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Running head: SAFETY 1 Safety and Community Care Shravan Santosh Capella University Orientation to Baccalaureate Nursing Safety and Community Care January, 2017 SAFETY 2 Though the American food supply system is considered the safest in the world, it is estimated that about 48 million cases of foodborne illness occur annually. According to the federal government, one in six Americans falls sick due to food-borne illnesses yearly. An estimated 128,000 hospitalizations and 3,000 deaths are caused by food-borne illnesses yearly (FDA, 2016a). Salmonella, E. coli, and Campylobacter are some of the common foodborne illness-causing pathogens (“Foodborne Illness”, 2016). According to the Arizona Department of Health Services, Maricopa County had almost the same rate of reported E. coli cases per 100,000 people as the state’s average in 2014 (AZDHS.2014). The outbreak was caused due to the consumption of food and drinks in a restaurant in the West Valley with about 94 people being affected by Shiga toxin-producing E. coli (STEC). The federal and state governments in the United States implemented certain health care initiatives, such as Food Safety Modernization Act (FSMA), Foodborne Disease Active Surveillance Network (FoodNet), Hazard Analysis and Critical Control Point (HACCP) to help identify and tackle similar outbreaks through various practices like inspecting food facilities, conducting lab tests for food items, designing measurements to reduce risk levels, and so on. Food Safety Modernization Act Large-scale outbreaks of foodborne illness nationwide in the United States have recently caused a focused attention on the ability of its food-safety system to protect the public health (NEJM, 2011).
To address the food safety concerns, the FSMA was enacted to ensure that food does not get contaminated during production, processing, distribution, and preparation. The FSMA mandates federal agencies to collaborate with state regulatory agencies to prevent outbreaks by educating the stakeholders, providing technical assistance on the implementation of FSMA, and inspecting food supply to its safety by shifting the focus from “responding to Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. Comment [JAR1]: Do not end a sentence with a number or abbreviation SAFETY 3 contamination to preventing it” (FDA, 2016b).
The FSMA rule for preventive controls for human food establishes an analysis system for monitoring and verifying the food sold for consumption (FDA, 2016c). The FSMA rule for preventive controls for animal food provides a variety of Current Good Manufacturing Practices (CGMPs) for “producing animal food taking into account the unique aspects of the animal food industry” to correspond to its food safety regulations (FDA, 2016d). Factors that Affect the Health of an Individual Many factors work together to affect human health. Whether people are healthy or not, is determined by their circumstances and environment (WHO, 2016). Some of the factors that adversely affect an individual’s health and help the spread of a food-borne illness are as follows:
• Weakened immune system: Individuals with an immunodeficiency-causing disease or older individuals are more likely to contract an infection (Mayo Clinic, 2014). The immune system fights off infections, germs, and cancer, but when it is weakened it does not work properly and fails to guard against infections and germs (Diagnose.Me, 2016); • Seasonal changes: The time of the year and weather conditions affect the health of an individual as they affect the spread of pathogens. Studies indicate that the number of E. coli cases spike during the summer months, especially in August (CDC, 2016). During summers, people are infected with E-coli as they tend to eat more outside, with lack of proper sanitation, and camp in open fields, which might be contaminated, and sometimes cook food without running water and so on (Food Safety News, 2011); and • Unprocessed food: The main source of food-borne illnesses, like an E. coli infection, is the consumption of raw or uncooked meat, contaminated fresh produce, and Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. Comment [JAR2]: This is not a professional source. Also it did not appear in the references. All citations need to appear in the references and visa versa SAFETY 4 unpasteurized milk (Food Safety News, 2013a).
The presence of various kinds of bacteria, viruses, parasites, and chemicals in raw food, unpasteurized milk, and dairy products contaminate the food and cause food-borne illness (NIDDK, 2014). The factors that contribute to the spread of a food-borne illness, like E. coli, can be prevented by employing hygienic practices and safety precautions such as the following; • Practicing proper hygiene. The use of alcohol-based hand sanitizers can help prevent infection when clean water is not available; • Following guidelines to cook meat properly and thoroughly (Foodsafety.gov, n.d.). Sometimes, bad refrigeration can also lead to the spread of infection (USDA, 2013);Assignment: Safety and community care Papers.
• Vaccinating cattle and humans to prevent or reduce the spread of disease (Food Safety News, 2013b); and • Avoiding consuming raw food products. Heat kills most of the pathogens and, hence, makes food safe. For example choosing pasteurized milk over raw milk. Following these hygienic practices and safety precautions will help prevent the spread of food-borne illness, like E. coli.
