Food safety in hospitals: Chemotherapy patients may be ill because they aren’t aware of the food poisoning risks (and neither are the food service types)

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It’s no secret I have my share of demons, but I’ve always shared them publicly, (whether you wanted to know or not; if you don’t, go start your own blog and stop reading mine).

Every Friday, on average, I am fortunate enough to go to a place called Damascus at the Brisbane Private Hospital, where a group of 10-15 of us sit and tell stories and get better.

Some people have been sober for 10 years.

Some are straight out of the detox ward upstairs.

I’m somewhere in between.

But I value this community of lawyers, doctors, vets – both the military and animal kind – financial planners and people who just got lost along the way.

When Bill Leiss asked me to write a second edition of my first book, Mad Cows and Mothers Milk, I quoted a Neil Young line: “Heart of Gold put me in the middle of the road. Traveling there soon became a bore so I headed for the ditch.”

The ditch trilogy stands up strong 45 years later, and was featured during Neil’s solo show in Omemee, Ontario (that’s in Canada) a few weeks ago.

To add insult to injury, his next studio recording was the harrowing “Tonight’s The Night”, though with a perversity that was becoming typical of him the latter wasn’t released until after the subsequently-cut “On The Beach”. Both albums stand up strongly to this day. Both use the rock format as a means of redemption and rejuvenation, the very act of recording (no overdubs) serving as therapy. “Tonight’s The Night” and “On The Beach” were pretty free records,” Young pondered, lighting another unfiltered Pall Mall. 

“I was pretty down I guess at the time, but I just did what I wanted to do, at that time. I think if everybody looks back at their own lives they’ll realise that they went through something like that. There’s periods of depression, periods of elation, optimism and scepticism, the whole thing is…. it just keeps coming in waves. 

You go down to the beach and watch the same thing, just imagine every wave is a different set of emotions coming in. Just keep coming. As long as you don’t ignore it, it’ll still be there. If you start shutting yourself off and not letting yourself live through the things that are coming through you, I think that’s when people start getting old really fast, that’s when they really age. 

‘Cause they decide that, they’re happy to be what they were at a certain time in their lives when they were the happiest, and they say ‘that’s where I’m gonna be for the rest of my life’. From that minute on they’re dead, y’know, just walking around. I try to avoid that.”

I can’t swim, but the quote above encapsulates why I like being near the beach.

I’m no Neil Young, but I do have my passions, like safe food, so when Brisbane Private Hospital keeps serving funeral home sandwiches loaded with raw sprouts, I say something.

No change, though the hospital is serving an immunocompromised population.

As Ellen W. Evans, junior research fellow, Cardiff Metropolitan University, writes in The Conversation, chemotherapy treatment can reduce immune function and the body’s ability to defend against opportunistic pathogens. It is well documented that people undergoing chemotherapy are at an increased risk of infection, including those transmitted via food.

This is not just about suffering through a tummy bug. People who are already undergoing the gruelling side effects of chemotherapy can be made seriously ill simply because the food they are eating isn’t being handled properly at home. Added to that is the fact that foodborne infection could cause delays in treatment, and potentially increase patient mortality.

But the problem is not down to patients’ laziness. In our newly published research, we have found that they are not being given consistent information, nor do they recognise the serious risks that food can pose.

In our study, we investigated the availability and adequacy of food safety information available to UK cancer patients. We looked at online food-related resources, and conducted in-depth interviews with patients and their families on their food experiences during chemotherapy treatment.

Although some food safety information exists for chemotherapy patients, their access to it is limited. In total, we found just 45 resources online that related to food safety. These included 35 from the 154 NHS chemotherapy providers in England, Scotland and Wales, the Department of Health, and three from 184 identified UK cancer charities.

Looking at the content, 67% of the food-related information resources we identified included food safety advice – for example, “ensure eggs are thoroughly cooked”. Guidance on hand decontamination routines, such as hand washing, was most frequently included (49%). But information on how to reduce the risk of listeriosis, or safe alternatives to particular foods – such as unpasteurised dairy products, and raw or under-cooked meat – were lacking.

Most worryingly, we found that some of the online advice actually promoted potentially unsafe practices. For example, some suggested eating lukewarm food, when this temperature range can encourage bacteria growth.

The most comprehensive food safety resources that we found were tailored to the needs of neutropenic patients – those that have very low levels of white blood cells – but these are unlikely to be given to, or accessed by, all people undergoing chemotherapy.

