This module is for use by community educators. Its appropriate for teaching groups of consumers or those that cook for others such as religous institutions. The guidelines within are for consumers, not for commercial food servce.
Module One-Foodborne illnessWe are now hearing more about foodborne illness than ever before. Although the food supply in the United States is considered one of the safest in the world, foodborne illness and death remain a significant public health challenge worldwide. Even though bacteria are everywhere in the natural environment—in the soil, air, water, and in the foods we consume, foodborne disease is common, but largely preventable. Healthy food safety habits should be practiced every day with every meal. It is important to learn how to keep yourself and your family safe from infectious disease. This course will teach the basics of how to prevent foodborne illness, including: the causes and sources of foodborne illness; identifying “at risk” populations; the importance of good personal hygiene; understanding that temperature matters; how to prevent cross-contamination; as well as current food safety topics and issues facing us today. In this course we will focus on food safety in the United States. Now, lets get started with Module 1.Source: www.fsis.usda.gov/Fact_Sheets/Refrigeration_&_Food_Safety/indexwww.cdc.gov
Estimated foodborne illness in the United States each year.Although the food supply in the United States is among the safest in the world, foodborne illness contributes to many cases of sickness and death each year. The Centers for Disease Control (CDC) estimate that 76 million people get sick, over 325,000 are hospitalized, and at least 5,000 people die each year from foodborne illness caused by contaminated foods or beverages. Five thousand deaths per year translates to thirteen men, women and children dying everyday. Although those numbers may seem high, it is widely believed that the real numbers are much higher, because the symptoms of foodborne illness often mimic those of the flu. When people become ill, they often do not go to the doctor.Source: Centers for Disease Control and Prevention (CDC)www.fda.gov/Food/ResourcesForYou/Consumers/ucm103263.htmwww.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm
Common symptoms of foodborne illness:Flu like symptoms such as nausea, vomiting, diarrhea, abdominal cramping, fever, headache, dehydration or blood or pus in the stools. My goodness, nausea, vomiting, diarrhea; almost sounds like a television commercial.Let’s take a trip down Harmful Microbe Lane:After ingesting a harmful microbe, an incubation period occurs which could range from a matter of hours to days depending on how much is ingested and what kind of organism it is. Now you can see how difficult it is to track down the source of the illness with all the meals that could have been eaten, and places we could have been in that time span.During the incubation period, the harmful microbes move from the stomach into the intestines and begin attaching to the intestinal wall; this is where the microbes multiply. Some microbes remain in the intestine and others will create toxins that go directly into the bloodstream. To add insult to injury, some microbes can spread into deep body tissues. It all depends on what kind of microbe is swallowed.Most foodborne illnesses are mild, and the symptoms go away within a day or two. Most of us recover, because we have healthy immune systems; therefore medical attention is not sought. Source:www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm
Causative agents implicated in foodborne illness:90% of foodborne illness is caused by bacteria. As stated earlier, our environment is filled with bacteria—in the soil, air, water and the foods we consume. Ninety-five percent of bacteria are beneficial to us, like the bacteria used to make cheese and yogurt, and the good bacteria in our gut, that aids our immune system and fights infection for us.There are two separate categories of bacteria—pathogenic and spoilage bacteria.Pathogenic bacteria:Disease causing bacteria are called pathogens. When some of these pathogens get into our food or water supply, they can cause foodborne illness.In the United States, the four most common causes of foodborne illness come from bacteria such as Salmonella, E.coli 0157-H7, Campylobactor and viruses called calicivirus or Norwalk virus. Most cases of foodborne illness are attributed to places where foods are handled, such as retail food establishments and the home.Spoilage bacteria:Can grow at low temperatures such as in the refrigerator. This can occur when food is kept too long in the refrigerator or counter. The food can develop a bad smell, off taste or/and slime. Most people would not get sick from this type of bacteria but most of us would choose not to eat the food. This would be considered “poor quality” food. Source:http://www.fsis.usda.gov/FactSheets/foodborne_illness_What_Consumers_Need_to_KnowCenters for Disease Control and Prevention (CDC)http://www.fsis.usda.gov/Fact_Sheets/Refrigeration_&_Food_Safety/index.asp
Bacterial growth.Each time bacteria divide, a new generation is created. A new generation can be created every 15-20 minutes. So you can see how quickly bacteria can multiply once they get into food and after they have been ingested. Symptoms of foodborne illness can begin in just hours or in a number of days. It all depends on what microbe has been swallowed and how many.Source: www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htmwww.fightbac.org
