Proper food handling to prevent
foodborne illness is necessary not only in the home, but also in the
workplace. Foodborne illnesses are a major cause of absenteeism, but
often, even healthcare workers forget that careful handwashing and
other simple precautions are necessary to keep them work-ready.
In May of 2005, the federal
government launched a national campaign to educate consumers about the
importance of proper food handling. The campaign was, in part, a
response to a revised Listeria monocytogenes Risk Assessment from
September 2003 released by the Food and Drug Administration (FDA) and
the United States Department of Agriculture, which revealed that
proper refrigeration could reduce by two-thirds the risk of
Listeriosis, the illness caused by a pathogen associated with foods
not chilled properly.1
A recent national study reveals that
only 30 percent of consumers have heard they should use a refrigerator
thermometer to monitor temperature and only 20 percent say they
actually use one. According to Tim Hammonds, chairman of the
Partnership for Food Safety Education (PFSE), "Retailers across
the country are joining the Partnership's effort by putting programs
in place to help educate consumers about this important food safety
recommendation. The message from retailers to consumers is: proper
refrigerator temperatures help consumers keep safe food that lasts
longer." The consumer-tested messages are part of the PFSE's
Fight BAC!<+><\#168><+$> campaign, which emphasizes
"Cook, Clean, Chill and Separate."
The Partnership for Food Safety
Education unites industry associations, consumer and public health
groups and the United States Department of Agriculture (USDA), the
Environmental Protection Agency (EPA) and the Centers for Disease
Control and Prevention (CDC) and the FDA, to educate the public about
safe food handling and preparation.
"Infectious diseases spread
through food or beverages are a common, distressing, and sometimes
life-threatening problem for millions of people in the United States
and around the world," according to the National Institutes of
Health (NIH). "The CDC estimates 76 million people suffer
foodborne illnesses each year in the United States, accounting for
325,000 hospitalizations and more than 5,000 deaths."2
Foodborne disease is not easy on the
healthcare pocketbook, either. The yearly cost of all foodborne
diseases in this country is estimated at $5 billion to $6 billion in
direct medical expenses and lost productivity. Infections with the
bacteria Salmonella alone account for $1 billion yearly in direct and
indirect medical costs.
There are more than 250 known
foodborne diseases. They can be caused by bacteria, viruses, or
parasites. Natural and manufactured chemicals in food products can
also cause illness. Some diseases are caused by toxins from the
disease-causing organism, while others are caused by bodily reactions
to the organism itself. People infected with foodborne germs may have
no symptoms or develop symptoms ranging from mild intestinal
discomfort to severe dehydration and bloody diarrhea.
A new concern has been added to the
mix since Sept. 11, 2001 -- public health, agriculture, and
environmental officials now are concerned with keeping the nation's
food and water supply safe from terrorist acts.
Prevention
Although foodborne illness is quite
common, they require only simple precautions to avoid contracting
them. Some basic steps include:
- Wash hands carefully before
preparing food.
- Wash hands, utensils, and kitchen
surfaces with hot soapy water after they touch raw meat or
poultry.
- Cook beef and beef products
thoroughly, especially hamburger.
- Cook poultry and eggs thoroughly.
- Eat cooked food promptly and
refrigerate leftovers within 2 hours after cooking.
- Wash fruits and vegetables
thoroughly, especially those that will be eaten raw.
- Drink only pasteurized milk and
juices and treated surface water.
- Wash hands carefully after using
the bathroom, changing infant diapers, or cleaning up animal
feces.
Botulism
Botulism is a rare but serious
illness caused by the toxin produced by Clostridium botulinum
bacteria. This toxin affects the nerves and if untreated, can cause
paralysis and respiratory failure. Each year, U.S. healthcare
providers report an average of 110 cases of food, infant, and wound
botulism to CDC. About 10 to 30 outbreaks of foodborne botulism are
reported every year. Although this illness does not occur frequently,
it can be fatal if not treated quickly and properly.
Often, cases of foodborne botulism
come from home-canned foods with low acid content, such as asparagus,
green beans, beets, and corn. C. botulinum is anaerobic, which
means it can survive and grow with little or no oxygen. Therefore, it
can survive very well in sealed containers. Outbreaks of the
infection, however, are often from more unusual sources such as chili
peppers, tomatoes, and improperly handled baked potatoes wrapped in
aluminum foil.
