Certain Diamond Pet Foods products have been recalled due to contamination with the bacterium Salmonella Infantis
CDC podcast on this topic

At least fourteen people in nine states have been infected with Salmonella Infantis as a result of contact with contaminated dry dog food, according to a report from the Centers for Disease Control and Prevention (CDC). Although no deaths have been reported, five of the patients were hospitalized. Those infected range in age from less than one year to 82 years old. No dogs have been reported sickened.

CDC determined that all of the ill individuals had handled dry Diamond Pet Foods produced in one Gaston, South Carolina, plant. A list of products recalled can be found on this Food & Drug Administration (FDA) website and on the Diamond Pet website. Pet owners can learn how to obtain a refund for recalled products here. For questions on the recall, CDC has posted the following telephone number for Diamond Pet Foods: (800) 442-0402.

I blogged last November on the issue of pet products and Salmonella contamination, and said that FDA had announced a year-long effort to collect and analyze samples of pet products for Salmonella bacteria. The program began last October and will extend until September, 2012. An FDA statement notes the agency became involved in the outbreak investigation early last month when the Michigan Department of Agriculture and Rural Development detected Salmonella during retail surveillance sampling. Salmonella was also detected in Ohio by the state Department of Agriculture and in South Carolina during an FDA inspection. In addition to those states, recalled products were distributed in Alabama, Florida, Georgia, Kentucky, Maryland, North Carolina, New York, Pennsylvania, Tennessee, and Virginia. According to the FDA, Diamond Pet Foods is working directly with distributors and retailers to remove recalled products as quickly as possible. Meanwhile, pet owners can reduce the ever-present risk of illness from contaminated pet products:

Pet Owner Safety Tips

Purchase and Storage

• Purchase products in good condition (with no damage to packaging).
• Store dry products in a cool, dry place (under 80 °F).

Pet Boundaries

• Keep pets away from household food storage and preparation areas.
• Keep pets away from garbage and household trash.
• Supervise young children around pets and keep them away from pet feeding areas.

Clean up after your pet: Dispose of pet feces in a tightly sealed plastic bag.

Food/Preparation

• Wash your hands for 20 seconds with hot water and soap before and after handling pet products.
• Use a clean, dedicated scoop or spoon to transfer pet food to feeding bowl; do not use your pet’s feeding bowl as a scooping utensil.
• Wash pet food bowls thoroughly with hot, soapy water to clean.
• Disinfect feeding bowls periodically (see downloadable poster):
• Wash with hot soapy water to clean; thoroughly rinse off soap
• Sanitize with chlorine bleach solution (1/4 cup bleach + 1 gallon water); leave wet for 10 minutes
• Rinse and dry.

Linda Golodner is President Emeritus of the National Consumers League and Vice Chair of the Water Quality & Health Council.

Rocky Ford cantaloupe being planted at Hirakata Farms, Colorado (Photo courtesy of BCDemocratOnline.com)

Spring cantaloupe planting is under way in Colorado, and following a tragic foodborne disease outbreak last year, growers are determined to regain consumer confidence. In 2011, over 30 people died and at least 146 were sickened during a Listeria outbreak traced to contaminated cantaloupe (see January 20, 2012 blog). Jensen Farms, the source of the Listeria outbreak, is located near Holly, Colorado, about 100 miles east of the Rocky Ford region, which was initially identified in news reports as the “epicenter” of the outbreak. Those reports took an economic and reputational toll on all Rocky Ford cantaloupe growers. This spring, as cantaloupe seeds are being pressed into Colorado soil, growers are taking aggressive measures to shore up their practices to avoid a repeat of last season’s catastrophe.

Rocky Ford Growers Association: According to The Durango Herald, growers have formed an association with self-imposed rules to promote safe cantaloupe production. The newspaper reports farmers who join the association must agree to twice-a-year safety audits—one announced and one unannounced—conducted by state Agricultural Department inspectors. Only association members will be allowed to use the Rocky Ford trademark. According to the newspaper article, Jensen Farms will not be asked to join the association reportedly due to its distance from the Rocky Ford region. It is unclear, according to the newspaper, whether Jensen Farms will resume cantaloupe production this year.

