Raw is risky: Salmonella growth on sprouts and microgreens

Microgreens, like sprouts, are relatively fast-growing products and are generally consumed raw. Moreover, as observed for sprouts, microbial contamination from preharvest sources may also be present in the production of microgreens.

In this study, two Salmonella enterica serovars (Hartford and Cubana), applied at multiple inoculation levels, were evaluated for survival and growth on alfalfa sprouts and Swiss chard microgreens by using the most-probable-number (MPN) method. Various abiotic factors were also examined for their effects on Salmonella survival and growth on sprouts and microgreens. Community-level physiological profiles (CLPPs) of sprout/microgreen rhizospheres with different levels of S. enterica inoculation at different growth stages were characterized by use of Biolog EcoPlates. In the seed contamination group, the ability of S. enterica to grow on sprouting alfalfa seeds was affected by both seed storage time and inoculation level but not by serovar. However, the growth of S. enterica on Swiss chard microgreens was affected by serovar and inoculation level. Seed storage time had little effect on the average level of Salmonella populations in microgreens. In the irrigation water contamination group, the growth of Salmonella on both alfalfa sprouts and microgreens was largely affected by inoculation level. Surprisingly, the growth medium was found to play an important role in Salmonella survival and growth on microgreens. CLPP analysis showed significant changes in the microbial community metabolic diversity during sprouting for alfalfa sprouts, but few temporal changes were seen with microgreens. The data suggest that the change in rhizosphere bacterial functional diversity was dependent on the host but independent of Salmonella contamination.

Sprouts and microgreens are considered “functional foods,” i.e., foods containing health-promoting or disease-preventing properties in addition to normal nutritional values. However, the microbial risk associated with microgreens has not been well studied. This study evaluated Salmonella survival and growth on microgreens compared to those on sprouts, as well as other abiotic factors that could affect Salmonella survival and growth on microgreens. This work provides baseline data for risk assessment of microbial contamination of sprouts and microgreens. Understanding the risks of Salmonella contamination and its effects on rhizosphere microbial communities enables a better understanding of host-pathogen dynamics in sprouts and microgreens. The data also contribute to innovative preventive control strategies for Salmonella contamination of sprouts and microgreens.

Plant-microbe and abiotic factors influencing salmonella survival and growth on alfalfa sprouts and Swiss chard microgreens

16 February 2018

Applied and Environmental Microbiology, vol 84 no 9

Elizabeth ReedaChristina M. Ferreiraa, Rebecca BellaEric W. Browna and Jie Zhenga

doi:10.1128/AEM.02814-17

http://aem.asm.org/content/84/9/e02814-17.abstract?etoc

10 sick: CDC says Jimmy John’s latest Salmonella-in-sprouts outbreak over

But will Jimmy John’s go back to using raw sprouts on sandwiches?

Probably, outbreaks haven’t stopped them before.

The U.S. Centers for Disease Control (CDC), public health and regulatory officials in several states, and the U.S. Food and Drug Administration investigated a multistate outbreak of Salmonella Montevideo infections.

Ten people infected with the outbreak strain of Salmonella Montevideo were reported from three states.

No hospitalizations and no deaths were reported.

Epidemiologic evidence indicated that raw sprouts were the likely source of this multistate outbreak.

Ill people in this outbreak reported eating raw sprouts on sandwiches served at Jimmy John’s restaurants in Illinois and Wisconsin.

One ill person in this outbreak reported eating raw sprouts purchased from a grocery store in Minnesota.

This outbreak appears to be over. Any contaminated sprouts that made people sick in this outbreak would now be older than their recommended shelf life. FDA and state, and local regulatory officials conducted traceback investigations to help determine the source of the sprouts and their distribution chain. To date, no contamination source has been identified.

Public health investigators used the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting was performed on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE.

As of February 27, 2018, 10 people infected with the outbreak strain of Salmonella Montevideo were reported from 3 states.

