At a glance
Use this practice to educate restaurants and other retail food establishments to prevent foodborne illness outbreaks. Southern Nevada led educational interventions for establishments with potential emerging outbreaks, even though their regulatory criteria for conducting environmental assessments were not met.
Background
The Southern Nevada Health District serves Clark County, Nevada. Clark County is home to Las Vegas, its suburbs, and outlying rural towns. The county has over 2.3 million residents and enjoys over 40 million visitors annually, making restaurant food safety a high priority.
The health department has criteria that trigger their assessment of foodborne illness reports at establishments. These criteria include, for example, illness complaints from two or more people who do not know each other with a common restaurant exposure. The goal of these assessments is to detect and prevent foodborne illness outbreaks.
Some situations that do not meet the health department's criteria could still indicate an outbreak is emerging. For example, illness complaints from two different restaurants in the same large resort could represent a concern. The health department considers establishments with these criteria to represent a potential emerging outbreak. They developed an educational practice for restaurant operators to stop potential outbreaks.
Key actions
The Southern Nevada Health District's practice involved the following key components:
- Meeting with establishment leadership. The meeting included heads of appropriate departments, such as food and beverage and environmental services, and the leadership of every on-site food operator and focused on the following tasks:
- Describing the risk of an illness outbreak and the need to act quickly. Health department staff also provided appropriate resources and answered questions. They emphasized that they were on the same team as the establishment and shared their contact information.
- Conducting an establishment walkthrough. Health department staff checked cleaning procedures and reviewed chemical labels for contact time and pathogen effectiveness. They also reviewed employee and guest illness logs and biohazard response logs to identify increases in illnesses or responses.
- Suggesting illness prevention strategies. The health department suggested strategies such as removing penalties for employees calling out sick and sending the health department weekly illness logs.
- Monitoring the situation. After the meeting, the health department stayed in regular communication with the establishment and their epidemiology and laboratory counterparts to identify additional illnesses or other concerns and to ramp up efforts as needed.
- Closing the response. Once illness complaints ceased, the health department notified the establishment and thanked them for their cooperation.
Using this practice
We selected this practice as an example of environmental public health successfully applied in the field. We based our selection on four domains:
- Effectiveness: Did it solve or help solve the environmental health problem?
- Feasibility: What conditions and resources are needed to use it?
- Sustainability: Is it realistically able to continue going forward?
- Transferability: Could other health departments use it with little to no changes?
Others interested in applying this practice can consider these factors and this health department's experience.
Effectiveness
Each time the health department used this practice with an establishment, the establishment took measures to stop pathogen transmission. In addition, neither the establishments nor the community reported any additional illness to the health department during the follow-up reporting, suggesting outbreaks were avoided.
Feasibility
Other health departments interested in this practice may need the following capacity:
- Attitude and culture that encourage proactive intervention with establishments
- Experience and technical knowledge of the environmental response to illness, such as illness risk factors, control measures, common practices in regulated establishments, outbreak investigations, and individualized recommendations for prevention
- Communication and partnership-building skills that empower establishment leadership to take action
- Educational resources (handouts, infographics, checklists) to provide to establishments
The health department's only costs to implement the practice were the personnel time spent on site. They typically sent one to three staff, depending on the establishment size and location. Staff included an outbreak subject matter expert, an inspector familiar with the property, and an expert in epidemiology. The educational session took one to four hours, depending on the number of questions and how long the walk-through took.
Sustainability
This practice is not expensive or resource intensive. To maintain this practice the health department took the following actions:
- Staff continued to commit time, maintain their expertise, and ensure up-to-date resources to share with establishments.
- Health department leadership continued to support the practice.
- Establishment operators appreciated the support and often thanked health department staff for their assistance.
Transferability
Programs interested in this practice may want to consider the following factors:
- Whether they have the subject matter experts, educational resources, and leadership support to offer the practice
- The types of establishments in their jurisdiction (this practice can be adapted to multiple establishment types, such as hotels, schools, and camps)
Successes and challenges
The following success story illustrates the real-life impact of this practice. At a large resort hotel in the health department's jurisdiction, the following events happened in the space of one week.
- A food worker at a hotel restaurant complained that the manager was making staff members work while sick.
- A different restaurant at the same hotel received an illness complaint (with no clinical laboratory testing).
- An inspector observed a worker at a third restaurant at the hotel vomiting in the restroom.
These events did not meet the health department's criteria for assessment (only one illness complaint and it lacked laboratory confirmation). However, taken together, these events were concerning. The health department used this practice to educate the hotel, which put additional mitigation strategies in place ahead of a large event occurring the next day.
Connections to Essential Services
Documenting how programs contribute to the Essential Public Health Services may help health departments in the accreditation process with the Public Health Accreditation Board. The activities in this practice support and align with these services:
- Assess and monitor (1)
- Investigate and address hazards (2)
- Educate (3)
- Strengthen communities and partnerships (4)
- Ensure access to services (7)
Citation
In citing this practice in articles, presentations, or elsewhere, we suggest the following citation:
Centers for Disease Control and Prevention. National Center for Environmental Health. Environmental Public Health Practices Gateway. Establishment education to prevent emerging foodborne outbreaks: A practice from the Southern Nevada Health District. U.S. Department of Health and Human Services, CDC, 2026, https://www.cdc.gov/environmental-health-practice/php/gateway/establishment-education-to-prevent-emerging-foodborne-outbreaks.html.