a foodborne outbreak of gastroenteritis in a teaching hospital l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
A Foodborne Outbreak of Gastroenteritis in a Teaching Hospital PowerPoint Presentation
Download Presentation
A Foodborne Outbreak of Gastroenteritis in a Teaching Hospital

Loading in 2 Seconds...

play fullscreen
1 / 19

A Foodborne Outbreak of Gastroenteritis in a Teaching Hospital - PowerPoint PPT Presentation


  • 339 Views
  • Uploaded on

Developing Family Medicine: Challenges for the Next Decade AKUH, February, 22, 2003. A Foodborne Outbreak of Gastroenteritis in a Teaching Hospital. Rashid A. Chotani, MD, MPH. Hospital. 940 bed hospital with 4 cafeterias.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'A Foodborne Outbreak of Gastroenteritis in a Teaching Hospital' - Olivia


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
a foodborne outbreak of gastroenteritis in a teaching hospital

Developing Family Medicine:

Challenges for the Next Decade

AKUH, February, 22, 2003

A Foodborne Outbreak ofGastroenteritis in a TeachingHospital

Rashid A. Chotani, MD, MPH

hospital
Hospital
  • 940 bed hospital with 4 cafeterias.
  • Cafeteria A, located in the OPD, serves approximately 600 visitors and employees daily.

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

events
Events
  • On 12/9/97 individuals who ate at Cafeteria A reported nausea and projectile vomiting after eating a noon meal.

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

method case definition
Method: case definition

Any person who ate lunch prepared at cafeteria A on December 9, 1997 and developed sudden onset of

  • vomiting or
  • diarrhea or
  • abdominal cramps

and

Any of the following symptoms including nausea, fever, body aches, headache, chills or fatigue.

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

method case finding
Method: case finding

We identified all cases who identified

individuals who ate with them.

All non-Ill persons were used as

controls.

  • Additional cases were found when we contacted:
      • Nurse managers
      • Hospital managers
      • Directors of nursing, functional unit directors, JHH vice-presidents
      • Several employee groups were notified via e-mail and asked to identify cases.

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

methods questionnaires
Methods: questionnaires

Standard questionnaires were

used to obtain medical and food

history from

      • Food service workers
      • Ill and non-ill employees
  • Menu reviewed at Cafeteria A.

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

control measures and interventions cafeteria a
Control Measures and Interventions: Cafeteria A

Cafeteria:

  • Kitchen was inspected
  • Leftover foods recovered and cultured
  • Food preparation, kitchen cleaning procedures reviewed
  • Certain food items quarantined
  • Employees were interviewed, inspected for sores, boils, cuts, IV tract marks and sent to occupational health services
  • We obtained nares swabs
  • 3 cafeteria staff members submitted stool samples or rectal swabs
  • All staff (n=17) were questioned daily for symptoms

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

laboratory
Laboratory
  • Food was processed in standard fashion
    • Blood agar plate R/O Bacillus
    • CAN plate R/O Staphylococcus
    • Plates for enteric pathogens

R/O

Salmonella, Shigella, Aeromonas, Campylobacter, Yersinia

  • Samples sent to city, state, FDA, and commercial laboratory
  • Sequencing preformed
  • Heavy metal testing

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

results
Results
  • N = 75 (ill = 40; non-ill = 35)
  • Mean age: 39 years (range 25-56)
  • Sex: 85% female

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

incubation period jhh employees n 40
Incubation period: JHH employees (n=40)

12

Point source outbreak

10

Number of Cases Reported

8

6

4

2

0

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Incubation Period (Hours)

symptoms
Symptoms

18

fever

25

body aches

43

chills

48

headache

63

diarrhea

fatigue

63

68

abdominal cramps

vomiting

78

93

nausea

0

20

40

60

80

100

Percent

results outcomes
Results: outcomes
  • Duration of illness: mean--24 hr. (range <24 - 72 hr.)
  • Bedridden 62.5%
  • Sought medical care 27.5%
  • Hospitalized 2.5%

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

results univariate analysis
Results: univariate analysis

Food item OR СI 95%p-value

Green beans 36.4 6.93,341.60 <0.0001

Tortellini 5.50 1.03, 54.50 0.02

Corn soup 0.23 0.04, 1.10 0.03

Veg soup 0.23 0.04, 1.10 0.03

Not associated: bread, breadsticks, chicken salad, broccoli salad, cheese salad, caesar salad, havarti cheese, swiss cheese, beef stew, Thai beef, couscous, honey turkey, chicken fingers, cheese pizza, sausage pizza, chow mein noodles, marinated tomatoes, onions, mixed greens, cucumbers, dressing tomato-bacon/peppercorn, creamy, sunflower seeds, crackers, chips, cookies, yogurt, and fresh fruits

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

results multivariate analysis
Results: multivariate analysis

VariableORCI 95%p-value

Green beans 1.84 1.49,2.27 <0.005

Tortellini 1.25 0.98,1.59 NS

Corn soup 0.89 0.69,1.16 NS

Veg soup 0.93 0.71,1.21 NS

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

results laboratory
Results: laboratory
  • Bacillus sp. recovered from garlic mix (opened/unopened jars), Moroccan beef stew and vegetable soup.
  • Bacillus subtilis was identified based on the library profiles.
  • Heavy metals negative.
  • Patient/employees culture negative.

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

food preparation
Food preparation
  • Frozen green beans steamed for 10 minutes.
  • Seasoned with salt, pepper, olive oil and garlic mix.
  • Baked in oven for 15 minutes at 375 OF.
  • Stored in warmer at 180 degrees.
  • Placed in pan and sent to serving line (140 degrees); maximum time 4 hours.

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

summary
Summary
  • 40 persons became ill after eating green beans.
  • We under-estimated magnitude of problem because case ascertainment difficult.
  • The symptoms pointed to a toxin mediated illness.
  • The process of preparing green beans with garlic (in soy oil base) most likely led to the illness.
  • Bacillus was isolated from opened/unopened jars.

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

conclusions
Conclusions
  • FDA
    • Inspected the manufacturing facility
    • Inspected food supplier
    • Ordered recall of all garlic jars produced by company A
    • Mandated new control protocols
  • Aggressive control measures should be taken to prevent the spread of any outbreak particularly in a hospitals in order to protect not just the patients but the staff.
  • Rarely bacillus subtilis has been associated in food poisoning.

Rashid A. Chotani, MD, MPH

GIDSAS-JHU

slide19
Thank you

Rashid A. Chotani, MD, MPH

GIDSAS-JHU