Sources of foodborne disease outbreaks.According to the Centers for Desease Control and Prevention, most cases of foodborne disease come from places where food is handled. During the period of 1998-2004, 52% of foodborne illness came from restaurants (this also includes delicatessens, cafeterias and hotels), 18% from the home, 4% from schools, 4% from unknown sources and 22% from other sources.An outbreak occurs when more than one person, or a group of people, consume the same contaminated food and two or more of them are found to have the same illness. The people may not have eaten together, or know each other, but they may have eaten from the same “batch” of contaminated food, causing the same illness. Source: Jones TF, Angulo FJ. Eating in Restaurants: A risk for Foodborne Disease? Clinical Infectious Diseases 2006;43:1324-8.www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm
Sources of foodborne illness.Sources of foodborne illness.It is possible for food to become contaminated if it comes in contact with anything that harbors harmful bacteria. Food handlers: Even a healthy food handler can be a source of disease carrying microbes. Right now 30% of people have staphylococcus aureus, or staph bacteria on their hands and in their nose, and if we do not wash our hands it can infect the food we handle. When these bacteria come in contact with food, it produces toxins. Bacteria do not have to establish and multiply in the gut. It produces toxins on the food that is equivalent to eating poison. Symptoms can start within 1 to 6 hours after ingesting food contaminated with staph infection. Source: www.cdc.gov/healthyswimming/w_print.htmwww.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm Adobe Connect “Antimicrobial Resistance, the Food Supply, and Our Health” 1 hour Guest speaker: Dr. Jianghong Meng
Sources of foodborne illness.Contaminates in, air, soil and water can cause major problems. For example, tobacco smoke in the air can contaminate foods. Ecoli bacteria can be found in the gut and feces of animals. If the fresh manure is contaminated with harmful Ecoli bacteria, it can spread to the crops. The most common recreational water illness reported is diarrhea. People entering swimming pools and hot tubs can get diarrhea from water not treated properly with chlorine. The ph level of pools should be checked regularly. Among the most common bacterial illnesses contracted from pools are shigella, E. coli 0157-H7 and norovirus. These bacteria will be discussed later. Source: www.cdc.gov/healthyswimming/w_print.htmwww.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm
Sources of foodborne illness continued…Food contact surfaces such as cutting boards that are not washed properly after each use. Grinders, can openers, blenders, utensils, food processors and other surfaces that are not cleaned before and after contact with raw foods, and before use with ready to eat foods. Animals, insects and rodents can carry foodborne diseases that enter our crops and our pantry.Source: Kitchen Companion: Your Safe Food Handbook. United States Department of Agriculture, Food Safety and Inspection Service.
Foods most associated with foodborne illness.Raw foods of animal origin are the most likely to be contaminated. This list includes: raw meat, poultry, raw eggs, unpasteurized milk, and raw shellfish. Bacteria occur naturally in animal products. Filter-feeding shell fish are likely to have contaminates if there are any pathogens in the water, because they naturally filter microbes through their bodies over a period of months. Ground beef, bulk milk and pooled raw eggs are examples of food products that mix scores of individual animals for one food product. One ground beef patty is the product of more that one hundred animals. If any one of those animals was infected with a harmful bacteria it would negatively affect the whole lot. Raw eggs and undercooked eggs: Often when we were growing up, we enjoyed our eggs sunny-side up or soft cooked. It is now recommended to thoroughly cook the yolk of an egg to kill any salmonella that may be present. At least one out of every 10,000 eggs is infected with salmonella. One dozen of eggs could come from one dozen chickens. Here again if one chicken was infected, it would infect the entire batch.Source: www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm
Fruits and vegetables.Due to a number of recent outbreaks, fruits and vegetables consumed raw have become a major concern. These recent outbreaks were due to unsanitary conditions during the washing and chilling of produce after harvesting. The water used to wash produce before it is sold to consumers must be free from contaminates or many containers of fruits and vegetables can become contaminated and dispersed to consumers.Washing fruits and vegetables in potable water for 30 seconds, can remove some pesticides, fertilizers, dirt and can reduce bacteria.Scientist used to believe that most harmful microorganisms were related to animal products. But now it is clear that we need to pay close attention to raw vegetables and fruits as well.Source: www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm Kitchen Companion: Your Safe Food Handbook. United States Department of Agriculture, Food Safety and Inspection Service.
