It was probably the kitchen sink: 82 sick with Salmonella from UK restaurant 2015-16

From Eurosurveillance:

It is estimated that over 38,000 community cases of salmonellosis occur annually within the United Kingdom (UK) [1,2]. Salmonellosis often results from consumption of contaminated food or water [3], however, transmission via asymptomatic shedding by food handlers and exposure to contaminated environments where conditions are favourable for pathogen survival have also been implicated [3,4]. Here we report the findings of an investigation of an outbreak of salmonellosis where the environment was pivotal in continued transmission.

On 7 March 2015, Public Health England (PHE) East Midlands was alerted by the clinical microbiology laboratory of a local hospital to 21 cases of Salmonella enterica serovar Typhimurium gastroenteritis, with onset in February 2015. Seven cases in this initial phase of the outbreak required hospitalisation. Following this notification we suspected there was a community outbreak of S. Typhimurium; investigations and attempts to control the outbreak followed.

Hypothesis-generating interviews at the outset of the investigation identified that several cases had eaten at the same restaurant during the incubation period for their illness. Descriptive epidemiological analyses including subsequent cases pointed to the restaurant being the likely source. This popular, purpose (newly) built restaurant had opened only 18 months before the outbreak. The restaurant offered a full table-service menu, self-service salad bar and hot self-service carvery buffet serving roasted meats (turkey, beef, gammon and pork at weekends) and vegetables and condiments. Despite interventions to control the initial outbreak, cases continued to emerge followed by a prolonged period of transmission until 2016. The evolution of the investigation into this community outbreak and subsequent control measures is described, with specific reference to the use of whole genome sequencing (WGS) to link isolates and the role of the drains in continued pathogen transmission.

Mapping and visual inspection of the drainage systems identified significant issues. Water filled traps (u-bends) designed to prevent foul air flow from the drainage system into the building had failed and smoke testing revealed some ineffective drain seals, potentially allowing contaminated bio-aerosol to be disseminated into the kitchen. One sink drain was not connected to any drainage system with waste water pooling under the floor. Other larger drains had failed after leaking waste-water washed away the supporting substrate forming a cavity under the kitchen area. It transpired at that point that drainage water had, on occasion, risen into the kitchen area, although this had not been previously reported. Substantial remedial works were undertaken, however, these were found to have failed on re-inspection and so these drains were later decommissioned.

Biofilm [15] and flooded areas in underfloor cavities may have sustained this outbreak, after repeated environmental cleaning failed. Drainage problems in one area of the kitchen led to liquid from the drains seeping into the kitchen suggesting a contamination pathway. We found isolates matching the outbreak strain on kitchen cloths, swabs from kitchen sinks, and pot wash areas suggesting contact with sinks may have provided a second contamination pathway. We also identified ineffective drain water-traps potentially allowing the movement of contaminated bio-aerosols [13]. Smoke tests demonstrated the potential for dissemination of foul air into the kitchen.

Investigation using whole genome sequencing of a prolonged restaurant outbreak of salmonella typhimurium linked to the building drainage system, England, February 2015 to March 2016

Eurosurveillance, John Mair-JenkinsRoberta Borges-StewartCaroline HarbourJudith Cox-RogersTim Dallman, Philip AshtonRobert JohnstonDeborah ModhaPhilip MonkRichard Puleston,  https://doi.org/10.2807/1560-7917.ES.2017.22.49.17-00037

http://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2017.22.49.17-00037

 

Checklist culture to reduce risk

Tina Rosenberg of the New York Times follows up her ‘machines that go ping’ piece about hi-tech handwashing compliance techniques with a low-tech approach that seems ridiculously successful: checklists.

“In 2003, the Michigan Health and Hospital Association began an experiment to see if its members could bring down the rate of infection in central line catheters — one of the deadliest types of hospital-acquired infections.

“The intensive care units at nearly every hospital in Michigan participated — 103 I.C.U.’s. What they had to do was use a five-point checklist to prevent infection when inserting the catheters. The steps were: Wash hands. Cover the patient with sterile drapes. Clean the skin with chlorhexidine antiseptic. Do not insert catheters into the groin area. Remove catheters as soon as they are no longer needed.

