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MINISTRY OF HEALTH
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SOCIALIST
REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
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No.: 39/2006/QD-BYT
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Hanoi, December 13th, 2006
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DECISION
ON PROMULGATION OF “STATUTE FOR
FOOD POISONING INVESTIGATION”
THE MINISTER OF HEALTH
Pursuant to Decree
No. 49/2003/ND-CP dated May 15th, 2003 by the Government providing for
functions, tasks, powers and organizational structures of the Ministry of
Health;
Pursuant to the
Ordinance on food safety and hygiene No. 12/2003/PL-UBTVQH11 dated July 26th,
2003;
Pursuant
to Decree No. 163/2004/ND-CP dated September 07th, 2004 by the Government
detailing a number of articles of the Ordinance on food safety and hygiene;
Upon reviewing the
request of Director of Department of Food safety and hygiene - the Ministry of
Health
DECIDES:
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Article
2. This Decision comes into effect 15 days after the day on
which it is posted on Official Gazette.
Article
3. The Chief officers, Chief Inspectors, Director of Legal
Department, Director of Department of Food safety and hygiene, Heads of
relevant units affiliated to the Ministry of Health, Directors of Departments
of Health of provinces and central-affiliated cities and Heads of medical
agencies shall comply with this Decision./.
P.P. THE MINISTER
THE DEPUTY MINISTER
Trinh Quan Huan
STATUTE
ON FOOD POISONING INVESTIGATION
(Enclosed with Decision No. 39/2006/QD-BYT dated December 13th, 2006 by the
Minister of Health)
Chapter
1:
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Article
1. Scope of regulation
This Statute provides
for the investigation into food poisoning.
Article
2. Regulated entities
This Statute applies
to organizations, households, individuals and establishments occurring food
poisoning, food manufacturing and trading establishments causing food
poisoning, poisoned individuals and central to local government medical
agencies.
Article
3. Interpretation of terms
In this Statute, these
terms can be construed as follows:
1. “Food poisoning” is
an acute syndrome caused by the consumption of food or drink containing
hazardous substances, which lead to symptoms in stomach, bowel, nervous system
or others depending on the poisoning elements.
2. A “food poisoning
case” is an acute poisoning situation where 2 or more people denote poisoning
after consuming the same food at the same time and in the same place. The death
of one person out of similar causes shall be also considered a food poisoning
case.
3. “Food specimens”
include food and drink remained after the meal where the food poisoning case
occurs or the stored food or ingredients used for preparing that meal.
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5. The “causal
establishment” means the establishment providing the meal causing food
poisoning.
6. “Causal meal"
means the meal causing food poisoning or meal containing causal food.
7. “Causal food"
means the food causing food poisoning or food containing the source of food
poisoning.
8. “Source of food
poisoning” means the elements causing food poisoning, which may be toxin from
microorganisms, chemical poison, poison naturally existing in food or produced
due to food decay.
9. “Food poisoning
investigation” means the conduct of investigating activities specified in this
Decision with the aim of finding the causal establishment, causal meal, causal
food and sources of food poisoning.
Article
4. General principles of food poisoning investigation
1. Having a thorough
grasp of the epidemic situation in local areas to determine if the case is of
food poisoning or epidemic.
2. Conducting
investigations into events that occurred 48 hours or at least 24 hours prior to
the time of food poisoning via:
a) The patients (if
he/she is not in a coma)
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3. Acquiring and
understanding the information about clinical symptoms to determine the cause of
food poisoning.
4. Collecting and
storing suspicious food, vomit, colon or gastric lavage liquid, urine, feces
and the like of the food poisoning victim, collecting and sending the specimens
to preventive medicine centers or professional institutes for testing.
5. Inspecting
environmental hygiene conditions, food supply, food preparing/storing places,
food-serving people and the like, using the regulated forms for the
determination of the source and cause of food poisoning.
6. Conducting
essential tests on patients, in case the poisoning is suspected to result from
microorganisms; examining and investigating food serving people.
7. In case of
fatality, cooperating with police authorities and forensic agencies in
conducting and examining pathological autopsy; collecting blood and fluids from
digestive tract, heart and lung of the deceased persons for testing.
8. Conducting tests on pathology specimens
immediately upon the receipt of such specimens. Tests shall vary according to
the symptoms.
9. Synthesizing and analyzing data, upon the receipt
of the on-site investigation results, to determine the time and place of
poisoning, number of people consuming the suspicious food, number of decreased
people, number of people transferred to hospitals, causal meals, causal food,
causal establishments and source of food poisoning as well as providing
measures to handle and prevent the situation.