Illnesses started on dates ranging from December 20, 2017 to January 28, 2018. Ill people ranged in age from 26 to 56, with a median age of 42. All 10 (100%) were female. No hospitalizations and no deaths were reported.

Epidemiologic evidence indicated that raw sprouts were the likely source of this multistate outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Eight (80%) of ten people interviewed reported eating at multiple Jimmy John’s restaurant locations. Of these eight people, all eight (100%) reported eating raw sprouts on a sandwich from Jimmy John’s in Illinois and Wisconsin. This proportion is significantly higher than results from a survey[PDF – 29 pages] of healthy people, in which 3% reported eating sprouts on a sandwich in the week before they were interviewed. Two ill people in Wisconsin ate at a single Jimmy John’s location in that state. One ill person reported eating raw sprouts purchased from a grocery store in Minnesota.

This outbreak appears to be over. Any contaminated sprouts that made people sick in this outbreak would now be older than their recommended shelf life. FDA and state, and local regulatory officials conducted traceback investigations to help determine the source of the sprouts and their distribution chain. To date, no contamination source has been identified.

Regardless of where they are served or sold, raw and lightly cooked sprouts are a known source of foodborne illness and outbreaks. People who choose to eat sprouts should cook them thoroughly to reduce the risk of illness.

Here’s a table of over 75 sprout-related outbreaks going back to 1973.

I’m a doctor and I joined The Doctors to talk food safety

I don’t ask anyone to call me doctor; I find it a bit awkward and pretentious.

I guess the title matters to some folks. So much so that it’s the basis for a nationally syndicated talk show produced by another doctor, Dr. Phil. Today, an episode I taped with the good doctors about a month ago aired.

We talked oysters, sprouts, raw milk and undercooked beef for a few minutes. I got my plug in for using a thermometer (although I think I erroneously said meat instead of beef).

I tried not to look too goofy (not sure I accomplished that).

My face isn’t always washed out but I ended up doing the interview via Skype from my home office (with an antique Hespeler hockey stick in the background), in direct afternoon sunlight, instead of my planned location of a campus office. The locale change was due to the 5” of snow that hit Raleigh the day before. I wasn’t driving anywhere with the NC snow-excited drivers.

I’m also not the creator of Barf Blog. I just happen to host the barfblog collective. And contribute to it sometimes.

Oh well, can’t get it all right, but food safety made it into a couple of million homes this afternoon.

But there’s no way the segment was as impactful as the one previous to mine – it was about farting at the gym.

Sprouts sicken at least 8 linked to Jimmy John’s: It’s all happening, again

I got invited by one of my former students to give a talk about food safety stuff at an American military base in Germany, about 2012.

This was after 5,500 people became sick and 53 died from E. coli O104 linked to raw sprouts, primarily in Germany.

Met a couple of lifelong friends, continued my work with the U.S. military, because those folks need to eat too, and learned that public bathroom in Germany is an oxymoron and people just piss at the side of the road (Australia has excellent public bathrooms, best I’ve ever seen).

After my presentation, one of my military friends said, guess you’re not a fan of Jimmy John’s.

I said, no, I’m not a fan of bullshit.

Before the U.S. government shut down, the folks at the Centers for Disease Control managed to publish the latest outbreak info of Salmonella linked to raw sprouts in Jimmy Johns subs, the preferred lunch meeting snack for Kansas State University food professors, who know nothing about safety.

To recap:

An outbreak linked to raw sprouts in the U.S. that sickened 140 people occurred between November 2010 into 2011, involving sandwich franchise, Jimmy John’s (CDC, 2011; Illinois Department of Public Health, 2010).

The owner of the Montana Jimmy John’s outlet, Dan Stevens, expressed confidence in his sprouts claiming that because the sprouts were locally grown they would not be contaminated, although the source of the contaminated sprouts had not yet been identified (KRTV, 2010).

By the end of December 2010 a sprout supplier, Tiny Greens Farm, was implicated in the outbreak (Food and Drug Administration, 2010).

