Cleaning: A Retail and Foodservice Perspective.

Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires’ Disease—North America, 2000–2014

One of the factors contributing to foodborne illnesses is improper cleaning and sanitization of food contact surfaces. This study aimed to investigate the influence of various factors onStaphylococcus aureusattachment and biofilm formation on food contact materials and to determine sanitizing efficacy. The factors examined were contact materials (stainless steel, SUS; glass, GL; polypropylene, PP; and polyethylene, PE), surface conditions (smooth vs. scratched and with vs. without biofilms), and chemical sanitizers (70% ethanol and 200 ppm chlorine). Sanitization more efficiently loweredS. aureuscounts on SUS and GL than on PP and PE. Sanitization efficacy of ethanol was better than that of chlorine. Surfaces with scratches and biofilms were the most resistant to sanitization methods. The use of low‐adherent materials in food facilities, the selection of effective sanitizing methods, and the application of proper cleaning and disinfection procedures for food contact surfaces are essential for ensuring food safety.Practical applicationsControl ofS. aureuson food contact surface is important to reduce cross‐contamination in the foodservice industry. Hydrophobic and rough food contact surfaces promoteS. aureusadherence and biofilm formation. Ethanol can be an effective chemical sanitizer againstS. aureusbiofilm, regardless of the material or roughness of the food contact surfaces. The use of hydrophilic materials, frequent replacement of equipment, and selection of proper sanitizing methods are recommended to prevent foodborne illnesses.

T HE NUMBER of reported outbreaks of waterborne and foodborne diseases was slightly higher in 1959 than in 1958 (table 1). There was a considerable increase in number of reported outbreaks and cases of staphylococcal food poisoning as compared with the previous year, but this was largely offset by smaller numbers in some other categories (table 2). While it seems improbable that outbreaks of foodborne diseases were more completely reported in 1959 than in previous years, there is evidence that more extensive laboratory investigations were being carried out in some areas. The number of outbreaks in which phage typing of staphylococci was done increased in 1959. In a few instances, the same phage type of organism was recovered from specimens of food as from persons who were handling or preparing foods. Phage types 7 and 47 were more commonly reported than any others. Phage type 80/81 was recovered from ham in one outbreak and from milk in another. A few reports indicated that phage typing was being done but the results of tests were not received. Introduction of coagulase-positive strains of staphylococci of human origin into herds of dairy cattle is receiving more attention. In one State antibiotic-resistant strains of phage type 80/81 were recovered from superficial lesions on the udders of cattle in a herd owned by a carrier of this type of staphylococcus. Two other adults in the family also were carriers of this type. When the animals were moved to new premises and their human contacts changed, their lesions disappeared. A similar situation was reported recently by Wallace (1). Phage type 80/81 was recovered from four cattle in a dairy herd and also from lesions on one worker at the dairy farm. One State is now conducting an intensive study of staphylococcal infections in cattle and their relationship to human infections and disease. Several outbreaks of foodborne diseases were reported in 1959 in which Closttidiuim perfringens (welchii) was considered or suspected as the etiological agent. This spore-forming organism, of which one type (A) causes gas gangrene, has been recognized as the etiological agent in outbreaks in England for a number of years. Its association with disease outbreaks in the United States had been suspected but was not proved until recently. Failure to recognize the role of this organism in foodborne diseases in this country has been due partly to the fact that it can be recovered only when incubated anaerobically. The procedures required for identification of the organism are complicated, and few laboratories are equipped to perform them. C. perfringens is widely distributed in nature in feces, sewage, and soil. Outbreaks due to this bacterium are usually associated with meat, includingfowl, that has been cooked and allowed to cool slowly at room temperature. The incubation period of illnesses is about 8 to 12 hours but may be as long as 22 hours. According to Dack (2), the characteristic symptoms are acute abdominal pain and diarrhea, usually of short duration. In 1959, there were 75 outbreaks of foodborne diseases, affecting more than 1,200 persons, in which poultry or other meat was thought to be the vehicle of infection but no etiological agent was identified. Possibly some of these were caused by C. perfringens. It has Dr. Dauer is medical adviser to the chief, and Mr. Davids is health program representative, in the National Office of Vital Statistics, Public Health Service.

