Category Archives: Handwashing

CDC: hand sanitizer useless against norovirus

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Although alcohol-based disinfectants prevent certain strains of flu, they are “useless” against viruses – including the norovirus – that are not coated in lipid “envelopes,” the New York Times reports.

The chilling news is based on data from the U.S. Centers for Disease Control and Prevention. During the winter of 2006-07, researchers norovirus-2determined that facilities in which staff used alcohol-based sanitizers were six times more likely to have an outbreak of norovirus compared to those in which staff cleaned their hands using soap and water.

“This study suggests that preferential use of [alcohol-based hand sanitizer] over soap and water for routine hand hygiene might be associated with increased risk of norovirus outbreaks,” the researchers concluded.

Oh, What a Feeling, when bacteria cross-contaminate

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I watch too much trashy TV in background while I work; I just saw back-to-back adverts of Rod Stewart flogging his new album, Merry Christmas, Baby, and Boston’s More Than a Feeling used to flog multivitamins.

Devo’s Whip It is being used to push baby clothing, Zip It, and Crowbar’s Oh, What a Feeling has been resurrected in an Australia Toyota advert.

Crowbar of Ancaster, Ont., 20 minutes from my hometown of Brantford, has been selling this song since it was penned back in 1970, so good on them if they get some Aussie money.

From 1969 to 1970, most of the members of the group had been a backup band for Ronnie Hawkins under the name “And Many Others”. However, in early 1970, he fired them, saying “You guys are so crazy that you could f**k up a crowbar in three seconds!” They recorded their first album in 1970, called “Official Music”, as “King Biscuit Boy and Crowbar.”

The other day on Good Morning America, which comes on at 3:30 a.m., there was a cooking bit so bad it’s faded into the mess of Love Boat, Kojak, and bad infomercials (which means I can’t remember it or find the video).

The recipe looked lovely but the cross-contamination was ridiculous, leading to yet another conversation between Sorenne and I about why she shouldn’t put her flip-flops or anything else into her mouth and about how bacteria move around.

She preferred this song.

Handwashing still isn’t enough at petting zoos, and I’ll repeat that until operators stop ignoring evidence

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In the fall of 2009, an E. coli O157:H7 outbreak at Godstone Petting Farm in the U.K resulted in 93 illnesses – primarily little kids.

An initial report by Professor George Griffin found that it could have been avoided if visitors had been kept away from animal feces, and was made worse by the slow reaction of health authorities before the petting farm in Surrey was closed.

Eight of the children infected required dialysis and some have been left with permanent kidney damage. At one point during the outbreak victims were occupying all the children’s acute renal support services in London.

As part of the response, U.K. health types recommended handwashing stations with soap and water only (no wipes or sanitizers).

But while some studies suggest inadequate handwashing facilities may have contributed to disease outbreaks, or washing hands was protective against illness, others suggest bugs like E. coli O157 may be aerosolized and inhaled, thus not prevented with handwashing.

In the 2009 outbreak, a bunch of U.K. researchers concluded that in the Godstone outbreak, “handwashing conferred no demonstrable protective effect.

“Moreover, from the findings of many previous published studies, it must be assumed that all petting or open farms are potentially high-risk environments for the acquisition of VTEC O157 infection.”

The Dispatch in North Carolina sorta realizes this when it writes in an editorial, “petting zoos at agricultural fairs have caused too much pain and sorrow for too many youngsters and their families in this state (North Carolina). Unless and until there’s a completely reliable method of assuring that no young child will contract E. coli-related illnesses at fairs’ petting zoos, the operations, popular as they are, should be prohibited.”

Lynne Terry of The Oregonian writes regarding an outbreak of E. coli that has sickened at least 10 people and shuttered a petting zoo and pumpkin patch in Longview, Wash. after 28 years of business.

“We voluntarily shut down and have not reopened,” said Ruth McKee,  co-owner of Willow Grove Gardens Pumpkin Patch. “Nobody wants children hurt.” 