Jimmy John’s owner, John Liautaud, responded by stating the sandwich chain would replace alfalfa sprouts with clover sprouts since they were allegedly easier to clean (Associated Press, 2011c). However, a week earlier a separate outbreak had been identified in Washington and Oregon (still miss ya, Bill Keene) in which eight people were infected with Salmonella after eating sandwiches containing clover sprouts from a Jimmy John’s restaurant (Oregon Department of Human Services, 2011; Terry, 2011). This retailer was apparently not aware of the risks associated with sprouts, or even outbreaks associated with his franchisees.

The FDA inspection of the Tiny Greens facility found numerous issues which may have led to pathogen contamination, including “the company grew sprouts in soil from the organic material decomposed outside without using any monitored kill step on it,” mold was found in the mung-bean sprouting room, and the antimicrobial treatment for seeds was not demonstrated to be equivalent to the recommended FDA treatment (Roos, 2011).

Months later, Bill Bagby Jr, owner of Tiny Greens, was quoted as saying “after the changes we made, it’s next to impossible for anything to happen,” hindering communication efforts by being defensive and overconfident (Des Garennes, 2011; Sandman & Lanard, 2011). Bagby also expressed confidence in sprouts following the German outbreak, commenting that for many like him, the nutritional benefits outweigh the risk: “Sprouts are kind of a magical thing. That’s why I would advise people to only buy sprouts from someone who has a (food safety) program in place (that includes outside auditors). We did not have (independent auditors) for about one year, and that was the time the problems happened. The FDA determined that unsanitary conditions could have been a potential source of cross-contamination and so we have made a lot of changes since then.”

In the second week of October, 2013, three Jimmy John’s restaurants in the Denver Metro area reportedly served up sandwiches that sickened eight people with E. coli bacteria.

“We believe that their illness came from a produce item that was on those sandwiches that they ate,” said Alicia Cronquit, epidemiologist with the Colorado Department of Public Health and Environment.

Cronquist said all eight cases were reported between October 18th and 22nd, and all of the people impacted ate at Jimmy John’s between October 7th and 15th.

The Department of Public Health has not closed down the three restaurants, and will not identify their locations because Cronquist says they do not believe the restaurants are at fault.

“Our leading hypothesis for what’s happened is that there was a contaminated produce item that was distributed to the stores,” Cronquist said. “We have not identified any food handling issues at the particular establishments that we think would contribute to illness.”

Raw sprouts are the poster child for failures in what academics call risk communication.

About 1999, graduate student Sylvanus Thompson started working with me on risk analysis associated with sprouts. He got his degree and went on to rock-star status in the food safety world with the implementation of the red-yellow-green restaurant inspection disclosure program with Toronto Public Health, but we never published anything.

I remember frantically flying to Kansas City to hang out with this girl in Manhattan (Kansas) I’d met a couple of weeks before, in the midst of the 2005 Ontario raw sprout outbreak that sickened over 700; Jen Tryon, now with Global News, interviewed me at the airport, with me wearing a K-State hockey shirt (that’s the joke; there is no hockey at K-State, and I was still employed by Guelph; and I was going to hang out with this girl).

After the German E. coli O104 outbreak, along with the ridiculous public statements and blatant disregard for public safety taken by sandwich artist Jimmy John’s in the U.S., I figured we really needed to publish something.

The basic conclusions:

  • raw sprouts are a well-documented source of foodborne illness;
  • risk communication about raw sprouts has been inconsistent; and,
  • continued outbreaks question effectiveness of risk management strategies and producer compliance.

We document at least 55 sprout-associated outbreaks occurring worldwide affecting a total of 15,233 people since 1988. A comprehensive table of sprout-related outbreaks can be found here.

