Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 11. Use of antiseptics and sanitizers in community settings and issues of hand hygiene compliance in health care and food industries.

Hand washing with soap is a practice that has long been recognized as a major barrier to the spread of disease in food production, preparation, and service and in health care settings, including hospitals, child care centers, and elder care facilities. Many of these settings present multiple opportunities for spread of pathogens within at-risk populations, and extra vigilance must be applied. Unfortunately, hand hygiene is not always carried out effectively, and both enteric and respiratory diseases are easily spread in these environments.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 10. Alcohol-based antiseptics for hand disinfection and a comparison of their effectiveness with soaps.

Alcohol compounds are increasingly used as a substitute for hand washing in health care environments and some public places because these compounds are easy to use and do not require water or hand drying materials. However, the effectiveness of these compounds depends on how much soil (bioburden) is present on the hands. Workers in health care environments and other public places must wash their hands before using antiseptics and/or wearing gloves.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 9. Washing and drying of hands to reduce microbial contamination.

During various daily activities at home and work, hands quickly become contaminated. Some activities increase the risk of finger contamination by pathogens more than others, such as the use of toilet paper to clean up following a diarrheal episode, changing the diaper of a sick infant, blowing a nose, or touching raw food materials. Many foodborne outbreak investigation reports have identified the hands of food workers as the source of pathogens in the implicated food.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 8. Gloves as barriers to prevent contamination of food by workers.

The role played by food workers and other individuals in the contamination of food has been identified as an important contributing factor leading to foodborne outbreaks. To prevent direct bare hand contact with food and food surfaces, many jurisdictions have made glove use compulsory for food production and preparation. When properly used, gloves can substantially reduce opportunities for food contamination.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 7. Barriers to reduce contamination of food by workers.

Contamination of food and individuals by food workers has been identified as an important contributing factor during foodborne illness investigations. Physical and chemical barriers to prevent microbial contamination of food are hurdles that block or reduce the transfer of pathogens to the food surface from the hands of a food worker, from other foods, or from the environment. In food service operations, direct contact of food by hands should be prevented by the use of barriers, especially when gloves are not worn.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 5. Sources of contamination and pathogen excretion from infected persons.

In this article, the fifth in a series reviewing the role of food workers in foodborne outbreaks, background information on the routes of infection for food workers is considered. Contamination most frequently occurs via the fecal-oral route, when pathogens are present in the feces of ill, convalescent, or otherwise colonized persons. It is difficult for managers of food operations to identify food workers who may be excreting pathogens, even when these workers report their illnesses, because workers can shed pathogens during the prodrome phase of illness or can be long-term excretors or asymptomatic carriers.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 6. Transmission and survival of pathogens in the food processing and preparation environment.

This article, the sixth in a series reviewing the role of food workers in foodborne outbreaks, describes the source and means of pathogen transfer. The transmission and survival of enteric pathogens in the food processing and preparation environment through human and raw food sources is reviewed, with the main objective of providing information critical to the reduction of illness due to foodborne outbreaks. Pathogens in the food preparation area can originate from infected food workers, raw foods, or other environmental sources.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 4. Infective doses and pathogen carriage.

In this article, the fourth in a series reviewing the role of food workers in foodborne outbreaks, background information on the presence of enteric pathogens in the community, the numbers of organisms required to initiate an infection, and the length of carriage are presented. Although workers have been implicated in outbreaks, they were not always aware of their infections, either because they were in the prodromic phase before symptoms began or because they were asymptomatic carriers. Pathogens of fecal, nose or throat, and skin origin are most likely to be transmitted by the hands, highlighting the need for effective hand hygiene and other barriers to pathogen contamination, such as no bare hand contact with ready-to-eat food.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 3. Factors contributing to outbreaks and description of outbreak categories.

In this article, the third in a series of several reviewing the role of food workers in 816 foodborne outbreaks, factors contributing to outbreaks and descriptions of different categories of worker involvement are discussed. All the outbreaks had worker involvement of some kind, and the majority of food workers were infected. The most frequently reported factor associated with the involvement of the infected worker was bare hand contact with the food followed by failure to properly wash hands, inadequate cleaning of processing or preparation equipment or utensils, cross-contamination of ready-to-eat foods by contaminated raw ingredients, and (for bacterial pathogens) temperature abuse.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 2. Description of outbreaks by size, severity, and settings.

This article is the second in a series of several by members of the Committee on the Control of Foodborne Illness of the International Association of Food Protection, and it continues the analysis of 816 outbreaks where food workers were implicated in the spread of foodborne disease. In this article, we discuss case morbidity and mortality and the settings where the 816 outbreaks occurred. Some of the outbreaks were very large; 11 involved more than 1,000 persons, 4 with more than 3,000 ill.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 1. Description of the problem, methods, and agents involved.

Food workers in many settings have been responsible for foodborne disease outbreaks for decades, and there is no indication that this is diminishing. The Committee on Control of Foodborne Illnesses of the International Association for Food Protection was tasked with collecting and evaluating any data on worker-associated outbreaks. A total of 816 reports with 80,682 cases were collected from events that occurred from 1927 until the first quarter of 2006.

Mexican-style Foodservice Operations: Hazard Analyses, Critical Control Points and Monitoring.

Hazard analyses critical control point evaluations were made in four restaurants specializing in Mexican-style foods. Time-temperature evaluations were made of beans, meat products, and rice during cooking, cooling, reheating, and hot-holding, and other food preparation procedures were observed during 3 d of operation. A few samples were collected and tested for Clostridium perfringens and aerobic plate counts (APC).

Hazard Analyses of Fried, Boiled and Steamed Cantonese-Style Foods.

Time-temperature exposures to which each stage of the preparation of a variety of fried, boiled or steamed Cantonese-style foods were subjected were evaluated at six restaurants. Samples of these foods were examined to determine their water activity, to detect the presence of Bacillus cereus and to count the number of mesophilic aerobic microorganisms. Temperatures of foods that were attained during cooking were usually high enough to cause rapid destruction of vegetative pathogenic foodborne bacteria.

Hazard Analyses of Char siu and Roast Pork in Chinese Restaurants and Markets.

Evaluations of time-temperature exposure of each stage of the preparation of char siu (marinated roast pork) were made at six Chinese restaurants and a market. These evaluations were also made of roast pork at the market. Samples of these products at the various stages of preparation and swabs of equipment surfaces that the pork touched during preparation were tested for Clostridium perfringens , Salmonella and Staphylococcus aureus .

Hazard Analyses of Duck in Chinese Restaurants.

Time-temperature exposures and water activity values were measured during the preparation and storage of Chinese-style duck products. Frozen ducks were usually thawed at room temperature and remained at room temperature for several hours thereafter. During cooking or during the post-oven temperature rise period, the temperatures at the geometric centers of the ducks exceeded 94 C (201 F).

Hazard Analyses, in Reference to Bacillus cereus , of Boiled and Fried Rice in Cantonese-Style Restaurants .

Hazard analyses were conducted in six Cantonese-style restaurants to evaluate the amount of Bacillus cereus in rice and the water activity and the temperatures of rice at each stage of processing. Each of 16 samples of raw, polished rice contained B. cereus .