Foods most associated with foodborne illness continued.Alfalfa sprouts and raw sprouts are grown under conditions that are conducive for sprouts to grow but also for harmful microbes to grow. In addition, these sprouts are eaten raw without further cooking.Unpasteurized milk and fruit juice. Pasteurized milk and juice are heated to a very high temperature for about 15 seconds before it is sold. About 98% of all milk sold in the United States is pasteurized.Source: www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm
Food Associated with foodborne illness.Cooked rice and pasta is naturally low in acid. Higher acid foods take longer to spoil. Although it seems we keep rice and pasta on the shelf forever, once it is cooked, it contains moisture which makes it susceptible to foodborne disease. Do not keep cooked rice, pasta or other foods longer than three to four days in the refrigerator. Ready to eat foods can be contaminated by the food handler, by cross contamination or/and temperature abuse. Heat destroys most harmful bacteria, but ready-to-eat foods do not require further cooking.Source: www.cdc.govwww.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm
Facts about foodborne illness continued.Foodborne illness can be very costly and can destroy the reputation of a food establishment.Think of the medical cost of victims of foodborne illness as well as lost time away from work, law suits paid out by eating establishments and loss of jobs due to the closing of food establishments. For example, do you remember a restaurant called:Jack in the Box—In 1992 E-coli 0157:H7 was found in undercooked hamburgers. Over 700 people got sick in five states.Four children died.Class action suits against Jack in the Box totaled over 50 million dollars.Six year old Lauren Beth Rudolph was one of the four children that died from eating undercooked hamburgers. Before her death she suffered three massive heart attacks and fell into a coma. And to think we used to think of foodborne illness as only a stomach ache.Source: http://science.nationalgeographic.com/science/health-and-human-body/human-body/food-s...Ackerman, Jennifer. Food—How Safe?. May 2002.
Facts about foodborne illness continued.Similarly, Chi Chi’s—a popular Mexican food restaurant—In 2003, over 500 people in Beaver County, Pennsylvania became ill from eating green onions infected with hepatitis A. Hepatitis A is a liver disease that will be discussed later in this course.Eighty people either contracted hepatitis A or had to be immunized for Hepatitis A. One man had a liver transplant.Four people died.Source: http://science.nationalgeographic.com/science/health-and-human-body/human-body/food-s...Ackerman, Jennifer. Food—How Safe? May 2002.
Now let’s talk about the “most at risk populations”:Given the right set of circumstances everyone is at risk for foodborne illness. Often a healthy immune system can fight off the bad bacteria and recover quickly. But let’s talk about the populations that are most at risk.Infants and children: An infant’s immune system is not fully developed yet and can lack the ability to fight off some infections.Older adults: As we age, our bodies change and our immune systems can become weaker, making it harder for the body to fight off illness. When seniors become ill, it can take them longer to recuperate. Some of those changes include:A decrease in the emission of stomach acids. Stomach acid is our primary defense against ingested bacteria.Many seniors take medications or are ill and this can affect their sense of taste and smell. Our sense of taste and smell can send a signal to our brain that food is spoiled.Some widowed seniors may not know their way around the kitchen to prepare and cook food safely.Many seniors like to eat out often, which puts them more at risk for foodborne illness, if food is not handled properly by restaurant workers. Remember, most food borne illness takes place where food is handled.Source: http://origin-www.fsis.usda.gov/PDF/Food_Safety_for_Older_Adults.pdfFood Safety for older Adults. A need to know guide for those 65 years of age and older. United States Department of Agriculture, Food Safety and Inspection Service.