Symptoms include double vision and
drooping eyelids; slurred speech; dry mouth and difficulty swallowing;
and weak muscles. Symptoms of foodborne botulism usually begin within
18 to 36 hours after eating contaminated food, but can occur in as few
as six hours or as much as 10 days afterward.
Treatment includes an antitoxin that
blocks the action of the bacterial toxin circulating in the blood.
Although antitoxin keeps the disease from becoming worse, it will
still take many weeks for recovery. Any contaminated food still
residing in the digestive system may be eradicated by inducing
vomiting or giving an enema.
Prevention includes following strict
hygienic steps when home canning; refrigerating oils that contain
garlic or herbs; keeping baked potatoes wrapped in aluminum foil
either hot until served or refrigerated; and boiling home-canned food
before eating it to kill any bacteria which might lurk in the food.
C. botulinum
toxin is one of the most potent toxins known in nature. Exposure to
the toxin, particularly in an aerosolized form, can be fatal. It has
been made into weapons by rogue states and is a focus of current
efforts to counter bioterrorism.
However, in 1989, FDA approved
Botulinum Toxin Type A, a protein produced by C. botulinum, as
a treatment for two eye muscle disorders. In 2000, FDA approved this
toxin to treat cervical dystonia, a neurological movement disorder
causing severe neck and shoulder contractions. And in April 2002, FDA
approved it to temporarily improve the appearance of moderate to
severe frown lines between the eyebrows.
Campylobacteriosis
Campylobacteriosis is an infectious
disease caused by Campylobacter bacteria. Campylobacter
jejuni, C. fetus, and C. coli are the types that
usually cause campylobacteriosis in people. C. jejuni causes
most cases of the illness.
According to CDC, C. jejuni is
the leading cause of bacterial diarrheal illness in the United States,
affecting an estimated 2.4 million people every year. The bacteria
cause between 5 percent and 14 percent of all diarrheal illness
worldwide. C. jejuni primarily affects children less than 5
years old and young adults (15 to 29 years old). Healthcare providers
report more than 10,000 cases to CDC yearly.
It can be transmitted by the handling
of raw poultry, by eating undercooked poultry, drinking
non-chlorinated water or raw milk, or handling infected animal or
human feces. Most frequently, poultry and cattle waste are the sources
of the bacteria, but feces from puppies, kittens, and birds also may
be contaminated.
Symptoms include diarrhea (often
bloody); abdominal cramping and pain; nausea and vomiting; fever; and
fatigue. Campylobacteriosis usually lasts for two to five days, but in
some cases as long as 10 days. Rarely, some people have convulsions
with fever or meningitis.
Most people infected with
Campylobacter will recover without treatment. But if treatment is
necessary, it may include an antibiotic such as ciprofloxacin or
azithromycin. Erythromycin helps treat diarrhea caused by
Campylobacter.
Prevention includes the ubiquitous
instruction to wash hands before preparing food; to wash hands
immediately after handling raw poultry or other meat; to wash
thoroughly with soap and hot water all food preparation surfaces and
utensils that have come in contact with raw meat; to cook poultry
products to an internal temperature of 170 degrees Fahrenheit for
breast meat and 180 degrees Fahrenheit for thigh meat; to drink
pasteurized milk and chlorinated or boiled water; and to wash hands
after handling pet feces or visiting zoos and petting zoos.
E. coli Infection
Certain types of Escherichia coli
bacteria, or E. coli, can cause foodborne illness. Harmless
strains of E. coli are found widely in nature, including within
the intestinal tracts of humans and warm-blooded animals. But
disease-causing strains are a frequent cause of both intestinal and
urinary-genital tract infections.
Several different strains of harmful E.
coli can cause diarrheal disease. Enterohemorrhagic E. coli
(EHEC) often causes bloody diarrhea and can lead to kidney failure in
children or people with weakened immune systems.
The type of harmful E E. coli
most commonly found in the United States is named O157:H7, which
refers to chemical compounds found on the bacterium's surface. This
type produces one or more related, powerful toxins that can severely
damage the lining of the intestines. Other types, including O26:H11
and O111:H8, can cause human disease. Cattle are the main sources of E.
coli O157:H7, but other domestic and wild mammals also can harbor
these bacteria.
