Archive for the ‘Front Page’ Category

The Terms of Germ Inactivation

Friday, May 20th, 2016

Reducing disease-causing microorganisms—aka “pathogens” or “germs”—on environmental surfaces is a matter of using the right agent for the task at hand.  You would no sooner wash your hands in a bleach solution after gardening than expect surgical instruments to be prepared by washing them in soapy water.

Terms that apply to germ reduction on surfaces—cleaning, sanitizing, disinfecting and sterilizing—have distinct definitions, but they are often misused.  To help you navigate these terms, please see the table below:

Vocabulary of Germ Inactivation on Environmental Surfaces1

TERM

PURPOSE

USE

EXAMPLES of AGENTS

NOTES

Cleaning

Removes visible dirt, impurities and pathogens using chemical or physical means.

Cleaning is appropriate when surfaces are visibly dirty.
When a surface is both visibly dirty and contaminated, and requires sanitizing or disinfecting, cleaning is the first step.

Water, detergent, enzymatic products

Cleaning does not remove all pathogens and does not necessarily kill them.  If cleaning tools are used on multiple surfaces before being sanitized, cross-contamination can occur.

Sanitizing

Lowers the number of pathogens on surfaces using chemical or physical means.  Pathogen numbers are lowered to a safe level, which is determined by a given public health standard or set of requirements.

Food-contact surfaces such as commercial deli slicers must be cleaned and sanitized on a regular basis. Other examples are the diaper-changing tables in day care centers and shared toys.

Water, detergent, enzymatic products, also liquid chemicals (e.g., alcohols, glutaraldehyde, formaldehyde, hydrogen peroxide, iodophors, ortho-phthalaldehyde, peracetic acid, phenolics, quaternary ammonium compounds, and sodium hypochlorite bleach solutions), wet pasteurization

Sanitizing works by cleaning and/or disinfecting to lower the risk of spreading infection. Sanitizing is often thought to be synonymous with disinfecting, but there is a subtle difference in that sanitizing lowers pathogen numbers to a particular standard.

Disinfecting

Kills many or all pathogens on surfaces (except bacterial spores) using chemical or physical means.
There are different degrees of disinfection depending on the purpose or use of the item being disinfected.

Low level disinfection is used for example for common items, such as toilets that do not pose significant risk while high level disinfection is used in healthcare for items that enter the body, such as endoscopes.

Liquid chemicals (e.g., alcohols, glutaraldehyde, formaldehyde, hydrogen peroxide, iodophors, ortho-phthalaldehyde, peracetic acid, phenolics, quaternary ammonium compounds, and sodium hypochlorite bleach solutions), wet pasteurization

For soiled surfaces, disinfecting should follow cleaning to ensure the disinfectant is not “used up” in reacting with dirt and other impurities.

Sterilizing

Destroys all forms of microbial life, including bacterial spores, using chemical or physical means.

Surgical instruments must be sterile.

Gamma and x-ray radiation
Ethylene oxide gas, steam under pressure, dry heat, hydrogen peroxide gas plasma, liquid peracetic acid

Sterilizing is preceded by cleaning.
There is no validity to the term “partially sterile.”

A Word about Antiseptics

Agents that kill germs on living tissue and skin are known as antiseptics.  Examples of antiseptics include alcohol in mouthwashes and chlorhexidine, and other anti-microbial agents in products designed to prepare skin surfaces for surgery or administering intravenous fluid.  CDC notes that antiseptics generally are not used on environmental surfaces.  By the same token, sanitizers, disinfectants and sterilants are not used as antiseptics because they can injure the skin and other tissues.

We hope this short article is a helpful resource in clarifying the terms of germ inactivation.

Click here to download this article.


1CDC sources include: Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 and
How to Clean and Disinfect Schools to Help Slow the Spread of Flu

Your Health in their Hands: Hand Hygiene in Healthcare Settings

Friday, May 13th, 2016

Would you be surprised to learn that healthcare professionals, on average, clean their hands less than half the number of times they should?  That statistic comes from a US Centers for Disease Control and Prevention (CDC) press release announcing a new campaign, “Clean Hands Count.” CDC is “urging healthcare professionals, patients, and patients’ loved ones to prevent healthcare-associated infections by keeping their hands clean.”

