Save Lives: Clean Your Hands

Megan Hardigree, a research associate at Kansas State University working on hand hygiene, writes that this year, Cinco de Mayo wasn’t just a holiday to celebrate the Mexican army’s victory over the French in the Battle of Puebla (yesterday) or a song by the band, Cake. It was also a day to celebrate the launch of the World Health Organization’s (WHO) newest hand hygiene campaign: Save Lives: Clean Your Hands.

The aim of Save Lives: Clean Your Hands is to stop the spread of infection by increasing hand hygiene of healthcare workers. This is said to be the next step of the original, Clean Care is Safer Care, from 2005. The initiative persuades individuals to join the movement with gain-framed messages (they apparently encourage positive behavior) such as “Help stop hospital acquired infections in your country” and “Make patient safety your number one priority.”

To help support this initiative, WHO has accompanied the promotion with a variety of tools and resources to aid healthcare facilities in promoting and enforcing better hand hygiene. These tools include: tools for system change, tools for training and education, tools for evaluation and feedback, tools as reminders in the workplace, and tools for institutional safety climate. My personal favorite, mostly because of the fun diagram, is in the “tools as reminders in the workplace” which includes “My 5 Moments for Hand Hygiene:”

• before touching a patient;
• before clean/aseptic procedures;
• after body fluid exposure/risk;
• after touching a patient; and,
• after touching patient surroundings.

 “Be a part of a global movement to improve hand hygiene, “ says WHO.

Now to evaluate whether any of these messages actually compel people to wash their hands.

The swine flu problem isn’t in the pigs

As easy as it may be to assume, there’s no evidence that the swine flu spreading through Mexico and beyond is sickening pigs now.

The World Health Organization reports that illnesses in Mexico are climbing close to 1,000 with more than 50 deaths—all of which are human. Eighteen of those cases were laboratory confirmed by labs in Canada.

Though, as a precaution, the Canadian Food Inspection Agency is “asking swine producers, veterinarians and labs to increase their vigilance in monitoring for and reporting swine disease.”

Is that a better use of resources than increasing monitoring activities of flu-like symptoms in humans?

The Public Health Agency of Canada website says of human swine influenza, “Sporadic human infections with swine flu have occurred, however these are usually caused by direct exposure to pigs,” and, “Human to human transmission of swine influenza has been documented.”

Are Canadians getting the whole story? Is this the best way to protect public health?

In the US, the Centers for Disease Control and Prevention have identified 20 human cases of swine flu in several states, and an investigation website outlines what is known about the virus to this point (it’s susceptible to certain antiviral drugs) and the steps being taken to find out more.

This information gives the public a better picture of the possible risks to their health and how those risks are being managed.

The interested public can generally handle more, not less, information about food safety.

Courtlynn Powell: Swine flu’s making me nervous

Daughter and would-be blogger Courtlynn (below right, exactly as shown) writes that,

“Coming home from school this afternoon, a rush of fear and anxiety seemed to linger. 20 people died in Mexico. 500 nurses in Mexico have this, as well as people returning from Canada, in the past week. It’s spread from California to Texas.”

The N.Y. Times reports this morning that Mexican officials, scrambling to control a swine flu outbreak that has killed as many as 61 people and infected possibly hundreds more in recent weeks, closed museums and shuttered schools for millions of students in and around the capital on Friday, and urged people with flu symptoms to stay home from work. …

The new strain contains gene sequences from North American and Eurasian swine flus, North American bird flu and North American human flu, said the Centers for Disease Control and Prevention. A similar virus has been found in the American Southwest, where officials have reported eight nonfatal cases. …

Mexico’s flu season is usually over by now, but health officials have noticed a significant spike in flu cases since mid-March. The W.H.O. said there had been 800 cases in Mexico in recent weeks, 60 of them fatal, of a flulike illness that appeared to be more serious than the regular seasonal flu. Mexican officials said there were 943 possible cases.

Still, only a small number have been confirmed as cases of the new H1N1 swine flu.

Buying fresh produce is an act of faith: Here’s why

Buying any sort of fresh produce is an act of faith. The Associated Press explains why in a story today.

At the end of a dirt road in northern Mexico, the conveyer belts processing hundreds of tons of vegetables a year for U.S. and Mexican markets are open to the elements, protected only by a corrugated metal roof.

The U.S. Food and Drug Administration suspects this packing plant, its warehouse in McAllen, Texas, and a farm in Mexico are among the sources of the United States’ largest outbreak of food-borne illness in a decade, which infected at least 1,440 people with a rare form of salmonella.