E. coli
bacteria and its toxins have been found in undercooked or raw
hamburgers; in salami; in alfalfa sprouts; in lettuce; in
unpasteurized milk, apple juice, and apple cider; and in contaminated
well water. Unsuspecting swimmers have been infected by accidentally
swallowing unchlorinated or underchlorinated water in swimming pools
contaminated by human feces.
E. coli
O157:H7 toxin can damage the lining of the intestine and cause
symptoms that include nausea; severe abdominal cramps; watery or very
bloody diarrhea; and fatigue. A low-grade fever or vomiting may also
occur. Symptoms usually begin from two to five days after eating
contaminated food and may last for eight days.
Enterotoxigenic E. coli
(ETEC), which produce a toxin similar to Cholera toxin, can cause
diarrhea. These strains typically cause so-called "traveler's
diarrhea" because they commonly contaminate food and water in
developing countries. Enteropathogenic E. coli (EPEC) are
associated with persistent diarrhea (lasting two weeks or more) and
are more common in developing countries where they can be transmitted
by contaminated water or contact with infected animals.
Treatment is not necessary in most
people infected with E. coli O157:H7; antibiotics are usually
not helpful, and healthcare experts recommend against anti-diarrheal
medication.
Prevention includes eating only
thoroughly cooked beef and beef products. Cook ground beef patties to
an internal temperature of 160 degrees Fahrenheit; avoid unpasteurized
juices and milk; and wash fresh fruits and vegetables thoroughly
before eating them raw or cooked.
Salmonellosis
Salmonellosis, or salmonella, is an
infection caused by Salmonella bacteria. While the occurrence
of different types of Salmonella varies from country to country, Salmonella
typhimurium and S. enteritidis are the two most commonly
found in the United States.
An antibiotic-resistant strain of S.
typhimurium, called Definitive Type 104 (DT104), is the second
most common strain (after S. enteritidis) of Salmonella found
in humans. This strain poses a major threat because it is resistant to
several antibiotics normally used to treat people with Salmonella
infections.
Salmonellosis may occur in small,
contained outbreaks in the general population or in large outbreaks in
hospitals, restaurants, or institutions for children or the elderly.
Every year, CDC receives reports of 40,000 cases of salmonellosis in
the United States. However, the CDC estimates that each year, 1.4
million people in this country are infected, and that 1,000 people
die. Symptoms are most severe in the elderly, infants, and people with
chronic conditions. People with AIDS are particularly vulnerable to
salmonellosis, often suffering from recurring episodes.
Salmonella
bacteria can be found in food products such as raw poultry, eggs, and
beef, and sometimes on unwashed fruit. Food prepared on surfaces that
previously were in contact with raw meat or meat products can, in
turn, become contaminated with the bacteria -- otherwise known as
cross-contamination.
In recent years, CDC has received
reports of several cases of salmonellosis from eating raw alfalfa
sprouts grown in contaminated soil. Salmonella infection
frequently occurs after handling pets, particularly reptiles like
snakes, turtles, and lizards.
Salmonellosis can become a chronic
infection in some people who may not have symptoms. Though they may
have no symptoms, they can spread the disease by not washing their
hands before preparing food for others. People who know they have
salmonellosis should not prepare food or pour water for others until a
laboratory tests show they no longer carry Salmonella bacteria.
The following symptoms usually begin
from 12 hours to three days after infection: diarrhea; fever;
abdominal cramps; and headache. These symptoms, along with possible
nausea, loss of appetite, and vomiting, usually last for four to seven
days. Diarrhea can be severe and require hospitalization.
The infection typically clears up on
its own within a week. However, in patients with severe diarrhea,
intravenous fluids may be necessary. If the infection spreads from the
intestines into the bloodstream, it may be treated with antibiotics
such as ampicillin.
To prevent salmonellosis, drink only
pasteurized milk; don't eat foods containing raw eggs, such as
homemade Caesar salad dressing, cookie dough, and hollandaise sauce,
or drink homemade eggnog made with raw eggs; handle raw eggs carefully
by keeping them refrigerated and throwing away cracked or dirty eggs.
Cook eggs thoroughly; cook poultry products to an internal temperature
of 170 degrees Fahrenheit for breast meat and 180 degrees Fahrenheit
for thigh meat; wash thoroughly with soap and hot water all food
preparation surfaces and utensils that have come in contact with raw
poultry or raw eggs; wash hands immediately after handling raw poultry
or raw eggs; and wash hands immediately after handling reptiles or
contact with pet feces.
