Escherichia coli (E. coli 0157:H7) Tayo Awopeju, Ph. D Escherichia coli (E. coli 0157:H7) Tayo Awopeju, Ph.D. student Walden University PH 8165-2 Instructor: Dr. Stephen Arnold Fall Quarter, 2009

Escherichia coli (E. coli 0157:H7) Presentation for Food Service Industry and Consumers

Agenda E. coli defined Transmission of E. coli 0147:H7 Prevention of E. coli and food-borne illnesses Safety measures Laws protecting consumers Today we are going to learn about the transmission and prevention of E. coli 0147:H7 as well as safety measures that can be taking to protect consumers from E. coli and food-borne illnesses. We will also discuss Federal laws that protect consumers from transmission of food-borne illnesses and established standardized regulations in the food service industry.

Escherichia coli (E. coli) E. coli are large and diverse groups of bacteria (FDA, 2009) Although most strains of E. coli are harmless, others can cause illnesses (CDC, 2009) According to the Federal Drug and Food Administration (FDA) Escherichia coli (E. coli) are large and diverse groups of bacteria. Although most strains of E. coli are harmless, others can make someone sick.

E. coli, continued E. coli can cause Diarrhea; Urinary track infections (UTI); Respiratory illness including pneumonia; and Other illnesses (CDC, 2009) People of all ages can become potentially infected According to the Centers for Disease Control and Prevention (CDC), some kinds of E. coli can cause diarrhea, while others cause urinary tract infections (UTI), respiratory illness, and pneumonia, and other illnesses. Still other kinds of E. coli are used as markers for water contamination, so it is not uncommon to hear about E. coli being found in drinking water, which are not themselves harmful, but indicate the water is contaminated

Other Kinds of E. coli Shiga Toxin-Producing E. coli (STEC) Bacterium that makes these toxins are called Shiga toxin-producing E. coli (STEC) In North America, the most common identified STEC is E. coli 0157:H7 Center for Disease Control and Prevention. (2009). Multistate Outbreak of E coli 0157:H7 Infections Linked to Eating Raw Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.cdc.gov/ecoli/009/0625.html There are also, some other kinds of E. coli that causes disease by making a toxin called Shiga toxin. The bacterium that makes these toxins are called Shiga toxin-producing E. coli, STEC for short. The most common identified STEC in North America is E. coli 0157:H7.(CDC, 2009)

Modes of Transmission Found in the intestine of healthy cattle Meat can be contaminated during slaughter and can be mixed in; particularly with ground beef Bacteria is present on the cow’s udders or on equipment and therefore, could possibly get into raw milk as well Ingestion of contaminated food Person to person contact Drinking or Swimming in contaminated water Center for Disease Control and Prevention. (2009). Multistate Outbreak of E coli 0157:H7 Infections Linked to Eating Raw Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.cdc.gov/ecoli/009/0625.html Most often humans are infected with E. coli 0157:H7 as a result of eating uncooked ground beef or meat, because cattle carry the pathogen on their intestines. E. coli can also be acquired from ingesting contaminated dairy products, It can also be transmitted through person to person contact and through either swimming in or drinking water contaminated with sewage.

Susceptible Groups Young children and the elderly are more likely to develop severe illness and hemolytic uremic syndrome (HUS) than others Healthy older children and young adults can become seriously ill as well U.S. Food and Drug Administration. (2009). FDA Confirms E. Coli 0157:H7 in Prepackaged Nestlé Toll House Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.fda.gov/NewsEvents/Newsroom/PressAnnoucements/ucm169733.htm People of all ages can become potentially infected. Young children and the elderly are more likely to develop severe illness and hemolytic uremic syndrome (HUS) than others.

Sequence of Events in E. coli Infection E. coli Ingested Non-bloody diarrhea, abdominal cramps 3-4 days 1-2 days Bloody diarrhea 6 days 92% Resolutions 8% HUS E. coli Ingested Non-bloody diarrhea, abdominal cramps 3-4 days 1-2 days Bloody diarrhea 6 days 92% Resolutions 8% HUS Once E. Coli is ingested it takes roughly 3-4 days to exhibit signs or symptoms of infection such as non-bloody diarrhea and abdominal cramps. If infection continues, within approximately 1-2 additional days bloody diarrhea may occur. If this occurs, within 6 days the majority (92%) are resolved with adequate intervention; however a small percentage result in hemolytic uremic syndrome (HUS). Mead, Lancet, 1999

Current Trend of E. coli 70,000 E. coli infections per year in the United States Possibly more because some do not seek medical care CDC estimated 76 million illnesses are caused by food-borne diseases every year in the United States (US) Center for Disease Control and Prevention. (2009). Multistate Outbreak of E coli 0157:H7 Infections Linked to Eating Raw Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.cdc.gov/ecoli/009/0625.html US CDC estimates there may be about 70,000 infections E coli 0157 each year in the united states (US) / this is only an estimate because many infected people do not seek medical care, many do not submit a stool specimen for testing and many laboratories do not test for STEC. The very young and the very old are particularly prone to developing life threatening HUS.

Prevention of E. coli infection The Centers for Disease Control and Prevention (CDC) recommends several measures to protect against STEC infections including good hand washing Center for Disease Control and Prevention. (2009). Multistate Outbreak of E coli 0157:H7 Infections Linked to Eating Raw Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.cdc.gov/ecoli/009/0625.html To prevent the infection of E. coli, one of the measures the CDC recommends is to wash your hands. When washing your hands it is important to use soap and water and vigorously rub your hands together for at least 15 seconds.