An assessment of food safety information provision for UK chemotherapy patients to reduce the risk od foodborne infection

Public Health, December 2017, vol. 153, pg 25-35, E.W. Evans, E.C. Redmond, DOI: http://dx.doi.org/10.1016/j.puhe.2017.06.017

http://www.publichealthjrnl.com/article/S0033-3506(17)30220-2/fulltext

Objectives

Given the increased risk of foodborne infection to cancer patients receiving chemotherapy treatment, and the risk of listeriosis reportedly five-times greater to this immunocompromised patient group, there is a need to ensure the implementation of domestic food safety practices among chemotherapy patients and their family caregivers. However, information regarding the adequacy of resources to inform and enable patients to implement domestic food safety practices to reduce the risk of foodborne infection is limited. Consequently, this study aimed to evaluate the provision of food safety information available to UK chemotherapy patients.

Study design

In-depth semi-structured interviews and content analysis of online patient information resources.

Methods

Interviews with patients and family caregivers (n = 15) were conducted to explore food-related experiences during chemotherapy treatment. Online food-related information resources for chemotherapy patients (n = 45) were obtained from 35 of 154 National Health Service chemotherapy providers in England, Scotland, and Wales, the Department of Health (DoH) and three of 184 identified UK cancer charities. Identified food-related information resources were reviewed using a content-analysis approach to assess the inclusion of food safety information for chemotherapy patients.

Results

In-depth interviews established that many patients indicated awareness of immunosuppression during treatment. Although patients reported practicing caution to reduce the risk of communicable diseases by avoiding crowded spaces/public transport, food safety was reported to be of minimal concern during treatment and the risk of foodborne infection was often underestimated. The review of online food-related patient information resources established that many resources failed to highlight the increased risk of foodborne infection and emphasize the importance of food safety for patients during chemotherapy treatment. Considerable information gaps exist, particularly in relation to listeriosis prevention practices. Cumulatively, information was inconsistent, insufficient, and varied between resources.

Conclusion

The study has identified the need for an effective, standardized food safety resource specifically targeting chemotherapy patients and family caregivers. Such intervention is essential to assist efforts in reducing the risks associated with foodborne infection among chemotherapy patients.

Neil Young – 2017-12-01 Coronation Hall, Omemee, Ontario, Canada [720p] from JoeRay Skrha on Vimeo.

 

 

From the duh files: UK chief scientific adviser’s report confirms that mandatory display of FHRS drives up food safety compliance

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You really didn’t need to do a study.

Toronto proved as much in 2004ish, but I’ve been binge-watching The Crown to try and understand my predecessor’s inkling for things British.

The UK Food Standards Agency has published a new Science Report by its Chief Scientific Adviser Professor Guy Poppy. In his seventh Report, Professor Poppy looks at the Food Hygiene Rating Scheme (FHRS), and its impact on food safety especially where the scheme is mandatory.

Been there. Done that.

Professor Poppy said: ‘The Food Hygiene Rating Scheme has been a significant development for food safety and one which has delivered tangible benefits for consumers across the country. The scheme has empowered people, helping them to choose to eat in places with higher ratings. This in turn has pushed restaurants and other food businesses to drive up hygiene standards to attract more customers. I’ve also been encouraged that our research has linked higher ratings to lower levels of microbes found in food businesses, ultimately lowering the risk to consumers from foodborne illness.

Mandatory display of hygiene ratings has been successful in Wales and Northern Ireland and I am pleased that the FSA remains committed to seeing these benefits also realised in England.’

Since the introduction of FHRS in 2010 there has been continued improvement in standards of food hygiene at places people choose to eat out or buy food. There are now over 430,000 food hygiene ratings published at food.gov.uk/ratings.

Of those food businesses, 67% achieved the top rating of ‘5 – very good’ and 95% were rated ‘3 – generally satisfactory’ or better.  In Wales and Northern Ireland, food businesses are legally required to display their food hygiene rating. This mandatory requirement has been in place in Wales since 2013 and in Northern Ireland since 2016. Evidence so far has shown that mandatory display has driven improved and sustained food safety compliance by the businesses.

The FSA is committed to introducing similar mandatory display of ratings at food outlets in England. There is an increasing call for this, and latest research indicates that 84% of consumers think that businesses should have to display their food hygiene rating at their premises.

Looking to the future the FSA is improving the way food businesses are regulated, with the aim of developing a sustainable system fit for the 21st century. This includes building on the success of FHRS by strengthening its robustness and resilience and introducing mandatory display.

You’re not royalty. Stop writing like one.

