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North Carolina Salmonella Outbreak Uncovered

Screen Shot 2012-08-03 at 4.31.59 PM.pngOn April 2, 2012 Mecklenburg County Health Department (MCHD) received a complaint via the MCHD website of a foodborne illness thought to be linked to food prepared and served at Toast of Dilworth, a restaurant located at 2400 Park Road in Charlotte. The complainant, Brian McWherter, described a family gathering for brunch at the Toast of Dilworth on March 25. Four out of 6 family members became ill within 24 hours after the meal. Mr. McWherter was culture positive for Salmonella. MCHD staff person, Tyler Ashe, conducted the first of several on-site visits to the restaurant on April 3rd. At that time Toast of Dilworth owner, Brian Burchill, reported that several customers had recently called to report having a “viral illness” after eating at the restaurant. He provided Mr. Ashe contact information for ill customers who had called. During this visit, Mr. Ashe noted that raw egg batter was stored above ready-to-eat foods and that a spray bottle contained less than the 200 ppm quaternary ammonium solution required for sufficient sanitizing.

Later that day health investigators spoke to Mr. McWherter and other ill Toast of Dilworth customers identified through the list Mr. Burchill had provided. MCHD staff collected information about foods eaten at the restaurant and meal dates. Anecdotally, ill persons reported consuming egg dishes with hollandaise sauce with meal dates beginning the weekend of March 24-25. Tyler Ashe followed up with Toast of Dilworth chef, Julio Heras, requesting information about eggs used and how the hollandaise sauce prepared. Chef Heras described a sauce made with egg yolks and butter that on weekends was prepared ahead of time and hot held. These findings were shared with state health department officials during a late afternoon conference call and a foodborne illness outbreak was declared.

Health investigators conducted a case/control study of Toast of Dilworth patrons. In total 30 persons were identified as having symptoms. Nine patients were laboratory confirmed with Salmonella serotype Enteriditis. Ill persons included in the case/control study reported eating at the Toast of Dilworth on March 25, 2012. Foods statistically associated with illness included eggs (Odds Ratio 20.0, 95% Confidence Interval 2.0-170.0), undercooked eggs (Odds Ratio 35.0, 95% Confidence Interval 7.0-176.0), and hollandaise sauce (Odds Ratio 115.00, 95% Confidence Interval 7.0-176.0). The majority of persons experienced symptom onset on March 26. Eventually MCHD staff identified ill Toast of Dilworth customers who ate at the restaurant through March 28.

A thorough on-site investigation was conducted by Mr. Ashe and MCHD registered sanitarian, Amy Michelone on April 4, 2012. They discovered there were critical food safety violations that likely led to a foodborne illness outbreak at the Toast of Dilworth. Customers ordered and were served undercooked unpasteurized eggs such as “soft” poached eggs. Hollandaise sauce was made with unpasteurized egg yolks and held at room temperature for several hours. Multiple foods in the “low boy prep refrigerator” were held at or above 41o F, exceeding regulations specified in the FDA Food Code. Cooks were not using a thermometer to determine the final temperatures of food items on a regular basis, relying instead on visual clues to determine doneness. Mr. Ashe and Ms. Michelone conducted a follow-up visit on April 11, 2012 and verified that all violations were corrected. Notably, the Toast of Dilworth began using pasteurized eggs for all egg-containing food items. See Attachment XX, Mecklenburg County Health Department Summary of Case-Control Study Findings”