Chapter
2:
FOOD
POISONING DECLARATION AND REPORT
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1. Food poisoning
declaration:
- Any person
discovering food poisoning cases or having foodborne illness must notify the
nearest medical agency, including:
- Medical stations of
communes.
- Medical
establishments of districts (or Preventive medicine centers).
- Departments of
Health or Preventive medicine centers of provinces or cities.
- Regional
institutions (National Institute of Nutrition, Pasteur Institute in Nha Trang,
Ho Chi Minh City Institute of Hygiene and Public health, Institute of Hygiene
and Epidemiology of the Central Highland).
- Department of Food
safety and hygiene.
The notification shall
be in accordance with the form M1 specified in Decision No. 01/2006/QD-BYT
dated January 09th, 2006 by the Minister of Health providing for the
promulgation of “Regulation on food safety and hygiene reporting regime and report
form”.
2. Receiving information about food poisoning and
foodborne illness;
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- His/her activities
before the symptoms emerge and the food he/she has eaten.
- Main symptoms
(stomachache, nauseous, vomitting).
- Specimens of vomit,
remaining food, contaminants (and check if the specimens are collected).
- Scale: number of
people eating food, number of people poisoned.
b) Notification by
medical practitioners and health workers: Any health workers or medical
practitioners working at medical stations, hospitals or private medical
establishments who discover a case of food poisoning or foodborne illness must
immediately notify relevant medical agencies. In such notification, the
following information shall be focused on:
- Whether food
poisoning affect an individual or groups of people.
- Symptoms of
patients, irregular symptoms, developments, elements related to patients’
eating and drinking within 48 hours (particularly 12 hours) before the event
occurs.
- Examination of
specimens of feces, blood, vomit or contaminants from the body of the victim.
- Diagnosis.
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c) Notification by
manager (of enterprises, schools, building sites, plantations, establishments):
the following information shall be focused on:
- Scale: total number
of people poisoned, total number of people transferred to hospitals.
- Issues related to
eating and drinking.
- Meal providers.
- Stored specimens of
suspicious food.
- For schools: grades
of poisoned students, type of causal meal, food providers.
3. Food poisoning
reports:
a) Any health workers
who receives information about food poisoning or foodborne illness must report
it to his/her superior.
b) Any person who is
the leader of a medical unit receiving information about food poisoning or
foodborne illness must consider the notification to make the following
decisions:
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+ If the food poisoning case or foodborne illness can
spread out, the scale and possibility of the outbreak must be promtly predicted
and reported to the local People’s Committee and the superior medical agency.
+ The following
information must be noticed:
- Suspicion of drug
intoxication.
- Suspicion of
poisoning caused by gas, tap-water, well-water or other elements
- Suspicion of
intentional causing of poisoning.
Food
poisoning reporting regime and report form shall be in accordance with
regulations in Decision No. 01/2006/QD-BYT dated January 09th, 2006 by the
Minister of Health providing for the promulgation of “Regulations on food
safety and hygiene reporting regime and report form”.
Chapter
3:
FOOD
POISONING INVESTIGATION METHODS
Article
6. Preparation for food poisoning investigation
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2. Preparing specimen
collecting tools
3. Establishing
investigating team: depending on the presumption, an investigating team shall
be established which is conformable in quantity and component (epidemiology,
microorganism, environmental hygiene, food safety and infection specialists).
4. Preparing traveling
vehicles and relevant machinery and equipment.
5. If an urgent issue
arises outside working hours, the investigating team shall be immediately
requested to conduct on-site investigation. Forms, machinery and tools
necessary for the investigation shall always stay prepared, even outside
working hours or on days off.
Article
7. Food poisoning investigation methods
Use the food
poisoning investigation slips to conduct the investigation, investigating staff
shall be assigned to specific missions according to the investigation slips:
Investigate
individuals suspected of being poisoned, persons having consumed the causal
meal, causal establishment, medical practitioners and declarants, epidemic
situation in local area; and collect specimens, etc.
Investigators must be
honest, unbiased and must abide by the regulations below:
1. Investigating
people who are poisoned, who ate the suspicious food and who are involved in
the poisoning case:
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a) Investigation into
details of the food poisoning case:
- Use food poisoning
investigation slip to investigate specifically the people who have eaten food
and got poisoned,
- Determine the incubation and patients’ health
conditions.
- Determine whether
the poisoned person has attended a party.
b) Investigation into
the consumption of food:
- Determine whether
poisoned people ate the same food. Investigate eating details through the menu
of the shared meal, if available.
- Investigate eating
details and component of meals within 24 hours (or even 48 to 72 hours, if
necessary) before the illness emerges, unless the meal (i.e. shared food)
consumed by the victims is specified.