A plant manager confirmed to The Associated Press that workers handling chili peppers aren’t required to separate them according to the sanitary conditions in which they were grown, offering a possible explanation for how such a rare strain of salmonella could have caused such a large outbreak.

The AP has found that while some Mexican producers grow fruits and vegetables under strict sanitary conditions for export to the U.S., many don’t — and they can still send their produce across the border easily.

Neither the U.S. nor the Mexican governments impose any safety requirements on farms and processing plants. That includes those using unsanitary conditions — like those at Agricola Zaragoza — and brokers or packing plants that mix export-grade fruits and vegetables with lower-quality produce. …

(There) is no public list of the chains that require sanitary practices, meaning there’s no way to know whether the fruit and vegetables in any particular store is certified or not. …

Agricola Zaragoza is one of the uncertified plants, manager Emilio Garcia told the AP. He said the packing plant washes produce from both certified and uncertified producers, opening up the possibility for contamination. He refused to give details about his suppliers. …

Kathy Means, a vice president for the U.S. Produce Marketing Associations, said food safety is in the hands of the food industry, with most major produce buyers requiring both U.S. and foreign food producers to have third-party audit programs. However, Means said, not all buyers follow the same rules.

"It’s not government-regulated, so it’s up to the company to require it.”

I say, cut the BS and start deliberately marketing food safety. That way, someone has to back it up; not some dance with an auditor or certifier, or some other third party that has nothing to do with credibility and everything to do with providing distance when the shit hits the fan – or the produce.

Salmonella Saintpaul found in irrigation water and serrano pepper at a Mexican farm

Follow the poop. And it usually leads to water. Poop in the water, which then gets on produce.

Dr. David Acheson, the Food and Drug Administration’s food safety chief, has just told a congressional hearing in Washington that the Salmonella Saintpaul strain that has sickened 1,307 people in 43 States and Canada has been found in irrigation water and a serrano pepper at a Mexican farm.

Acheson said the farm is in Nuevo Leon, Mexico. Previously, the FDA had traced a contaminated jalapeno pepper to a farm in another part of Mexico.

Associated Press reports that if it turns out the tainted irrigation water was also used on tomatoes, it could provide some of the evidence that federal authorities are looking for to back their original focus on the fruit.

Strict safety guidelines enforced as produce travels from Mexico

The Dallas Morning News ran a couple of excellent features on the flow of food from Mexico to the U.S. Yesterday’s story was about the lack of inspectors, how little product was actually inspected, and, perhaps unwittingly, the problem of inspecting fresh produce for microbial contaminants.

“In December, officials took a sample for testing from a 5,500-pound load of Mexican basil moving through the Otay Mesa border crossing in San Diego. The basil continued on to its destination and was sold to restaurants and other customers in California, Texas and Illinois the next day. When the test results came back two weeks later, they suggested salmonella contamination, sparking a late recall.”

It’s much better to design safety into all operations, beginning on the farm.

Glenn Fry helps run Taylor Farms de Mexico’s new $14 million plant in San José Iturbide, Mexico. He picked the land where it sits, designed just about every facet of it, and he manages more than 800 workers who plant, harvest and package produce – including lettuce, onions and broccoli – for export to the U.S.

Today’s story says that Taylor Farms is just one of a handful of U.S. companies lured by Mexico’s ideal year-round growing climate, proximity to Texas, low labor costs and plentiful workforce.

During a recent lettuce harvest, quality-control supervisor Laura Patino pointed to an aide who monitors workers coming out of the mobile toilets at the end of the fields to make sure they wash their hands before returning to work.

"Many of our workers don’t even have toilets at home, so this is new to them," Ms. Patino explains. "We’ve literally taught many of them how to go to the restroom. It’s that basic."

The lettuce field – owned by Oscar A. Bitar Macedo and leased by Taylor – is fenced off from outside "contamination." Heavy strips of yellow plastic keep out dogs, cattle and other livestock.

Mr. Bitar, owner of Rancho Don Alberto, leases all of his 100 hectares (about 247 acres) to Taylor. And he’s responsible for maintenance, water wells, monthly water testing, fencing, security guards and, yes, even toilet paper. …

Within two hours, 24 boxes, each holding about 850 pounds of lettuce, are transported to Taylor’s plant a few miles down the road for the first of several safety checks.

At the entrance, 19-year-old Efigenia Rosas checks the boxes to make sure they’re labeled with bar codes identifying the owner’s farm, crew supervisor, field and time of harvest – a crucial step in the process. If a consumer later finds a problem, Taylor can trace the produce back to the field and farmer. …

At 6 p.m., driver Roman Ayala, an employee of Flensa Trucking, begins the drive north on Mexico’s Highway 57. He’s in no rush because he has no chance of getting to Nuevo Laredo before Customs shuts down the bridge at 11 p.m. And it won’t reopen until 8 a.m., something that frustrates Mr. Fry to no end.

