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Preventing Disease at home and on Emergency Deployment

Preventing Disease at home and on Emergency Deployment

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Food And Waterborne Diseases Powerpoint Presentation Transcript

  • 1. FOOD AND WATERBORNE DISEASES JAMES GERVASE, R.PH. DMAT PA-3
  • 2. The Danger
    • How it applies to you at home and work
    • How it applies to us when on Deployment
    • Deliver the information recognizing that we have Health Care Professionals, together with people who are not in Health Care
  • 3. Major Breakdowns in Food Safety
    • E.coli outbreaks
      • Kroger/Nebraska Ltd (June 2008)
      • Totino's/Jeno's Pizza (Nov 2007)
      • Ground Beef Patties Outbreak (Oct 2007)
      • TacoBell Outbreak (Nov-Dec 2006)
      • Spinach Outbreak (Sep-Oct 2006)
    ○ People are affected by Breakdowns in Food Safety EVERYDAY
  • 4. WATERBORNE ILLNESSES
    • Acanthamoeba ( CDC )
    • Adenoviruses ( CDC , CDC-general )
    • Aeromonas hydrophila (FDA)
    • Algal Blooms, Harmful (HABs) ( CDC )
    • Amebiasis ( CDC )
    • Anemia (WHO)
    • Arsenic ( CDC-ATSDR , WHO)
    • Arsenicosis ( CDC-ATSDR , WHO)
    • Ascariasis ( CDC , WHO, WHO-general)
    • Ascaris lumbricoides ( CDC , WHO, WHO-general)
    • Astrovirus ( CDC-general )
    • Atrazine ( CDC-ATSDR )
  • 5. WATERBOURNE ILLNESSES
    • Balamuthia mandrillaris ( CDC-DPDx , WHO)
    • Benzene ( CDC-ATSDR )
    • Bilharzia ( CDC , WHO, WHO-PPC) (see also Schistosomiasis )
    • Boating ( CDC )
    • Burkholderia cepacia complex ( CDC )
    • Buruli Ulcer (WHO)
  • 6. WATERBOURNE ILLNESSES
    • Campylobacter ( CDC , CDC-water , WHO)
    • Campylobacteriosis ( CDC , CDC-water , WHO)
    • Cercarial Dermatitis ( CDC )
    • Chlamydia trachomatis ( CDC , WHO) (see also Trachoma )
    • Chloramines ( CDC , EPA)
    • Chlorine ( CDC , CDC-ATSDR )
    • Cholera ( CDC , WHO)
    • Coliform bacteria (EPA)
    • Copper ( CDC-ATSDR )
    • Coxsackievirus (A16, B) (Enterovirus) ( CDC )
    • Cryptosporidiosis ( CDC , CDC-water )
    • Cryptosporidium ( CDC , CDC-water )
    • Cyanobacteria ( CDC , WHO)
    • Cyclospora ( CDC )
    • Cyclosporiasis ( CDC )
  • 7. WATERBOURNE ILLNESS
    • CAN ALSO BE CAUSED BY CHEMICALS OR BIOLOGICALS THAT ARE SPILLED INTO THE WATER
  • 8. What Is Foodborne Illness?
    • Foodborne illness often presents itself as flu-like symptoms such as nausea, vomiting, diarrhea, or fever, so many people may not recognize the illness is caused by bacteria or other pathogens in food. Thousands of types of bacteria are naturally present in our environment. Not all bacteria cause disease in humans. For example, some bacteria are used beneficially in making cheese and yogurt. Bacteria that cause disease are called pathogens. When certain pathogens enter the food supply, they can cause foodborne illness. Millions of cases of foodborne illness occur each year. Most cases of foodborne illness can be prevented. Proper cooking or processing of food destroys bacteria. Age and physical condition place some persons at higher risk than others, no matter what type of bacteria is implicated. Very young children, pregnant women, the elderly and people with compromised immune systems are at greatest risk from any pathogen. Some persons may become ill after ingesting only a few harmful bacteria; others may remain symptom free after ingesting thousands.
  • 9. HOW DOES BACTERIA GET INTO FOOD ?
    • Bacteria may be present on products when you purchase them. Plastic-wrapped boneless chicken breasts and ground meat, for example, were once part of live chickens or cattle. Raw meat, poultry, seafood, and eggs are not sterile. Neither is fresh produce such as lettuce, tomatoes, sprouts, and melons.
  • 10. The "Danger Zone"
    • Bacteria multiply rapidly between 40 °F and 140 °F. To keep food out of this "Danger Zone," keep cold food cold and hot food hot .
    • Store food in the refrigerator (40 °F or below) or freezer (0 °F or below).
    • Cook food to a safe minimum internal temperature.