Sprouts present a unique food safety challenge compared to other fresh produce, as the sprouting process provides optimal conditions for the growth and proliferation of pathogenic bacteria. The sprout industry, regulatory agencies, and the academic community have been collaborating to improve the microbiological safety of raw sprouts, including the implementation of Good Manufacturing Practices (GMP), establishing guidelines for safe sprout production, and chemical disinfection of seed prior to sprouting. However, guidelines and best practices are only as good as their implementation. The consumption of raw sprouts is considered high-risk, especially for young, elderly and immuno-compromised persons (FDA, 2009).

In late December 2011, less than one year after making the switch to clover sprouts, Jimmy John’s was linked to another sprout related outbreak, this time it was E.coli O26 in clover sprouts. In February 2012, sandwich franchise Jimmy John’s announced they were permanently removing raw clover sprouts from their menus. As of April 2012, the outbreak had affected 29 people across 11 states. Founder and chief executive, John Liautaud, attempted to appease upset customers through Facebook stating, “a lot of folks dig my sprouts, but I will only serve the best of the best. Sprouts were inconsistent and inconsistency does not equal the best.” He also informed them the franchise was testing snow pea shoots in a Campaign, Illinois store, although there is no mention regarding the “consistency” or safety of this choice.

In spite of widespread media coverage of sprout-related outbreaks, improved production guidelines, and public health enforcement actions, awareness of risk remains low. Producers, food service and government agencies need to provide consistent, evidence-based messages and, more importantly, actions. Information regarding sprout-related risks and food safety concerns should be available and accurately presented to producers, retailers and consumers in a manner that relies on scientific data and clear communications.’

On Friday, Jan. 19, 2018, CDC along with public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) announced a multistate outbreak of Salmonella Montevideo infections that has sickened at least eight people.

Illnesses started on dates ranging from December 20, 2017 to January 3, 2018. Ill people range in age from 26 to 50, with a median age of 34. All 8 (100%) are female. No hospitalizations and no deaths have been reported.

Epidemiologic evidence indicates that raw sprouts served at Jimmy John’s restaurants are a likely source of this multistate outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Seven (88%) of eight people interviewed reported eating at multiple Jimmy John’s restaurant locations. Of these seven people, all seven (100%) reported eating raw sprouts on a sandwich from Jimmy John’s in Illinois and Wisconsin. This proportion is significantly higher than results from a survey[PDF – 29 pages] of healthy people, in which 3% reported eating sprouts on a sandwich in the week before they were interviewed. Two ill people in Wisconsin ate at a single Jimmy John’s location in that state.

Federal, state, and local health and regulatory officials are conducting traceback investigations from the six Jimmy John’s locations where ill people ate raw sprouts. These investigations are ongoing to determine where the sprouts were distributed, and to learn more about the potential route of contamination.

The information available to date indicates that raw sprouts served at Jimmy John’s restaurants in Illinois and Wisconsin may be contaminated with Salmonella Montevideo and are not safe to eat. CDC recommends that consumers not eat raw sprouts served at Jimmy John’s restaurants in Illinois and Wisconsin.

Failures in sprouts-related risk communication

Food Control.2012. 10.1016/j.foodcont.2012.08.022

Erdozain, M.S., Allen, K.J., Morley, K.A. and Powell, D.A.

http://www.sciencedirect.com/science/article/pii/S0956713512004707?v=s5

Nutritional and perceived health benefits have contributed to the increasing popularity of raw sprouted seed products. In the past two decades, sprouted seeds have been a recurring food safety concern, with at least 55 documented foodborne outbreaks affecting more than 15,000 people. A compilation of selected publications was used to yield an analysis of the evolving safety and risk communication related to raw sprouts, including microbiological safety, efforts to improve production practices, and effectiveness of communication prior to, during, and after sprout-related outbreaks. Scientific investigation and media coverage of sprout-related outbreaks has led to improved production guidelines and public health enforcement actions, yet continued outbreaks call into question the effectiveness of risk management strategies and producer compliance. Raw sprouts remain a high-risk product and avoidance or thorough cooking are the only ways that consumers can reduce risk; even thorough cooking messages fail to acknowledge the risk of cross-contamination. Risk communication messages have been inconsistent over time with Canadian and U.S. governments finally aligning their messages in the past five years, telling consumers to avoid sprouts. Yet consumer and industry awareness of risk remains low. To minimize health risks linked to the consumption of sprout products, local and national public health agencies, restaurants, retailers and producers need validated, consistent and repeated risk messaging through a variety of sources.