And as long as FSA keeps publishing BS advice, like it did, yet again this year in its annual Let’s Talk Turkey briefing, that stated, “Check that: the meat is steaming hot throughout; there is no pink meat visible when you cut into the thickest part and meat juices run clear” I will continue to make fun of your country and customs.

FSA is neither science nor evidence-based.

 

Filion, K. and Powell, D.A. 2009. The use of restaurant inspection disclosure systems as a means of communicating food safety information. Journal of Foodservice 20: 287-297.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments. Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.

 

Filion, K. and Powell, D.A. 2011. Designing a national restaurant inspection disclosure system for New Zealand. Journal of Food Protection 74(11): 1869-1874

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated. Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant’s inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.

Merry Xmas: Video of UK McDonald’s worker wearing antlers and headbutting a customer goes viral

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A McDonald’s employee in the UK was reportedly suspended for headbutting a customer after an argument broke out over Chicken McNuggets.

The altercation was caught on video early Tuesday morning at the Liverpool One location of the fast-food restaurant, the Liverpool Echo reports.

The customer allegedly became upset after being told he couldn’t order nuggets because the menu had already changed over to breakfast, according to the Echo.

The incident occurred at around 4:50am.

Maybe don’t get turkey from a pizza joint

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The Daily Tribune News reports that preliminary laboratory findings by the Georgia Department of Public Health have identified the food source responsible for the salmonella outbreak at last month’s catered Thanksgiving meal for Toyo Tire employees.

According to Georgia Department of Public Health spokesperson Logan Boss, preliminary findings implicate catered turkeys served by Angelo’s New York Style Pizza & Bistro.

Boss added the laboratory investigation is ongoing.

Five people were hospitalized and more than 70 were treated at area medical facilities in connection with the salmonella outbreak at the catered meal on Nov. 14-15.

Angelo’s New York Style Pizza & Bistro reopened last week after the restaurant was reinspected and received a perfect score.

48 million cases of foodborne illness a year; most are not linked to foul play

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Foodborne illness happens. It sucks when it does.

It’s pretty much never intentional; not never, but rare.

In 1986, two Rajneeshee commune mem­bers were indicted for conspiring to tamper with consumer products by poi­soning food after over 750 community members in The Dalles, Oregon became ill with salmonellosis in 1982.

It sucks that twelve Alabamans ended up with what looks like foodborne illness after a holiday party this week. It’s weird that the Montgomery Advertiser coverage twice says that the cases probably weren’t as result of intentional contamination.

No foul play is suspected, and it looks like it is a case of accidental food poisoning, said Capt. Jeff Hassell, who commands the Prattville Police Department’s investigations division. Kinedyne Corporation, which operates a plant in the 1100 block of Washington Ferry Road, held its holiday lunch Friday. About an hour after eating, several employees complained of feeling sick, Hassell said.

Three employees were taken by ambulance to Prattville Baptist Hospital’s emergency room, with a fourth employee going by private vehicle, said Ernie Baggett, director of the Autauga County Emergency Management Agency. 

“We are investigating because it is an unusual situation, so many people becoming sick so quickly,” Hassell said. “Right now, we have nothing to point to an intentional act. We are looking at improperly cooked chicken as the most likely source for a food poisoning situation.”

“It was a pot luck dinner,” Baggett said. “No one became seriously ill, but a few employees wanted to go to the hospital just to get checked out.

 

Wash your bagged lettuce? I don’t. Here’s why.

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The coverage of an outbreak usually follows a familiar story arc – people get sick; additional illnesses roll in as the investigation unfolds; media shares what people can do with the product to protect themselves and finally, sometimes a source is fingered.

In Canada’s lettuce-linked E. coli O157 outbreak, we’re in phase three – what can you do?

One challenge in answering that question is the Public Health Agency of Canada hasn’t released (or doesn’t know) exactly what types of romaine lettuce are linked – and whether it’s sold as a head, or chopped (like in a salad kit). The ‘what can you do?’ is influenced by that.

According to Global News, one of the risk management steps a home chef could employ is washing the lettuce. Even if its washed, bagged and ready-to-eat.

Jason Tetro, a visiting scientist at the University of Guelph in Ontario, explained that the bacteria is typically not found in produce such as lettuce. Instead, it’s in the water that’s used to irrigate produce on farms. For example, he said the water from a nearby river could be contaminated with manure from cows on the farm.

But Tetro explained that if lettuce is properly washed, it can minimize the risk of contamination.

“If you are buying lettuce, romaine or otherwise, make sure each leaf is given a good washing under warm to hot water,” he advised.

Using “friction,” or rubbing the leaves with hands, is one way of making sure any bacteria is washed off.