In recent decades, health officials across the country have tied dozens of outbreaks to petting zoos, rodeos and county fairs, said William Keene,  senior epidemiologist at Oregon Public Health. 

Oregon alone has seen five outbreaks traced to fairs or rodeos since 1990, he said, including three linked to Clackamas County Fair in 2003, 2006 and 2007. The biggest was in 2002 when about 80 people were sickened by E. coli O157:H7 after walking through animal exhibits at Lane County Fair. 

“If you go visit the goats and sheep at the county fair, it’s like going back in a miniature way to the farm — and that brings a little bit of the farm risk to your doorstep,” Keene said. 

Farm animals shed harmful bacteria in their feces, which can spread to dirt, railings, soles of shoes and hides. 

Lab tests confirmed five illnesses — four children were infected by E. coli O157:H7  and one child contracted another harmful strain, O121.  Five other people, mostly children, suffered gastro-intestinal symptoms after visiting the farm. Those sickened included two children and an adult from Oregon. 

Just last month, a 2-year-old boy died in North Carolina in an E. coli O157 outbreak traced to a petting zoo at a county fair. Health officials were stunned by the final toll: 106 sickened, 11 hospitalized and seven with kidney failure. 

Carl Williams, state public health veterinarian in North Carolina, said bacteria were found around the petting zoo but also in other areas. Officials even found E. coli O157 in a parking lot separated from the petting zoo by a chain-link fence and a two-lane asphalt road. 

The only state with petting zoo regulations as stringent as North Carolina’s is Pennsylvania, according to Benjamin Chapman, associate professor of food safety at North Carolina State University. 

Washington state requires hand-washing stations and signs near animal exhibits, but petting zoos do not have to undergo inspections or obtain permits. Oregon regulations don’t address the issue. 

Even with rules, it’s impossible to eliminate all risk of contamination, said Doug Powell, food safety professor at Kansas State University. But he said well-designed exhibits can reduce the threat. 

Powell said petting zoos and animal exhibits should have one entrance, allowing visitors to flow through to a hand-washing station at the exit staffed with employees encouraging their use. He also recommends barriers, keeping the animal areas and bedding as clean as possible, and not allowing eating or smoking. 

“You have to be a lot more careful than you ever thought you had to be,” Powell said. 

A table of petting zoo outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

Handwashing still isn’t enough at petting zoos, no matter what the owner says

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In the fall of 2009, an E. coli O157:H7 outbreak at Godstone Petting Farm in the U.K resulted in 93 illnesses – primarily little kids.

An initial report by Professor George Griffin found that it could have been avoided if visitors had been kept away from animal feces, and was made worse by the slow reaction of health authorities before the petting farm in Surrey was closed.

Eight of the children infected required dialysis and some have been left with permanent kidney damage. At one point during the outbreak victims were occupying all the children’s acute renal support services in London.

As part of the response, U.K. health types recommended handwashing stations with soap and water only (no wipes or sanitizers).

But while some studies suggest inadequate handwashing facilities may have contributed to disease outbreaks, or washing hands was protective against illness, others suggest bugs like E. coli O157 may be aerosolized and inhaled, thus not prevented with handwashing.

In the 2009 outbreak, a bunch of U.K. researchers concluded that in the Godstone outbreak, “handwashing conferred no demonstrable protective effect.

“Moreover, from the findings of many previous published studies, it must be assumed that all petting or open farms are potentially high-risk environments for the acquisition of VTEC O157 infection.”

So Beth McNair, the mother of a 12-year-old who was hospitalized from complications of E. coli contracted at the Cleveland County Fair, sorta has a point when she says more needs to be done to prevent outbreaks.

“Well, it’s been very difficult. I mean just, one day you’re going along with your daily lives, then all of the sudden you run into this brick wall, and it stops your life.”

Jordan McNair was released from Levine Children’s Hospital last week, after being in the hospital for almost a month.

WSOCTV.com reports that the Zootastic Park in Troutman is getting ready for its annual light show and petting zoo starting Friday.