Post-harvest Produce Processing 

Growers in the new association will adhere to stringent food safety standards developed by Colorado State University and California researchers to avoid the problems that led to Listeria contamination at Jensen Farms. In particular, cantaloupe post-harvest processing will include rapid cooling and chlorine disinfectant in wash water.  Both measures help curtail the growth of Listeria and other bacteria; both were lacking in the Jensen Farms packing shed.

Seed-to-Store Tracking

In an effort to provide increased transparency for customers, including consumers, the Rocky Ford Growers Association has hired a tracking company to monitor cantaloupe from seed to store, identifying any problems along that path.  KOAA.com reports consumers can use smartphones to read a QR code on a sticker that tracks produce back to the seed and farm from which it originated and the date of its harvest.  In some cases the sticker will be on individual melons, in other cases they may be on packing crates.

Going Forward

Rocky Ford cantaloupe growers are to be commended for their aggressive food safety measures, which could serve as a model for other growers. The only good that can come from a tragedy as serious as last year’s outbreak is earnest determination to increase the safety of food processing.  Consumers should remember that they can play a role in food safety too:

• Wash fresh produce thoroughlyunder running water just before eating, cutting or cooking, paying special attention to the convoluted outer skin of produce such as cantaloupe. (see www.FoodSafety.gov for more information).
• Clean and sanitize food-contact surfaces (see the FDA web page, “Keep Listeria out of Your Kitchen”).

Linda Golodner is President Emeritus of the National Consumers League and Vice Chair of the Water Quality & Health Council.

¹QR codes are small, 2-dimensional, square icons on products and advertising material that one can hold a smart phone up to in order to access product information instantly.

Image of hand sores associated with Hand, foot and mouth disease; image courtesy of CDC

Hand, foot and mouth diseaseⁱ is a viral illness caused by coxsackievirus. Afflicting mostly children, coxsackievirus normally causes mild fever and rash or sores on the palms of the hands and soles of the feet, and sores or blisters in the mouth. Recently, the US Centers for Disease Control and Prevention (CDC) reported coxsackievirus A6 in four states. Previously seen only in some European and Asian countries, the “A6” strain causes more severe symptoms and more hospitalizations. An April 20 article in USA Today states the virus “can hit kids and adults hard, causing fingernails and toenails to fall off two to three weeks after the illness has passed.”

The Reno Gazette-Journal cited 30 cases of hand, foot and mouth disease in Nevada’s Washoe County in a March 30 article. According to the article, in addition to the Nevada cases, 46 other cases had been reported in California, Connecticut and Alabama. The April 20 USA Today article indicates the virus is spreading around the country and that, according to one physician, about 25 percent of cases are in adults.

According to CDC, the cases were identified as unusual by healthcare providers or by health departments that contacted CDC for diagnostic assistance. Coxsackievirus A6 was identified in clinical specimens collected from 25 of 34 patients. The majority of those infected, 70 percent, had exposure to a child care facility or school. Hand, foot and mouth disease is not a “reportable” illness in the United States, meaning that physicians are not obliged to report diagnoses of the illness to government agencies. However, as healthcare providers and health departments contacted CDC with questions, and the significance of clinical results became clear, attention was focused on this uncommon strain of coxsackievirus.

Coxsackievirus is spread by person to person contact, especially during summer and autumn months. According to WebMD, there is no treatment for hand, foot and mouth disease other than pain relievers, such as acetaminophen. Infection usually lasts about one week. CDC notes that transmission of the virus can be reduced by maintaining good hygiene, including frequent hand-washing and disinfecting surfaces in child care settings.

Advice for Preventing Hand, Foot and Mouth Diseaseⁱⁱ

• WASH YOUR HANDS often and carefully, especially after using the bathroom, preparing food or drinks and changing diapers.
• DISINFECT ITEMS AND HARD SURFACES by washing them with hot, soapy water, then applying a solution of two tablespoons of bleach and four cups of water; rinse with clear water and dry.
• LIMIT CONTACT WITH INFECTED PERSONS by avoiding hugging, kissing or sharing cups or utensils.