Logo for CDC’s new hand hygiene campaign

In an age of astounding advances in medical technology, it is ironic that one of the simplest methods known to avoid spreading pathogens is overlooked so often.  CDC estimates 722,000 infections are contracted each year in US hospitals, and that 75,000 patients die of these infections during their hospital stay.  Good hand hygiene will help reduce these infections and deaths.

CDC’s 2002 guidelines for hand hygiene in healthcare settings include a thorough review of soaps, alcohols, and other hand hygiene agents, how to select an agent, techniques for using each agent, skin care, and more.  CDC notes that alcohol-based hand sanitizers are the preferred method of hand cleaning when hands are not visibly dirty1.  That’s because alcohol-based cleaners:

  • Are more effective at killing potentially deadly germs on hands than soap
  • Require less time to apply
  • Are often more accessible than hand washing sinks
  • Produce reduced bacterial counts on hands compared to hand washing
  • Are less irritating and drying than soap and water

Setting the Record Straight
As part of its campaign, CDC is addressing hand hygiene “myths and misperceptions:”

Myth

Fact

Using alcohol-based hand sanitizer contributes to antibiotic resistance. Alcohol-based sanitizer kills germs quickly and in a different way than antibiotics.  Using these sanitizers does not contribute to antibiotic resistance.
Alcohol-based hand sanitizers kill all the germs found in healthcare settings. Alcohol-based sanitizers kill most of the bad germs found in healthcare settings, but they do not kill “C. diff,” a bacterial “super bug” infection that causes severe diarrhea.  Hand washing with soap and water is more effective than alcohol-based hand sanitizers against C. diff.
Alcohol-based hand sanitizers cause hands to develop dry skin. Alcohol-based hand sanitizers are less irritating to hands than frequent use of soap and water.
Patients in healthcare settings are powerless to avoid new infections. Patients and their loved ones can remind healthcare providers to clean their hands.  They can ask tactfully, e.g., “Would it be alright if you cleaned your hands before you examine me?” They should also “practice what they preach” and clean their own hands often.

How often hand hygiene is needed per worker shift depends upon the particular tasks to be done and the amount of contact with  the patient, patient equipment and patient environment.  CDC discusses observational studies in hospitals in which healthcare workers washed their hands on average 5 to 30 times per shift, but notes that some nurses washed their hands as many as 100 times per shift.

We commend CDC for its renewed focus on hand hygiene.  Given the fact that on any given day, about one in 25 hospital patients has at least one healthcare associated infection, we agree it’s time to reconsider the hygiene of the hands that heal.

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.
Barbara M. Soule, R.N. MPA, CIC, FSHEA is an Infection Preventionist and a member of the Water Quality & Health Council.

Click here to download this article.


1 Wash visibly dirty hands first with soap and water and then apply alcohol-based hand sanitizer.

Elizabethkingia anophelis Outbreak in Wisconsin: A Mystery for CDC Disease Detectives

Friday, April 29th, 2016

What causes a bacterium that is ubiquitous in soil, rivers, water reservoirs and the guts of mosquitoes to suddenly cause an outbreak of human infection? The bacterium is Elizabethkingia anophelis1, and the outbreak is affecting at least 12 Wisconsin counties. The common source of the outbreak remains a mystery at this time. According to the World Health Organization, the current US outbreak (it also includes one case each in Illinois and Michigan) is the largest of Elizabethkingia anophelis on record.

A Very Rare Infection

Although it is common in the environment, Elizabethkingia anophelis only rarely makes people sick, according to the US Centers for Disease Control and Prevention (CDC). In fact, most states typically report no more than five to ten Elizabethkingia anophelis infections per year. Currently, the Wisconsin Department of Health Services website notes 59 confirmed and four possible cases of infection, including 19 deaths.  Symptoms of infection include fever, shortness of breath, chills or cellulitis (a potentially serious bacterial skin infection).