 

 

Jimmy Johns linked to sprout outbreak again

I can’t remember if this is outbreak number 3 or 4 (oops, it’s number 5 according to the Chicago Tribune) but Jimmy Johns, the sub folks, have been linked to a bunch of salmonellosis illnesses through sprouts again.

I wonder if their PR folks regret this sprout marketing ploy (right, exactly as shown) from a few years ago. Skull. Crossbones. Eat at your own risk. Nudge. Nudge. Say no more.

Yeah. And there are illnesses again.

“Food safety and the welfare of our customers are our top priorities and not negotiable in our business,” said James North, Jimmy John’s President and CEO, in a news release, adding the company is working with the various agencies in the investigation.

Here’s a table of over 75 sprout-related outbreaks going back to 1973. We’ll add this one when there are more details.

Nudge. Nudge.

 

Yup, they get into produce seeds, especially sprouts: Salmonella and E. coli internalization

Vegetable seeds contaminated with bacterial pathogens have been linked to fresh-produce-associated outbreaks of gastrointestinal infections. This study was undertaken to observe the physiological behavior of Salmonella enterica and enterohemorrhagic Escherichia coli (EHEC) cells artificially internalized into vegetable seeds during the germination process.

Surface-decontaminated seeds of alfalfa, fenugreek, lettuce, and tomato were vacuum-infiltrated with four individual strains of Salmonella or EHEC. Contaminated seeds were germinated at 25°C for 9 days, and different sprout/seedling tissues were microbiologically analyzed every other day. The internalization of Salmonella and EHEC cells into vegetable seeds was confirmed by the absence of pathogens in seed-rinsing water and the presence of pathogens in seed homogenates after post-internalization seed surface decontamination.

Results show that 317 (62%) and 343 (67%) of the 512 collected sprout/seedling tissue samples were positive for Salmonella and EHEC, respectively. The average Salmonella populations were significantly larger (P < 0.05) than the EHEC populations. Significantly larger Salmonella populations were recovered from the cotyledon and seed coat tissues, followed by the root tissues, but the mean EHEC populations from all sampled tissue sections were statistically similar, except in pre-germinated seeds. Three Salmonella and two EHEC strains had significantly larger cell populations on sprout/seedling tissues than other strains used in the study.

Salmonella and EHEC populations from fenugreek and alfalfa tissues were significantly larger than those from tomato and lettuce tissues. The study showed the fate of internalized human pathogens on germinating vegetable seeds and sprout/seedling tissues and emphasized the importance of using pathogen-free seeds for sprout production.

Fate of Salmonella enterica and Enterohemorrhagic Escherichia coli cells artificially internalized into vegetable seeds during germination

Appl. Environ. Microbiol. January 2018 84:e01888-17; Accepted manuscript posted online 27 October 2017, doi:10.1128/AEM.01888-17

Da Liu, Yue Cui, Ronald Walcott and Jinru Chen

http://aem.asm.org/content/84/1/e01888-17.abstract?etoc

 

 

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)

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.

 

 

Sprouts still suck: FDA sampling shows sprouts a problem

There’s a reason Walmart and Costco and Kroger stopped selling raw sprouts: they suck, meaning that, like raw milk, they cause a disproportionate percentage of illness based on low consumption rates.

The U.S. Food and Drug Administration wrote in a recent report sprouts are especially vulnerable to pathogens given the warm, moist and nutrient-rich conditions needed to grow them. From 1996 to July 2016, there were 46 reported outbreaks of foodborne illness in the U.S. linked to sprouts. The U.S. outbreaks accounted for 2,474 illnesses, 187 hospitalizations, and three deaths (and, tragically, many more in Canada, Australia, Japan and Europe).