Finally, CDC recommends contacting your health provider if you suspect a severe case of hand, foot and mouth disease.

Fred Reiff, P.E., is retired from the Pan American Health Organization, and lives in the Reno, Nevada area.

ⁱVesicular pharyngitis and vesicular stomatitis with exanthema
ⁱⁱBased on recommendations from the Washoe County, Nevada Health District

Recycle a clean, clear plastic, one-liter beverage bottle by filling it with water and three tablespoons of chlorine bleach, secure the bottle in a hole in a metal roof, and you have all the technology needed to illuminate the dark interiors of thousands of homes of the world’s poorest people. In an ingenious use of optics and chlorine chemistry, and for very little money, 55 watts of solar energy are streaming into formerly unlit homes in communities in Brazil and the Philippines. Many of the homes being outfitted with the device were perpetually dark due to the close, side-by-side construction of rudimentary dwellings. Now the spirits of residents are brightening along with their interior dwellings: Daylight is penetrating their living quarters.

The solar bottle bulb was invented by a group of resourceful Massachusetts Institute of Technology students; bulbs take approximately an hour to install. Solar bottle bulbs are positioned to rest partly above and partly below the roof surface, protruding from the interior ceiling. During the daytime sun rays stream into the water bottle, bending (refracting) and internally reflecting to produce a bright light source that does not depend on an electrical connection. As an example of the physical phenomena responsible for this lighting technology, the brilliance and “fire” of diamonds are caused by light refracting and reflecting throughout the crystal.

Chlorine Bleach Helps Light up the Darkness

Good sunlight refraction and reflection depend upon a clear water medium, just as a diamond’s brilliance depends on its clarity. Chlorine bleach plays the role of destroying the microorganisms that could proliferate inside the bottles, reducing the clarity of the water. As for maintenance, water and bleach must be replaced, but only every five years. It is not clear how long the beverage bottles hold up in this role (caps are protected from cracking with sealant—see the video), but replacing them should not be too great a hurdle.

Solar bottle bulbs are a wonderfully safe, cheap, energy-efficient lighting technology being supplied to those who need it most! Kudos to the inventors and the installers!

Bruce Bernard, PhD, is President of SRA International, Inc. and Associate Editor of the International Journal of Toxicology.

Norovirus is a highly contagious virus that causes flu-like symptoms of nausea, vomiting, diarrhea and abdominal cramping.

(Image from CDC website)

The dreaded “stomach flu” that hits particularly hard in winter is not a flu at all. It is norovirus, a highly contagious virus that causes symptoms of diarrhea, vomiting and stomach cramping. According to the Centers for Disease Control and Prevention (CDC), the illness often begins suddenly and lasts for one to two days with no long-term adverse health effects. True “flu” is a respiratory disease caused by the influenza viruses; sometimes the “true flu” can also cause gastrointestinal symptoms similar to norovirus. Getting an annual flu vaccine can help prevent flu; unfortunately, there is no vaccine for the norovirus and antibiotics, useful only for bacterial infections, do not help.

Norovirus is extremely common and has gained notoriety as a vacation cruise spoiler and an unwelcome visitor in child and adult care facilities, schools, restaurants, hospitals and dormitories. Norovirus particles are extremely small and are discharged by the billions in the stool or vomit of infected people, according to CDC. Yet, fewer than 100 virus particles are highly likely to make a person sick. The virus spreads through direct contact with an infected person or when an individual touches a contaminated surface and then touches their mouth or even their nose.

A 2011 study found norovirus is the leading cause of foodborne illness in the US, responsible for 5.5 million cases each year. In many cases, sick food handlers are responsible for these outbreaks. Eating foods contaminated with norovirus is a leading cause of hospitalizations.

Recipe for an Outbreak

Close quarters and a breakdown in sanitation is the simple recipe for a norovirus outbreak. Attention to surface disinfection is critical to controlling the spread of norovirus. Proper hand washing is another “must” as the virus can be transmitted easily via contaminated hands. It is important to know that a norovirus carrier can infect others for at least three days after recovery.