Elizabethkingia anophelis is known as an opportunistic bacterium, which means it normally does not cause disease, but can do so under the right circumstances, such as when a human host’s immune system is compromised.  Most Elizabethkingia anophelis infections occur in people over the age of 65 and are associated with healthcare environments.  A few cases of infection with the bacterium in newborns were associated with meningitis. Elizabethkingia anophelis usually infects the bloodstream of adults but has also been isolated from respiratory systems or joints.

Though not considered a “superbug,” the bacterium is resistant to many antibiotics. According to the Wisconsin Department of Health Services, it has “identified effective antibiotic treatment for Elizabethkingia, and has alerted health care providers, infection preventionists and laboratories statewide.”

Because victims usually have severe underlying health conditions, it may be unclear whether the bacterium caused death or was a contributing factor in death. To complicate matters, the CDC lab in Atlanta is the only lab that can distinguish Elizabethkingia anophelis from the closely related Elizabethkingia meningoseptica, another emerging pathogen associated with infections in immunocompromised individuals and meningitis in newborns.  Therefore, it is possible that cases of Elizabethkingia anophelis are underreported.

Addressing the Outbreak

CDC and Wisconsin Department of Health Services “disease detectives” are working diligently to identify a common source of Elizabethkingia anophelis infection. Potential sources include food, water, medications, personal care products and medical equipment. Given the population affected thus far, healthcare facilities, including hospitals, nursing homes and long‐term care facilities are likely venues for investigation. Meanwhile, according to the Wisconsin Department of Health Services website, guidance from health officials is promoting more rapid identification of cases, timely treatment and improved outcomes for patients.

While not a concern for most healthy people, the current outbreak of Elizabethkingia anophelis infection is an excellent example of an unfolding disease investigation that includes the essential elements of disease monitoring, reporting and communicating.

Barbara M. Soule, R.N. MPA, CIC, FSHEA is an Infection Preventionist and a member of the Water Quality & Health Council. 

Fred M. Reiff, PE, is a retired official from both the US Public Health Service and the Pan American Health Organization, and lives in the Reno, Nevada area. 

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, Minnesota.
Click here to download this article.

 


1 Elizabethkingia anophelis was named after its CDC bacteriologist discoverer, Elizabeth O. King.

Aedes Mosquitoes: A Force in Human History

Friday, April 22nd, 2016

Aedes aegypti mosquito The female mosquito draws blood with a long, pointed mouthpart called a proboscis.
Image courtesy of the CDC website.

 

At the center of the current Zika virus epidemic is the humble insect vector, the Aedes mosquito, both aegypti and albopictus species.  The female Aedes 1acquires and transmits the virus by simply doing what she does—extracting blood from people, birds and other animals to obtain proteins needed to develop her eggs.  To many of us, mosquitoes are just a warm weather nuisance, but in his 2010 book, “Mosquito Empires:  Ecology and War in the Greater Caribbean,”2 J. R. McNeill demonstrates that the mosquito has impacted the course of human history.

A Mosquito’s Role in HistoryZika virus is only one of several flaviviruses spread by Aedes mosquitoes.  Aedes also transmit the viruses that cause yellow fever, dengue and chikungunya.   Most of these diseases originated in Africa.  According to McNeill3, the mosquito carriers might have crossed the Atlantic Ocean on slave ships hundreds of years ago.  McNeill makes the point that by the end of the 17th century, mosquitoes and the diseases they spread were playing a major role in shaping world events.

European colonizers paid a heavy toll in human life in the Americas, and this was due in no small part to Aedes-transmitted diseases.  One example offered by McNeill is a campaign by Scotland between 1697 and 1698 to establish a lucrative trading colony in Panama.  The project was thwarted when over 1,700 Scots, about 70% of those sent to Panama, succumbed to “fever,” which McNeill interprets as dengue, yellow fever and malaria (spread by the Anopheles mosquito), illnesses against which the Scots had no defenses.  The financial debt resulting from the failed enterprise was so great, according to the author, that it was a factor in Scotland’s acceptance of union with England.

