Thanksgiving is in the heart, or stomach: Clostridium perfringens outbreak associated with a catered lunch — North Carolina, November 2015

Yesterday, while picking Sorenne up from school I asked several of the attendees at our Thanksgiving feast in the park on Saturday, if there was any intestinal upset.

All clear.

doug-turkey-cater-nov-16I was especially concerned about C. perfringens, what with the prior cooking of the turkeys and the transporting to the park, and the outside temp of90F as we move into summer, but I would have heard by Sunday.

The U.S. Centers for Disease Control reports that in November 2015, the North Carolina Division of Public Health was notified by the Pitt County Health Department (PCHD) that approximately 40 persons who attended a catered company Thanksgiving lunch the previous day were ill with diarrhea and abdominal pain. The North Carolina Division of Public Health and PCHD worked together to investigate the source of illness and implement control measures.

Within hours of notification, investigators developed and distributed an online survey to all lunch attendees regarding symptoms and foods consumed and initiated a cohort study.

A case of illness was defined as abdominal pain or diarrhea in a lunch attendee with illness onset <24 hours after the event. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated for all menu items. Among 80 attendees, 58 (73%) completed the survey, including 44 respondents (76%) who reported illnesses meeting the case definition; among these, 41 (93%) reported diarrhea, and 40 (91%) reported abdominal pain. There were no hospitalizations. Symptom onset began a median of 13 hours after lunch (range = 1–22 hours). Risk for illness among persons who ate turkey or stuffing (38 of 44; 86%), which were plated and served together, was significantly higher than risk for illness among those who did not eat turkey or stuffing (six of 14; 43%) (RR = 2.02; 95% CI = 1.09–3.73).

PCHD collected stool specimens from ill persons and samples of leftover food from the company that hosted the lunch. Stool specimens were tested for norovirus and bacterial enteric pathogens at the North Carolina State Laboratory for Public Health. Based on reported symptoms and short interval between the lunch and symptom onset, a toxin was suspected as the cause of the outbreak; therefore, five stool specimens from ill persons and 20 food samples were submitted to CDC for Clostridium perfringens detection.

debbiedownerthanksgiving_postStools were tested for C. perfringens enterotoxin (CPE) using reversed passive latex agglutination. Stool culture and enumeration of C. perfringens colony forming units (CFU) were performed for five samples of foods implicated by the epidemiologic investigation (one stuffing sample and four turkey samples). Because meat is the most common source of C. perfringens outbreaks (1), one ham sample also was analyzed, although consumption of ham was not associated with an increased risk for illness. CPE was detected in all five stool specimens. C. perfringens containing the C. perfringens enterotoxin gene (cpe) was recovered from all five stool specimens and from all four turkey samples; one turkey sample contained >105 CFU/g. C. perfringens was not recovered from samples of other foods. No other pathogens were detected in stool specimens. Collectively, laboratory results met CDC guidelines for confirming C. perfringens as the outbreak source (3).

PCHD environmental health specialists interviewed the caterer about food handling and preparation practices. The North Carolina Food Code requires that all commercial caterers operate in a facility that has been inspected for compliance and permitted by the regulatory authority (4). The caterer had previously maintained a permitted facility, but reported having prepared the lunch food served at this event in an uninspected, residential kitchen. Turkeys were cooked approximately 10 hours before lunch, placed in warming pans, and plated in individual servings. Food was then delivered by automobile, which required multiple trips. After cooking and during transport, food sat either in warming pans or at ambient temperature for up to 8 hours. No temperature monitoring was conducted after cooking.

C. perfringens toxicoinfection (a foodborne illness caused by ingestion of toxin-producing bacteria) is often associated with consumption of meat that has been improperly prepared and handled (1,2). Because diagnostic testing is not widely available, C. perfringens can go undetected as a cause of foodborne illness outbreaks (2,3,5). Diagnostic testing to assist with outbreak source identification is useful to corroborate epidemiologic information, document disease prevalence, and guide prevention recommendations.

Epidemiologic, laboratory, and environmental evidence indicate that this outbreak was caused by consumption of turkey prepared by a commercial caterer operating in an unpermitted kitchen. Inadequate facilities, extended time between turkey preparation and consumption, and failure to monitor and control temperature before and during transport resulted in an anerobic environment conducive to C. perfringens spore germination and growth (6). Prompt local health department response, use of an online survey, and rapid collaboration between local, state, and federal public health agencies were instrumental in identifying the outbreak source quickly and preventing additional cases.

These findings confirm the need for commercial food preparers to adhere to existing food safety regulations (4), including use of permitted facilities and having a certified kitchen manager on staff. Caterers should be aware of the risks associated with improper storage of prepared food for long periods and the importance of temperature monitoring and regulation during food preparation and handling.

