A Bacterial Investigation

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Campylobacter is one of the most common bacterial causes of gastro intestinal diarrheal sickness in the United States of America. The vast majority of these cases occur as isolated and sporadic events and not as part of recognized epidemic like outbreaks. Ongoing surveillance by FoodNet demonstrates that about thirteen cases are diagnosed each year for each 100,000 persons in the population. Many more cases go undiagnosed or unreported, and campylobacteriosis is estimated to affect more than 2.4 million persons each year, or 0.8% of the total population of the USA. This disease is also very common in Europe, the Middle East and Asia. Campylobacteriosis occurs far more frequently in the summer months than in the winter months. The organism is isolated from infants and young adults more frequently than from persons in other age groups and from males more frequently than females. Although Campylobacter does not commonly cause death, it has been estimated that approximately 124 persons with Campylobacter infections die each year in the USA.

Campylobacter organisms are spiral-shaped bacteria that can cause disease in humans and animals. Most human illness is caused by one species, called Campylobacter jejuni, but human illness can also be caused by other species. Campylobacter jejuni grows best at the body temperature of a bird, and seems to be well adapted to birds, who carry it without becoming ill. These bacteria are fragile. They cannot tolerate drying and can be killed by oxygen. They grow only in places with less oxygen than the amount in the atmosphere. Freezing reduces the number of Campylobacter bacteria on raw meat.

Almost all persons infected with Campylobacter recover without any specific treatment. Patients should drink extra fluids as long as the diarrhea lasts. In more severe cases, antibiotics such as erythromycin or a fluoroquinolone can be used, and can shorten the duration of symptoms if given early in the illness. Your doctor will decide whether antibiotics are necessary.

Most people who get campylobacteriosis make a complete recovery within two to five days after the onset of symptoms, although sometimes in more serious cases recovery can take up to 10 days. Rarely, Campylobacter infection results in long-term consequences. Some people may develop arthritis. Others may develop a rare disease called Guillain-Barré syndrome that affects the nerves of the body which begins several weeks after the onset diarrheal illness. This occurs when a person’s immune system is triggered to attack the body’s own nerves which results in temporary paralysis that lasts several weeks and usually requires an intensive care regime. It is estimated that approximately one in every 1,000 reported Campylobacter illnesses leads to Guillain-Barré syndrome. As many as 40% of Guillain-Barré syndrome cases in this country may be triggered by campylobacteriosis.Campylobacteriosis usually occurs in single, sporadic cases, but it can also occur in outbreaks, when a number of people become ill at one time. Most cases of campylobacteriosis are associated with eating raw or undercooked poultry meat or from cross-contamination of other foods by these poultry items. Infants may get the infection by contact with poultry meat wrappings in shopping carts. Outbreaks of Campylobacter are usually associated with unpasteurized milk or contaminated water. Animals can also be infected, and some people have acquired their infection from contact with the stool of infected dogs or cats. The organism is not usually spread from one person to another, but this can happen if the infected person is producing large volumes of diarrhea and/or vomit. A very small number of Campylobacter organisms (fewer than 500) can cause illness in humans. Even one drop of juice from raw chicken meat can infect a person. One way to become infected is to cut poultry meat on a chopping board, and then use the unwashed chopping board and knife or other utensils which came into contact with the raw meat to prepare vegetables or other raw or lightly cooked foods. The Campylobacter organisms from the raw meat can by these means spread to the other food products.

Many chicken flocks are infected with Campylobacter but may very well show no signs of illness. Campylobacter can be easily passed from bird to bird through a common water source or through contact with infected feces of other birds. When an infected bird is slaughtered, Campylobacter organisms can be transferred from the intestines to the meat. Likewise, the bacteria can infect a whole batch of birds via the presence of the bacteria being present on equipment and on the hands and/or the gloves of the slaughter house workers who do not wash hands between each bird they handle. In 2005, Campylobacter was present on 47% of raw chicken breasts tested through the FDA-NARMS Retail Food program. Campylobacter is also present in the giblets, especially the liver.