These steps, from CDC, can help reduce your risk of contracting norovirus:

• Wash your hands carefully with soap and water, especially after using the toilet and changing diapers and always before eating or preparing food.
• Carefully wash fruits and vegetables, and cook oysters and other shellfish thoroughly before eating them.
• If infected with norovirus, do not prepare food for others while experiencing symptoms and for three days after recovery (see Norovirus: Food Handlers).
• After throwing up or having diarrhea, immediately clean and disinfect contaminated surfaces by using a solution made with chlorine bleach and water:

Disinfecting against Norovirus with Chlorine Bleach

• Immediately remove and wash clothing or linens that may be contaminated with vomit or stool. Handle soiled items carefully—without agitating them—to avoid spreading the virus. If available, wear rubber or disposable gloves while handling soiled clothing or linens and wash hands after handling. Soiled items should be washed with detergent at the maximum available cycle length and then machine dried.

Joan Rose, PhD, is the Homer Nowlin Chair in Water Research at Michigan State University and a member of the Water Quality and Health Council.

¹http://emergency.cdc.gov/disasters/disease/pdf/diarrhea-evac.pdf
²http://health.utah.gov/epi/diseases/norovirus/Guidelines_for_Environmental_Cleaning_125846_7.pdf

Eight people who walked by just such a water wall in a Wisconsin hospital lobby in 2010 are believed to have contracted the disease by inhaling the mist from the streaming water. Legionella can affect people whose immunity may be depressed due to an underlying illness, or due to a medication regimen; smokers may also be vulnerable. One of the patients affected in Wisconsin was a delivery person who had been a smoker and had made two deliveries to the hospital. Others had visited the pharmacy adjacent to the water wall to obtain medications.

The outbreak is an unintended consequence of well-intentioned efforts to create a soothing and welcoming healthcare environment. For now, we know those decorative water walls are a bad idea unless sanitary conditions are meticulously maintained.

Legionella under the Rocks

A new study published in the journal Infection Control and Hospital Epidemiology notes that although the decorative water wall underwent routine cleaning and maintenance, the bacterium Legionella pneumophila found a niche at the base of the water wall. The bacterial breeding ground was identified as a bed of sponge-like foam installed under decorative rocks to prevent water splashing.

In a January 11, 2012 interview with National Public Radio, the study’s lead author, Dr. Thomas Haupt, a respiratory disease epidemiologist for the Wisconsin Division of Public Health, was asked whether chlorine in the water would have prevented the outbreak. Haupt replied that chlorine in the atrium of a hospital “would have caused a lot of smell.” Haupt also described what seems to have been a “perfect storm” for Legionella contamination: Lights installed under the foam material in the trough and the trough’s close proximity to a fireplace helped provide a warm environment highly conducive to Legionella growth.

Haupt’s study notes the Wisconsin outbreak is the second example of Legionnaires disease associated with a decorative fountain in a healthcare setting. (The first example occurred in 2007.) The Wisconsin Department of Public Health has developed interim guidelines advising healthcare facilities with similar water walls or fountains to “establish strict maintenance procedures and conduct periodic bacteriologic monitoring to assess levels of Legionella.”

Fortunately, all eight Wisconsin patients recovered from Legionnaire’s disease and the hospital water trough has been converted into a planter. Going forward, let’s either use the tools we have to keep Legionella in check in decorative water walls, or keep them dry.

Jerod M. Loeb, Ph.D. is Executive Vice President, Healthcare Quality Evaluation at The Joint Commission in Oakbrook Terrace, Illinois.

Chlorinated wash water used during cantaloupe processing can help reduce the risk of foodborne illness to consumers.

Last summer a family-owned farm in Colorado became the focal point of the largest foodborne illness outbreak in the US in 25 years. Tragically, cantaloupe contaminated with Listeria bacteria sickened 146 people in 28 states, killed 30 and caused one pregnant woman to miscarry, according to the Centers for Disease Control and Prevention (CDC). The US Food and Drug Administration (FDA) concluded the outbreak likely could have been prevented if Jensen Farms had maintained its facilities in accordance with existing voluntary FDA guidance. FDA has no enforceable regulations on cantaloupe processing, and farm facility auditors conducting inspections do not consider FDA voluntary guidance when scoring facilities. Scores can be lowered only if practices are inconsistent with FDA regulations. That could, and should, change.