Foodborne illness is a life threatening public health challenge, but it is preventable. Anyone and everyone can be affected with such illness if proper care and hygiene is not maintained during the various phases of the food supply system as prescribed by the several state and federal laws. Also, certain basic precautions should be taken at the individual level before consumption of food. Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. SAFETY 5 References Arizona Department of Health Services. (2014). Rates of Reported Cases of Selected Notifiable Diseases, by Category, for each County, Arizona, 2014, per 100,000 population [Data file]. Retrieved from http://azdhs.gov/documents/preparedness/epidemiology-diseasecontrol/disease-data-statistics-reports/annual-reports-archive/2014-rates-of-reportedcases-of-notifiable-diseases-by-county.pdf About Foodborne illness (2016). Foodborne Illnesses. Retrieved from http://foodborneillness.com/ Centers for Disease Control and Prevention. (2016, January 19). FoodNet 2013 Annual Report. Retrieved from Foodsafety.gov. (n.d.). Cook to the right temperature. Retrieved from http://oodsafety.gov/keep/basics/cook/index.html Food Safety News. (2013a, January 23). How Do Pathogens Get Into Produce? Retrieved from http://foodsafetynews.com/2013/01/how-do-pathogens-get-intoproduce/#.Vvz2wuJ9600 Maricopa County Department of Public Health. (2013, November 25). Federico’s Mexican Restaurant. Retrieved from http://foodsafetynews.com/files/2013/11/Federicos-FinalReport.pdf Michael R. Taylor, J.D. N (2011). Will the Food Safety Modernization Act Help Prevent Outbreaks of Foodborne Illness? The New England Journal of Medicine. Retrieved from http://nejm.org/doi/full/10.1056/nejmp1109388 Copyright ©2016 Capella University. Copy and distribution of this document is prohibited.
SAFETY 6 Mayo Clinic. (2014, August 1). Risk factors. Retrieved from http://mayoclinic.org/diseasesconditions/e-coli/basics/risk-factors/con-20032105 National Institute of Diabetes and Digestive and Kidney Diseases. What causes foodborne illnesses? (2014, June).
Retrieved from http://niddk.nih.gov/health-information/healthtopics/digestive-diseases/foodborne-illnesses/Pages/facts.aspx Smith, M.S (2011, January). Why are there more E-coli infections in summer? Food Safety News. Retrieved from http://foodsafetynews.com/2011/01/why-are-there-more-e-coliinfections-in-the-summer/#.VxTTA_l94dU The determinants of health. (2016). Health Impact Assessment. World Health Organization. Retrieved from http://who.int/hia/evidence/doh/en/ United States Department of Agriculture: Food Safety and Inspection Service. (2013, July 30).Assignment: Safety and community care Papers.
Keeping Food Safe During an Emergency. Retrieved from http://fsis.usda.gov/ wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/ emergency-preparedness/keeping-food-safe-during-an-emergency/CT_Index U.S. Food and Drug Administration. (2016a, January 7). Foodborne Illnesses: What You Need to Know. Retrieved from http://fda.gov/Food/FoodborneIllnessContaminants/ FoodborneIllnessesNeedToKnow/default.htm U.S. Food and Drug Administration. (2016c, January 22). FSMA Final Rule for Preventive Controls for Human Food. Retrieved from http://.fda.gov/Food/GuidanceRegulation/FSMA/ucm334115.htm Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. SAFETY 7 U.S. Food and Drug Administration. (2016d, January 22). FSMA Final Rule for Preventive Controls for Animal Food. Retrieved from http://fda.gov/Food/GuidanceRegulation/FSMA/ucm366510.htm U.S. Food and Drug Administration. (2016b, March 17). FDA Food Safety Modernization Act (FSMA). Retrieved from http://fda.gov/Food/GuidanceRegulation/FSMA/ Weakened Immune System (2016, January). Diagnose.Me. Retrieved from http://diagnoseme.com/symptoms-of/weakened-immune-system.php
Zuraw, L (2013b, September 23). E. Coli Cattle Vaccination Could Prevent 83 Percent of Human Cases. Food Safety News. Retrieved from http://www.foodsafetynews.com/2013/09/ecoli-cattle-vaccination-could-prevent-83-percent-of-human-cases/#.VxXwifl94dU Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. SAFETY 8 Safety and Community Care (Health Care Providers) Sitara Monnappa Capella University Orientation to Baccalaureate Nursing Safety and Community Care January, 2017 Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. SAFETY 9 Every year, an estimated 48 million people in the United States suffer from food-borne illnesses and about 3,000 people die because of these diseases (“Foodborne Illnesses,” 2014). Bacteria such as Campylobacter and Salmonella are commonly found in food and often cause illnesses in humans (“Bacteria,” 2015).Assignment: Safety and community care Papers.
