno’s test-and-hold sampling methods took off. Granted, beef still causes E. coli outbreaks. Recalls still get prompted. For the most part, however, multi-million-pound recalls are a thing of the past. Today, nearly all beef recalls are kept below 10,000 pounds, Reagan said. Many are under 1,000. “The industry has made terrific strides,” Theno said. “Things are much better today than they were. Some of that’s thanks to regulation, but a lot of it is people realizing they had an issue and they needed to be on top of it. At the end of the day, if you’re going to make food safer, the leadership at every company needs to be committed to it.” It all comes back to Jack in the Box “As I look at it, the initiative that moved us further down the road and still drives us today is the Jack in the Box outbreak,” Reagan told Food Safety News. “I see that as more significant to the industry than the adulterant declaration.” Attorney and Food Safety News publisher Bill Marler got his start in foodborne illness litigation representing victims of the Jack in the Box outbreak. He joined Theno and Reagan on stage at the 2012 Beef Industry Safety Summit to give a keynote address in which he commended the industry on its work to curb E. coli infections since that outbreak. From 1993 to 2005, Marler said, roughly 90 percent of his firm’s foodborne illness revenue came from E. coli O157:H7 in beef. Today, it accounts for about 5 percent — and that’s with better government surveillance than ever before. But all three agree there’s always more room for progress. Next for the industry and regulators to tackle, Marler said, will be antibiotic-resistant Salmonella, other toxic strains of E. coli, and the issue of needle-tenderized steak. “The reality is, we’re not seeing as many E. coli cases linked to hamburger anymore,” Marler said. “That doesn’t mean they aren’t happening and that they don’t have devastating consequences when they do, but we certainly haven’t seen anything close to the scale of Jack in the Box. You can chalk that up to industry taking charge and Michael Taylor’s decision to make E. coli in ground beef an adulterant — to establish a culture where E. coli is simply illegal.”