Are those leafy greens kept cold? Meh

Leafy green vegetables are highly susceptible to microbial contamination because they are minimally processed. Pathogenic bacteria of concern include Escherichia coliO157:H7, Salmonella spp., and Listeria monocytogenes. Leafy greens are a highly perishable commodity, and in some cases have a postharvest shelf-life limited to one week.

lettuceThis study provides an approach to optimize storage temperature of leafy greens in the supply chain, considering the cost of refrigeration, sensory quality parameters (i.e., fresh appearance, wilting, browning, and off-odor), and microbial safety using nonlinear programming (NLP).

The loss of sensory quality parameters was expressed as Arrhenius equations and pathogen growth were represented by three-phase linear (primary) and square-root (secondary) models. The objective function was refrigeration cost, which was to be minimized. The constraints were growth of pathogens and the loss of sensory characteristics. An interactive graphical user interface was developed in MATLAB.

Pathogen growth is of more concern than loss of sensory quality in fresh-cut Iceberg lettuce when considering a shelf-life of up to two days, and the model indicates is difficult to maintain sensory qualities for longer shelf-life values. Browning is of maximum concern for fresh-cut Iceberg and Romaine lettuce, whereas off-odor is the biggest concern for fresh-cut chicory.

Cost, quality, and safety: A nonlinear programming approach to optimize the temperature during supply chain of leafy greens

LWT – Food Science and Technology, Volume 73, November 2016, Pages 412–418

Abhinav Mishra, Robert L. Buchanan, Donald W. Schaffner, Abani K. Pradhan

http://www.sciencedirect.com/science/article/pii/S002364381630370X

What goes in the fridge for safety reasons and other tales

Evidence and perception aren’t often congruent in the food safety world. There are lots of examples from the pages of the Internet: Dirty bathrooms are an indicator of sanitation in the kitchen; pathogens won’t transfer in less than five seconds when food hits the floor; and, yogurt is dangerous if consumed after the best-before date are just a few.

K. Aleisha Fetters of Yahoo News connected with Schaffner and I on the difference between refrigeration for safety and keeping stuff cool for spoilage and quality reasons.

Here are some excerpts.k2-_bd216f83-0923-407e-aea5-f57dc7338ebc.v1

Ketchup: Can remain at room temperature.
Ever wondered why restaurants keep ketchup on their tables rather than back in the fridge? Because it won’t make you sick, says Benjamin Chapman, PhD, associate professor and food safety extension specialist at North Carolina State University. Ketchup is so acidic that it prevents the growth of harmful bacteria. It will spoil faster if left out on the counter, but it could still take months to turn bad.

Fruits and vegetables: It depends.
If you think about it, fruits and vegetables grow outside at temps far higher than room temperature. That’s why, when they are whole, they are safe on your counter. However, when you cut them (or in the case of lettuce, just tear their stems from the ground), you actually rip open the cells of the plant. This releases nutrients, water, and bacteria, and allows them to mingle with each other, says food microbiologist Donald W. Schaffner, PhD, distinguished professor at Rutgers University. For example, when you cut a tomato or avocado, you need to keep it in the fridge to prevent the growth of salmonella. However, it’s worth noting that listeria can grow (albeit slowly) at cold temps. That’s why, even if you keep cut melons in the fridge, you should throw them out or add them to the compost pile after four days, Chapman says.

Mayonnaise: Must be refrigerated.
Well, this one is really more of an “it depends,” but we’re going to suggest sticking it in the fridge just in case. Most store-bought mayo is acidic enough to keep on the counter without it growing bad-for-you bacteria all by itself. (That’s why fast-food joints can keep it out in pumps until it’s used up.) But, if you cut some veggies with a knife, and then stick that knife in your jar of mayonnaise, you could potentially introduce bacteria into the mayo that is able to grow at room temperature, Chapman says. Meanwhile, whatever the recipe, homemade mayo is generally not acidic enough to fend off pathogens.

FDA alleges food safety violations at New Bedford scallop plant

The US Food and Drug Administration (FDA) found “serious” food safety violations at a seafood processing facility operated by Massachusetts-based M&B Sea Products, the FDA said in a warning letter to the company.

raw.scallops.dillions.aug.09Refrigerated, reduced-oxygen packaged raw scallops at the facility have been “prepared, packed or held under insanitary conditions whereby they may have been rendered injurious to health,” the FDA said in the Aug. 26 letter.

John Murray, president of the New Bedford-based company, did not respond to requests for comment from Undercurrent News on Tuesday. Mutahar Shamsi, director of the FDA’s New England district, declined to comment on an open case.

Random inspection finds spoiled meat, dairy on truck for delivery to Grand Buffet, Little Hunan more

The Ohio Department of Food Safety inspected a Cleveland company Friday after its delivery truck was found hauling contaminated food.

Press secretary Samantha Krepps said New Sheng Hung Inc. wasn’t cited after the company agreed to destroy the food. An employee said the manager wasn’t available to comment Friday, The Associated Press reported.

Mahoning Township police in Pennsylvania said a New Sheng Hung truck carrying meat, fish and dairy was stopped Wednesday on Route 224 for an inspection, a news release said.

Police found the refrigeration unit wasn’t working and the food was completely thawed and no longer safe to eat. The temperature was over 60 degrees. The food had been cross-contaminated.