Shigellosis
Shigellosis, also called bacillary
dysentery, is an infectious disease caused by Shigella
bacteria. Four main types of Shigella cause infection: Shigella
dysenteriae, S. flexneri, S. boydii, and S. sonnei. CDC
estimates that more than 400,000 cases occur every year in the United
States. Healthcare providers report about 18,000 cases to CDC each
year.
Shigella can be acquired by eating
food or drinking beverages contaminated by food handlers infected with
Shigella who didn't wash their hands properly after using the
bathroom; by eating vegetables grown in fields containing sewage; by
eating food contaminated by flies which were bred in infected feces;
or by drinking or swimming in contaminated water.
Even those with no symptoms of
shigellosis can still pass the bacteria to others. An extremely low
number of bacteria (10 to 100) is needed to transmit the infection.
Therefore, it is commonly transmitted by food service workers who are
sick or infected, but have no symptoms, and who do not properly wash
their hands after using the toilet. Those with shigellosis should not
prepare food or pour water for others until laboratory tests show they
no longer carry Shigella bacteria.
Symptoms include fever; fatigue;
watery or bloody diarrhea; nausea and vomiting; and abdominal pain.
Symptoms usually begin within two days after being exposed to Shigella
and are usually gone within five to seven days.
Mild infections rarely require
medication; more serious disease may be treated with an antibiotic
such as ampicillin or ciprofloxacin. Antidiarrheal medicines may make
the illness worse.
People who have diarrhea symptoms
typically recover completely, although their bowel habits may not
return to normal until several months later.
Food Handlers
According to the Federal Register of
Sept. 27, 2002, the presence of any one of the following signs or
symptoms in persons who handle food may indicate infection by a
pathogen that could be transmitted to others through handling the food
supply: Diarrhea, vomiting, open skin sores, boils, fever, dark urine,
or jaundice. The failure of food-handlers to wash hands (in situations
such as after using the toilet, handling raw meat, cleaning spills, or
carrying garbage, for example), wear clean gloves, or use clean
utensils is responsible for the foodborne transmission of these
pathogens. Non-foodborne routes of transmission, such as from one
person to another, are also major contributors in the spread of these
pathogens. Pathogens that can cause diseases after an infected person
handles food are the following: Norwalk and Norwalk-like viruses,
Hepatitis A virus, Salmonella typhi, Shigella species, Staphylococcus
aureus, Streptococcus pyogenes.3
"Other pathogens are
occasionally transmitted by infected persons who handle food, but
usually cause disease when food is intrinsically contaminated or
cross-contaminated during processing or preparation. Bacterial
pathogens in this category often require a period of temperature abuse
to permit their multiplication to an infectious dose before they will
cause disease in consumers. Preventing food contact by persons who
have an acute diarrheal illness will decrease the risk of transmitting
the following pathogens: Campylobacter jejuni, Cryptosporidium
parvum, Entamoeba histolytica, Enterohemorrhagic Escherichia coli,
Enterotoxigenic Escherichia coli, Giardia lamblia, Nontyphoidal
Salmonella, Taenia solium, Vibrio cholerae 01, Yersinia enterocolitica,"
says the CDC in its annual update of infectious and communicable
diseases transmitted through the food supply.
Although the elderly, infants, young
children, and people who are already ill are more vulnerable to
foodborne illness, the reason for youngsters' vulnerability differs
from that of the elderly and the ill.
The National Network for Child Care
(NNCC) offers tips for preventing foodborne illness in children, and
notes that "Infants and children are at high risk for foodborne
illness because their immune systems are still developing. Also, they
produce less of the acid in their stomachs that kills harmful
bacteria, so it's easier for them to get sick."4
The network also notes that
"bacteria grow best in moist, non-acid foods that are high in
protein such as milk, eggs, meat, poultry, fish, and shellfish.
Vegetables and dry foods are less likely to cause illness. Most
vegetables have some acid that slows the growth of bacteria. And dry
foods such as sugar, flour, dry cereal, rice, cookies, and biscuits
usually do not have enough moisture in them to allow bacteria to
grow."