“E. coli always worries me,” said owner Scottie Brown. “What’s most important is for people to know that you got to wash your hands. It’s not about the animals, it’s about people too.”

Brown said his zoo has handwashing stations all around the facility.

Brown sorta misses the point: handwashing is never enough.

A table of petting zoo outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks

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Restaurant inspection and public health

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Do restaurant inspections improve public health? Do inspections reduce the incidence of foodborne illness associated with restaurants? Can inspection data be used to predict problem restaurants?

Previous research has been largely inconclusive, but researchers at the University of Minnesota attempted to parse inspection data and make it more useful for future inspections. The goal in all this is fewer sick people.

I agree when the researchers conclude, “Inspections provide feedback to the operator concerning the effectiveness of the establishment’s process controls, thus enabling the operator to focus on interventions and programs that can have the greatest impact. Despite their limitations, restaurant inspections are a valuable tool that can be used to verify the existence of appropriate preventative controls and an active managerial control system.”

But inspections are only one tool.

The abstracts for the two papers are below.

Health department inspection criteria more likely to be associated with outbreak restaurants in Minnesota

Petran, Ruth L.; White, Bruce W.; Hedberg, Craig W.

Journal of Food Protection®, Volume 75, Number 11, November 2012 , pp. 2007-2015(9)

http://www.ingentaconnect.com/content/iafp/jfp/2012/00000075/00000011/art00012

Millions of routine restaurant inspections are performed each year in the United States, and the Centers for Disease Control and Prevention has reported that a majority of foodborne illness outbreaks occur in restaurant settings. In an attempt to relate the data collected during inspections in Minnesota to illness likelihood, data from routine inspections conducted at outbreak restaurants were compared with data from routine inspections conducted at nonoutbreak restaurants. The goal was to identify differences in recorded violations. Significantly more violations were recorded at restaurants that had outbreaks. The majority of these violations were related to contamination in the facility and environment and to food handling procedures. Relative risks also were calculated for violations significantly more likely to occur at locations that had outbreaks of norovirus infection, Clostridium perfringensinfection or toxin-type illness, and Salmonella infection. These three pathogens are estimated to cause the majority of foodborne illnesses in the United States. Meta-analysis of composited data for the three pathogens revealed 11 violations significantly more likely (α < 0.05) to be identified during routine inspections at outbreak restaurants than during inspections at nonoutbreak restaurants. Application of this information permits assessment of health department inspection data in a consistent fashion. This approach can help identify criteria more likely to be associated with outbreak locations and allow operators to focus on interventions that will have the most significant impact in higher risk establishments.

Using a theoretical predictive tool for the analysis of recent health department inspections at outbreak restaurants and relation of this information to foodborne illness likelihood

02.nov.12Journal of Food Protection®, Volume 75, Number 11, November 2012 , pp. 2016-2027(12)

Petran, Ruth L.; White, Bruce W.; Hedberg, Craig W.

http://www.ingentaconnect.com/content/iafp/jfp/2012/00000075/00000011/art00013

Because U.S. restaurants are inspected at least annually against criteria in the U.S. Food and Drug Administration Model Food Code, large amounts of data are generated and
should be systematically reviewed. The purpose of this study was to determine the relationships among the data obtained through health department inspections, the contributing factors to foodborne illness identified by the Centers for Disease Control and Prevention, and the risks of outbreaks of norovirus, Salmonella, and Clostridium perfringens infection associated with a specific restaurant. These agents were chosen for the analysis because they cause the majority of foodborne illnesses. A theoretical predictive assessment tool was built that extracts data from routine health department inspection reports for specific restaurants to establish a risk profile for each restaurant and identify the likelihood of a norovirus, Salmonella, or C. perfringens outbreak at that restaurant. The tool was used to examine inspection reports from restaurants known to have had confirmed norovirus, Salmonella, and C. perfringens outbreaks. Although evaluation of an extensive data set revealed lack of an overall association between outbreak inspection scores and routine inspection scores obtained at outbreak restaurant locations, certain specific violations were significantly more likely to be recorded. Significant differences in types of violations recorded during outbreak and routine inspections were determined. When risks based on violation type can be identified, targeted actions may be able to be prioritized and implemented to help decrease illnesses.