A table of sprout-related outbreaks is available at http://barfblog.com/wp-content/uploads/2016/02/Sprout-associated-outbreaks-2-23-16.xlsx.

From the executive summary:

The U.S. Food and Drug Administration (FDA) set out to collect and test sprouts in 2014 as part of a new proactive and preventive approach to deploying its sampling resources with the ultimate goal of keeping contaminated food from reaching consumers.

The new approach, detailed in the Background section of this report (page 4), centers on the testing of a statistically determined number of samples of targeted foods over a relatively short period of time, 12 to18 months, to ensure a statistically valid amount of data is available for decision making. This approach helps the agency determine if there are common factors – such as origin, season, or variety – associated with pathogen findings.

The FDA issued the sprouts assignment in January 2014 under its new sampling model. The assignment targeted sprouts at three points in the production process (seeds, finished product and spent irrigation water), with the aim of collecting and testing 1,600 samples to determine the prevalence of select pathogens in the commodity. As background, the FDA designed its sampling plan such that if contamination of one percent or greater was present in the commodity, the agency would detect it. The FDA monitored the assignment closely to gather lessons learned and make changes to its sampling procedures if needed to address trends or food safety issues. About one year into the assignment, the FDA decided to stop its collection and testing at 825 samples because it had already collected samples on more than one occasion from many of the sprouting operations known to the agency and its state partners. The sample set acquired was sufficient for the FDA to estimate the bacterial prevalences in the commodity with a 95 percent confidence interval of 0% to 2% for a one percent contamination rate.

The FDA tested only domestically grown sprouts for this assignment because virtually all sprouts eaten in the United States are grown domestically due to the commodity’s delicate nature and relatively short shelf-life. Of note, the industry features a preponderance of relatively small operations.

The FDA tested the sprout samples for three pathogens: Salmonella, Listeria monocytogenes and Escherichia coli (E. coli) O157:H7. Based on the test results, the FDA found the prevalence of Salmonella in the finished product sprouts to be 0.21 percent. The agency also found that the prevalence of Salmonella in seeds (2.35%) was significantly higher than in finished product (0.21%) and in spent irrigation water (0.54%). Based on the test results, the FDA found the prevalence of Listeria monocytogenes in the finished product to be 1.28 percent. There was no significant difference in the prevalence of Listeria monocytogenes based on point in the production process. None of the samples tested positive for E. coli O157:H7. The agency did not test seed for E. coli O157:H7 due to limitations associated with the test method.

Among the FDA’s other findings, the agency found most of the positive samples at a small number of sprouting operations. Specifically, the FDA found violative samples at eight (8.5%) of the 94 sprouting operations visited for purposes of this assignment. The fact that the agency found multiple positive samples at some of these operations underscores the need for sprouting operations to comply with the agency’s Produce Safety Regulation (published November 2015), which seeks to prevent outbreaks of foodborne illness and improve sprout safety.

To address the positive samples, the FDA worked with the firms that owned or released the affected product to conduct voluntary recalls or to have their consignees destroy it, and then followed up with inspections. Of particular note, this sampling assignment helped detect and stop an outbreak of listeriosis while it still entailed a small number of cases, as described in the Public Health Impact section of this report (page 14). This assignment also prompted six product recalls.

The FDA will continue to consider microbial contamination of sprouts and how best to reduce it. Such contamination remains a concern to the FDA given the aforementioned outbreak and the recalls initiated. Going forward, the FDA intends to inspect sprouting operations to ensure they are complying, as applicable, with the Produce Safety Rule, which includes new requirements for sprouts growers. The agency has no plans to conduct additional large-scale sampling of sprouts at this time but may sample the commodity in accordance with its longstanding approach to food sampling, which centers on (but is not limited to) the following criteria:

  • A firm has a previous history of unmitigated microbial contamination in the environment (e.g., human illness, recalled or seized product, previous inspectional history, or environmental pathogens without proper corrective actions by the facility), or
  • Inspectional observations that warrant collection of samples for microbiological analyses.