- Determine the
peculiarity of the meal (pufferfish, uncooked oyster, blood pudding, animal
organs, mushroom, agar-agar, etc.).
- Investigate into
drinking water (well-water, spring water).
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a) Investigate people
who did not eat the causal food but succumb to the illness or have abnormal
symptoms.
b) Must not make any
suggestion or impression of any food when investigating children. Regarding
infants, information shall be obtained from their mothers.
c) For cases of false
food poisoning, the investigator shall notice if the cases occur due to the
surrounding circumstances or rumor.
d) Investigate
peculiar conditions of residences, workplaces or schools.
dd) Where the
poisoning case is suspected to be caused by pets, transmission routes shall be
investigated.
e) Where the patient
falls sick after or during a tour, his/her activities (i.e. accommodation,
meal) and travel schedule and the group's travel plan shall be investigated.
g) For foreigners or
people who have just entered Vietnam, their activities outside Vietnam before
falling sick shall be investigated.
3. Investigation at
establishments
The investigation at a
business establishment which is, or is suspected to be, the origin of food
poisoning (including households and establishments declared) shall be recorded
into establishment investigation slips or food preparing and storing
investigation slips. The investigation shall be conducted in conformity with
the following regulations:
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b) Investigation into
food supply:
- Inspect food which
the investigated people have eaten.
- Inspect the supply,
processing and preparation of food for each menu (box lunch, food for meeting,
food served at canteens of schools or hospitals, etc.)
- Investigate people
who use the service of the food-supplying establishments.
- Check the list
(containing addresses and phone numbers) of buyers, sellers, consumers. Such
list must be retained for further investigation.
c) Investigation into
food processing and preparing:
- Investigate food
processing and preparing methods and selling method, transmission routes,
germ-increasing conditions, negligence in cooking and so on.
- Inspect the storage
of food, applicable to the business subject to inspection (e.g. eating stores,
box lunch suppliers, food suppliers providing food for schools, hospitals and
hotels providing room and board).
d) Investigation into
hygienic conditions of establishments:
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- Inspect sewage
treatment and maintenance (public and domestic drainage).
- Observe and note
down the extermination of pests and harmful animals; examine the survival of
such pests and animals.
- Inspect other possible pollutants (insecticides,
agricultural medicines, cleansers).
- Where the poisoning
case is suspected to be caused by animals (livestock and/or poultry),
transmission routes shall be investigated.
- Investigate people
who get into and out of food processing and preparing areas.
- Besides, depending
on regulations on food safety and hygiene, the investigation shall involve: the
suitable conditions of the food preparing sites (i.e. size, temperature, humidity,
refrigerator's and freezer’s capacity).
dd) Investigation into
cooking staffs:
- Investigate health
conditions of cooking and serving staffs.
- Investigate whether
any member of cooking and serving staffs contracted an epidemic disease (for
example, typhoid or dysentery) or a virus-borne disease in 1 - 2 prior weeks.
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- Investigate whether
any member of cooking and serving staffs has acne, whitlow or pain or works
with dirty hands.
- Investigate whether
or not members of cooking and serving staffs has a hobby of eating blood
pudding or raw fish or other special food.
e) Other
investigations:
- Check if there are
other complaints.
-Investigate whether or not the establishment has
conducted self-inspection and produced self-inspection reports.
4. Investigate food
selling systems and measures
Investigate
the market supply chain, depending on the retrospective inspection of the
causal food, to discover food poisoning cases or to determine suspicious food,
including the inspection of ingredient suppliers and food-selling
establishments. The following details must be noticed:
a) Investigation into
the possibility of pollution caused by germs
and chemicals in food.
b) Inspection of the
compliance with regulations on food storage (food storing standards and
measures) during the sale of food.
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d) If a great amount
of such food is sold on a large scale, such case shall be reported to the
superior medical agencies and the Department of food safety and hygiene.
5. Investigation by
interviewing medical practitioners
Food poisoning
investigators shall interview medical practitioners who have conducted
examination for the patients. The following contents must be specified when a
medical practitioner is interviewed:
a) Date of examination
for the patient.
b) Name of the
disease.
c) Whether or not the
patient was hospitalized; in case of admission to a hospital, the expected date
of discharge from the hospital.
d) Whether or not the
patient has received treatment and date that the patient uses the medicines.
dd) Whether or not the
patient has irregular symptoms.
e) Whether or not the
patient’ feces, blood, vomit specimens have been tested (assign another person
to collect such specimens if necessary).
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h) If the patient is
diagnosed to be poisoned, the food poisoning declaration by the patient shall
be presented.