      • Beef, veal, and lamb steaks, roasts, and chops may be cooked to 145 °F.
      • All cuts of pork to 160 °F.
      • Ground beef, veal and lamb to 160 °F.
      • All poultry should reach a safe minimum internal temperature of 165 °F.
    • Maintain hot cooked food at 140 °F or above.
    • When reheating cooked food, reheat to 165 °F.
  • 11.  
  • 12. Bacteria that Causes Foodborne Illness
  • 13. Fever, headache and muscle pain followed by diarrhea (sometimes bloody), abdominal pain, and nausea that appear 2 to 5 days after eating; may last 7 to 10 days. Contaminated water, raw milk, and raw or undercooked meat, poultry, or shellfish. intestinal tracts of animals and birds, raw milk, untreated water, and sewage sludge. Campylobacter jejuni Symptoms Trans mission Where Found Bacteria
  • 14. Toxin affects the nervous system. Symptoms usually appear 18 to 36 hours, but can sometimes appear as few as 4 hours or as many as 8 days after eating; double vision, droopy eyelids, trouble speaking and swallowing, and difficulty breathing. Fatal in 3 to 10 days if not treated. Bacteria produce a toxin that causes illness. Improperly canned foods, garlic in oil, vacuum-packed and tightly wrapped food. Widely distributed in nature; soil, water, on plants, and intestinal tracts of animals and fish. Grows only in little or no oxygen. Clostridium Botulinum
  • 15. Diarrhea and gas pains may appear 8 to 24 hours after eating; usually last about 1 day, but less severe symptoms may persist for 1 to 2 weeks. Called "the cafeteria germ" because many outbreaks result from food left for long periods in steam tables or at room temperature. Bacteria destroyed by cooking, but some toxin-producing spores may survive. Soil, dust, sewage, and intestinal tracts of animals and humans. Grows only in little or no oxygen. Clostridium perfringens
  • 16. Diarrhea or bloody diarrhea, abdominal cramps, nausea, and malaise; can begin 2 to 5 days after food is eaten, lasting about 8 days. Some, especially the very young, have developed hemolytic-uremic syndrome (HUS) that causes acute kidney failure. Contaminated water, raw milk, raw or rare ground beef, unpasteurized apple juice or cider, uncooked fruits and vegetables; person-to-person. Intestinal tracts of some mammals, raw milk, unchlorinated water; one of several strains of E. coli that can cause human illness. Escherichia coli O157:H7
  • 17. Fever, chills, headache, backache, sometimes upset stomach, abdominal pain and diarrhea; may take up to 3 weeks to become ill; may later develop more serious illness in at-risk patients (pregnant women and newborns, older adults, and people with weakened immune systems). Ready-to-eat foods such as hot dogs, luncheon meats, cold cuts, fermented or dry sausage, and other deli-style meat and poultry, soft cheeses and unpasteurized milk. Intestinal tracts of humans and animals, milk, soil, leaf vegetables; can grow slowly at refrigerator temperatures. Listeria monocytogenes
  • 18. Stomach pain, diarrhea, nausea, chills, fever, and headache usually appear 8 to 72 hours after eating; may last 1 to 2 days. Raw or undercooked eggs, poultry, and meat; raw milk and dairy products; seafood, and food handlers. Intestinal tracts and feces of animals; Salmonella Enteritidis in eggs. Salmonella (over 2300 types)
  • 19. Disease referred to as "shigellosis" or bacillary dysentery. Diarrhea containing blood and mucus, fever, abdominal cramps, chills, and vomiting; 12 to 50 hours from ingestion of bacteria; can last a few days to 2 weeks. Person-to-person by fecal-oral route; fecal contamination of food and water. Most outbreaks result from food, especially salads, prepared and handled by workers using poor personal hygiene. Human intestinal tract; rarely found in other animals. Shigella (over 30 types)
  • 20. Severe nausea, abdominal cramps, vomiting, and diarrhea occur 1 to 6 hours after eating; recovery within 2 to 3 days -- longer if severe dehydration occurs. Person-to-person through food from improper food handling. Multiply rapidly at room temperature to produce a toxin that causes illness. On humans (skin, infected cuts, pimples, noses, and throats). Staphylococcus aureus
  • 21. SO, HOW DO WE AVOID CONTAMINATION? CLEAN Wash hands, knives, tools surfaces often. Wash fruits and vegetables. Sanitize cutting boards and counters with bleach water. Replace tools prior to serving. SEPARATE Don’t cross contaminate. Store, and prepare meats separately from fruits and vegetables COOK Cook to proper temperatures. USE A THERMOMETER CHILL Refrigerate promptly. 1
  • 22. FOOD SAFETY ON DEPLOYMENT
    • Choose RESTURANTS carefully
    • Make sure that your MRE cooks completely
    • WASH YOUR HANDS…WASH YOUR HANDS…WASH YOUR HANDS
  • 23.  