In another example, McNeill describes Napoleon’s 1804 decision to sell 827,000 square miles of the mid-section of North America to the United States for $15 million, at the bargain rate of $18/square mile.  Napoleon’s willingness to sell the land was catalyzed by the discouraging loss of nearly 55,000 troops sent to St. Domingue (modern day Haiti) to quell a slave insurrection following the French Revolution.  In both of these examples, the modest mosquito proved a mighty force against invaders who bore no immunity against the diseases they spread. We could say of these examples, “the proboscis was mightier than the sword.”

Now, Zika

According to the World Health Organization (WHO), Zika virus was first identified in 1947 in Uganda in rhesus monkeys.  In 1952, it was identified in humans in Uganda and the United Republic of Tanzania.  Confined to Africa, Southeast Asia and the Pacific Islands until 2015, the Pan American Health Organization alerted the world to the first confirmed Zika virus infections in Brazil in May of that year.  Aedes aegypti is present in over 100 countries, the mosquito has “high competence as a vector,” and there is a possibility that Zika virus will begin to be transmitted in the US, according to an article4 in the April, 2016 edition of the American Journal of Public Health.

The virus has devastated families with Zika-affected babies born with the birth defect known as microcephaly.  The US Centers for Disease Control and Prevention (CDC) announced in an April 13 media statement that it has concluded that Zika virus causes microcephaly and other severe fetal brain defects.  This affirms CDC’s earlier guidance to pregnant women and their partners to take steps to avoid Zika infection, including avoiding travel to areas where Zika is actively spreading.  It seems we are learning more about Zika virus every day.  The WHO reports a scientific consensus that Zika virus also causes Guillain-Barre syndrome, a neurological condition that could lead to paralysis and death.

Better diagnostic testing and a vaccine for use against Zika virus are needed, according to Teixieria et al., who call for “a joint effort of the national and international scientific communities, public health policymakers and funders.”  Unlike the historical examples described by McNeill, public health professionals today have advanced technologies and rapid communication methods to combat the Zika virus and its mosquito carrier in ways that could not have been imagined hundreds of years ago.  These include national disease tracking networks and genomic analysis.

Only time will tell what impact Zika virus will have on the course of modern history.

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

Barbara M. Soule, R.N. MPA, CIC, FSHEA is an Infection Preventionist and a member of the Water Quality & Health Council.
Click here to download this article.


1 Mainly aegypti species and potentially albopictus

2 McNeill, J.R. Mosquito Empires:  Ecology and War in the Greater Caribbean, 1620-1914.  New York, NY:  Cambridge University Press; 2010.

3 McNeill, J. Aedes Rides Again:  Mosquitoes and Flaviviruses in the Americas, American Journal of Public Health (April 2016), Vol. 106, No. 4, pp. 596-7.

4 Teixeira, M.G., Costa, M.C.N., de Oliveira, W. K, Nunes, M.L. and Rodrigues, L.C.  The Epidemic of Zika Virus-Related Microcephaly in Brazil:  Detection, Control, Etiology, and Future Scenarios.  American Journal of Public Health (April 2016), Vol. 106, No. 4, pp. 601-5.

Avoiding MRSA at the Gym

Friday, March 11th, 2016

A healthy workout in the gym should leave you with a feeling of well-being and nothing worse than a duffle bag full of sweaty clothes.  It should not leave you with a MRSA skin infection.

What is MRSA?

MRSA, or “Methicillin-resistant Staphylococcus aureus,” is a type of staph bacteria that is, according to the US Centers for Disease Control and Prevention (CDC), resistant to common antibiotics.  CDC   reports that about two in every 100 people carry MRSA on their bodies, with no symptoms of infection.

A MRSA infection may at first be mistaken for a spider bite.  It may appear as a bump or infected area on the skin and could be accompanied by a fever.  The CDC website provides photos of MRSA skin infections to help the public identify this potentially serious infection.

Older people and those with compromised immune systems are most vulnerable to MRSA infection.  For that reason, healthcare facilities are the most common environment of MRSA transmission.  In otherwise healthy people, however, MRSA infections are usually mild and improve after a few days of oral antibiotic treatment if the infection is sensitive to the antibiotic.  Those infections are called “community-associated MRSA,” and are common in environments in which healthy people interact in close quarters; your gym is just such an environment.