The truck was transporting meat, dairy and vegetable products to Chinese restaurants in Ohio and Pennsylvania.

The Cleveland company at the center of this services roughly 500 restaurants in Eastern Ohio and Western Pennsylvania.

Officials said seven more of the New Sheng Hung companies refrigeration trucks were not working and they are not sure how long they have been broken.

Prevention and training are boring – and essential

I learned how to use an epi pen.

braun.sorenne.skate_.sept_.13-225x300And that all of my CPR training was about 30 years out of date.

As part of my subtle but ultimate quest to get more girls playing hockey (that’s ice hockey, not running or in-line hockey, they’re different) I participated in an 8-hour sports medic course on Saturday (far more training than most cities require staff to serve food that can kill).

When the instructor, who’s the medic for girls rugby league teams, got to the part about, if you’re there and have the knowledge, you have the responsibility to help, I glanced again at the leftover deli-based sandwiches that had been provided for lunch and noted they’d been out at least an hour after we had eaten.

I saw a refrigerator, so just got up and went to move the leftovers – that many were planning to take home.

But that fridge wasn’t cold.

I spoke up and said, if anyone wants to take those sandwiches home to their families, they need to be refrigerated; is there a refrigerator that works?

I briefly explained why, and how I had knowledge, so had a responsibility to act.

One of the hockey club dudes took the sandwiches and placed them in a working braunwynn.hockeyrefrigerator.

But the class of 10 was whispering, what an a-hole.

That’s the boringness of how tragedies are avoided.

64 sick with Salmonella; Texas Country Club makes changes to fix food safety issues

Refrigeration of fresh produce is not something to trifle with in Texas — in summer.

But that’s exactly what the fancy-pants Abilene Country Club did and now it has been linked to 35 of the 64 confirmed cases of salmonella in the area in the past month.

KTXS reports the club scored a ridiculously low 63 out of 100 on their July health inspection.

The club addressed the possible 35 cases in a letter to its members on August 21. Mike Bannister, president of the club’s board of directors provided KTXS with a copy of the letter.

The letter, signed by General Manager Edward Grothaus III acknowledges the club has been "identified as a potential source of the salmonella type D cases recently reported in our community."

The July health inspection found the club was storing fruit at temperatures that were too warm. In the letter, Grothaus said the club has purchased a new, refrigerated salad bar along with other refrigerated units to correct temperatures.

Can eating at your desk make you sick?

 A new survey, released by the American Dietetic Association and ConAgra Foods’ Home food Safety program, found that while lots of us remain chained to our desks at meal time – 62 per cent at lunch time and 27 at breakfast – we’re skipping out on basic precautionary measures that reduce the risk of foodborne and other illnesses.

Alyssa Schwartz of iVillage.ca writes that while experts say perishable food needs to be refrigerated within two hours of leaving home or it will start to spoil, half of the survey respondents admitted they left theirs sit out for three or more hours.

That may not be particularly risky for some items, says Dr. Doug Powell, a professor of food safety at Kansas State University, but not storing others properly could put you at risk for serious – even deadly – bugs such as E. coli, salmonella and listeria. And here’s the rub: “It’s probably not the foods you think that will make you sick,” Powell says.

An egg salad sandwich, for example, will likely keep unrefrigerated until lunchtime – provided you use store-bought mayo, which acts as a built-in preservative. On the other hand, eat with caution when it comes to deli meats and soft cheeses and commercially prepared dishes (“all the foods they warn pregnant mummies about,” Powell says).

Powell also cites some unexpected culprits – in particular, salad fixings and rice. “When you cut produce, you create a lot of opportunities for existing microorganisms to grow,” he says. In the case of rice, leaving it sitting at room temperature, whether at home after cooking or on your desk at work, can allow spores to grow. For both, refrigeration is key. And for rice and other cooked foods, make sure to reheat your dish in the microwave up to at least 60°C, the minimum temperature for killing bacteria.

“If you do get sick,” Powell says, “it’s likely not going to happen for a few days. In the case of listeria, it can take up to 30 days. It can be very difficult to attribute food poisoning to a certain food.”

That’s why you shouldn’t assume that just because you haven’t gotten food poisoning in the past that your lunchtime practices are just fine.

“Most people mistake food bugs for the stomach flu. But they’re wrong.”

NYC’s Birdbath Bakery closed for filth and inadequate refrigeration on rickshaws

Who would name a food place the Birdbath Bakery?

Birds are factories for salmonella and campylobacter and I wouldn’t want them bathing around food.

If the goal is to be New York City’s most sustainable bakery, then why not. But sustainable is not the same as sanitary.

Grub Street New York reports inspection results indicate the bake shop couldn’t present a Food Protection Certificate, there was evidence of mice, and food-contact surfaces weren’t properly sanitized.

But an employee tells us that the main reason for the closure was that Birdbath had started transporting savory items (salads, pizzas, sandwiches) by rickshaw from City Bakery and didn’t have adequate refrigerators for keeping them at the Department’s required temperature of 41 degrees or below.