1. Gastrointestinal Infections
Chapter 12

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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