Within the gym, intentional skin-to-skin contact (e.g., during wrestling and martial arts training) and unintentional skin contact between teammates during practice and competition (e. g., volleyball) are documented risk factors for MRSA transmission, according to a 2008 review of MRSA infection in athletes1.  Skin damage during exercise, e.g., mat burns, broken blisters, and other workout related injuries that abrade the skin, represent another common risk factor, particularly if broken skin contacts MRSA-contaminated surfaces.

Tips for avoiding MRSA infections at the gym:

  • WASH YOUR HANDS – thoroughly with soap and water before and after your workout and after using the bathroom; bar soap should not be shared during MRSA outbreaks; use liquid soap instead
  • SHOWER – promptly after any skin-to-skin contact; use liquid soap
  • OTHER PEOPLE’S OPEN WOUNDS – don’t touch wounds or bandages
  • YOUR OWN OPEN WOUNDS –
    • Cover and protect with clean bandages
    • Avoid using whirlpools, therapy pools and swimming pools
  • DISINFECT EQUIPMENT – wipe down exercise equipment (e.g., wrestling mats and the bench press), before and after use, with disinfecting wipes; use bleach wipes or other EPA-registered products that are effective against MRSA.
  • DON’T SHARE –
    • Razors with others; according to the 2008 review of MRSA transmission in the gym, razors create tiny lacerations, which increase the risk of acquiring MRSA from others
    • Towels with others; if shared towels have not been laundered between uses, they may be contaminated with MRSA
  • AVOID REUSING UNLAUNDERED EXERCISE CLOTHES – use fresh, clean clothes for each workout
  • LAUNDER – sweaty gym clothes and towels promptly after your workout; if laundering instructions permit, use chlorine bleach

A final tip:  Keep up the good work at the gym.  In the grand scheme of things, the benefits of working out greatly overshadow the risk of MRSA infection.  Why not increase your benefits by following these tips?

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

Bruce Bernard, PhD, is President of SRA Consulting, Inc., and Associate Editor of the International Journal of Toxicology, and lives in Cambridge, MD.

Click here to download this article.


1 Cohen, P.R. (2008).  “The skin in the gym:  a comprehensive review of the cutaneous manifestations of community-acquired methicillin-resistant Staphylococcus aureus infection in athletes,” Clinics in Dermatology, 26, 16-26.

Understanding Norovirus in Less than Three Minutes

Friday, February 26th, 2016

Norovirus:  It’s the leading cause of outbreaks of diarrhea and vomiting in the US.  The virus can spread like wildfire through homes, schools, healthcare facilities, sports teams, child care centers and nursing homes.  Norovirus causes an average of 20 million cases of illness each year, including tens of thousands of hospitalizations and hundreds of deaths, mostly among young children and the elderly.  The winter months are usually the busiest season for norovirus.

There is no vaccine to prevent norovirus, but understanding how it spreads can go a long way to avoiding it.  The CDC animated video above presents the facts about norovirus in a clever, simple-to-understand way.  My hope is that this video will go as “viral” as norovirus itself.  Share it widely, and be well.

For more information on norovirus, please see this CDC webpage.

Barbara M. Soule, R.N. MPA, CIC, FSHEA is an Infection Preventionist and a member of the Water Quality & Health Council.

Click here to download this article.

Preventing RSV

Friday, January 15th, 2016

What is RSV?
RSV is “Respiratory Syncytial (sin-SISH-uhl) Virus,” a virus that affects the lungs and breathing passages.  In healthy people, an RSV infection resembles a cold (colds are caused by rhinoviruses, another type of virus), but the very young and the very old[1]
and those with weakened immune systems may develop more serious symptoms.  Healthcare and child care workers are also at risk for RSV infections.

RSV affects millions of children each year.  According to the U.S. Centers for Disease Control and Prevention (CDC), RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (lung infection) in children younger than one year of age in the United States.  CDC notes that nearly all children will have an RSV infection by their second birthday.

Up to 40 percent of children will have signs or symptoms of bronchiolitis or pneumonia after their first exposure to RSV, and a small percentage of children will require hospitalization.