It is important to remember that
microwaves do not always cook evenly, potentially leaving undercooked
areas in food. "Always cover food with a lid or plastic wrap so
steam can aid in thorough cooking, even when you're just reheating
leftovers, says the NNCC. "Vent the plastic wrap and make sure it
doesn't touch the food. Then stir and rotate the food so it cooks
evenly. Use a turntable or rotate the dish by hand once or twice
during cooking. It's important to allow the standing time called for
in a microwave recipe or in package directions. The standing time
ensures that the food is cooked thoroughly. Use an oven temperature
probe or a meat thermometer to check that the food is done, inserting
it at several different spots."
Early Steps
Prevention of foodborne illness
begins with a trip to the grocery store. When shopping, remember to
purchase more "risky" foods later, so they remain cold if
they should be kept cold, and hot if they should be kept hot.5
Tips from the FDA in its FDA
Consumer publication include the following:
- Pick up your packaged and canned
foods first.
- Don't buy food in cans that are
bulging or dented or in jars that are cracked or have loose or
bulging lids.
- Choose eggs that are refrigerated
in the store. Before putting them in your cart, open the carton
and make sure that the eggs are clean and none are cracked.
- Select frozen foods and
perishables such as meat, poultry or fish last. Always put these
products in separate plastic bags so that drippings don't
contaminate other foods in your shopping cart.
- Don't buy frozen seafood if the
packages are open, torn or crushed on the edges. Avoid packages
that are above the frost line in the store's freezer. If the
package cover is transparent, look for signs of frost or ice
crystals. This could mean that the fish has either been stored for
a long time or thawed and refrozen.
- Check for cleanliness at the meat
or fish counter and the salad bar. For instance, cooked shrimp
lying on the same bed of ice as raw fish could become
contaminated.
- When shopping for shellfish, buy
from markets that get their supplies from state-approved sources;
stay clear of vendors who sell shellfish from roadside stands or
the back of a truck. And if you're planning to harvest your own
shellfish, heed posted warnings about the safety of the water.
- Take an ice chest along to keep
frozen and perishable foods cold if it will take more than an hour
to get your groceries home.
Store Foods Safely
Essentially, keep hot foods hot and
cold foods cold. When it's time to put away groceries or to store
leftovers, remember to refrigerate or freeze perishables immediately.
"The refrigerator temperature should be 40 degrees Fahrenheit (5
degrees Celsius), and the freezer should be zero F (minus 18 C). Check
both the refrigerator and freezer periodically with a
refrigerator/freezer thermometer," says the FDA.
"Poultry and meat heading for
the refrigerator may be stored as purchased in the plastic wrap for a
day or two. If only part of the meat or poultry is going to be used
right away, it can be wrapped loosely for refrigerator storage. Just
make sure juices can't escape to contaminate other foods. Wrap tightly
foods destined for the freezer. Leftovers should be stored in tight
containers. Store eggs in their carton in the refrigerator itself
rather than on the door, where the temperature is warmer. Seafood
should always be kept in the refrigerator or freezer until preparation
time."
Also, says the FDA, "Don't crowd
the refrigerator or freezer so tightly that air can't circulate. Check
the leftovers in covered dishes and storage bags daily for spoilage.
Anything that looks or smells suspicious should be thrown out. A sure
sign of spoilage is the presence of mold, which can grow even under
refrigeration."
Also, be sure to keep dishcloths
clean because, when wet, they can harbor bacteria and may promote
their growth. Use smooth cutting boards made of hard maple or a
non-porous material such as plastic and free of cracks and crevices.
Always wash and sanitize cutting boards after using them for raw
foods, such as seafood or chicken, and before using them for
ready-to-eat foods. Always use clean utensils and wash them between
cutting different foods. Wash the lids of canned foods before opening
to keep dirt from getting into the food. Also, clean the blade of the
can opener after each use.
Cooked foods should not be left
standing on the table or kitchen counter for more than two hours.
Disease-causing bacteria grow in temperatures between 40 and 140 F
(between 4 and 60 C). Cooked foods that have been in this temperature
range for more than two hours should not be eaten.
For more information to share with
staff members, visit http://portal.fightbac.org/pfse/toolsyoucanuse.
Works Cited
- www.fightbac.org/main.cfm
- www.niaid.nih.gov/factsheets/foodbornedis.htm
- http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=2002_register&docid=02-24579-filed.pdf
- www.nncc.org/Health/cc44_tips.foobourne.ill.html
- www.cfsan.fda.gov/~dms/fdunwelc.html
