Gastrointestinal Infections Chapter 12

Introduction Gastrointestinal infections can be acquired by ingestion of contaminated water or food, may be spread from person to person Once again the young, elderly, and debilitated can be more susceptible Poor hygiene and food handling practices in the kitchen of a hospital, nursing home, or daycares can effect a large number of persons

Foodborne Infection Food is an important source of infection. Campylobacter bacteria causes 1.3 million illnesses each year in the US (CDC) Most illnesses likely occur due to eating raw or undercooked poultry, or to eating something that touched it. Some are due to contaminated water, contact with animals, or drinking raw (unpasteurized) milk. Reason includes more restaurants, available food at convenience stores, among other places to be able to get food products

Foodborne Infection Salmonella infections also have become an infection that causes food poisoning Escherichia coli is another bacteria that has increased in causing foodborne infections Botulism is a bacteria that is caused by home canned foods, preserved or fermented foods usually found in low acid content are the sources

The FDA Food Safety Modernization Act (FSMA)  Is transforming the nation’s food safety system by shifting the focus from responding to foodborne illness to preventing it. Congress enacted FSMA in response to dramatic changes in the global food system and in our understanding of foodborne illness and its consequences, including the realization that preventable foodborne illness is both a significant public health problem and a threat to the economic well-being of the food system.

Food Preparation Raw food is frequently contaminated with pathogens Poultry can be heavily contaminated with Campylobacter Red meat can be contaminated with E Coli Produce can be contaminated with C. perfringens since it is found in the environment Milk and dairy products are readily contaminated during collection or processing

Guidelines in Food Preparation Wash hands before and after handling food Wash hands after using toilet Use separate equipment and utensils for raw and cooked food; clean thoroughly with detergent and bleach if needed Clean preparation surfaces thoroughly with detergent and water and if needed bleach Blenders, mixers, and slicing machines need to be cleaned well after each use Wash all vegetables and fruits under running water Do not store raw and cooked food together Keep food covered in refrigerator to prevent inadvertent contamination

Cooking Food Inadequate cooking or reheating of food is a big contribution in many of the outbreaks with foodborne illnesses Most bacteria is killed at 60 degrees Celsius, but need to ensure that heat enters the center of the food Can be especially dangerous with some types of foods Salmonella and Campylobacter can be present deep in muscle tissues near poultry carcasses E. coli colonizes on the guts of cattle, sheep, and goat Principles should apply to reheating foods

Microwave Ovens Heat from the foods out and vegetative bacteria are unlikely to survive provided all parts of the food reach 70 degrees Celsius Heating can be uneven so food should be allowed to sit for 5 minutes to ensure heat is distributed evenly throughout the food Thermometer should be used to ensure food is heated throughout

Guidelines for Cooking Foods Safely Defrost meat thoroughly before cooking Adhere to standard or recommended cooking times Use a thermometer to check the temperature in the center of the food Reheat food thoroughly and use a thermometer to check if the temperature reaches 70 degrees Celsius

Food Storage Raw food is not sterile and microorganisms present will multiply Inadequate chilling or storage of food is a contributory factor When refrigerated bacteria slows down and cannot multiply at temperatures at 0 degrees

Guidelines for Storage of Foods Do not keep prepared food at room temperature for more than an hour Do not keep foods warm at temperatures below 60 degrees Celsius Do not save and reheat meals for patients absent at mealtimes Do not use chilled meals or food beyond its sell by date Ensure refrigerator is fitted with a thermometer and maintained at 1 to 4 degrees Celsius Date items stored in the fridge and discard after 3 days

Storage Temperature Food should be stored at temperatures below 8 degrees Celsius or above 63 degrees Celsius Food if not consumed immediately after being prepared should be cooled quickly and refrigerated. Hot food should not be put in refrigerator because can raise temperature in fridge

Serving Food Method of delivering is used to ensure that kept at proper temperatures Meals should be served as soon as possible Meals should not be saved for more than 1 hour if patient is not in room Raw and ready to eat foods should be stored separately Raw meats should be kept at the bottom of the refrigerator so that other foods do not become contaminated with any drippings or touch other foods

Enteral Feedings Feeding by tubes is an alternative parenteral nutrition when patients are not able to take in foods Significant microbiological hazards associated with feedings Liquid medium provide an optimal environment for bacteria to grow and easily contaminated during preparation, assembly and manipulation of administration sets Bacteria can multiply rapidly

Norovirus Generally causes a relatively mild and short lived disease. Symptoms include nausea, abdominal cramps, headache and fever. Can be spread by contact Incubation period is less than 2 days Virus can be excreted for up to 10 days, maximum excretion occurs in 24 to 72 hours Gloves and gowns should be worn; PPE should be removed before leaving room

Clostridium difficile Anaerobic, spore forming, gram positive bacillus can colonize in gut Symptoms can range from mild diarrhea to severely dilated bowel (gross megacolon) Gloves and gowns should be used and removed before leaving the room and isolation precautions should continue for 48 hours after symptoms have resolved