Foodborne diseases have become a serious public health problem worldwide, and foodborne disease outbreaks have placed a heavy disease burden on China. Foodborne disease outbreaks occur most frequently among families in China. The objectives of this study were to analyze the cause of household foodborne disease outbreaks in China from 2010 to 2020 and to identify where preventive measures could be targeted. All data were obtained from the China Foodborne Disease Surveillance System Report. A total of 17,985 outbreaks, which resulted in 73,252 illnesses, 38,829 hospitalizations, and 1269 deaths, were reported in this period. Most household outbreaks of foodborne diseases occurred in May-October, and the highest number occurred in July (3620 outbreaks, 20%). The province with the highest number of outbreaks was Yunnan Province (4829 outbreaks), followed by Hunan Province (2264 outbreaks). The attribution analysis revealed that fungi (mainly poisonous mushrooms) were the most implicated food category, with 8873 (49.3%) cases. The second was poisonous plants and their products, with 1552 (8.6%) cases. Fungi were the primary etiologic agent, with 31,125 illnesses, accounting for 42.5% of the incidents. Inedibility and misuse (9423 outbreaks), unknown origin (2505 outbreaks), and improper processing (2365 outbreaks) were the main contributing factors causing outbreaks of foodborne diseases. The results show that southwest China was a high-risk area for household foodborne diseases. Therefore, public health institutions should strengthen supervision and food safety education of residents to reduce the outbreaks of household foodborne diseases.

Impacts of Microbial Food Safety in China and Beyond.

Meteorological factors are of crucial importance in foodborne disease (FBD) outbreaks, and more quantitative research is required to elucidate the underlying mechanisms. This study aimed to evaluate the impact of meteorological factors on FBD outbreaks in Yantai from 2014 to 2024, using data reported by the Yantai Foodborne Disease Surveillance Network. The distributed lag non-linear model (DLNM) was employed to model the exposure-response relationships between temperature, precipitation, wind speed, and FBD outbreaks. Prior to model fitting, multicollinearity among variables was addressed via the variance inflation factor (VIF). Results demonstrated non-linear relationships and complex correlations between these variables. Higher temperatures, greater precipitation, and slower wind speeds were associated with an increased risk of FBD outbreaks. In the lagged time dimension, temperature had an immediate effect that decayed after 2–3 weeks; the maximum lagged risk for precipitation occurred within 1–3 weeks; and wind speed showed subdued fluctuations. The lag patterns of high-value and low-value effects of different elements exhibited symmetry. These findings underline the necessity of integrating meteorological monitoring into FBD surveillance systems in accordance with their respective impact patterns.

Objective To analyze the epidemiological characteristics of school foodborne disease outbreaks in Henan Province from 2011 to 2020 and to provide the basis for effective prevention and control of school foodborne disease outbreaks. Methods The outbreaks of foodborne diseases in schools in Henan Province reported by the foodborne disease outbreak surveillance system from 2011 to 2020 were statistically analyzed. Results A total of 47 outbreaks of school foodborne diseases were reported in Henan province in the past 10 years, with a total of 1 258 cases, 701 hospitalizations and 1 death. Zhengzhou, Zhumadian, Xinyang and Xinxiang were the top 4 cities in Henan Province in terms of the number of school foodborne disease outbreaks reported. The peak of foodborne illness incidents in schools was in June and September. The largest number of incidents occurred in middle school canteens and primary school canteens (all 12). The number of reported incidents (12) and the number of cases of foodborne diseases (371) in schools caused by cereals and their products were the largest. Pathogenic bacteria and their toxins were the main pathogenic factors that caused the outbreaks of foodborne diseases in schools, accounting for 78.26% of the identified causes. Bacillus cereus was the top pathogens causing foodborne diseases outbreaks in schools. The pathogenic factor that caused the largest number of cases was Diarrheogenic Escherichia Coli, and the pathogenic factor that caused the death cases was poisonous mushrooms. Apart from unexplained incidents, improper processing was the main link leading to foodborne diseases outbreaks in schools. Conclusion The primary and middle school students are the group with high incidence of foodborne diseases in schools. The supervision and management of school canteen should be strengthened in summer to prevent the outbreak of bacterial foodborne diseases caused by improper processing and storage of grain food. 【摘要】 目的 分析河南省 2011—2020 年学校食源性疾病暴发事件的流行病学规律及特点, 为有效防控学校食源性疾病 暴发事件提供依据。 方法 对国家食品安全风险评估中心的食源性疾病暴发监测系统报告的 2011—2020 年河南省学校 食源性疾病暴发事件进行流行病学统计分析。 结果 河南省 10 年间共报告学校食源性疾病暴发事件 47 起, 累计发病人 数 1 258 人, 住院人数 701 人, 死亡 1 人。河南省学校食源性疾病暴发事件报告起数前 4 位的城市为郑州市、驻马店市、信 阳市, 新乡市。学校食源性疾病事件高峰期是 6 和 9 月。中学食堂和小学食堂导致的事件数最多 (均为 12 起)。粮食制品 引起的学校食源性疾病上报事件数和发病人数最多 (14 起, 371 人)。致病菌及其毒素是引起学校食源性疾病暴发事件的 主要病原因子, 占查明原因事件数的 78.26%。引起学校食源性疾病暴发事件最多的致病菌是蜡样芽孢杆菌, 引起发病人 数最多的致病因素是致泻大肠埃希菌, 引发死亡病例的致病因素是毒蘑菇。除原因不明的事件外, 加工不当是导致学校食 源性疾病暴发事件的主要环节。 结论 中小学生是学校食源性疾病高发群体, 应加强夏秋季学校食堂的监督和管理, 预防 粮食类食品加工储存不当导致的细菌性食源性疾病暴发事件。