Washington pumpkin patch closes petting zoo over E. coli cases

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KPTV reports that a Washington state petting zoo linked to four E. coli illnesses in children has voluntarily closed its petting zoo for the season.

The owner of Willow Grove Gardens in Longview, WA, told  Fox 12 last week the children may have become ill by petting the animals and not washing their hands, even though signs are clearly posted reminding visitors to clean up at a washing station by the petting zoo.

Handwashing is never enough.

Hospital food contaminated with C. diff

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Could Clostridium difficile be circulating in hospitals through food? A new report suggests, yes.

Houston researchers found that about one-fourth of nearly 100 hospital food samples they tested were positive for C. diff. Among the worst culprits: turkey, chicken, and egg products, vegetables and fruits, and desserts. Almost all were cooked.

It’s only one hospital. And no cases of human infection were linked to the food.

But together with past research, the findings suggest that contaminated food may be an important route of spread of C. diff in hospitals, says researcher Hoonmo Koo, MD, an infectious diseases specialist at Baylor College of Medicine in Houston, Texas.

Moreover, the temperatures at which hospital foods are cooked may be too low to kill the bug, he says.

An infectious diseases expert not involved with the research says the major C. diff strains that contaminate food are different from the ones responsible for human disease.

“You should be more concerned about whether your doctor or nurse is washing their hands before touching you than about anything coming up from the cafeteria,” says Stuart Cohen, MD, professor of medicine at the University of California School of Medicine, Davis. Contaminated hands are a proven risk factor for infection.

The new study was presented at the annual meeting of the Infectious Diseases Society of America in San Diego.

6 sick; how do kids get E. coli in a park? From the animals; and handwashing is never enough

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Children have been given the all clear to return to a Birmingham, UK, park that was at the center of an E. coli outbreak.

The Health Protection Agency said there have been no new cases of the deadly bug in nearly six weeks at Sutton Park after steps were taken to reduce the risk of infection.

The Birmingham Mail reports parents of children under the age of 10 had been advised to keep them away from beauty spot in July, after two youngsters were rushed to hospital with the O157 strain of the bug. It was linked to the feces of animals that live in the park.

Four other children were also said to have had E.coli.

All six have now recovered.

Dr Roger Gajraj, a consultant with the Health Protection Unit (HPU) in Birmingham said, “the advice to wash hands before eating or drinking remains essential for visitors to the park and indeed for anyone visiting areas where contact with animals or animal feces is possible.”

New signage has been put up at the park, for visitors reminding them to wash their hands to avoid infection and showing them where facilities are available. Additional handwashing points have also been installed and areas such as the playgrounds and car parks have been cleaned.

The cattle that graze Sutton Park have now moved off site for the winter.

Handwashing is never enough at petting zoos – North Carolina edition

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In 2004, 187 people became ill with E. coli O157 after visiting the North Carolina State fair in Raleigh. One of those visitors was a two-year-old who was hospitalized for 36 days with hemolytic uremic syndrome. That led to the passage of Aedin’s Law, which directs the Commissioner of Agriculture to adopt rules establishing sanitation requirements for petting zoos and animal exhibitions.

The law says that all animal events need to be permitted, and it is the responsibility of the permit holder to follow rules around signage, education, provision of handwashing facilities and risk-reducing animal care and management practices. Changes happened because a bunch of people got sick.

In 2011, 25 attendees at the same fair acquired E. coli O157 by walking through the Kelley Building where a livestock competition was held. The epidemiology didn’t point to animal contact as a risk factor. In response to the outbreak, Ag Commissioner Steve Troxler formed a multiagency group to evaluate management practices and come up with changes to be implemented at future events.