Does pre-washed lettuce need to be rinsed?

The shorter answer, according to Tetro, is yes.

“Let’s put it this way, did you see the person who washed it? No,” he said, explaining that consumers can never be too sure of how the produce was cleaned.

“It’s much better for your own safety that you do something yourself.”

I disagree when it comes to prewashed bagged lettuce from a regulated processor who’s managing food safety, because of what these folks wrote:

Recommendations for Handling Fresh-cut Leafy Green Salads by Consumers and Retail Foodservice Operators
Mary S. Palumbo, James R. Gorny, David E. Gombas, Larry R. Beuchat, Christine M. Bruhn, Barbara Cassens, Pascal Delaquis, Jeffrey M. Farber, Linda J. Harris, Keith Itoto, Michael T. Osterholm, Michelle Smith, Katherine M.J. Swanson
Biblographic citation: Food Protection Trends, vol. 27, no. 11, pp. 892-898, Nov 2007
Volume 27, Issue 11: Pages 892–898

A panel of scientists with expertise in microbial safety of fresh produce was convened to review recent research and re-evaluate guidelines for foodservice and restaurant operators, regulatory agencies with oversight over food facilities, and consumers for handling prewashed bagged salads. The guidelines developed by the panel, together with materials reviewed by the panel to develop the guidelines, are presented. The background materials reviewed include published research and recent recommendations made by other authoritative sources. The panel concluded that leafy green salad in sealed bags labeled “washed” or “ready-to-eat” that are produced in a facility inspected by a regulatory authority and operated under cGMPs, does not need additional washing at the time of use unless specifically directed on the label. The panel also advised that additional washing of ready-to-eat green salads is not likely to enhance safety. The risk of cross contamination from food handlers and food contact surfaces used during washing may outweigh any safety benefit that further washing may confer.

 

South African grocers urged to test food for Listeria. Not sure that would do much for public health

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According to MSN, as a result of the massive, unsourced, outbreak of listeriosis in South Africa, folks have been asking retailers to test their food before selling it.

Following the announcement of an outbreak of listeria in South Africa, there are now calls for supermarkets to test their food for the bacteria before it’s sold to customers.

AfriForum’s Marcus Pawson says restaurants should also take the necessary precautions.

“These big chain stores must do this themselves while we wait for government to come up with a plan to ensure that South Africans are safe.”

Maybe there’s something lost in the scientific translation, but as lots of folks have mentioned in the past, you can’t test your way to safe food. Good epidemiology and a matching active food surveillance program is what’s really needed. Test and hold, not sure what that will really accomplish, public health-wise.

Canadian STEC/lettuce outbreak leads to a death

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Every day I eat food that doesn’t kill me. Or hasn’t yet.

I get kinda emotional when I read about a death linked to food.

While billions of servings of food every year don’t lead to tragedy, when it does I take notice.

I’ve met folks who continue to suffer the life-long impacts of foodborne pathogens; people who have watched their loved ones in pain in a hospital bed and ultimately them.

All from food.

According to an updated statement from the Public Health Agency of Canada, 30 people across Canada are dealing with E. coli O157 linked to romaine lettuce.  There’s not a lot of details though.

Currently, there are 30 cases of E. coli O157 illness under investigation in five provinces: Ontario, (6), Quebec (5), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and December 2017. Twelve individuals have been hospitalized. One individual has died. Individuals who became ill are between the ages of 4 and 80 years of age. The majority of cases (70%) are female.

Many individuals who became sick reported eating romaine lettuce before their illnesses occurred. The Canadian Food Inspection Agency is working with public health officials to determine the source of the romaine lettuce that ill individuals were exposed to.

No one should die as a result of food they ate.

Are chefs trying to kill us? (Asks the Boston Globe). Probably not. But might not be focused on public health

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‘Every place has a closet behind lock and key that has a lot of that kind of stuff in it,’ The stuff – usually something fermenting, curing or some unapproved (foraged/home produced) food is back there.

According to the Boston Globe, Today’s menus are filled with foraged food, fermented food, food that bubbles, food that molds, food that looks almost exactly like another thing that should probably not be called food because it is poisonous. It’s all perfectly safe, when sourced and prepared properly, under sanitary conditions, by people who adhere to proper procedure and take rules seriously. (Note: This last does not necessarily always describe chefs.)
“You shouldn’t be fermenting and jarring everything without a HACCP plan,” says Brandon Baltzley, chef and co-owner of Falmouth’s Buffalo Jump and a forager for Poplar. “But people know how to get away with it. Every place has a closet behind lock and key that has a lot of that kind of stuff in it.” He once visited a restaurant in Ohio that had a fermentation lab in a hidden attic that was just as big as the production kitchen itself, he says; a restaurant in another country had an entire secret facility a few blocks from the restaurant. 