Disinfection efficacy tests were conducted on surface carriers inoculated with the monkeypox virus (MPXV) by applying six disinfectant solutions (and three controls) on six surfaces common in low-resource settings: four nonporous surfaces (stainless steel, glass, plastic, and latex) and two porous surfaces (ceramic and wood). Disinfectants were wiped on carriers in triplicate, with a 1 min contact time: 0.05 and 0.5% sodium hypochlorite, 70% ethanol, two quaternary ammonium compound (QAC)-based disinfectants, and 1.4% hydrogen peroxide. MPXV was then quantified, and log10 removal values were calculated. Sodium hypochlorite (0.05 and 0.5%) and ethanol (70%) removed MPXV to below detection level, ≥ 99.97% reduction for nonporous surfaces, and ≥99.40% for wood, QAC-based disinfectants were efficacious on nonporous surfaces (≥99.97% inactivation) but had diminished efficacy on wood, a porous surface, and 1.4% H2O2 had limited efficacy across all tested surfaces. Results varied by disinfectant type and surface type. Based on our results, we recommend using 0.05% sodium hypochlorite or 70% ethanol with 1 min contact time to inactive MPXV on clean nonporous and porous surfaces. As MPXV is evolving, future research with additional disinfectants, application methods, and environmental conditions and research to understand adsorption, disinfection efficacy, and transmission risk on porous surfaces are needed to develop practical disinfection recommendations.

Surface Contamination Genesis, Detection and Control: K.L. Mittal. Volumes 1 and 2