When should I go to the doctor?

Bronchiolitis and Asthma?
According to KidsHealth, children who have had bronchiolitis may be more likely to develop asthma later in life, but more research is needed to understand what, if any, relationship exists between bronchiolitis and asthma.

When symptoms become severe, it’s time to go to the doctor.RSV symptoms resemble other respiratory infection symptoms, including a runny nose and decreased appetite beginning about four to six days after exposure to the virus.  Coughing,
sneezing and fever commonly develop one to three days later.
Wheezing may also develop. In very young infants, the only symptoms may be irritability, decreased activity, and breathing difficulty.
Healthcare providers can assess the severity of RSV infection and determine if the patient requires hospitalization.   Severe cases of infection may require supplemental oxygen, suctioning mucus from the airways or using a breathing tube. Some patients may be treated effectively with hyperbaric oxygen[2].

How can I prevent RSV?

There is no vaccine to prevent RSV, and antibiotics are not effective unless a secondary bacterial infection occurs.  People can be infected with RSV more than once, but symptoms may be milder in subsequent infections. The CDC poster at the beginning of this article outlines six strategies to help prevent RSV infection.

RSV is spread by direct or close contact with contaminated secretions, such as mucous.  Keeping sick children home from day care is key to preventing the spread of contagious illnesses like RSV.  Keep in mind that very young children and children with weakened immune systems can continue to spread the virus for one to four weeks.

The virus is easily transported from the hands, where researchers say it can live for over 30 minutes, to the eyes and nose.  It also survives on surfaces for several hours.[3]  That’s why CDC recommends frequent hand washing, covering coughs and sneezes, and keeping hands away from the face.

Disinfecting Surfaces Contaminated with RSV
According to researchers, RSV can be destroyed on  frequently touched hard surfaces by first cleaning with detergent and water and then applying a one-to-ten dilution of regular (5.25%) bleach and water (e.g., one cup of bleach to nine cups of water).4 

For more information about RSV, please see http://www.cdc.gov/rsv/index.html.


Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

Click here to download this article.


1 Falsey AR and Walsh EE (2005).  Respiratory Syncytial Virus infection in elderly adults.  Drugs Aging, 22(7) 577-87 (Abstract).

2 Hyperbaric oxygen treatment refers to administering oxygen at a higher level than atmospheric pressure.

3 Eiland, L.S. (2009).  Respiratory Syncytial Virus:  Diagnosis, Treatment and Prevention, J Pediatr Pharmacol Ther. 2009 Apr-Jun; 14(2): 75–85, (online:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461981/)

4 If using 8.25% bleach, make a one-to-16 dilution (e.g., one cup of bleach to approximately 16 cups of water).

Closing Produce Contaminant Loopholes

Friday, January 8th, 2016

What role could organic and locally sourced produce have played in the recent Chipotle foodborne illness outbreaks?  As we reported previously, Chipotle’s 2014 annual report notes the company’s “significant commitment to serving local or organic produce when seasonally available.”  Chipotle admits these initiatives may “present additional risk of food-borne illnesses given the greater number of suppliers involved in such a system and the difficulty of imposing our quality assurance programs on all such suppliers.”  We agree, and we suggest that uncertainties and “contaminant loopholes” exist in federal regulations that may be contributing to US foodborne outbreaks associated, not only with Chipotle, but with any vendor or consumer sourcing local and organic produce.

Guidance to Minimize Produce Contamination

What is Organic?
A product labeled “organic” must be certified by the US Department of Agriculture (USDA), and be produced and processed according to USDA standards.  The USDA website indicates, “Overall, organic operations must demonstrate that they are protecting natural resources, conserving biodiversity, and using only approved substances.”Organic standards address soil and water quality, pest control, livestock practices, and rules for food additives.  Organic practices avoid the use of synthetic fertilizers, sewage sludge, irradiation and genetic engineering and most pesticides, according to the USDA Organic Practices Factsheet

Improperly composted manure and improperly applied raw manure fertilizers are major sources of pre-harvest microbial contamination. Contaminated irrigation water is another potential source of pathogens.  According to the Food and Drug Administration (FDA), organic farmers in particular utilize raw manure, which is seen as an effective source of nitrogen and other soil nutrients, especially when multiple crops are produced in the same field in one growing season.