Recently the House Committee on Energy and Commerce released a report outlining multiple operational problems contributing to the cantaloupe contamination. The investigation report notes FDA officials were “highly critical of the processing methods used at Jensen Farms,” and emphasized two probable causes of the contamination: a change in processing equipment and a decision not to chlorinate cantaloupe wash water. In 2011, after 20 years of cantaloupe production with no reported food safety problems, these decisions helped spell disaster at Jensen Farms.

Deadly Decisions

Eric and Ryan Jensen inherited Jensen Farms upon the recent death of their father. Ironically, the House Committee report states that during an August, 2010 safety audit, one of the Jensen brothers expressed interest in improving their processes. The auditor suggested the Jensens consider replacing the hydrocooler, which sprays water on cantaloupes to cool the harvested fruit. The auditor considered the hydrocooler a “hotspot” due to its recirculating water. Believing they were strengthening their food safety efforts, the Jensens purchased and retrofitted equipment previously used to process potatoes. The House Committee cited FDA’s characterization of this equipment as “inappropriate” and “difficult to clean.” Listeria was later detected on the felt roller brushes of this processing equipment.

Up until 2011, Jensen Farms followed FDA voluntary guidance with regard to using antimicrobial solutions, such as chlorine, in cantaloupe wash water. Disinfectants are added routinely to produce wash water to help destroy pathogens like Listeria. This measure is particularly important for cantaloupe with its convoluted outer surface that can harbor moisture and bacteria. According to the House Committee report, the Jensen brothers discontinued this precaution in 2011, a fact that was noted on the front page of that year’s audit report. No reason was given for this process change, and Jensen Farms received a glowing audit score because scores are not based on adherence to FDA voluntary guidelines.

Going Forward

According to the House Committee report, the cantaloupe distributor for Jensen Farms, Frontera Produce, is working with NSF International, a standard-setting organization, and other firms to improve the current audit system. Additionally, the new Food Safety Modernization Act requires FDA to establish an accreditation system and model auditing standards. These measures should be taken without delay to prevent a repeat of the preventable tragedy that started last summer at Jensen Farms. We’ll be watching…

Chris Wiant, M.P.H., Ph.D., is president and CEO of the Caring for Colorado Foundation. He is also chair of the Water Quality & Health Council.

“Clostridium difficile,” is a spore-forming bacterium that can live in the lower gastrointestinal tract of some humans and is shed in feces. Persons hosting C. diff may have no symptoms and be unaware that they are contagious. Other persons will become infected under specific circumstances. A C. diff infection may produce watery diarrhea, fever, loss of appetite, nausea or abdominal pain and tenderness. According to the Centers for Disease Control and Prevention (CDC), patients who are at increased risk for infection include those who:

• are taking antibiotics
• have had gastrointestinal procedures
• have had a prolonged stay in a healthcare institution
• have a serious underlying illness
• are of an advanced age.

Any surface or medical device that becomes contaminated with feces may serve as a reservoir for C. diff spores including toilets, bathtubs, or electronic rectal thermometers. In the healthcare setting, the spores are thought to be transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item. Dr. Robert Orenstein, of the Mayo Clinic Arizona, calls C. diff infection “a significant threat to our public health”. His goal is to reduce the risk of C. diff infection by reducing environmental contamination and he has a strategy that just might work.

A Tale of Two Hospital Units

In a 2011 publication Dr. Orenstein describes a study in which two high-risk hospital units were targeted for daily cleaning of high touch surfaces with germicidal bleach wipes (in addition to terminal cleaning after a patient is dismissed). The researcher chose bleach wipes because a 10 percent solution of hypochlorite bleach destroys the spore form of C. diff. The study showed that over a six-month period the units experienced a 92 percent decline in hospital-acquired C. diff infection! This result was achieved without any other interventions, such as increased attention to hand hygiene. Further, Dr. Orenstein reports, the results were sustained for over one year with only two infections in 12 months. Meanwhile, infection rates in other units in the study hospital remain high.

