food and waterborne diseases powerpoint
DESCRIPTION
Preventing Disease at home and on Emergency DeploymentTRANSCRIPT
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
Principles of appropriate treatment for INFANTS AND
TODDLERS with diarrhea and dehydration dehydration
•Oral rehydration should be taken by patient in small, frequent volumes (spoonfuls or small sips for toddlers; small volumes in bottles for infants)
Principles of appropriate treatment for INFANTS AND
TODDLERS with diarrhea and dehydration 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
Principles of appropriate treatment for INFANTS AND
TODDLERS with diarrhea and dehydration 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)
Principles of appropriate treatment for INFANTS AND
TODDLERS with diarrhea and dehydration 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.
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:
Principles of appropriate treatment for Older Children and Adults
with diarrhea and dehydration 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
Principles of appropriate treatment for Older Children and Adults
with diarrhea and dehydration 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
Principles of appropriate treatment for Older Children and Adults
with diarrhea and dehydration 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
Principles of appropriate treatment for Older Children and Adults
with diarrhea and dehydration 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
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
Clean Hands Save LivesClean Hands Save Lives
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
Clean Hands Save LivesClean Hands Save Lives
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