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

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

3. 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.

4. 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.

5. 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

6. 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
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)

7. 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
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.

8. 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
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.

9. 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

10. 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
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.

11. 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
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.

12. 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
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.

13. 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
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.

14. 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
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.

15. 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
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.

16. 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
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.

17. 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
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.

18. 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.

19. Further Sources for Information
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.

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

21. 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
Medpedia. (2007). E. coli. Retrieved on September 20, 2009 from
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