The complete report is available at https://www.fda.gov/downloads/Food/ComplianceEnforcement/Sampling/UCM566981.pdf?source=govdelivery&utm_medium=email&utm_source=govdelivery

94 sickened: Sprouted chia seed powder – USA and Canada, 2013–2014

Salmonella is a leading cause of bacterial foodborne illness. We report the collaborative investigative efforts of US and Canadian public health officials during the 2013–2014 international outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder.

The investigation included open-ended interviews of ill persons, traceback, product testing, facility inspections, and trace forward.

Ninety-four persons infected with outbreak strains from 16 states and four provinces were identified; 21% were hospitalized and none died. Fifty-four (96%) of 56 persons who consumed chia seed powder, reported 13 different brands that traced back to a single Canadian firm, distributed by four US and eight Canadian companies.

Laboratory testing yielded outbreak strains from leftover and intact product. Contaminated product was recalled. Although chia seed powder is a novel outbreak vehicle, sprouted seeds are recognized as an important cause of foodborne illness; firms should follow available guidance to reduce the risk of bacterial contamination during sprouting.

 

Dirty UK hospitals serving out-of-date poorly stored food

I wrote a letter to the hospital in Brisbane where my friend has been holed up, complaining about serving sandwiches with raw sprouts to sick people – or anyone.

brisbane-hospital-foodThere was some totally unscientific answer about how these sprouts were special because they came from a different place and they disappeared from the sick persons menu for a few weeks.

The sprouts are now back.

Nothing new, food hygiene reports obtained by the Press Association under the UK Freedom of Information Act and data from the UK Food Standards Agency (FSA) concluded that dirty hospitals are serving out-of-date food to patients.

Meals are being prepared in mouldy kitchens, putting vulnerable patients at “high risk” of food poisoning, while others have unclean worktops, food trolleys and sinks.

FSA data also revealed poor rankings for hundreds of care homes and children’s nurseries.

Some 400 hospitals, hospices, care homes, nurseries and school clubs are currently listed as needing “major”, “urgent” or “necessary” improvement.

One care home was infested with cockroaches while another had evidence of rats.

The Patients Association has called the findings “shameful” and “immensely worrying”.

The Food Hygiene Rating Scheme – which rates organisations and businesses from zero to five – is run by the FSA and councils in England, Wales and Northern Ireland.

The investigation found:

Eight health and care premises currently have a zero rating – which means urgent improvement is necessary. None are hospitals.

Some 187 have a rating of one – which means major improvement is necessary. Three of these are hospital premises, including the private Priory Hospital in Altrincham, Cheshire (because in the UK, like its bastard child, Australia, private is considered better, except when it comes to the basics)..

hospital-foodAnd 205 are ranked as two – improvement necessary. They include six hospitals and about 100 care homes. Among those given the ranking of two was Glenfield Hospital in Leicester.

At Glenfield Hospital in Leicester, an inspection of its kitchens serving patients found:

Sliced chicken two days past its use-by date (hello, Listeria?).

Staff had created their own date labels for when they thought food should be used, creating a “high risk” for patients who might develop food poisoning (food fraud)).

The experts also found leaking sinks, “inadequate” knowledge among staff about how to handle food safely, and mouldy areas, including the salad preparation room.

Food was being kept in fridges with temperatures up to 13C despite rules saying they should be 5C or below to prevent bacteria developing.

Darryn Kerr, director of facilities at Leicester’s Hospitals, said the organisation was “disappointed” by the ratings.

He said catering services were brought back in-house in May after being run by an external provider.

Parkview Residential Care Home in Bexleyheath, south-east London, was found to have an “infestation of Oriental cockroaches” during an August inspection.

The kitchen was closed voluntarily for the second time following a previous warning and inspectors gave it a zero rating.

Ivy House care home in Derby, which specialises in dementia care, scored zero after inspectors found evidence of rat activity.