Snohomish County Health District (SCHD) Communicable Disease (CD) program received the first report of a confirmed E. coli O157:H7 illness, in what would soon become a cluster of such illnesses, on October 14, 2008. The next report of illness came the following day, October 15.  It was subsequently determined that both ill individuals had dined at Ixtapa in Lake Stevens in the days before onset of their illnesses.

The third and fourth reports of illness came in on October 16, and when these people reported that they, too, had eaten at Ixtapa, SCHD knew that an outbreak was underway.  Many more reports of illness followed.  Accordingly, SCHD issued a press release on October 21, 2008, stating that the health authorities investigating the cluster of E. coli O157:H7 illnesses had “narrowed down the likely source of E. coli illness . . . [to] Ixtapa restaurant, 303-91st Ave. NE. #B201.”  Ixtapa voluntarily closed for business the same day so that it could be sanitized.

Ultimately, the collaborative investigation between SCHD and the Washington State Department of Health (WDOH) concluded that 68 people were likely infected by E. coli O157:H7 in the outbreak. The investigation also determined that there was a “strong association” between consuming guacamole at Ixtapa and becoming ill, but SCHD/WSDOH was unable to definitively conclude that guacamole was the specific food vehicle for transmission of E. coli bacteria to all restaurant patrons.

More likely, it was a combination of contaminated guacamole and other modes of transmission within the Ixtapa facility that made so many people ill.  Notably, WSDOH’s lead investigator wrote in an October 20, 2008 email:

We learned that they don’t wear gloves all the time (just as Chris suspected).  Primarily the cooks have bhc [bare-hand contact] at night when there is less chance someone will catch them without gloves.  Also, The wait staff use bare hands on tortillas both before and after they are warmed in the steamer.  They use a scoop to put chips in a basket but bare hands to assist in this process.


They do not regularly use sanitizer and they don’t know how to check the concentration of the sanitizer.  We found buckets without sanitizer and many wiping cloths without sanitizer too.  This indicates a lack of ability to properly clean and sanitize work areas.

The cutting boards and wiping cloths are all stained and or very dirty.  Their outer clothing and dry towels are frequently used for hand cleaning as they too are very dirty with food debris.  The stains are from both raw meat and other foods indicating a lack of cross contamination control.

In other words, conditions at Ixtapa were ripe for exactly the kind of unfortunate scenario that played out at the restaurant in October 2008.  The E. coli O157:H7 bacteria clearly came into the restaurant on one item (if not from an infected foodworker), and there it found an environment where it was allowed to flourish, sickening people for almost two straight weeks by multiple different vectors and food-handling errors.

In any case, the SCHD and WSDOH findings leave little doubt whether Ixtapa the source of this significant outbreak; and they eliminate any argument that any other person or entity—e.g. upstream suppliers—are at fault.  As a result, unless Ixtapa challenges the epidemiological relatedness of any particular client to the outbreak, these are damages-only cases.

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