“A paper in the New England Journal of Medicine by Peter Pronovost, the Johns Hopkins University doctor who designed the checklist, set out the results.

“’Within 3 months after implementation, the median rate of infection was 0, a rate sustained throughout the remaining 15 months of follow-up. All types of participating hospitals realized a similar improvement.’”

“Atul Gawande wrote about the checklist in The New Yorker, and went on to write a book called “The Checklist Manifesto.” In his article, he talks about how the checklist makes each step explicit and helps harried doctors and nurses to remember all of them. …

“The checklist itself probably isn’t useful for routine hand-washing — there would be only one item on it. What is useful is borrowing the way the checklist replaces a culture of “no questions” with a culture of “patient safety comes first and it is part of my job to speak up.”

“One very valuable source for ways to improve hand-washing rates comes from the health care industry’s Joint Commission Center for Transforming Healthcare Hand Hygiene Project. The project worked with eight hospitals to implement pilot programs designed to raise hand-washing rates in different ways. A solution that helped almost everywhere was to streamline workflow to make it easier and more automatic to wash hands: for example, to put sinks in the same place in every room, with a table to put down items the nurse might be carrying. Keep supplies in every room so nurses don’t have to go in and out to get them.

But the project also found, as many readers suggested, that hospital managers needed to elevate hand-washing as a priority, stress its importance, and hold all hospital workers accountable. Accountability requires knowing the hand-washing rates of different units and people, which is why the technological systems I wrote about on Tuesday can be important. But data only matters if it is used. Once hospitals can know their workers’ hand-washing rates, they need to use the information for coaching and to create incentives — both negative and positive.”
 

Dirty dining in Vegas: Hot N Juicy Crawfish

I’m not sure I understand the difference between crayfish and crawfish (wiki gives it a shot) but after posting about vibrio from crayfish, a devoted barfblogger sent this story from Las Vegas about the Hot and Juicy Crawfish.

KTNV reports the Southern Nevada Health District recently paid a visit to the restaurant and slapped it with 49 demerits, prompting its closure.

Inspectors found cooked crawfish being stored at the wrong temperature, live crawfish in a sink next to dirty dishes, dirty floors – including dead crawfish on the floor of a walk-in freezer – and dried food debris caked to shelves and "clean" kitchen knives.

Inspectors also say three employees were working without valid health cards, a requirement for anyone working with or around food, and a kitchen worker was cited for not properly washing his hands after handling the trash.

Open once again with an "A" grade after re-inspection, Channel 13 Action News stopped by Hot and Juicy Crawfish to speak with the manager about the restaurant’s high number of demerits.

An employee interviewed by KTNV — Channel 13 Action News — said the owner was not available but subsequently added, “We’re not the dirtiest restaurant in Las Vegas. It was a lot of little technicalities. “
 

Three California KFC employees take a dip in restaurant’s sink

Don’t slaughter goats in the restaurant kitchen; don’t moon drive-through customers at the Dairy Queen, and don’t make your girls gone wild demo tape in the commercial dishwashing sink at the KFC where you work.

Three Anderson, California girls (right) decided to go for a dip in the sink at the local Kentucky Fried Chicken, and one of the girls thought only her close friends who would never tell would see the pics so she decided to share on MySpace.

The Redding Record Searchlight reports the photos had been filed under a gallery called “KFC moments.” Captions for the photos included “haha KFC showers!” and “haha we turned on the jets.” …

Although the pictures were available to the public earlier today, all of the photos on the girl’s site were restricted to private viewers tonight.

Restaurant sinks are not bathtubs

An Ohio man is in hot water for taking a hot bath in a Burger King bathtub. The video shows a man sitting in the sink, while other employees look on laughing. At one point the employee with the camera goes to ask the manager if she wants to come watch. The manager declines, but also fails to take any action. The video was then posted on Myspace. The fast food restaurant has fired all employees involved. They added that the sink was sanitized twice and all utensils were thrown out. Health officials are working with prosecutors to see if charges will be filed. However the health department has declined to issue any fines. If bathing in a kitchen sink isn’t worth a fine, what is?

The video contains some not safe for work language.
 

Burger King Employee Takes Bath In Sink – Watch more free videos