Government guidance to minimize microbial contaminants in fruits and vegetables notes that good agricultural practices regarding animal manure fertilizers includes treating (e.g., composting) manure to reduce pathogens and maximizing the time between applying manure to cropland and harvesting crops.  Proper composting procedures are well documented and microbial standards set limits on detectable amounts of bacteria following treatment.  From a microbial safety perspective, appropriately developed compost is preferable as a fertilizer to raw manure, but when raw manure is used, what is the appropriate time interval between applying manure and harvesting crops?  According to FDA, as part of its new Produce Safety Rule, the agency is conducting a risk assessment and extensive research over the next five years to answer that question.  FDA notes for the time being, it does not object to farmers adhering to the US Department of Agriculture’s (USDA’s) National Organic Program (NOP) standards, which require uncomposted animal manures be applied …at least 90 days prior to harvest for crops whose edible portions do not come in contact with the soil and at least 120 days prior to harvest of crops whose edible portions do come in contact with the soil…”

Loopholes for Contaminants

Buying local or organic produce? Here are some relevant questions for your seller:

  • Was animal manure used for fertilizer?
  • When was the manure applied relative to harvesting?
  • If purchased at a farmers’ market, how was produce protected against contamination after harvesting?

As important as the planned FDA research and risk assessment are, some of the farms selling produce to vendors may be unaffected by the resulting recommendations. That’s because the new FDA rule does not apply to farms that have an average annual value of produce sold during the previous three-year period of $25,000 or less.  Qualified exemptions are also possible for farmers whose food sales average less than $500,000 per year during the previous three year period and sell predominantly to either the consumer of the food or a local restaurant or retail food establishment.  This may constitute a loophole for small farms that do not adhere to best organic practices.  Of course, large organic farming operations can also inject risk into the food supply by not abiding by science-based organic practices.

Many restaurants also sources produce from farmers markets.  A 2014 study1 of microbial safety and quality of fresh herbs from 13 farmers’ markets in California and Washington concluded a relatively high level of microbiological contamination of fresh herbs compared with that reported in previous studies.  How prevalent is this problem? The authors note more research is needed, but that “storing herbs at ambient temperatures in the open environment during warm summer days could impact the microbiological safety and quality of these items.”  Could this be another contaminant loophole for vegetable ingredients?

Safety comes first, and Chipotle is being proactive in the face of the recent outbreaks to close contaminant loopholes.  In a December 18 MarketWatch article, Chipotle communications director Chris Arnold is quoted as saying the chain is “implementing new programs that will make us an industry leader in food safety.”  These include cutting down on local ingredients and moving toward more centralized vegetable preparation.  Where smaller suppliers are still involved, however, we recommend Chipotle and other vendors require adherence to the same food safety standards to which larger suppliers are held.  That would be a win-win for both the small farmer and the companies that have made a strong safety commitment to their customers.

Click here to download this article.

1 Levy et al. (2014).  Microbial safety and quality of fresh herbs from Los Angeles, Orange County and Seattle farmers’ markets, Journal of the Science of Food and Agriculture, 95:  2641-2645 (abstract)

When Fresh Ingredients Make Consumers Sick

Friday, December 18th, 2015

Over 140 Boston College students were sickened recently after eating at a Chipotle restaurant near the Chestnut Hill, Massachusetts campus.  The culprit:  norovirus, the most common cause of foodborne illness in the US.  The norovirus outbreak comes on the heels of a multistate outbreak of E. coli associated with Chipotle that made 52 people sick in the Pacific Northwest.

In response to these outbreaks, Chipotle has been in frequent communication with the media, including a pointed interview with Chipotle’s founder, Steve Ells.  Additionally, according to the Chipotle website, the company is taking several steps to ensure “best-in-class food safety.” These steps include voluntarily closing restaurants, conducting deep cleaning and sanitization of restaurants in the affected area, testing surfaces, equipment and food, and enhancing internal training.  These are all steps in the right direction.

