Psychosocial Perspectives
Home Health Care Management & Practice
22(7) 533­–535
© 2010 SAGE Publications
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DOI: 10.1177/1084822310376611
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Causes and Prevention
of Foodborne Illness
Marshelle Thobaben, RN, MS, P-MHNP, PHN, FNP1
Keywords
foodborne illness, food poisoning, safe food handling, prevention
Foodborne illness is caused by eating or drinking contaminated foods or beverages. According to the U.S. Department
of Agriculture (USDA; 2006) and the Centers for Disease
Control and Prevention (CDC; 2005), 76 million persons get
sick, 325,000 are hospitalized, and 5,000 die annually from
foodborne infection and illness in the United States. A century ago, typhoid fever, tuberculosis, and cholera were the
common foodborne diseases (CDC, 2005). As a result of
improvements in food safety (pasteurization of milk, safe
canning, and disinfection of water), the food supply in the
United States is among the safest in the world; nevertheless,
food and beverages are still sources of bacteria and viruses
that can cause foodborne illnesses, sometimes also referred
to as food poisoning (CDC, 2005).
The most commonly recognized foodborne infections
are those caused by the bacteria Campylobacter jejuni,
Salmonella, and Escherichia coli O157:H7 and by a group
of viruses called Noroviruses (and other calciviruses; CDC,
2005). See Table 1 for a list of the major pathogens that cause
foodborne illnesses.
providing them with information about safe food handling, that
is, being vigilant when handling, preparing, and consuming
foods. They can recommend clients to follow the four basic
steps to food safety: clean, separate, cook, and chill (USDA,
2006). The following are examples of each basic step:
Clean
• Wash hands in warm soapy water for at least
20 seconds before and after handling food and
after using the bathroom, changing diapers, or
handling pets
• Wash cutting boards, dishes, utensils, and counter tops with hot soapy water after preparing each
food item and before going on to the next food
• Wash produce
• Wash canned goods lids before opening
Separate (to prevent cross-contamination of bacteria
from one food product to another)
• Use different cutting boards for fresh produce
and raw meat, poultry, and seafood
• Separate raw meat, poultry, seafood, and eggs
from other foods in a grocery shopping cart, grocery bags, and in the refrigerator
• Do not use the same plate for cooked food that
previously was used for the raw meat, poultry,
seafood, or eggs
Cook
• Do not eat raw or undercooked meat, poultry,
fish, or eggs (the most important thing is to use a
food thermometer to be sure foods have reached
a safe minimum internal temperature)
• Reheat food thoroughly to temperature of 165°F
or until hot and steaming
• When cooking in a microwave oven, cover food,
stir, and rotate for even cooking
Foodborne Illnesses
According to the USDA (2006), the elderly are more susceptible to foodborne illnesses because as people age their
stomach and intestinal tract may hold on to foods for a longer period of time, their liver and kidneys may not readily rid
their bodies of toxins, and their sense of taste and/or smell
may be altered.
Clients may also have one or more chronic conditions,
such as diabetes, arthritis, cancer, or cardiovascular disease,
which may weaken their immune system, causing them to be
more susceptible to contracting foodborne illnesses. Additionally, clients’ sense of taste and smell is often affected by
medication or an illness, so these senses may not always alert
them when meat is spoiled or milk is soured (USDA, 2006).
1
Humboldt State University, Arcata, CA, USA
Guidelines for Safe Food Handling
Home health nurses can teach clients how to help prevent
contracting foodborne illnesses from food and beverages by
Corresponding Author:
Marshelle Thobaben, Humboldt State University, Arcata,
CA 95521, USA
Email: [email protected]
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534
Home Health Care Management & Practice 22(7)
Table 1. Major Pathogens That Cause Foodborne Illness
Pathogens and Associated Foods/Other Sources
Campylobacter jejuni
Contaminated water
Symptoms and Potential Impact
Fever, headache, and muscle pain followed by diarrhea
(sometimes bloody), abdominal pain, and nausea that appear
2 to 5 days after eating; may last 7 to 10 days
May spread to bloodstream and cause a life-threatening
infection
Unpasteurized milk
Raw or undercooked meat, poultry, or shellfish
Clostridium perfringens
Called “the cafeteria germ” because many outbreaks result
from food left for long periods in steam tables or at room
temperature
Meats, meat products, and gravy
Escherichia coli O157:H7 (one of several strains of E. coli that can
cause human illness)
Undercooked beef, especially hamburger
Unpasteurized milk and juices, such as “fresh” apple cider
Contaminated raw fruits and vegetables and water
Person to person
Listeria monocytogenes (can grow slowly at refrigerator
temperatures)
Contaminated hot dogs, luncheon meats, cold cuts, fermented or
dry sausage, and other deli-style meat and poultry
Soft cheeses and unpasteurized milk
Smoked seafood and salads made in the store, such as ham salad,
chicken salad, or seafood salad
Noroviruses (and other calciviruses)
Shellfish and fecally contaminated foods or water
Ready-to-eat foods touched by infected food workers, for
example, salads, sandwiches, ice, cookies, fruit