Causes of Food-borne Illnesses Food-borne illnesses are caused by consuming food or beverages that contain harmful bacteria, viruses, parasites, or chemicals. According to a study conducted on the major pathogens that cause food-borne illnesses in the United States over the last decade, 5.5 million (59%) foodborne illnesses were caused by viruses, 0.2 million (2%) by parasites, and 3.6 million (39%) by bacteria. Nontyphoidal Salmonella spp., Campylobacter spp., and Clostridium perfringens caused the most food-borne illnesses. Nontyphoidal Salmonella spp., Campylobacter spp., Toxoplasma gondii (T. gondii), and Listeria monocytogenes caused the most hospitalizations and deaths (Scallan, E., et al, 2011). Fish, poultry, and meat in raw form, fresh produce, and dairy products contain harmful bacteria. Bacteria contamination of food can occur during the growth stage, slaughter or harvesting, processing, storage, and transportation.
Bacterial contamination during food preparation in a restaurant or home kitchen occurs if food handlers fail to wash their hands, cutting boards, kitchen appliances and utensils, and other kitchen surfaces that come into contact with raw foods often. This bacterial contamination leads to cross-contamination—the spread of bacteria from contaminated food to uncontaminated food (“Foodborne Illnesses”, 2014). Treatment for Food-borne Illnesses People suffering from food-borne illnesses exhibit certain symptoms such as abdominal pain, vomiting, and diarrhea (with or without blood), accompanied by fever and chills. Diarrhea Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. SAFETY 10 and vomiting causes the loss of fluids and electrolytes, leading to dehydration, which can be reversed by replacing the lost fluids and electrolytes. Adults can take over-the-counter medications such as bismuth subsalicylate (Pepto-Bismol and Kaopectate) and loperamide (Imodium) to stop diarrhea (“Foodborne Illnesses,” 2014). However, caution while using these agents is suggested when fever, chills, or bloody diarrhea is present (Deshpande, et al, 2013).Assignment: Safety and community care Papers.
Factors That Can Adversely Affect the Health of Individuals Eating food that contains harmful bacteria can cause food-borne illnesses in people. Some factors that can make people even more susceptible to food-borne illnesses are; • Primary immunodeficiencies: Food-borne diseases due to bacteria such as Giardia, Campylobacter, and Salmonella are commonly seen in people with primary immunodeficiencies since their immune systems are compromised; • Cancer and immunosuppressive treatment: The immunosuppressive treatment given to transplant recipients, to prevent organ or transplant rejection, and chemotherapy and radiotherapy given to cancer patients affect the gastrointestinal mucosa and bone marrow cells, thus reducing the barriers to the entry of harmful bacteria (Lund & O’Brien, 2011); • Pregnancy: Cell-mediated immune function reduces during pregnancy on account of hormonal changes (Tam, 2010).
Assignment: Safety and community care Papers. L. monocytogenes and T. gondii commonly infect pregnant women. The infection can be manifested as fever or flu-like illness, stillbirth, fetal loss, or birth of a critically infected infant (Lund & O’Brien, 2011); and • Age: Immune system function reduces with age, making the body more susceptible to infections (“Senior Citizens and Foodborne Diseases”, 2014). In people above the age of 65, listeriosis and infections from Campylobacter and Salmonella are common (Lund Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. SAFETY 11 & O’Brien, 2011). Children under the age of five are commonly infected by Campylobacter, Salmonella, Shiga toxin-producing Escherichia coli O157, and Shigella since their immune systems are still developing (“Food safety concerns for children under five,” 2016). Methods to Prevent Food-borne Illnesses The following steps help prevent the growth of harmful bacteria in food;
• Washing hands thoroughly before handling food will reduce the spread of any harmful bacteria; • Storing food at low temperatures through refrigeration and freezing slows down the growth of bacteria and can even stop it; • Heat treatments, such as sterilization and pasteurization, of food kill bacteria in the food; • Preservatives, namely organic acids, can kill bacteria in food (“Introduction to the microbiology of foods,” n.d.); • Processes such as salting and drying, which reduce the water available to the bacteria present in food, can inhibit bacterial growth in food (Bax, 2015); • Vacuum packaging (“Preserve my food,” 2011) and gas flush packaging (“Gas flush/modified atmosphere packaging,” 2013) can prevent the growth of pathogenic bacteria. These processes reduce atmospheric oxygen in food packages, protecting the food from spoiling by limiting the growth of aerobic bacteria; • Separating poultry, raw meat, eggs, and seafood from other foods can prevent crosscontamination (“Information for consumers,” 2015);Assignment: Safety and community care Papers.
and Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. SAFETY • 12 Cooking meat to temperatures at least 145°F kills any bacteria present (“Tracking and Reporting Foodborne Disease Outbreaks,” 2014). Health Initiatives to Control Food-borne Illnesses Surveillance systems across United States alert the Centers of Disease Control (CDC) and the Food and Drug Administration (FDA) about cases of food-borne illness and any increase in their number. The Foodborne Diseases Active Surveillance Network (FoodNet), a surveillance system, conducts surveillance on infections caused by nine species of bacteria including Listeria, Salmonella, and Shiga toxin-producing Escherichia Coli (STEC) diagnosed by laboratory testing of samples from patients through surveys and studies. FoodNet personnel collate the data on infections diagnosed in the residents of different states in the United States and determine the factors and risk for enteric infections. FoodNet serves as a surveillance and research platform that can be adapted to address emerging issues (“About FoodNet,” 2015).Assignment: Safety and community care Papers.
The FDA conducts regulatory programs to regulate the production and sale of milk, shellfish, and all food products that directly reach consumers through retail-level food establishments. The organization regularly inspects food samples to check for the presence of pathogenic bacteria. The FDA has also created a set of guidelines for food producers and processors to follow so as to ensure food safety. Diagnosis and Management of Foodborne Illnesses, a Primer for Physicians and Other Healthcare Professionals, was released in April 2004 to enable primary care physicians and other health professionals identify, diagnose, and treat food-borne illness. The Primer also provides handouts to educate patients about the four key food safety behaviors: Clean, Separate, Cook, and Chill (FDA, 2015). Conclusion Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. SAFETY 13 Spreading awareness about food safety and high-risk foods as well as ensuring the microbiological safety of food are essential to minimize food-borne infections. Proactive collaborations of local, federal, state, and international food safety partners with consumers, industry, and academia will enable the American food supply to prevent food-borne illnesses. Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. SAFETY 14 References Bax, K. (2015). Preserving food at home: Freezing, drying, salting, smoking, pickling. Retrieved from http://countryfarm-lifestyles.com/preserving-food.html#.VxdiGtR97IX
Centers for Disease Control and Prevention (2015, October). Information for consumers. Retrieved from http://cdc.gov/foodsafety/groups/consumers.html Centers for Disease Control and Prevention (2015, December). About FoodNet. Retrieved from http://cdc.gov/foodnet/about.html Deshpande, A., Lever, D. S., and Soffer, E. (2013, August).
Acute diarrhea. Retrieved from http://clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterolog y/acute-diarrhea/ Foodborne Illnesses (2016), Retrieved from http://foodborneillness.com/ Food safety concerns for children under five (2016). Retrieved from http://foodsafety.gov/risk/children/ Gas flush/modified atmosphere packaging (2013). Retrieved from https://sorbentsystems.com/gas-flush.html Introduction to the microbiology of food (n.d.).
Retrieved from http://aggiehorticulture.tamu.edu/food-technology/food-processing-entrepreneurs/microbiology-offood/ Klein, E. J., Boster, D. R., Stapp, J. R., Wells, J. G., Qin, X., Clausen C. R., Swerdlow D. L., Braden C .R., Tarr P. I. (2006, August). Diarrhea etiology in a children’s hospital emergency department: A prospective cohort study. Retrieved from http://ncbi.nlm.nih.gov/pubmed/16941358 Copyright ©2016 Capella University. Copy and distribution of this document is prohibited. SAFETY 15 Lund, B. M., O’Brien, S. J. (2011, September). The occurrence and prevention of foodborne disease in vulnerable people. Foodborne Pathog Dis. 8(9). 961–973. doi: 10.1089/fpd.2011.0860. Retrieved from http://ncbi.nlm.nih.gov/pmc/articles/PMC3159107/#B42 Preserve my food (2011). Retrieved from http://preservemyfood.com/techniques/vacuum_packing.html Scallan, E., Hoekstra, R.M., Angulo, F.J., Tauxe, R. V., Widdowson, M., Roy, S. L., Jones, J. L., and Griffin, P. M. (20 … Assignment: Safety and community care Papers.