Most at risk populations continued.Pregnant women: A pregnant woman and the fetus are at risk because the immune system is weakened, making it difficult for the body to fight infection. A family of bacteria of particular concern to pregnant women is listeria. Listeria is a dangerous infection caused by undercooked animal products. The following foods have been found as a source of listeria for pregnant women—soft cheeses, undercooked hot dogs and sliced deli meats. High risk populations should also keep away from unpasteurized milk and juices and alfalfa sprouts. Immunocompromised populations: have weakened immune systems. For example, people with diabetes, cancer treatments, HIV and AIDS, those who take medications, and organ and bone marrow transplants are at higher risk for critical illness and death from harmful microbes.Source: www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm
Why are we hearing so much about foodborne illness now? We are hearing so much about foodborne illness now because foodborne illness is a growing problem. The range of foodborne diseases is always changing. Scientists have discovered more microbes or pathogens that cause foodborne illness. Many microbes are stronger than ever before, and much harder to eliminate, because they have learned to survive in tough environments and can be found in foods that at one time were not considered hazardous. Just one-hundred years ago cholera, typhoid fever and tuberculosis were considered common foodborne diseases. But since then we have had vast improvements in food safety, including—disinfection of water supplies, safer canning practices and pasteurized milk and juice. Today, due to advances in laboratory testing, and identification, we can now detect morefoodborne illnesses and the pathogens that may be causing the illness. A few examples of these pathogens are—E. coli O157:H7, Campylobacter Jejuni infection and Listeria. Campylobactor is the most common cause of bacterial diarrhea in the world. This bacteria is found in the intestines of birds and is on the surface of most raw chickens. The most frequent cause of campylobactor is undercooked chicken and raw chicken juices dripping on to other foods. The symptoms are abdominal cramps, fever and diarrhea.Twenty years ago these pathogens were not even on our radar as foodborne pathogens. To date there is no antibiotic for these pathogens. With all of our scientific advancements there are still foodborne outbreaks reported to the CDC for which there are still no identified causative agents. You will learn more about foodborne pathogens later in the presentation. Source:http://www.cdc.gov/ncidod/eid/Vol5no5/mead.htm - Food-Related Illness and Death in the United Stateshttp://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm
Why are we hearing so much about foodborne illness now.More centralized food distribution: Often food products are distributed from large centralized processing locations. If any of the food is contaminated, it can be mass distributed throughout a large area, and this can lead to large outbreaks of foodborne illness. For example, in 2006, the bacterium, E. coli 0157:H7 found in the spinach crop, was traced to a section of California where at least 70% of bagged spinach is grown, packaged and then distributed. This outbreak affected 199 people in 26 states. Again, most recently in 2008-2009, the Multistate outbreak of Salmonella infections (43 states to be exact) was associated with peanut butter and peanut butter-containing products in the United States and Canada. The infection was traced to the Peanut Corporation of America (PCA), at one plant in Blakely, Georgia that distributed peanut products under the name of “King Nut”. These peanut products were distributed in bulk to many institutions, food service industries and a few private label food companies (but not for retail sale in grocery stores). In all, 116 people were hospitalized. A total of 8 deaths may be attributed to this salmonella outbreak.Source: www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htmCenters for Disease Control and Prevention. MMWR Weekly. Multistate outbreak of Salmonella Infections Associated with Peanut Butter and Peanut Butter-Containing Products—United States, 2008-2009. February 6, 2009/58(04);85-90.Access this weekly publication at www.cdc.gov/mmwr/preview/mmwrhtml/mm5804a4.htm
Why are we hearing so much about foodborne illness continued.Let’s talk about globalization: We live in a global society. If you want peaches in January, Guatemala and other countries with a year round warm climate will be happy to send them to you, along with any other summer fruit you would like. Our food now comes from all over the world, which means there are many more opportunities for our food to come in contact with contaminates while it is produced, prepared and shipped to us.Source: www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htmCenters for Disease Control and Prevention. MMWR Weekly. Multistate Outbreak of Salmonella Infections Associated with Peanut Butter and Peanut Butter-Containing Products—United States, 2008-2009. February 6, 2009/58(04);85-90.Access this weekly publication at www.cdc.gov/mmwr/preview/mmwrhtml/mm5804a4.htm