Salmonella (over 2,300 types)
Raw or undercooked eggs, poultry, and meat
Unpasteurized milk or juice
Cheese and seafood
Contaminated fresh fruits and vegetables
Toxoplasma gondii
Raw or undercooked meat
Accidental ingestion of cat feces through touching hands to
mouth after gardening, handling cats, cleaning cat’s litter box, or
touching anything that comes in contact with cat feces
Vibrio vulnificus
Undercooked or raw seafood (fish or shellfish)
Intense abdominal cramps and diarrhea begin 8 to 22 hours
after eating; usually lasts 24 hours. In the elderly, symptoms
may last 1 to 2 weeks
Complications and/or death occur only very rarely
Severe diarrhea that is often bloody, abdominal cramps, and
vomiting; usually little or no fever
Can begin 1 to 8 days after food is eaten and last about 5 to
10 days
Fever, chills, headache, backache, sometimes upset stomach,
abdominal pain, and diarrhea; may take up to 3 weeks to
become ill
Those at risk may later develop more serious illness; death can
result from this bacteria
Nausea, vomiting, stomach pain, fever, muscle aches, and some
headache usually appear within 1 to 2 days and may last 1 to
2 days
Stomach pain, diarrhea, nausea, chills, fever, and headache
usually appear 8 to 72 hours after eating; may last
4 to 7 days
A more severe illness may result if the infection spreads from
the intestines to the bloodstream
Without treatment, death may result
Flu-like illness that usually appears 5 to 23 days after eating
may last months
Those with a weakened immune system, including older adults,
may develop more serious illness
Diarrhea, stomach pain, and vomiting may appear within 1 to
7 days and last 2 to 8 days
May result in a blood infection
May result in death for those with a weakened immune system,
including older adults
Note. Adapted from U.S. Department of Agriculture (2006).
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535
Thobaben
Chill
• Two-hour rule: refrigerate or freeze meat, poultry, eggs, seafood, and other perishables within
2 hours of cooking or purchasing (refrigerate
within 1 hour if the temperature outside is more
than 90°F)
• Never thaw food at room temperature
• Divide large amounts of leftovers into shallow
containers for quicker cooling in the refrigerator
• When thawing food in the microwave, cook the
food immediately
For a complete guide to food safety, nurses can provide
clients with the U.S. Department of Agriculture’s (2006)
booklet, Food Safety for Older Adults: A Need-to-Know
Guide for Those 65 Years of Age and Older. It is available
online at http://www.fsis.usda.gov/pdf/food_safety_for_older
_adults.pdf.
Foodborne Illness Action Plan
There is no one “syndrome” that is characteristic of symptoms
of foodborne illnesses. However, nausea, vomiting, abdominal cramps, and diarrhea are commonly the first symptoms
clients experience in many foodborne illnesses (CDC,
2005). See Table 1 for a list of the major symptoms caused
by different bacteria and viruses causing foodborne
illnesses.
Depending on the bacteria or virus that caused the foodborne infection, the treatments may be different. Home health
nurses should inform clients that if they suspect they have a
foodborne illness, they should contact their physicians, particularly, if they have a high fever (temperature over 101.5°F,
measured orally), blood in their stools, prolonged vomiting
that prevents them from keeping liquids down (which can
lead to dehydration), or if they have a diarrheal illness that
lasts more than 3 days (CDC, 2005; USDA, 2006).
If clients suspect certain foods or beverages caused their
foodborne illness, they should preserve the suspected food
or beverage by wrapping it securely, labeling it DANGER,
and freezing it. It may later be used to accurately diagnose
the specific pathogen or virus that caused their foodborne
illness. They should also contact their physician or the local
health department and report their suspected foodborne infection (food poisoning). Their physician or health department
staff will advise them if an investigation is warranted to determine the cause of their illness and/or preventing others from
also becoming ill (USDA, 2006).
Home health nurses can be instrumental in preventing clients from contracting foodborne illnesses by teaching them to
be vigilant when handling, preparing, and consuming foods.
References
U.S. Department of Agriculture. (2006). Food safety for older
adults: A need-to-know guide for those 65 years of age and
older. Retrieved from http://www.fsis.usda.gov/pdf/food_safety
_for_older_adults.pdf
U.S. Department of Health & Human Services, Centers for
Disease Control and Prevention. (2005). Foodborne illness.
Retrieved from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/
foodborneinfections_g.htm#mostcommon
Bio
Marshelle Thobaben, RN, MS, P-MHNP, PHN, FNP, is professor
of nursing and former department chair at Humboldt State University (HSU) in Arcata, California. She has published more than
150 articles on international nursing education, elder abuse, and
psychosocial issues affecting clients and nurses in leading nursing
journals and has coauthored several textbooks. She has been nationally recognized for her work in elder abuse prevention and psychiatric home health. She has received HSU’s Outstanding Service and
Scholar of the Year Awards as well as the American Association of
University Women’s Woman of Achievement Award for her ongoing commitment to nursing education.
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