Foodborne diseases cause an estimated 48 million illnesses each year in the United States, including 9.4 million caused by known pathogens. Foodborne disease outbreak surveillance provides valuable insights into the agents and foods that cause illness and the settings in which transmission occurs. CDC maintains a surveillance program for collection and periodic reporting of data on the occurrence and causes of foodborne disease outbreaks in the United States. This surveillance system is the primary source of national data describing the numbers of illnesses, hospitalizations, and deaths; etiologic agents; implicated foods; contributing factors; and settings of food preparation and consumption associated with recognized foodborne disease outbreaks in the United States.1998-2008.The Foodborne Disease Outbreak Surveillance System collects data on foodborne disease outbreaks, defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Public health agencies in all 50 states, the District of Columbia, U.S. territories, and Freely Associated States have primary responsibility for identifying and investigating outbreaks and use a standard form to report outbreaks voluntarily to CDC. During 1998-2008, reporting was made through the electronic Foodborne Outbreak Reporting System (eFORS).During 1998-2008, CDC received reports of 13,405 foodborne disease outbreaks, which resulted in 273,120 reported cases of illness, 9,109 hospitalizations, and 200 deaths. Of the 7,998 outbreaks with a known etiology, 3,633 (45%) were caused by viruses, 3,613 (45%) were caused by bacteria, 685 (5%) were caused by chemical and toxic agents, and 67 (1%) were caused by parasites. Among the 7,724 (58%) outbreaks with an implicated food or contaminated ingredient reported, 3,264 (42%) could be assigned to one of 17 predefined commodity categories: fish, crustaceans, mollusks, dairy, eggs, beef, game, pork, poultry, grains/beans, oils/sugars, fruits/nuts, fungi, leafy vegetables, root vegetables, sprouts, and vegetables from a vine or stalk. The commodities implicated most commonly were poultry (18.9%; 95% confidence interval [CI] = 17.4-20.3) and fish (18.6%; CI = 17.2-20), followed by beef (11.9%; CI = 10.8-13.1). The pathogen-commodity pairs most commonly responsible for outbreaks were scombroid toxin/histamine and fish (317 outbreaks), ciguatoxin and fish (172 outbreaks), Salmonella and poultry (145 outbreaks), and norovirus and leafy vegetables (141 outbreaks). The pathogen-commodity pairs most commonly responsible for outbreak-related illnesses were norovirus and leafy vegetables (4,011 illnesses), Clostridium perfringens and poultry (3,452 illnesses), Salmonella and vine-stalk vegetables (3,216 illnesses), and Clostridium perfringens and beef (2,963 illnesses). Compared with the first 2 years of the study (1998-1999), the percentage of outbreaks associated with leafy vegetables and dairy increased substantially during 2006-2008, while the percentage of outbreaks associated with eggs decreased.Outbreak reporting rates and implicated foods varied by state and year, respectively; analysis of surveillance data for this 11-year period provides important information regarding changes in sources of illness over time. A substantial percentage of foodborne disease outbreaks were associated with poultry, fish, and beef, whereas many outbreak-related illnesses were associated with poultry, leafy vegetables, beef, and fruits/nuts. The percentage of outbreaks associated with leafy vegetables and dairy increased during the surveillance period, while the percentage associated with eggs decreased.Outbreak surveillance data highlight the etiologic agents, foods, and settings involved most often in foodborne disease outbreaks and can help to identify food commodities and preparation settings in which interventions might be most effective. Analysis of data collected over several years of surveillance provides a means to assess changes in the food commodities associated most frequently with outbreaks that might occur following improvements in food safety or changes in consumption patterns or food preparation practices. Prevention of foodborne disease depends on targeted interventions at appropriate points from food production to food preparation. Efforts to reduce foodborne illness should focus on the pathogens and food commodities causing the most outbreaks and outbreak-associated illnesses, including beef, poultry, fish, and produce.

BackgroundFoodborne diseases are a worldwide public health problem. However, data regarding epidemiological characteristics are still lacking in China. We aimed to analyze the characteristics of foodborne diseases outbreak from 2010 to 2016 in Guangxi, South China.MethodsA foodborne disease outbreak is the occurrence of two or more cases of a similar foodborne disease resulting from the ingestion of a common food. All data are obtained from reports in the Public Health Emergency Report and Management Information System of the China Information System for Disease Control and Prevention, and also from special investigation reports from Guangxi province.ResultsA total of 138 foodborne diseases outbreak occurred in Guangxi in the past 7 years, leading to 3348 cases and 46 deaths. Foodborne disease outbreaks mainly occurred in the second and fourth quarters, and schools and private homes were the most common sites. Ingesting toxic food by mistake, improper cooking and cross contamination were the main routes of poisoning which caused 2169 (64.78%) cases and 37 (80.43%) deaths. Bacteria (62 outbreaks, 44.93%) and poisonous plants (46 outbreaks, 33.33%) were the main etiologies of foodborne diseases in our study. In particular, poisonous plants were the main cause of deaths involved in the foodborne disease outbreaks (26 outbreaks, 56.52%).ConclusionsBacteria and poisonous plants were the primary causative hazard of foodborne diseases. Some specific measures are needed for ongoing prevention and control against the occurrence of foodborne diseases.

--To describe the epidemiology of foodborne disease outbreaks in nursing homes and to identify where preventive efforts might be focused. --Reports by state and local health departments of foodborne disease outbreaks occurring from January 1, 1975, through December 31, 1987. --Foodborne disease outbreaks reported to the Centers for Disease Control, Atlanta, Ga, on standard investigation forms. --Each foodborne disease outbreak report was examined by an epidemiologist or statistician. Outbreaks were considered to have a known pathogen if confirmed by laboratory tests, and a known vehicle when an epidemiologic investigation implicated a specific food item. --From 1975 through 1987, 26 states reported 115 outbreaks of foodborne disease in nursing homes, causing illness in 4944 persons and death in 51. These outbreaks represented 2% of all reported foodborne disease outbreaks and 19% of outbreak-associated deaths in this period. Of 52 outbreaks with a known cause, Salmonella was the most frequently reported pathogen, accounting for 52% of outbreaks and 81% of deaths. Salmonella enteritidis outbreaks accounted for 56% of the Salmonella-associated deaths since 1981. The implicated food vehicles in S enteritidis outbreaks were made with eggs or prepared with equipment contaminated with eggs. Staphylococcal foodborne disease was the next most commonly identified cause, accounting for 23% of outbreaks. --Since the elderly are at high risk for serious morbidity from foodborne disease, nursing homes should practice careful food handling, preparation, and storage procedures; provide education for food handlers; and have active infection control programs to rapidly detect and control outbreaks of foodborne disease.