Prevention of E. coli infection, continued Good hand washing Thoroughly wash hands after Using the bathroom Changing diapers Contact with animals or their environments (at farms, petting zoos, fairs, even your own backyard) Thoroughly wash hands before Preparing food Eating food Center for Disease Control and Prevention. (2009). Multistate Outbreak of E coli 0157:H7 Infections Linked to Eating Raw Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.cdc.gov/ecoli/009/0625.html Another critical prevention method is good personal hygiene and sanitation. This means good hands washing should take place after using the toilet, changing a baby’s diaper and when coming in contact with animals or their environments; such as farms, petting zoos, fairs, and even your own back yard. It is also important to wash hands before preparing or eating food.

Food Safety Measures Cook ground beef, meat and eggs well Wash raw fruits and vegetables Do not chop vegetables on the same surface where you just handled meat Refrigerate leftovers promptly Center for Disease Control and Prevention. (2009). Multistate Outbreak of E coli 0157:H7 Infections Linked to Eating Raw Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.cdc.gov/ecoli/009/0625.html In addition to washing your hands, here are some food safety precautions that will help keep you from becoming infected with food-borne illnesses including E. coli.

Other forms of Prevention Ice and Refrigeration A form of food preservation. Refrigeration technology has evolved and allowed retardation of bacteria growth Pasteurization Designed to destroy all pathogens that can be transmitted through milk to humans U.S. Food and Drug Administration. (2009). FDA Confirms E. Coli 0157:H7 in Prepackaged Nestlé Toll House Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.fda.gov/NewsEvents/Newsroom/PressAnnoucements/ucm169733.htm From history, we have learned that humans in the prehistoric times found that food lasts longer if kept in cool environments or packed in snow; however over time, refrigeration technology has evolved, allowing us to effectively refrigerate food, thereby retarding bacteria growth. Pasteurization is the method used in the food industry not only to semi-sterilize liquids, but also to inhibit enzyme action in beverages such as fresh apple cider that can cause the beverage to deteriorate.

Food Service Sanitation Good personal hygiene Obligated to protect customers and food handlers from individuals who have personal habits that can affect food safety A healthy worker with poor personal habits is very likely to cause food contamination Federal, State and Local governmental agencies set regulations and standards to protect the public from food-borne illness Center for Disease Control and Prevention. (2009). Multistate Outbreak of E coli 0157:H7 Infections Linked to Eating Raw Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.cdc.gov/ecoli/009/0625.html Food handlers have a professional obligation to protect their customers and the food they serve their customers by practicing good personal hygiene. Practicing this reduces the chance of transmitting the E. coli infection through food to the public. It also reduces the chance of food contamination ensuring public safety.

Food Service Sanitation, continued The role of people, restaurants & facilities Eliminate poor housekeeping, faulty refrigerators, hard to clean areas, and conditions attractive to pest infestations Center for Disease Control and Prevention. (2009). Multistate Outbreak of E coli 0157:H7 Infections Linked to Eating Raw Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.cdc.gov/ecoli/009/0625.html Everyone must play their part to reduce the transmission of E. coli. This means food service workers must eliminate poor housekeeping, restaurant owners must utilize good functioning refrigerators and get rid of faulty ones. In addition, it is important to eliminate conditions that are conducive to pest infestations and pay extra attention to hard to clean areas.

Food Safety Laws Department of Health and Human Services (DHHS) and Food and Drug Administration (FDA) are responsible for the: Regulation of food labeling; Safety of food and food additives; Inspection of food-processing plants; Control of food contaminants; and Establishments of food standards U.S. Food and Drug Administration. (2009). FDA Confirms E. Coli 0157:H7 in Prepackaged Nestlé Toll House Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.fda.gov/NewsEvents/Newsroom/PressAnnoucements/ucm169733.htm DHHS and the FDA are two regulatory agencies to help protect the consumers from food-borne illnesses. They enforce laws to keep food from being contaminated with E. coli . These include making sure that the food industry keeps meat safer during the slaughter and grinding process. In addition they also ensure that the food industry keep vegetables safer when they are grown, picked and washed.

Conclusions Prevention is better than cure Practice good personal hygiene and clean sanitation Food preparation Seek early medical care In conclusion prevention is better than cure, therefore the key to prevention is good personal hygiene and clean sanitation especially for food handlers, restaurants and consumers alike. If symptoms of E. coli infection do develop, it is important to seek early medical care and make sure your health care provider reports any findings to the local health department.

Further Sources for Information http://www.epa.gov/safewater/contaminants/ecoli.html http://www.health.state.ny.us/communicable/e_coli/fact_sheet.htm http://www.mayoclinic/health/e-coli/DS01007 http://www.who.int/foodsafety/foodborne_disease/ecoli.pdf There are several sources of information on E. coli, some of the ones that I recommend are listed on this slide and can be found at the EPA website, State of NY health department website, the Mayoclinic’s website and the World Health Organization’s website.

Questions Thank you for your time and attention, I will now take any questions you may have.

References Center for Disease Control and Prevention. (2009). Multistate Outbreak of E coli 0157:H7 Infections Linked to Eating Raw Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.cdc.gov/ecoli/009/0625.html Medpedia. (2007). E. coli. Retrieved on September 20, 2009 from http://wiki.medpedia.com/E._coli U.S. Food and Drug Administration. (2009). FDA Confirms E. Coli 0157:H7 in Prepackaged Nestlé Toll House Refrigerated Cookie Dough. Retrieved on September 20, 2009 from http://www.fda.gov/NewsEvents/Newsroom/PressAnnoucements/ucm169733.htm