  • 24. Floods: Sanitation and Hygiene It is critical for you to remember to practice basic hygiene during the emergency period. Always wash your hands with soap and water that has been boiled or disinfected: • before preparing or eating food; • after toilet use; • after participating in flood cleanup activities; and • after handling articles contaminated with flood water or sewage .
  • 25. Flood waters may contain fecal material from overflowing sewage systems, and agricultural and industrial byproducts. Although skin contact with flood water MAY not, by itself, pose a serious health risk, there is some risk of disease from eating or drinking anything contaminated with flood water. If you have any open cuts or sores that will be exposed to flood water, keep them as clean as possible by washing well with soap to control infection. If a wound develops redness, swelling, or drainage, seek immediate medical attention.
  • 26. In addition, parents need to help children avoid waterborne illness. Do not allow children to play in flood water areas, wash children's hands frequently (always before meals), and do not allow children to play with flood-water contaminated toys that have not been disinfected. You can disinfect toys using a solution of one cup of bleach in 5 gallons of water .
  • 27. INFORMATION FOR HEALTHCARE PROVIDERS Guidelines for the Management of Acute Diarrhea
    • Increased incidence of acute diarrhea may occur in post-disaster situations where access to electricity, clean water, and sanitary facilities are limited. In addition, usual hygiene practices may be disrupted and healthcare seeking behaviors may be altered.
  • 28. INFORMATION FOR HEALTHCARE PROVIDERS Guidelines for the Management of Acute Diarrhea
    • The primary goal of treating any form of diarrhea—viral, bacterial, parasitic, or non-infectious—is preventing dehydration or appropriately rehydrating persons presenting with dehydration. The following are general guidelines for healthcare providers for the evaluation and treatment of patients presenting with acute diarrhea in these situations.
  • 29.
    • Infants and Toddlers
      • Refer infants and toddlers with acute diarrhea for medical evaluation if any of the following are present:
    • Young age (e.g., aged <6 months) or weight <18 lbs
    • Premature birth, history of chronic medical conditions or concurrent illness
    • Fever > 38 °C (100.4 °F) for infants aged <3 months or > 39 °C (102.2 °F) for children aged 3–36 months
    • Visible blood in stool
    • High output diarrhea, including frequent and substantial volumes of stool
    • Persistent vomiting
    • Caregiver’s report of signs consistent with dehydration (e.g., sunken eyes or decreased tears, dry mucous membranes, or decreased urine output)
    • Change in mental status (e.g., irritability, apathy, or lethargy)
    • Suboptimal response to oral rehydration therapy already administered or inability of the caregiver to administer oral rehydration
  • 30. Principles of appropriate treatment for INFANTS AND TODDLERS with diarrhea and dehydration
    • Oral rehydration solutions (ORS) such as Pedialyte® (Abbott Laboratories)* or Gastrolyte® (Aventis Pharmaceuticals)* or similar commercially available solutions containing appropriate amounts of sodium, potassium and glucose should be used for rehydration whenever patient can drink the required volumes; otherwise, IV Fluids may be needed
  • 31. Principles of appropriate treatment for INFANTS AND TODDLERS with diarrhea and dehydration
    • Oral rehydration should be taken by patient in small, frequent volumes (spoonfuls or small sips for toddlers; small volumes in bottles for infants)
  • 32. Principles of appropriate treatment for INFANTS AND TODDLERS with diarrhea and dehydration
    • For rapid realimentation, an age-appropriate, unrestricted diet is recommended as soon as dehydration is corrected
    • For breastfed infants, nursing should be continued
    • Additional ORS or other rehydration solutions should be administered for ongoing diarrheal losses
  • 33. Principles of appropriate treatment for INFANTS AND TODDLERS with diarrhea and dehydration
    • • No routine laboratory tests or medications are recommended
    • However, if a patient is living in conditions that are crowded or otherwise conducive to outbreaks of gastrointestinal disease, providers should consider testing for bacterial, viral or parasitic pathogens. If an outbreak is suspected, testing a subset of patients may be sufficient to confirm of the outbreak (e.g., 10 stool specimens for norovirus)
  • 34. Principles of appropriate treatment for INFANTS AND TODDLERS with diarrhea and dehydration
    • The decision to treat with antimicrobial therapy should be made on a patient-by-patient basis. Even when a bacterial cause is suspected in an outpatient setting, antimicrobial therapy is not usually indicated among children because most cases of acute diarrhea are self-limited and their duration is not shortened by the use of antimicrobial agents.