6. If the
food-poisoned patient is deceased, medical practitioners and relevant people
shall be investigated for the following contents:
a) Time and
developments of the illness since the patient fell sick to the time of his/her
death.
b) Treatment since
hospitalization.
c) The investigator
shall interview family and relatives of the patient and note down information.
d) The investigator
shall cooperate with the food hygiene team (of Preventive medicine center) in
inspecting and researching other information if necessary.
7. Collection of
specimens
The
entire testing of specimens related to food poisoning (including the people
having symptoms) shall be conducted at preventive medicine center or regional
institutes.
The collection of specimens
is important to clarify the causes of the poisoning case. People in charge of
collecting specimens shall have suitable tools. The collection of specimens
must be carried out promptly and conformably. Specimens shall be collected in
sufficient amount for each type of tests and shall be cryopreserved and shall
be promptly transferred so that changes to the specimens are minimized.
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- Feces.
- Vomit.
- Contaminants.
- Remaining food.
- Blood of patients.
- Where the patients
are suspected of dying of food poisoning, pathological autopsy shall be
conducted. The testing through pathological autopsy must be based on the
forensic observation records; specimens of blood, organ, feces and spinal cord
of deceased patients must be transferred to research institutes for testing.
b) Collection of
specimens from establishment and food supply chains:
The
following specimens shall be collected from food supply establishments
(manufacturing or trading establishments suspected as the causal
establishments) and food supply chains (retail-sale stores, processing
establishments, whole-sale establishments, delivery establishments).
- Food subject to
inspection.
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- Reference food,
including ingredients.
- Cookware,
receptacle, package, fridge cleasing tools.
- Tissues for wiping
hands.
- Fingers of people
working in cooking areas.
- Water.
- Specimens of feces
people working at cooking areas.
- Additives, cleansers, disinfectants might be mixed
in food.
- Specimens of other
substance to be tested (mouse droppings, pet droppings, waste water in drainage
ditches).
c) When collecting
specimens, the following contents shall be investigated:
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- The relationship
between the storage temperature and time (the amount of time for storage at
ambient temperature, low temperature, outdoor temperature).
d) The storage and
transport of specimens shall be cared about:
- Every collected
specimen shall be stored in box containing ice which is tightly closed before
being transported to ensure that it is not contaminated or modified by time.
- Specimens shall be
sent to research institutes or preventive medicine center immediately on the
date of collection.
Chapter
4:
FOOD POISONING INVESTIGATION PROCEDURES
Article
8. Food poisoning investigation procedures
Food poisoning
investigation shall be conduct according to the following procedures in the
following order:
1. Investigating
individuals according to form No. 1 – Annex.
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3. Investigating food, people and time of meal
according to form No. 3 – Annex.
4. Investigating food,
people being poisoned and being not poisoned according to form No. 4 – Annex
5. Investigating
causal meal according to form No. 5 – Annex.
6. Investigating
causal food according to form No. 6 – Annex.
7. Investigating
origin and processing of food according to form No. 7 – Annex.
8. Investigating
health records of people who preparing such food and drink according to form
No. 8 – Annex.
9. Investigating food specimens collected for testing
according to form No. 9 – Annex.
10. Investigating
establishments according to form No. 10 – Annex.
11. Investigating
local environmental and epidemic conditions according to form No. 11 – Annex.
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CONCLUSION ON FOOD POISONING
Article
9. Conclusion on investigation results
After 11 steps of food
poisoning investigation, food poisoning investigating team shall collect,
analyze and make conclusion of the investigating results including the
following contents: unit where the food poisoning occurs; place and time of
poisoning; number of people eating food, number of poisoned people, number of
people transferred to hospitals, number of dead people; causal meal; causal
food; causal establishments and origin of food poisoning.
Article
10. Motion of food poisoning handling measures
Depending on
investigating results, handling measures shall be taken to prevent the
repetition of food poisoning.
1. Innovating the
production process ensuring hygiene standards according to regulations.
2. Improving
food-producing or food service-trading staffs’ awareness of hygiene.
3. Actively complying
with food safety and hygiene standards and regulations.
4. Taking measures for
hazardous food (collecting, destroying, changing use purpose, recycling).
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Depending on the rate,
characteristic, causes and effects of the food poisoning case, motions for
handling shall be made according to laws applied to food-poisoning causal
establishment.
Article
12. Food poisoning announcement
Depending on the
characteristic of the food poisoning case, time, form and jurisdiction,
relevant agencies and news agencies shall be announced about the food poisoning
case.
Chapter
6
IMPLEMENTARY
CLAUSE
Article
13. Implementation
1. Department of Food
safety and hygiene shall be responsible for the conduct and implementation of
this Regulation in relevant areas and agencies.
2. The
Department of Health shall conduct and implement this Regulation within
administrative divisions.