Why are we hearing so much about foodborne illness continued.Change in consumer demographics: People with immune system disorders are increasing in our society. This includes individuals that are HIV positive, organ transplant recipients, chemotherapy patients and those with long term chronic disease. Human behavior:Lack of knowledge of basic home food safety. Most individuals who cook will report that they can tell when a food is fully cooked by looking at it. Not so! Only a food thermometer placed correctly into the food item can give us an accurate, reliable, internal food temperature. Convenience and saving time are more important to people than proper food handling. For example, more already prepared foods are eaten than ever before.In addition, more people use labor saving equipment in kitchens, such as food processors and microwave ovens. Often these appliances are not cleaned properly and foods are not always cooked to temperature to kill harmful bacteria.Also , Americans now spend more money on food eaten away from home than ever before. Salad bars and fast food restaurants are a main component in the lives of many Americans. In the next slide you will see why this is such a problem.Source: www.cdc.gov
Foodborne illness continued.Schools now focus on other health concerns such as sexually transmitted diseases and not as much attention is given to consumer safety issues.Home: Because so many meals are eaten away from home, there is much less opportunity for food safety education in the home. Many American consumers are not aware of the sources of foodborne illness in the home or the basic awareness of proper food safety practices when cooking meats. National and international travel has increased dramatically in the 20th century. Travelers can become infected with foodborne pathogens. These pathogens can be carried wherever they go and infect other travelers and non-travelers as well within 24 hours or less. Source: www. Uri.edu/ce/ceec/food/factsheets/foodborneill.htmlwww.cdc.gov
Other important causes of foodborne illness are:Poor personal hygieneCross contamination andTemperature AbuseNow let’s move on to Module 2: Personal hygiene
Food Safety is for Everyone, Module 1: Foodborne Illness
Food Safety is for Everyone Module One Written and developed by: Lorraine Harley, Family and Consumer Sciences Educator University of Maryland Extension Calvert/Charles/St Mary’s Counties Equal Access Programs Copyright 2010 by Lorraine Harley, Family and Consumer Sciences Educator, University of Maryland Extension
Foodborne illness Module 1 Copyright 2010 by Lorraine Harley, Family and Consumer Sciences Educator, University of Maryland Extension
What is foodborne illness??? <ul><li>“ When a person becomes ill after ingesting contaminated foods or beverages.” </li></ul>
Common symptoms of foodborne illness: <ul><li>Nausea </li></ul><ul><li>Vomiting </li></ul><ul><li>Diarrhea </li></ul><ul><li>Abdominal cramping </li></ul><ul><li>Fever </li></ul><ul><li>Headache </li></ul><ul><li>Dehydration </li></ul><ul><li>Blood or pus in the stools </li></ul>
Estimated foodborne illness in the United States each year: 76 million people get sick 325,000 are hospitalized 5,000 deaths Centers for Disease Control and Prevention 2007
Foodborne illness can be caused by: <ul><li>Biological hazards (bacteria, viruses and parasites) </li></ul><ul><li>Chemical hazards (cleaning agents, toxins) </li></ul><ul><li>Physical hazards (bone, glass, </li></ul><ul><li>metal, false fingernails, plastics) </li></ul><ul><li>Parasites </li></ul>
Causative agents implicated in foodborne illness Bacteria 90% Viruses 6% Chemical 2% Parasites 1%
Bacterial growth <ul><li>Bacteria multiply rapidly by dividing: </li></ul><ul><li>1,2,4,8,16,32,64…etc. </li></ul>
Foods most associated with foodborne illness… <ul><li>Raw foods of animal origin </li></ul>
Foods associated with foodborne illness continued… <ul><li>Raw and undercooked shellfish </li></ul>
Foods associated with foodborne illness continued…Fruits and vegetables
Foods most associated with foodborne illness continued… <ul><li>Alfalfa sprouts and raw sprouts </li></ul><ul><li>Unpasteurized milk, fruit and juice </li></ul>
A few facts about foodborne illness: <ul><li>Common </li></ul><ul><li>Under reported </li></ul><ul><li>It contributes to many cases of sickness and death each year </li></ul>
Facts about foodborne illness continued… <ul><li>It is very costly $$$$$ </li></ul>
Facts about foodborne illness continued… <ul><li>It can destroy the reputation of a food establishment </li></ul>
Why are we hearing so much about foodborne illness now? <ul><li>A growing problem: </li></ul><ul><li>Increase in foodborne pathogens </li></ul><ul><li>Antibiotic resistant pathogens </li></ul><ul><li>Better methods of detection and identification </li></ul>
Why are we hearing so much about foodborne illness? Continued… <ul><li>More centralized food distribution </li></ul>
Why are we hearing so much about foodborne illness continued… <ul><li>Globalization </li></ul>
Why are we hearing so much about foodborne illness Continued… <ul><li>Change in consumer demographics </li></ul><ul><li>Human behavior </li></ul>
Why are we hearing so much about foodborne illness continued… <ul><li>Education </li></ul><ul><li>Schools/home </li></ul><ul><li>Travel </li></ul>
Other important causes of foodborne illness: <ul><li>Poor personal hygiene </li></ul><ul><li>Cross contamination </li></ul><ul><li>Temperature abuse </li></ul>Copyright 2010 by Lorraine Harley, Family and Consumer Sciences Educator, University of Maryland Extension
To Learn More: <ul><li>http://www.fsis.usda.gov/Fact_Sheets/ </li></ul><ul><li>p://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm </li></ul><ul><li>www.cdc.gov </li></ul>Copyright 2010 by Lorraine Harley, Family and Consumer Sciences Educator, University of Maryland Extension