This study aimed to assess the foodborne diseases (FBD) outbreaks reported in Brazil between 2000 and 2018, based on data from the Brazilian Ministry of Health (official data) and from scientific literature. According to official data, 13,163 FBD outbreaks were reported in the country during this period, involving 247,570 cases and 195 deaths. The largest prevalence of FBD outbreaks was observed in the Southeast region of Brazil (45.6%). In most outbreaks it was not possible to determine the food implicated (45.9%) but among those identified, water was the most frequently associated (12.0%). The etiological agent was not identified in most outbreaks (38.0%), while Salmonella (14.4%) was the most frequently reported among those identified. Homes were the main site of FBD occurrence (12.5%). Regarding data obtained from the scientific literature, 57 articles dealing with FBD in the country throughout the same period were selected and analyzed. Based on these articles, mixed foods were the most prevalent in the outbreaks (31.6%), Salmonella spp. was the pathogen most frequently reported (22.8%) and homes were also the main site of FBD occurrence (45.6%). Despite under-notification, the records of FBD outbreaks that have occurred in Brazil in the past recent years show alarming data, requiring attention from health authorities. The notification of outbreaks is essential to facilitate public health actions.

Bioaerosols and pathogens in indoor workplaces and residential environments are the primary culprits of several infections. Techniques for sanitizing air and surfaces typically involve the use of UV rays or chemical sanitizers, which may release chemical residues harmful to human health. Essential oils, natural substances derived from plants, which exhibit broad antimicrobial properties, could be a viable alternative for air and surface sanitation. The objective of this study has been to investigate the efficacy of thyme essential oil (TEO) in environmental sanitation processes. In Vitro assays through agar well diffusion, disk volatilization and tube dilution methods revealed significant antimicrobial activity of TEO 100% against foodborne and environmental isolates, with both bacteriostatic/fungistatic and bactericidal/fungicidal effects. Therefore, aqueous solutions of TEO 2.5% and 5% were formulated for air sanitation through nebulization and surface disinfection via direct contact. Bioaerosol samples and surface swabs were analyzed before and after sanitation, demonstrating the efficacy of aqueous solutions of TEO in reducing mesophilic and psychrophilic bacteria and environmental fungi levels in both air and on surfaces. The obtained results prove the antimicrobial potential of aqueous solutions of TEO in improving indoor air quality and surface cleanliness, suggesting thyme essential oil as an effective and safe natural sanitizer with minimal environmental impact compared to dangerous chemical disinfectants.

Introduction: Environmental surfaces may serve as a reservoir for various microorganisms and consequently, they represent a potential risk for the spread of healthcare-associated infections. Objective: This study aimed to assess the cleaning and sanitation of surfaces (CSS) before and after implementing a Standardization Program for Cleaning and Sanitation of Surfaces (SPCSS). Methods: An analytical, comparative, and intervention study was conducted from 2020 to 2021 in a pediatric hospitalization unit in Midwest Brazil. Four frequently touched surfaces were monitored before and after the cleaning and sanitation process using the following methods: Adenosine Triphosphate (ATP) quantification, Colony-Forming Unit (CFU) count, and visual inspection. The study consisted of three stages: stage I (situational diagnosis of the CSS process), stage II (implementation of the SPCSS), and stage III (assessment 60 days after implementing the program). A total of 576 assessments were performed in all three study stages. Results: The CSS process was effective in all three study stages by using the ATP and CFU methods. In stage I, statistically significant results were obtained for four surfaces using the ATP method, and two by the CFU count. In stages II and III, all surfaces presented lower ATP and CFU results (p<0.05). In the visual inspection, only the bathroom door handle (stage I: p=0.041; stage III: p=0.007) and toilet flush handle (stage I: p=0.026; stage III: p=0.007) passed the test. Implications for Nursing: This study presents subsidies to evaluate the cleaning and disinfection process carried out by the nursing and hygiene team. Conclusion: The SPCSS exerted a positive impact on the CSS process.