When he cooked at Ribelle, a Brookline restaurant that has since closed, he would sometimes bring foraged ingredients into the kitchen. Several chefs, under condition of anonymity, reported it is easy to find workarounds when it comes to foraging. One recounted bringing a haul of mushrooms to a wholesaler, who then “sold” them back to the chef with appropriate documentation for a nominal fee. Another, appreciative of the flavor of wild clams from a particular area, purchased other clams, used their tags on the wild shellfish, and served the purchased ones for staff meal. The wild clams went to the customers.

Regulations, can sometimes be burdensome on the regulated party. Especially they aren’t familiar with the consequences. States set restaurant food safety laws, based on the federal FDA food code, and most jurisdictions have a process for variances to that code; there’s already a way for businesses to opt out, via variance, if they feel overburdened by the law as long as the outcome is the same.

Stuff like wild-grown mushrooms, ramps and game carry different risks because they aren’t in a managed system or environment. Misidentify a mushroom and a customer can die. Hunting morels are big business and many of the foraged fungi end up in restaurants sold on somewhat of a black market.

One way to encourage [better risk management] is to build more collaborative relationships between chefs and inspectors, says Bridget Sweet, executive director of food safety at Johnson & Wales. “So many people hate the health department and don’t even know why,” she says. She’s heard the horror stories about people operating in secret and hoping they don’t get caught. She finds them immensely distressing. “It’s such a risk. Inspectors don’t want to shut businesses down. If they have a really good discussion, it will remove the barriers. The answer’s not an inherent no, it’s ‘How can you do this safely within the food code?’ ”

Does Europe have an egg problem? Salmonella cases no longer falling in the EU

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The declining trend of salmonellosis cases in the EU has levelled off according to the annual report on zoonotic diseases published today.

The European Centre for Disease Prevention and Control reports that cases of Salmonella Enteritiis acquired in the EU have increased in humans by 3% since 2014. In laying hens, the prevalence increased from 0.7% to 1.21% over the same period. 

“The increase shown by our surveillance data is worrying and a reminder that we have to stay vigilant,” said Mike Catchpole, ECDC’s Chief Scientist. “Even in a state of high awareness and with national control programmes for S. Enteritidis in place, there is a need for continuing risk management actions at the Member State and EU level,” he added. 

Marta Hugas, EFSA’s Chief Scientist, said: “The decrease of Salmonella has been a success story in the EU food safety system in the last 10 years. Recent S. Enteritidis outbreaks contributed to a change in this trend in humans and poultry. Further investigations by competent authorities in the field of public health and food safety will be crucial to understand the reasons behind the increase.” 

There were 94 530 human cases of salmonellosis reported in the EU in 2016. S. Enteritidis – the most widespread type of Salmonella, accounted for 59% of all salmonellosis cases originating in the EU and is mostly associated with the consumption of eggs, egg products and poultry meat. 

Campylobacter and Listeria

Campylobacter, the most reported food-borne pathogen in humans, was detected in 246 307 people, an increase of 6.1% compared with 2015. Despite the high number of cases, fatalities were low (0.03%). Levels of Campylobacter are high in chicken meat.

Listeria infections, which are generally more severe, led to hospitalisation in 97% of reported cases. In 2016, listeriosis continued to rise, with 2 536 cases (a 9.3% increase) and 247 deaths reported. Most deaths occur in people aged over 64 (fatality rate of 18.9%). People over 84 are particularly at risk (fatality rate of 26.1%). Listeria seldom exceeded legal safety limits in ready-to-eat foods.

Salmonella food-borne outbreaks increasing 

The 4 786 food-borne disease outbreaks reported in 2016 represent a slight increase in comparison with 2015 (4 362 outbreaks), but the figure is similar to the average number of outbreaks in the EU during 2010–2016. 

Outbreaks due to Salmonella are on the rise, with S. Enteritidis causing one in six food-borne disease outbreaks in 2016. Salmonella bacteria were the most common cause of food-borne outbreaks (22.3%), an increase of 11.5% compared to 2015. They caused the highest burden in terms of numbers of hospitalisations (1,766; 45.6% of all hospitalised cases) and of deaths (10; 50% of all deaths among outbreak cases).

Salmonella in eggs caused the highest number of outbreak cases (1 882).