"It was the potato salad at the church picnic that poisoned half the people”. Every public health student has heard this example in school I’m sure. It’s the classic case of a single, ready to eat food item served to a group of people who may have eaten it, along with other food. The example goes on to explain how we calculate attack rates and discover the contaminated item that sickened the people. Sounds like the game Clue. Investigating foodborne illnesses is very much a detective game. The investigation as to who, what, when, and where all need answers to determine the source of contamination. There may be isolated cases of illness, or there may be a larger group of people that have a common link i.e. the holiday party at work. Either way, food can make us sick.
The CDC estimates that approximately 48 million people in the US gets sick from food borne illnesses each year (4). Of those, 128,000 are hospitalized, and 3,000 die(4) ! The main culprits are norovirus, and bacteria like Salmonella, C. perfringens, and Campylobacter (4). These bacteria and norovirus are the cause of enteric illness in people which result in symptoms of diarrhea, nausea, vomiting, fever, and abdominal cramps. Most people stick it out at home and recover on their own within a few days, but some people do end up in the emergency department for supportive care. When they call and report the food poisoning to the health department it is often a difficult task to try and track down the causative agent. During the patient interview some of the information we gather is:
Even with this information it is still difficult to implicate a certain food or restaurant. What is really needed, but rarely done, is to have lab work done in order to isolate the pathogen. From there, we are able to use the pathogen’s incubation time period to trace back how long it would take to cause symptoms. From that information we can look at the food history and determine where that person was eating to help narrow down the list of places.
So, what types of places get reported frequently as “suspect” places of illness? Buffet-style restaurants. Nowadays we have so many choices when it comes to a serve yourself setup. There are the smaller, all you can eat, less than $10 average ones, all the way up to the deluxe 5-star food with crab legs, Kobe beef, sushi, buffalo, duck, and quail. But in either case, it is important that the food is kept safe, and that you are a smart eater.
It’s interesting to see why the buffet setup may pose some problems. Food that’s served on a buffet or salad bar are ready to eat foods which can, in the right conditions, grow pathogens. These types of food are already cooked or are to be served cold and are available to patrons to serve themselves. On buffets the food sit in pans which rest in steam tables or ice. It is important that hot food stays hot, 140°F or hotter, and cold foods stay cold, 40°F or colder. In between 40°F and 140°F is known as the danger zone. This range is optimal for pathogen growth. Food should not be left out sitting for more than an hour or two. When taking your food scoop from the bottom of the pan where the food is hottest or coldest. As with all good health tips, hand hygiene is key. Think about how many people have touched the spoon you just used to get your food. Did they all wash their hands? How effective is the “sneeze guard” when some people don’t realize that one is supposed to sneeze in your sleeve?!
A few things to watch for: Look at the entire setup. Is it clean, with no spilled food or utensils that have fallen into the food? Are there enough serving spoons available so patrons aren’t temped to touch the food with bare hands? Is there a sneeze-guard? Do the wait staff regularly check temperatures and replace old pans with new pans of food? Some “food for thought” from food-safety experts - 8 foods they never eat (1):
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