"How can the U.S. government be serious about food safety when they shut down the border overnight and perishable goods have to sit there and wait?" he asks.

There is also a good video overview of the lettuce harvesting procedures available along with the story at

Fresh tomatoes sicken 30 with Salmonella in New Mexico

Health officials have announced that those cases of Salmonella St. Paul that have been popping up in New Mexico for the past three weeks have been linked to fresh tomatoes.

Dr. Mike Landen, deputy state epidemiologist with the Department of Health, said,

"We have alerted physicians and hospitals around the state to be on the lookout for people presenting with fever and diarrhea and to test those people for salmonella. We are asking the public to take general precautions to avoid being exposed to salmonella and to seek health care if they develop a severe illness with fever and diarrhea."

The department says some of the infected tomatoes were bought from a Wal-Mart in Las Cruces or Farmington, a Lowe’s in Las Cruces or Bashas’ in Crownpoint. But they say other stores are probably selling the tomatoes too.
Health officials are still trying to pinpoint which tomatoes are carrying the bacteria.

A table of tomato-related North American outbreaks is available at

Tomatoes are one type of fresh produce where it appears pathogens like Salmonella can be internalized, which means washing is of little use. The problems need to be prevented on the farm. Regulators and the industry in the past have have released food safety guidelines for tomatoes, but there is a lack of verification; it is unclear if all growers are actually following the guidelines.

Guidelines are a first step, but we need more creative ways to compel everyone, from the person harvesting to the person distributing, to take food safety seriously, even in the absence of an outbreak. Here are some references for the work we’ve done.

Luedtke, A., Chapman, B. and Powell, D.A. 2003. Implementation and analysis of an on-farm food safety program for the production of greenhouse vegetables. Journal of Food Protection. 66:485-489.

Powell, D.A., Bobadilla-Ruiz, M., Whitfield, A. Griffiths, M.G.. and Luedtke, A. 2002. Development, implementation and analysis of an on-farm food safety program for the production of greenhouse vegetables in Ontario, Canada. Journal of Food Protection. 65: 918- 923.

We also published a book chapter entitled Implementing On-Farm Food Safety Programs in Fruit and Vegetable Cultivation, in the recently published, Improving the Safety of Fresh Fruit and Vegetables.

Norovirus (?) strikes Socorro, New Mexico

Manhattan (Kansas) already feels empty as Kansas State University prepares for the annual adolescent orgy of excess known as Spring Break.

Two years ago I experienced my first U.S.-style spring break with Amy and we went on the great Tex-Mex road trip, heading south through Oklahoma and then west to Albuquerque.

We stayed for an hour; didn’t like it. So we headed south, stopping for the night in Socorro, NM. We spent the next morning walking around the campus of New Mexico Tech, raising suspicions by wandering to close to classified areas, and checking out the PhD hair salon. Then it was off to a bizarre encounter in Truth or Consequences, NM, and eventually to Tuscon.

But back to Socorro. On March 6, 2008, the Student Health Center issued a statement saying the

New Mexico Tech campus has identified an outbreak of an intestinal disorder (gastroenteritis). … We are working with the N.M. Department of Public Health to identify the specific type of pathogen and how to treat it. … Hand-washing and hand sanitizers are effective methods to reduce the spread of pathogens Surface sanitizing with chlorine based-cleaners is recommended in areas where a virus may be present on surfaces. Residential Life has already begun a marketing campaign to encourage hand- washing. Facilities Management and Residential Life staff also are using different cleaning products to decrease the spread of the suspected virus.

However, a student informs that students began blogging about norovirus striking the campus before March 2, 2008.

On March 3, 2008, another student blogs that they were questioned about what they had eaten at Chartwells, but doesn’t identify who questioned them. On March 4, 2008, a student posts on their blog that they were questioned by the N.M. Health Department about their diet for the previous five days. Another student reports on March 6, 2008, after the warning was issued by the Student Health Center, that,

"It’s a little late for this warning. My friends and I were all sick at different points over the last two weeks."

Our correspondent reports,

"I was around for "Death Meal 82" and "Death Meal 85" (no one actually died) living in town but I suspect a lot of people have either forgotten those events or are hoping to avoid bad publicity for the school/town. Death Meal 85 was eventually identified as a bucket full of raw chicken that was subsequently used to carry ice to the ice machine."

Local media has shown almost no interest in the outbreak.