Unpasteurized milk can become contaminated if the cow has an infection with Campylobacter in her udder or milk which has been contaminated with manure. Surface water and mountain streams can become contaminated from infected feces from cows or wild birds. This infection is common in the developing world, and travelers to foreign countries are also at risk for becoming infected with Campylobacter.

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Last Monday morning I received a phone call from the area superintendent of the department of public health. She told me that there was a steady stream of people falling sick due to eating food prepared by one of the large kitchens in our area. She continued to tell me that her department had been through the place with a fine tooth comb but still couldn’t find the source of the contamination. I arranged to meet them at the premises in question the following day to conduct an inspection.

To tell you the truth, I had a pretty good idea what I would be looking for because I had been to that particular kitchen several times in the past and had spotted a few things that seemed problematic. However, I had to make it seem as if I was earning my money so I decided that we would start somewhere quite far from the place that I suspected to be the problem.

We started by taking swabs of everything we saw and asked staff to provide swabs, blood, urine and stool samples. We checked the toilets of staff and diners alike and took swabs from all manner of cooking pots and trays,

I knew that this kitchen was using a type of bread basket within which to thaw meats and fish. The bread baskets were stacked one upon the other and left inside the two degree Celsius anti room of the freezer complex for up to four days. I also knew that the baskets were loaded onto a low level service trolley and brought up to the kitchen. I had known the chef of this kitchen for a number of years and I also knew that it was his practice to unload the baskets into plastic tubs after the lunch had gone out to the dining room. I always made a practice of doing this first thing in the morning before we started on the days chores.

What this meant was that the contents of the baskets were left to warm up from between seven o’clock in the morning until 11 o’clock in the morning. This wasn’t a very good practice. Every chef has his ways but I knew that this was not the exact point I wanted to look at closely. What bothered me were the baskets themselves. I had a word with the chef and asked him to make an exception today and vacate the baskets earlier. What i notices was what I suspected. After rinsing the basket with water to remove the blood I saw that there was a light colored plaque stuck to the plastic. I took a scraper and saw that it came away fairly easily. I took scrapings from all the baskets used that day and then took the baskets to the aluminium washing machine to see what happened.

The man working on the machine proudly took a stack of five baskets and but them onto the machine and presses the operating handle down. The baskets disappeared into the machine for a few seconds and then came out. The worker informed me that this was a very efficient way of washing the baskets. he then placed them back onto the service trolley which had not been washed only sprayed with a water gun and placed the baskets next to the lift ready to by taken back down to the freezers.

The guy in charge of the freezer units the proceeded to re fill them with produce for another day. I had noticed several things, 1) the baskets had not been scrubbed with a stiff plastic brush of Brillo pad with detergent, 2) they had only been rinsed inside the machine which used high pressure but was ineffective due to the fact that the stacking of baskets inside the machine rendered the high pressure ineffective,3) chicken, beef, pork and fish had been set out to thaw in the same tower of eight baskets.

All of this led us to believe that we had quite possibly found the missing link of the food contamination dilemma. What had been happening was that liquid released from the thawing meat and fish had been dripping onto the plaque in the bottom of the baskets which in turn had been dripping onto the neat inside the baskets below. Then we discovered something else. The worker who had been handling the baskets went to work on the dish washing machine that cleaned the crockery and cutlery merely wiping his hands on a towel and removing his plastic apron before going onto the dish washing machine. It was his job to remove the clean cutlery off the dish washing machine. We clearly saw that he could be contaminating the cutlery.

All we needed to do now was to take the cultures we had taken back to the lab and have them checked out. These were the findings. Camphilobacter, Staph Aureus, Salmonella, e. coli, vibrio an listeria were all present in large quantities within the plaque which we removed from the bread baskets. Our findings were relayed to the company management with the following recommendations. All bread baskets to receive immediate soaking in caustic soda. 2) All bread baskets to be scrubbed individually before putting them onto the aluminium machine,3) all bread baskets to be put into the aluminium machine individually and 4) all bread baskets to receive a weekly soaking in caustic soda. 4) aluminium machine worker was to thoroughly wash his hands and change overalls before helping out anywhere else.

A re check will be conducted in two weeks from the day all the baskets were washed in caustic soda.

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