The CIFOR Toolkit: A Powerful Training Resource Advancing Foodborne Outbreak Response

By Scott E. Holmes, REHS, MS, Environmental Public Health Manager, Lincoln-Lancaster County Health Department

What do you get when you bring together over 60 public health professionals specializing in environmental health, epidemiology, and laboratory sciences, representing 15 different local and state agencies to discuss how to improve foodborne outbreak response in Nebraska? A major “reboot” of the state’s outbreak response system!

Many may say, “That sounds great, but how did you get there?” 

For Nebraska, it all started with Anna Carlson, the Foodborne Illness and Surveillance Coordinator at the Nebraska Department of Health. Anna was awarded a Council of State and Territorial Epidemiologists grant from the Centers for Disease Control and Prevention (CDC) to hold a workshop using the Council to Improve Foodborne Outbreak Response (CIFOR) Toolkit. She then contacted two colleagues at the Minnesota Center for Excellence on Foodborne Outbreak Response and Senior Epidemiologists with the Minnesota Department of Health, Amy Saupe and Stephanie Meyer, who agreed to assist with facilitating a statewide foodborne outbreak response workshop.

After figuring out the “lay of the land” in Nebraska, Amy and Stephanie agreed that event attendees would receive the most benefit by covering three of the CIFOR focus areas, including communication, environmental health, and epidemiology. Using these topics as a guideline, they developed a workshop tailored to the state’s needs, while also creating an inviting and comfortable environment encouraging engagement and feedback. Anna Carlson later emphasized this training atmosphere as a highlight of the event.

“We got a lot of really great feedback, and I think this will be very beneficial to everyone in the future. Just being in the same room [to openly discuss] foodborne outbreak response and how to handle communication was a huge win,” said Carlson.

Amy and Stephanie used the environmental health and epidemiology sections of the CIFOR Toolkit to create an innovative training structure. They also emphasized an open communication approach to addressing these topics, which garnered a lot of positive commentary from attendees. For example, Avery Paulson, Disease Surveillance Specialist at Public Health Solutions described the event as “super valuable,” attributing it to generating “more communication and coordination than the state has had in recent history.”


Action Shot from Nebraska’s CIFOR Toolkit Workshop

Participating public health professionals first worked collaboratively through each focus area as a mixed group of local, state, environmental health, epidemiology and laboratory representatives. They were then grouped to examine the same focus area within their own jurisdiction. This strategy led to excellent discussion and a broadened thought process, resulting in both statewide and local objectives and action steps to improve food safety practices in Nebraska.

As one of the participating agencies, the Lincoln-Lancaster County Health Department (LLCHD) greatly benefited from the training. Through active engagement with the diverse representatives from state and local agencies in attendance, LLCHD staff left with a better understanding of how to improve local outbreak response efforts. The workshop became a foodborne outbreak response strategic planning session for each local health jurisdiction and the state as a whole. As a result, LLCHD developed ten recommendations for action items, timelines and staff responsible for each area. Some of the action steps LLCHD developed included:

  • Conduct after-action reviews following foodborne outbreaks;
  • Create an environmental health investigation checklist;
  • Improve LLCHD’s public communication strategy around addressing outbreak situations; and
  • Ensure improved communication among all staff and partners involved in an outbreak response.

Once implemented, these practical quality improvements will improve LLCHD’s local foodborne outbreak responses, and allow the staff to better protect the health throughout the City of Lincoln and Lancaster County.

As a whole, this CIFOR Toolkit workshop helped develop peer relationships among state and local public health professionals. But more importantly, the work completed will improve Nebraska’s ability to respond to foodborne outbreaks and reduce the number of cases of foodborne illnesses through quicker detection, reporting, investigation, and control of outbreaks. Those combined factors are solid indicators of the workshop’s success because that is what CIFOR is all about – reducing the disease burden caused by foodborne illness.

ABOUT THE CIFOR: The Council to Improve Foodborne Outbreak Response (CIFOR) is a multidisciplinary working group convened to increase collaboration across the country and within relevant areas of expertise in order to reduce the burden of foodborne illness in the United States. The Council of State and Territorial Epidemiologists (CSTE) and the National Association of County and City Health Officials (NACCHO) co-chair CIFOR with support from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).

ABOUT THE CIFOR TOOLKIT: The CIFOR toolkit is one of the signature resources produced through the collective efforts of this group. Now in its second edition, this worksheet-based tool was designed to further the ability of state and local health departments to understand the contents of the CIFOR Guidelines for Foodborne Disease Outbreak Response, informing local, state, and federal agencies managing foodborne disease on how to prepare, detect, investigate, control, and follow-up when addressing outbreaks.


About Anastasia Sonneman

Anastasia Sonneman serves as a Communications Specialist at NACCHO. Her work includes promoting local health departments' best practices, as well as partner tools and resources, in environmental health, health and disability, and preparedness through NACCHO's communications channels, storytelling, and outreach to various audiences.

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