To implement these effective risk reduction measures, environmental service staff were trained in proper use of bleach wipes. Housekeepers worried about the irritating effects of bleach were given plain surgical masks and ventilation was ensured. As the study progressed, patient and employee tolerance of the wipes was monitored and found to be satisfactory. Orenstein notes no reports of equipment damage; keyboard covers, however, “often had a haze after the product dried on them.” A wet cloth applied to the covers removed the haze, which is a salt residue.

Dr. Orenstein’s study provides importance evidence to help destroy C. diff—a significant hospital public enemy found on surfaces in healthcare settings. Healthcare officials should consider adopting a bleach disinfection strategy for daily and terminal cleaning, a step that could help decrease the risk of serious infection.

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

Neti pot¹ use is being blamed for the deaths of two Louisiana residents who developed a rare fatal brain infection after using the device to clear their sinuses (The Advocate article). The infections are believed to have been caused by the water-dwelling parasite, Naegleria fowleri. According to the Centers for Disease Control and Prevention (CDC), Naegleria may be present in warm lakes and rivers and geothermal waters, such as hot springs and natural spas. It can also live in inadequately chlorinated swimming pool water. If the parasite is inadvertently inhaled and migrates from the human nose to the brain, it can cause “amoebic meningoencephalitis” and almost certain death. People cannot be infected with this parasite by drinking water.

Neti pot users circulate warm saline water through the nostrils; if water is contaminated with Naegleria, which appears to have been the case for two unfortunate people in Louisiana, the result can spell tragedy. In the case last June of one victim, a young man in his 20s, the infection was traced to the man’s home water system even though the parasite was not found in city water samples. More recently a 51-year old Baton Rouge woman succumbed to the brain infection caused by Naegleria. These cases are troubling, and we anticipate more information will be forthcoming as a result of further investigation.

Naegleria: Rare but Deadly

The Louisiana Department of Health cites statistics that demonstrate how rare Naegleria infections are: Between 2001 and 2010, 32 infections were reported in the US, most in southern states and mostly during summer, particularly during extended heat waves. Of the 32, 30 were caused by contaminated recreational water and two resulted from contact with a geothermal water supply. Updated statistics will include the recent deaths associated with neti pots.

What You Should Know about Naegleria

The greatest risk to humans of Naegleria is its inadvertent inhalation in contaminated water, usually through two routes:

Contact with recreational waters:

• When swimming in freshwater lakes and rivers, particularly in the South, nose clips can be worn to prevent inhaling infected water. Caution should also be exercised around geothermal waters. The CDC recommends avoiding water-related activities in warm freshwater during periods of high water temperature and low water levels. It is best not to dig in or stir up sediment while taking part in water-related activities in shallow, warm, freshwater areas.
• Swimming pools must be adequately disinfected to destroy Naegleria and other waterborne pathogens. The CDC and the Water Quality & Health Council recommend swimmers use pool test kits to check pH and free chlorine levels of chlorinated pools before swimming. If readings are out of the appropriate range (pH between 7.2 and 7.8; free chlorine level between 1 and 3 parts per million), a pool manager should be notified. If pool chemistry is not properly adjusted, the local public health department should be contacted.

Net pot use:

• When using a neti pot, follow directions for preparing saline water solutions. A December 6 press release issued by the Louisiana Department of Health and a CDC online resource urge neti pot users to use distilled, sterile or previously boiled water (least expensive option) to make up the irrigation solution.
• Clean and disinfect neti pots after use. After washing with soap and water, rinse with a solution of ½ tablespoon of chlorine bleach added to ½ gallon of water and allow to air dry.

News of rare Naegleria infections is not cause for alarm, just reason to be well-informed. We pledge to follow this issue and keep you updated.

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

For more information on disinfecting surfaces, please go to www.disinfect-for-health.org.

For more information on disinfecting pools, please go to www.healthypools.org