Food And Waterborne Diseases Powerpoint

FOOD AND FOOD AND WATERBORNE WATERBORNE

DISEASESDISEASES

JAMES GERVASE, R.PH.JAMES GERVASE, R.PH.

DMAT PA-3DMAT PA-3

The DangerThe Danger

• How it applies to you at home and How it applies to you at home and workwork

• How it applies to us when on How it applies to us when on DeploymentDeployment

• Deliver the information recognizing Deliver the information recognizing that we have Health Care that we have Health Care Professionals, together with people Professionals, together with people who are not in Health Carewho are not in Health Care

Major Breakdowns in Major Breakdowns in Food SafetyFood Safety

• E.coli outbreaksE.coli outbreaks– Kroger/Nebraska Ltd (June 2008) Kroger/Nebraska Ltd (June 2008) – Totino's/Jeno's Pizza (Nov 2007) Totino's/Jeno's Pizza (Nov 2007) – Ground Beef Patties Outbreak (Oct 2007) Ground Beef Patties Outbreak (Oct 2007) – TacoBell Outbreak (Nov-Dec 2006) TacoBell Outbreak (Nov-Dec 2006)

– Spinach Outbreak (Sep-Oct 2006)Spinach Outbreak (Sep-Oct 2006)

○ People are affected by Breakdowns in Food Safety EVERYDAY

WATERBORNE WATERBORNE ILLNESSESILLNESSES

• AcanthamoebaAcanthamoeba ( (CDCCDC) ) • Adenoviruses (Adenoviruses (CDCCDC, , CDC-generalCDC-general) ) • Aeromonas hydrophilaAeromonas hydrophila (FDA) (FDA) • Algal Blooms, Harmful (HABs) (Algal Blooms, Harmful (HABs) (CDCCDC) ) • Amebiasis (Amebiasis (CDCCDC) ) • Anemia (WHO) Anemia (WHO) • Arsenic (Arsenic (CDC-ATSDRCDC-ATSDR, WHO) , WHO) • Arsenicosis (Arsenicosis (CDC-ATSDRCDC-ATSDR, WHO) , WHO) • Ascariasis Ascariasis ( (CDCCDC, WHO, WHO-general) , WHO, WHO-general) • Ascaris lumbricoidesAscaris lumbricoides ( (CDCCDC, WHO, WHO-general) , WHO, WHO-general) • Astrovirus (Astrovirus (CDC-generalCDC-general) ) • Atrazine (Atrazine (CDC-ATSDRCDC-ATSDR) )

WATERBOURNE WATERBOURNE ILLNESSESILLNESSES

• Balamuthia mandrillaris (Balamuthia mandrillaris (CDC-DPDxCDC-DPDx, , WHO) WHO)

• Benzene (Benzene (CDC-ATSDRCDC-ATSDR) ) • Bilharzia (Bilharzia (CDCCDC, WHO, WHO-PPC) , WHO, WHO-PPC)

(see also (see also SchistosomiasisSchistosomiasis) ) • Boating (Boating (CDCCDC) ) • Burkholderia cepaciaBurkholderia cepacia complex ( complex (CDCCDC) ) • Buruli Ulcer (WHO) Buruli Ulcer (WHO)

WATERBOURNE WATERBOURNE ILLNESSILLNESS

• CAN ALSO BE CAUSED BY CAN ALSO BE CAUSED BY CHEMICALS OR BIOLOGICALS CHEMICALS OR BIOLOGICALS THAT ARE SPILLED INTO THE THAT ARE SPILLED INTO THE WATERWATER

What Is Foodborne Illness?What Is Foodborne Illness?• Foodborne illness often presents itself as flu-like symptoms such Foodborne illness often presents itself as flu-like symptoms such

as nausea, vomiting, diarrhea, or fever, so many people may not as nausea, vomiting, diarrhea, or fever, so many people may not recognize the illness is caused by bacteria or other pathogens in recognize the illness is caused by bacteria or other pathogens in food.food.

Thousands of types of bacteria are naturally present in our Thousands of types of bacteria are naturally present in our environment. Not all bacteria cause disease in humans. For environment. Not all bacteria cause disease in humans. For example, some bacteria are used beneficially in making cheese example, some bacteria are used beneficially in making cheese and yogurt.and yogurt.

Bacteria that cause disease are called pathogens. When certain Bacteria that cause disease are called pathogens. When certain pathogens enter the food supply, they can cause foodborne pathogens enter the food supply, they can cause foodborne illness. illness. Millions of cases of foodborne illness occur each year. Millions of cases of foodborne illness occur each year. Most cases of foodborne illness can be prevented.Most cases of foodborne illness can be prevented. Proper Proper cooking or processing of food destroys bacteria. cooking or processing of food destroys bacteria.

