Oklahoma State Department of Health Final Update on Locust Grove Outbreak

The Oklahoma State Department of Health announced today that the Country Cottage restaurant in Locust Grove, OK, has undergone a rigorous inspection process and has been cleared to resume normal business operations. The restaurant had been closed since August 25 after being identified as the source of a large foodborne outbreak in northeastern Oklahoma resulting in severe diarrheal illness.

The restaurant passed an inspection conducted by state and local health inspectors on Nov. 12. The inspection included environmental swabbing of 35 locations within the restaurant, and no E. coli 0111 contamination was identified.

The owners of the Country Cottage restaurant have worked with the Oklahoma State Department of Health and Mayes County Health Department to comply with the terms established in a formal “Agreement to Reopen Country Cottage Restaurant”. The restaurant has met all terms of that agreement which include the following:

1. The restaurant will not be allowed to reopen until an inspection by the Oklahoma State Department of Health reveals no critical violations.

2. Country Cottage must disconnect the private well located on restaurant premises from the water lines that supply the restaurant. Drinking water at the restaurant must be from an approved public water supply system.

3. The operators shall not employee persons without determining by interview that those persons do not have a diarrheal illness. Operators will exclude employees from working at the restaurant if the employee has diarrheal illness.

4. Country Cottage must allow repeat environmental swabbing/testing of the interior of the restaurant upon request.

5. Country Cottage will conduct a thorough cleaning and disinfection of all floors, walls, tables, coolers, food preparation surfaces and food serving surfaces at the restaurant.

6. Operators shall complete the installation of three additional handwashing sinks that were being installed at the time the restaurant closed.

7. All bathrooms must be fully operational and a monitoring system for employee hand-washing must be implemented.

8. The operators shall require each employee to attend and complete a food handler’s class to be conducted at Country Cottage within 30 days of the date of execution of the agreement to reopen the restaurant.

9. The kitchen manager and owner who work at Country Cottage shall obtain a Food Service Manager’s Certificate by attending training for food service managers conducted by representatives of the Oklahoma Restaurant Association within 30 days of the date of execution of the agreement to reopen the restaurant.

10. The operators shall ensure the entire facility is maintained and cleaned as necessary to comply with Oklahoma State Department of Health regulations.

11. The operators shall use monitoring plans applicable to the facility to monitor cleaning, food temperature and other regulatory requirements identified during routine inspections for a year from the date of execution of the agreement to reopen the restaurant.

The outbreak was linked in August to contamination by E. coli 0111, a rare type of toxin-producing bacteria not normally associated with a foodborne outbreak of the magnitude experienced in Oklahoma. While no single food item was found to be the source of illness at the restaurant, the Oklahoma State Department of Health believes several different foods became contaminated with the E. coli 0111 bacteria, leading to exposure of restaurant customers Aug. 15-24.

Health officials note that toxin-producing E. coli are notoriously difficult to culture from food or the environment. This provided a challenge throughout the investigation. Despite testing numerous surfaces within the restaurant, various food items, stool specimens from foodhandlers and well water specimens, no specimen yielded the E. coli O111 bacteria.

A total of 341 outbreak-related cases were reported; 56 were children less than 18 years of age. The age range of cases was 3 months to 88 years. Seventy-two persons were hospitalized; one person died.

The Oklahoma State Department of Health is continuing to study the range of complications and severity of illness of persons hospitalized.