  • 35. Principles of appropriate treatment for Older Children and Adults with diarrhea and dehydration
    • Refer children > 3 years old and adults with acute diarrhea for medical evaluation if any of the following are present:
  • 36. Principles of appropriate treatment for Older Children and Adults with diarrhea and dehydration
    • Elderly age
    • History of chronic medical conditions or concurrent illness
    • Fever > 39 °C (102.2 °F)
    • Visible blood in stool
    • High output of diarrhea, including frequent and substantial volumes of stool
    • Persistent vomiting
    • Signs consistent with dehydration (e.g., sunken eyes or decreased tears, dry mucous membranes, orthostatic hypotension or decreased urine output)
    • Change in mental status (e.g., irritability, apathy, or lethargy)
    • Suboptimal response to oral rehydration therapy already administered or inability to administer oral rehydration therapy
    F
  • 37. Principles of appropriate treatment for Older Children and Adults with diarrhea and dehydration
    • While sports drinks are fine for maintaining hydration in well persons, they are inappropriate for treatment of persons with diarrhea. In settings of diarrheal illness, oral rehydration solutions (ORS) such as Pedialyte® (Abbott Laboratories)*, Gastrolyte® (Aventis Pharmaceuticals)* or similar commercially available solutions containing appropriate amounts of sodium, potassium and glucose should be used for rehydration whenever patient can drink the required volumes; otherwise appropriate intravenous fluids may be used
  • 38. Principles of appropriate treatment for Older Children and Adults with diarrhea and dehydration
    • Oral rehydration should be taken by patient in small, frequent volumes (spoonfuls or small sips); see attached table for recommended volume and time period.
    • For rapid realimentation, unrestricted diet is recommended as soon as dehydration is corrected
  • 39. Principles of appropriate treatment for Older Children and Adults with diarrhea and dehydration
    • Antimotility agents such as Lomotil ® (Pfizer) or Immodium ® (McNeil Consumer) should be considered only in adult patients who are NOT febrile or having bloody/mucoid diarrhea. Antimotility agents may reduce diarrheal output and cramps, but do not accelerate cure. Antimotility agents are generally contraindicated for children
    • The decision to treat with antimicrobial therapy should be made on a patient-by-patient basis, and may differ by age group
  • 40. WRAPUP
    • RAISE YOUR HANDS IF YOU THINK THAT IT IS A GOOD IDEA TO WASH A CHICKEN BEFORE COOKING IT
  • 41.  
  • 42. WRAPUP
    • RAISE YOUR HANDS IF YOU THINK YOU SHOULD COOK A HAMBURGER UNTIL THE MIDDLE IS NO LONGER PINK
  • 43.  
  • 44.  
  • 45. Clean Hands Save Lives Keeping our hands clean is one of the most important things we can do to keep from getting sick and from spreading germs to others.
  • 46.  
  • 47.
    • Keeping our hands clean is one of the most important things we can do to keep from getting sick and from spreading germs to others
    • It is best to wash hands with soap and clean running water for 20 seconds
    • If soap and clean water are not available, use an alcohol-based product to clean your hands
    Clean Hands Save Lives
  • 48.  
  • 49.
    • Alcohol-based handrubs significantly reduce the number of germs on skin and are fast acting
    • When using an alcohol-based hand rub, apply the product to the palm of one hand and rub hands together. Rub the product over all surfaces of hands and fingers until hands are dry
    Clean Hands Save Lives
  • 50.
    • Before preparing or eating food
    • After going to the bathroom
    • After changing diapers or cleaning
    • a child who has gone to the bathroom
    • Before and after tending to someone who is sick
    When should I clean my hands?
  • 51.
    • After blowing your nose,
    • coughing, or sneezing
    • After handling an animal or animal
    • waste
    • After handling garbage
    • Before and after treating a cut or wound
    When should I clean my hands?
  • 52.
      • Wet your hands with clean running water and and apply soap. Use warm water if it is available.
      • Rub hands together to make a lather and scrub all surfaces.
      • Continue rubbing hands for 20 seconds. Need a timer? Imagine singing “Happy Birthday” twice through to a friend!
    Washing hands with soap and water
  • 53.
    • When hands are visibly dirty, they should be washed with soap and clean running water when available.
    • If soap and water are not available, use an alcohol-based product to clean your hands.
    Cleaning hands with alcohol-based hand sanitizers
  • 54.
    • Alcohol-based handrubs significantly reduce the number of germs on skin and are fast acting.
    • When using an alcohol-based handrub, apply product to the palm of one hand and rub hands together. Rub the product over all surfaces of hands and fingers until hands are dry.
    Cleaning hands with alcohol-based hand sanitizers
  • 55. HANDWASHING VIDEO