The Public Health Perspective

Chipotle prides itself on using fresh produce and meats, traditional cooking methods and local and organic produce, when seasonally available, factors that the company admits in its 2014 annual report, may present additional foodborne illness risk:

“…we have made a significant commitment to serving local or organic produce when seasonally available, and a small portion of our restaurants also serves produce purchased from farmers markets seasonally as well. These produce initiatives may make it more difficult to keep quality consistent, and present additional risk of food-borne illnesses given the greater number of suppliers involved in such a system and the difficulty of imposing our quality assurance programs on all such suppliers.”

The statement above is telling and honestly assigns a degree of risk to what many perceive as an unquestionable health advantage:  produce that is local, organic, seasonally available and sourced from farmers’ markets.

Folks will look at this in one of two ways:

  1. For some, the increased risk of foodborne illness is acceptable to avoid produce harvested using traditional agricultural practices, including manufactured fertilizers and pesticides.
  2. Others may be wary of the trend for restaurant chains to increase their use of organic produce without increased steps by suppliers and restaurants to prevent food contamination.

Chipotle should be congratulated for their honesty in acknowledging their food safety problems, and the company should continue to share its findings and plans to tackle those problems.  For their part, consumers must make their own choices about where and what to eat based on their own health perspective.  As with all decisions we make regarding acceptable or unacceptable risks, the accuracy of the decision depends upon the use of accurate and reliable information.

Click here to download this article.

In the coming weeks:  “What is Organic Produce?”

Five Flu Facts

Friday, December 11th, 2015

CDC director, Dr. Tom Frieden gets this year’s flu vaccine. Photo from www.cdc.gov/flu/professionals
  1. Getting the flu vaccine is strategic. Getting the annual flu vaccine is the single best thing you can do to prevent the flu.  The US Centers for Disease Control and Prevention (CDC) recommends a yearly flu shot for everyone six months old and older.  Some folks are proudly posting their “vax” photos on the CDC’s website!  Follow on Twitter at #VaxWithMe.
  1. Flu can be complicated. Although most people who get the flu will have a mild illness, flu complications can include pneumonia, bronchitis, sinus or ear infections and even death.  Those at high risk for flu-related complications include pregnant women; children younger than five, but especially children younger than two; people 65 years old and older; and people of any age with certain chronic medical conditions such as asthma, diabetes and heart disease.

Unsure as to whether you have the flu or the common cold?  This chart can help you decide.

  1. Timing is everything. According to CDC, flu activity usually peaks in January or later, but outbreaks can happen as early as October.  It takes about two weeks after being vaccinated for the body’s immune response to kick in fully. 

Planning holiday visits?  Take a look at the calendar and schedule your flu shot to make sure you arrive for holiday gatherings as fully protected as possible. 

For Frequently Touched Surfaces:

Clean surfaces first with detergent and water and then sanitize using 1 tablespoon of regular strength household bleach (5.25%) in 1 gallon of water.  If using concentrated bleach (8.25%), reduce bleach volume to 2 teaspoons per gallon of water. Let surfaces air dry.

  1. Prevention is key. The flu virus wants you!  Evade it by:
  • Avoiding close contact with people who are sick
  • Staying home when you are sick
  • Covering your coughs and sneezes with a tissue, or cough into your sleeve
  • Washing your hands frequently with warm water and soap for at least 20 seconds
  • Keeping your hands away from your eyes, nose and mouth
  • Cleaning and disinfecting frequently touched surfaces in your environment
  • Getting sufficient exercise, hydration, nutrition and rest
  1. A flu pandemic (a world-wide flu epidemic) would be another story altogether. Flu severity is unpredictable from year to year.  While it’s not expected this year, a flu pandemic is always a possibility.  To keep tabs on the flu, CDC provides a weekly flu surveillance report.  The website includes a handy “Flu Activity Map” to indicate the geographic spread of flu through the US.

To get an idea of how you could prepare for a pandemic flu outbreak, check out Dr. Ralph’s Flu Preparedness Closet.  Forewarned is forearmed!

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN

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