These changes were released last week and focus on limiting access to animal areas (including show areas and washing areas where the poop is knocked off of animals), increasing the availability of handwashing stations, evaluating their use, and increased communication about risks.

Not sure what that last one means.

Outbreaks of zoonotic disease at petting zoos demonstrates that although contact with animals in public settings (such as fairs, petting zoos, and schools) can provide educational and entertainment opportunities, the potential to spread disease exists at these events if proper hygiene measures and precautions are not taken and reinforced. Human illness outbreaks have been linked to visiting petting zoos or similar settings with animal contact in the U.S., Canada, U.K., New Zealand, Australia, Ireland and the Netherlands.

The U.S. Centers for Disease Control and Prevention (CDC) has documented approximately 150 outbreaks of human infectious disease involving animals in public settings from 1996-2010.

Children have an increased risk of infection in animal-contact settings due to certain factors and behaviors, including lack of awareness of the risk for disease, inadequate handwashing, lack of close supervision, and frequent hand-to-mouth activities (e.g., use of pacifiers, thumb-sucking, and eating).

In the fall of 2009, an E. coli O157:H7 outbreak at Godstone Petting Farm in the U.K resulted in 93 illnesses – primarily little kids.

The investigation into the Godstone outbreak identified evidence of environmental contamination outside the main barn, indicating acquisition of illness through both direct animal or fecal contact, and indirect environmental contact (e.g. contacting railings or soiled footwear).

Aerosolization of potential pathogens is also possible, as suggested in an E. coli O157:H7 outbreak at a county fair in Oregon, in which 60 people fell ill.

As part of the response to the Godstone outbreak, U.K. health types recommended handwashing stations with soap and water only (no wipes or sanitizers, because they don’t work that well under certain conditions).

Ihekweazu et al. subsequently concluded that in the Godstone outbreak, “handwashing conferred no demonstrable protective effect. …

“Moreover, from the findings of many previous published studies, it must be assumed that all petting or open farms are potentially high-risk environments for the acquisition of VTEC O157 infection.”

Against this backdrop, the Raleigh News Observer wrote in an editorial last week that Commissioner Troxler has instituted some common sense changes to the fair like limiting contact with animals and moving some food vendors away from the animal buildings.

That may be common sense after two E. coli outbreaks at the same fair, but it’s not common sense unless organizers have actually thought about it. At the Ekka yesterday in Brisbane, we saw untold amounts of food, water bottles, pacifiers, and baby bottles being consumed or transported, all while petting animals through a fence.

Troxler also said, “Handwashing, handwashing, handwashing.”

This means that as folks go through the fairgrounds, they ought to take advantage of well-placed handwashing stations and lather up (or use sanitizer) often. Very often. And it means giving the little ones a frequent handwashing exercise as well.

Sanitizers have limited effectiveness, and in a petting zoo situation, so does handwashing; it’s only one component of an overall strategy to reduce risk. But it’s easy to say handwashing because that blames the patrons, not something else.

A table of petting zoo outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

Guy Fieri weighs in on the gloves vs handwashing in food service debate on The Talk

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 I don’t like cropped poodles and I don’t like guys named Guy; they should be Buddy or Friend.
Guy Fieri showed up on The Talk the other day (in Australia they have The Circle for the 9 a.m. crowd) and when asked whether to glove or not, as reported by The Braiser, “performed his duty to chefs everywhere by pointing out that it’s important for chefs to interact with food in a tactile manner in order to understand textures, etc.”

“I understand what they’re trying to do. They’re trying to make safe food. People are worried about food borne illness, they’re worried about this cross-contamination that happens. I really can’t say I’m down with it. I mean, I believe in the concept and I believe in the direction. But I don’t believe we understand what the glove is gonna do. I think people think they put on the gloves and it’s like, ‘I have magic gloves on, and no contamination will happen.’ And then they’re picking stuff up and doing stuff, you can’t go wash your gloves. So what are people more likely to do? Wash their hands when they contaminate a hand, or change the glove? They’re not gonna change a glove.”