A preliminary investigation by food safety officials identified pulled pork in sandwiches from an outside vendor as the likely cause last week of food poisoning that hit more than 70 staff at South Peninsula Hospital.

The affected food was not served to patients or Long Term Care residents. The vendor that made the food did not serve the sandwiches to the general public or people other than SPH employees, according to a Facebook post by the Alaska Department of Health and Social Services on Monday.

For the people who ate the implicated food and got sick, symptoms resolved within about 24 hours, according to DHSS. No one involved in the outbreak required hospitalization.

“DEC has closed its portion of the investigation and has determined that there is no ongoing risk to the public,” the post said.

The Food Safety and Sanitation Program with the Alaska Department of Environmental Conservation, Division of Environmental Health, and the DHSS Section of Epidemiology started the investigation after the hospital reported last Thursday that staff had gastrointestinal illnesses, including diarrhea and stomach cramps. DHSS reported the incident in a Facebook post last Friday asking the public to fill out a survey to help narrow down the cause of the food poisoning.

On Monday, the updated Facebook post by DHSS reported that as part of the investigation, officials from the DEC Food Safety and Sanitation program looked at sanitation and food handling at the business linked to the outbreak.

In an interview on Tuesday, Jeremy Ayers, section manager for the DEC Food Safety and Sanitation Program, said food safety officers inspected Captain’s Coffee, a Homer cafe and restaurant on Pioneer Avenue, in connection with the food poisoning incident. Ayers said the Cubano sandwiches Captain’s Coffee made in an order for the hospital staff were the suspected food item, and that one ingredient, pulled pork, likely caused the outbreak. The pulled pork was made in a large batch on Wednesday night and then cooled on sheet pans in a refrigerator — a good way to cool it, Ayers said.

Traditional Cuban sandwiches have their origin in Ybor City in Tampa, Florida, and are made with sliced pork, ham, turkey, Genoa salami, Swiss cheese, pickles and mustard on Cuban bread.

A Food Establishment Inspection Report dated Aug. 6 also indicates that a food safety officer inspected Captain’s Coffee in response to the SPH staff foodborne illness outbreak. That inspection found Captain’s Coffee was not in compliance with codes regulating the proper cooling of potentially hazardous foods. A report of the inspection will be posted on the DEC Safe Food Inspection website at https://adec.safefoodinspection.com/Inspection/PublicInspectionSearch.aspx. The inspector discussed with the Captain’s Coffee owner ways to ensure proper cooling, including keeping cooling logs. Possibly tainted food was thrown out during the inspection.

According to the report, no staff at Captain’s Coffee reported being sick, and the cafe had received no other complaints. Food was found to be from approved sources.

Although further testing of the food and human samples needs to be done, based on an investigation into the food preparation process for the Cubano sandwiches, Ayers said officials think a bacteria, clostridium perfringens, caused the gastorintestinal infection. According to a Centers for Disease Control and Prevention article on c. perfringens, the bacteria makes spores which act like a protective coating. When food is kept at temperatures between 40 to 140 degrees Fahrenheit, the bacteria can grow. If ingested, c. perfringens makes a toxin that causes diarrhea.

Based on the theory that c. perfringens caused the intenstinal distress in the hospital staff, Ayers said, “The pulled pork would have been our most suspected ingredient to have caused the illness.”

Ayers said of Captain’s Coffee, “The facility was very cooperative and worked well with us.”

Captain’s Coffee was not closed as a result of the inspection. Ayers said the incident with the Cubano sandwiches was isolated.

“Based on what the environmental health officer observed in her inspection, we don’t believe there’s any further concern for illnesses,” Ayers said.

A phone message seeking comment was left at Captain’s Coffee on Tuesday, and a follow-up email also was sent to the cafe’s owners. At press time they did not reply.

South Peninsula Hospital Director of Public Relations and Marketing Derotha Ferraro said the hospital’s dietary department was short staffed last week and only served patients and residents, so the hospital ordered about 200 box lunches a day, including last Thursday, from local businesses to feed employees.

“All the vendors were so cooperative and went out of their way to make this happen,” Ferraro said on Tuesday. “It was as much a favor to the hospital as anything to do this.”

The hospital cafeteria has been open for employees but closed to the public. The staffing shortage was caused by a number of factors, including vacations and staff quaranting because of COVID-19 exposure.

After dozens of employees called in on Friday with gastrointestinal issues, they all were required to get tested for COVID-19 before returning to work. Ferraro said state epidemiologists were able to determine the sickness was not caused by COVID-19 and began investigating other sources for the outbreak.

“Our infection prevention team reached out to state epidemiology, and they interviewed us and got all of the facts,” Ferraro said. “They were able to confidently say that this was not a COVID-related event, and they went ahead and cleared us all to work.”

Some employees stayed home sick on Friday, but most of them did not immediately report to work because they got COVID-19 tests or were taking COVID-19 precautions.

Hospital staff who have COVID-19 symptoms like diarrhea are required to get COVID-19 testing, stay home and report the testing to their supervisors. Ferraro said that requirement probably led to the hospital’s employee health and prevention department quickly realizing there was a food poisoning outbreak.

“Because so many managers got phone calls, you start talking to each other,” she said.

No hospital patients consumed the food or were affected by the staff shortage. Ferraro said while the hospital was short staffed on Friday while waiting for the test results, most of the employees had returned to work by mid-morning.

“Most importantly, this did not impact patients or residents in any way,” Ferraro said. “We were able to cover all shifts first thing in the morning, so our care was not compromised.”

DHSS officials thanked members of the public who participated in the survey and helped the investigation.

In Monday’s post from DHSS, officials advised that in the event someone experiences suspected foodborne illness, they can make a report at at this webpage: https://dec.alaska.gov/eh/fss/yuck-line/ or by calling or texting the Yuck-line at 907-764-9825 (YUCK); the line is staffed from 8 a.m. to 4 p.m. Monday through Friday (not including holidays). For Anchorage area only, please call 907-343-4200.

Reach Homer News editor and reporter Michael Armstrong at marmstrong@homernews.com. Reach Sarah Knapp at sarah.knapp@homernews.com.