Age and physical condition place some persons at higher risk Age and physical condition place some persons at higher risk than others, no matter what type of bacteria is implicated. Very than others, no matter what type of bacteria is implicated. Very young children, pregnant women, the elderly and people with young children, pregnant women, the elderly and people with compromised immune systems are at greatest risk from any compromised immune systems are at greatest risk from any pathogen. Some persons may become ill after ingesting only a pathogen. Some persons may become ill after ingesting only a few harmful bacteria; others may remain symptom free after few harmful bacteria; others may remain symptom free after ingesting thousands.ingesting thousands.

HOW DOES BACTERIA GET HOW DOES BACTERIA GET INTO FOOD ?INTO FOOD ?

• Bacteria may be present on products Bacteria may be present on products when you purchase them. Plastic-when you purchase them. Plastic-wrapped boneless chicken breasts and wrapped boneless chicken breasts and ground meat, for example, were once ground meat, for example, were once part of live chickens or cattle. Raw meat, part of live chickens or cattle. Raw meat, poultry, seafood, and eggs are not poultry, seafood, and eggs are not sterile. Neither is fresh produce such as sterile. Neither is fresh produce such as lettuce, tomatoes, sprouts, and melons.lettuce, tomatoes, sprouts, and melons.

The "Danger Zone"The "Danger Zone"• Bacteria multiply rapidly between 40 °F and 140 °F. Bacteria multiply rapidly between 40 °F and 140 °F.

To keep food out of this "Danger Zone," To keep food out of this "Danger Zone," keep cold keep cold food cold and hot food hotfood cold and hot food hot. .

• Store food in the refrigerator (40 °F or below) or Store food in the refrigerator (40 °F or below) or freezer (0 °F or below). freezer (0 °F or below).

• Cook food to a safe minimum internal temperature. Cook food to a safe minimum internal temperature. – Beef, veal, and lamb steaks, roasts, and chops may be cooked Beef, veal, and lamb steaks, roasts, and chops may be cooked

to 145 °F. to 145 °F. – All cuts of pork to 160 °F. All cuts of pork to 160 °F. – Ground beef, veal and lamb to 160 °F. Ground beef, veal and lamb to 160 °F. – All poultry should reach a safe minimum internal All poultry should reach a safe minimum internal

temperature of 165 °F. temperature of 165 °F.

• Maintain hot cooked food at 140 °F or above. Maintain hot cooked food at 140 °F or above. • When reheating cooked food, reheat to 165 °F. When reheating cooked food, reheat to 165 °F.

Bacteria that Causes Bacteria that Causes Foodborne Illness Foodborne Illness

BacteriaWhereFound

Transmission

Symptoms

Campylobacterjejuni

intestinal tracts of

animals and birds, raw

milk, untreated water, and

sewage sludge.

Contaminated water, raw

milk, and raw or undercooked meat, poultry, or shellfish.

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.

ClostridiumBotulinum

Widely distributed in nature; soil,

water, on plants, and intestinal tracts of

animals and fish. Grows

only in little or no oxygen.

Bacteria produce a toxin that

causes illness. Improperly

canned foods, garlic in oil,

vacuum-packed and

tightly wrapped food.

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.

Clostridiumperfringens

Soil, dust,

sewage, and

intestinal tracts of animals

and humans. Grows only in little or

no oxygen.

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.

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.

Escherichia coli

O157:H7

Intestinal tracts of some mammals,

raw milk, unchlorinated water; one of

several strains of E. coli that can cause human

illness.

Contaminated water, raw milk, raw or rare ground

beef, unpasteurized apple juice or

cider, uncooked fruits and

vegetables; person-to-person.

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.

Listeriamonocytogenes

Intestinal tracts of

humans and animals,

milk, soil, leaf

vegetables; can grow slowly at

refrigerator temperatur

es.

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 unpasteurize

d milk.

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).

Salmonella

(over 2300

types)

Intestinal tracts and feces of animals;

Salmonella Enteritidis in

eggs.

Raw or undercooked eggs, poultry, and meat; raw milk and dairy

products; seafood, and

food handlers.

Stomach pain, diarrhea,

nausea, chills, fever, and headache

usually appear 8 to 72 hours after eating;

may last 1 to 2 days.

Shigella

(over 30

types)

Human intestinal

tract; rarely

found in other

animals.

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.

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.

Staphylococ

cusaureus

On humans (skin,

infected cuts,

pimples, noses,

and throats).

Person-to-person through food from

improper food handling. Multiply

rapidly at room temperature to

produce a toxin that causes illness.

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.

SO, HOW DO WE AVOID SO, HOW DO WE AVOID CONTAMINATION?CONTAMINATION?

CLEANWash 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

COOKCook to proper temperatures.

USE A THERMOMETERCHILL

Refrigeratepromptly.

1

FOOD SAFETY ON FOOD SAFETY ON DEPLOYMENTDEPLOYMENT

• Choose RESTURANTS carefullyChoose RESTURANTS carefully• Make sure that your MRE cooks Make sure that your MRE cooks

completelycompletely• WASH YOUR HANDS…WASH WASH YOUR HANDS…WASH

YOUR HANDS…WASH YOUR YOUR HANDS…WASH YOUR HANDSHANDS

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.

