A one-state E. coli O157: H7 outbreak in July likely involved at least one dozen customers of a Red Robin restaurant in Westminster, CO. Colorado’s Tri-County Health Department is out with a final report on the outbreak of Shiga toxin-producing E. coil infections.
The report contains what some call troubling findings of poor employee hygienic practices and a climate for cross-contamination. It shows how serious the local health department was in persuading the restaurant to close temporarily and employees to submit to rectal swabs.
Red Robin Gourmet Burgers Inc. is a full-service chain of 560 restaurants in the United States and Canada. Red Robin’s headquarters is just a stone’s throw away from Westminster in Greenwood Village, CO. It promises “high-quality gourmet burgers in a family-friendly atmosphere,”
The Colorado Department of Public Health and Environment (CDPHE) first informed Tri-County about three lab-confirmed E. coli cases with matching pulsed-field gel electrophoresis (PFGE) patterns on July 8. Interviews pointed to a common exposure at the Red Robin at 799 W. 140th Ave. in Westminster, CO. The restaurant is located in Adams County, CO., which is part of Tri-County’s jurisdiction. “No additional common exposures were identified between the three cases,” the report says.
Tri-County conducted an outbreak investigation to implement disease control measures and attempt to identify the source of the illnesses. Tri-County’s environmental health specialists and epidemiologists reviewed food handling procedures, hand hygiene practices, food temperatures, cross-contamination, glove-use, and sanitization.
During a July 9 inspection, Tri-County questioned Red Robin management personnel about any other illness complains by both patron and employees. They also queried management about handwashing protocols and reviewed disease control measures. These included cleaning and disinfection, surveillance, and food safety procedures.
Red Robin then closed voluntarily from July 10-13. The Tri-County report says Red Robin “addressed all stipulations for re-opening and were appropriately staffed” at the re-opening.
A second inspection occurred on July 12, with two additional enforcement inspections on Aug. 21 and Sept 11. Additional ones were scheduled.
Red Robin employees volunteered for standardized food worker interviews, and Tri-County “facilitated rectal swabbing and bacterial testing of all active employees as part of the facility’s requirement for re-opening.”
CDPHE’s laboratory conducted bacterial culture testing for 54 Red Robin employees.
An enforcement review hearing was first delayed until September and then canceled. However, Red Robin has agreed to the enforcement process.
The investigation’s areas of concern included:
- Cross-contamination between raw and ready to eat foods.
- Failures of employees to wash hands when required and for an appropriate amount of time.
- Failure to properly wash, rinse and sanitize food preparation surfaces throughout the kitchen.
- Failure to properly stock necessary hand-washing supplies at handwashing stations in the kitchen.
In addition to the three confirmed cases, the investigation identified nine probable cases. The confirmed cases involved two children and one adult. Two of the three were hospitalized, and one developed the sometimes fatal hemolytic uremic syndrome or HUS.
On-site inspections found that violations involving employee hygienic practices and cross-contamination were numerous. Tri-County set out to improve Red Robin’s hand-washing and general food safety knowledge among the staff. Among the recommendations, Tri-County has made during the course of its investigation are:
- Red Robin was not keeping an active log of ill employees. It needs to actively track employees for illness trends.
- Educate and monitor employees on proper hand-washing.
- Assure staff is using single-use disposable gloves or suitable utensils when handling ready-to-eat foods.
- Continue to identify areas at risk of cross-contamination.
- Constantly clean and sanitize food preparation areas.
- Continue training including certified food protection manager training.
- Report all suspected outbreaks within 24 hours.
It’s likely the number of illnesses caused by the outbreak is underestimated, according to the report. Case ascertainment may have been incomplete or some might have waited too long before seeking medical attention, both examples of how an illness might be missed by public health officials.
And, the report says a precise transmission vehicle was not identified.
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