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.

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.

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 healthcare

seeking behaviors may be seeking behaviors may be altered.altered.

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.

• 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

Principles of appropriate treatment for INFANTS AND

TODDLERS with diarrhea and dehydration 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



•Oral rehydration should be taken by patient in small, frequent volumes (spoonfuls or small sips for toddlers; small volumes in bottles for infants)



• 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



• 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)



• 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.

Principles of appropriate treatment for Older Children and Adults

with diarrhea and dehydration dehydration

•Refer children > 3 years old and adults with acute diarrhea for medical evaluation if any of the following are present:



• 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



• 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



• 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



• 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

WRAPUPWRAPUP

• RAISE YOUR HANDS IF YOU RAISE YOUR HANDS IF YOU THINK THAT IT IS A GOOD THINK THAT IT IS A GOOD IDEA TO WASH A CHICKEN IDEA TO WASH A CHICKEN BEFORE COOKING ITBEFORE COOKING IT

WRAPUPWRAPUP

• RAISE YOUR HANDS IF YOU RAISE YOUR HANDS IF YOU THINK YOU SHOULD COOK THINK YOU SHOULD COOK A HAMBURGER UNTIL THE A HAMBURGER UNTIL THE MIDDLE IS NO LONGER MIDDLE IS NO LONGER PINKPINK

Clean Hands Save LivesClean Hands Save Lives

Keeping our hands clean is Keeping our hands clean is one of the most important one of the most important things we can do to keep things we can do to keep

from getting sick and from from getting sick and from spreading germs to others. spreading germs to others.

Keeping our hands clean is one of the most Keeping our hands clean is one of the most important things we can do to keep from important things we can do to keep from getting sick and from spreading germs to getting sick and from spreading germs to others others

It is best to wash hands with soap and clean It is best to wash hands with soap and clean running water for 20 secondsrunning water for 20 seconds

If soap and clean water are not available, use If soap and clean water are not available, use an alcohol-based product to clean your handsan alcohol-based product to clean your hands


Alcohol-based handrubs Alcohol-based handrubs significantly reduce the number of significantly reduce the number of germs on skin and are fast actinggerms on skin and are fast acting

When using an alcohol-based hand When using an alcohol-based hand rub, apply the product to the palm rub, apply the product to the palm of one hand and rub hands of one hand and rub hands together. Rub the product over all together. Rub the product over all surfaces of hands and fingers until surfaces of hands and fingers until hands are dry hands are dry


Before preparing or eating foodBefore preparing or eating food

After going to the bathroomAfter going to the bathroom

After changing diapers or cleaning After changing diapers or cleaning a child who has gone to the bathrooma child who has gone to the bathroom

Before and after tending to someone who is Before and after tending to someone who is sick sick

When should I clean my hands?When should I clean my hands?

After blowing your nose, After blowing your nose, coughing, or sneezing coughing, or sneezing

After handling an animal or animal After handling an animal or animal waste waste

After handling garbage After handling garbage

Before and after treating a cut or wound Before and after treating a cut or wound

When should I clean my hands?When should I clean my hands?

Wet your hands with clean running water Wet your hands with clean running water and and apply soap. Use warm water if it and and apply soap. Use warm water if it is available.is available.

Rub hands together to make a lather and Rub hands together to make a lather and scrub all surfaces.scrub all surfaces.

Continue rubbing hands for 20 seconds. Continue rubbing hands for 20 seconds. Need a timer? Imagine singing “Happy Need a timer? Imagine singing “Happy Birthday” twice through to a friend!Birthday” twice through to a friend!

Washing hands with soap and waterWashing hands with soap and water

When hands are visibly dirty, they When hands are visibly dirty, they should be washed with soap and should be washed with soap and clean running water when available.clean running water when available.

If soap and water are not available, If soap and water are not available, use an alcohol-based product to use an alcohol-based product to clean your hands. clean your hands.

Cleaning hands with alcohol-based Cleaning hands with alcohol-based hand sanitizershand sanitizers

Alcohol-based handrubs significantly reduce the Alcohol-based handrubs significantly reduce the number of germs on skin and are fast acting.number of germs on skin and are fast acting.

When using an alcohol-based handrub, apply When using an alcohol-based handrub, apply product to the palm of one hand and rub hands product to the palm of one hand and rub hands together. Rub the product over all surfaces of together. Rub the product over all surfaces of hands and fingers until hands are dry. hands and fingers until hands are dry.

Cleaning hands with alcohol-based Cleaning hands with alcohol-based hand sanitizershand sanitizers

HANDWASHING VIDEOHANDWASHING VIDEO

HandWashing video.wmv

Food And Waterborne Diseases Powerpoint

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