food and drink safety

Food and Drink Safety

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Hugh J. Davis RN, MHA,MPH Betsy Christiansen BSN, RN

In the field, remember:1. Eat to stay healthy!2. Follow safe water protocols.3. Protect yourself from blood-borne disease.4. Follow basic immunization schedules.5. Know how to diagnose & treat travelers’ diarrhea.6. Follow malaria protection protocols.7. Protect yourself from TB.

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Pathways to Infection

Water Food SkinMucous Membranes

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Universal Precautions… …what’s wrong here?

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Universal Precautions

What’s right in this picture?

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It’s been said,“Travel broadens the mind as it loosens the bowels!”

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MTW Medical Team Goal:

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>90% of our medical teams have achieved that goal!

0% incidence of diarrhea and

THINK Before You Eat!!!

Everything that looks good may not be safe.

That which looks unpalatable may be safe.

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Boil it, Cook it,Peel it, or…Forget it!Giardia

trophozoites104-10 AMLT - Honduras

Only 2% of travelers are compliant!

53% use ice in drinks;71% consume uncooked vegetables;40-60% get diarrhea!

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An Unwanted Part of the Missionary Experience

Julie: 9 mo diarrhea 4-5 days per month 10% weight loss

Laurie: 1 year Giardia 2 week hospitalization

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Hepatitis Polio Typhoid fever Protozoa Bacteria Viral enteritis

What does Cipro cover?

Your body is not your own; you were bought with a price.

1 Cor. 6:20

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‘Sacrificial gifts’ from donors lead to loss of…• a caregiver’s time• a translator’s time• a transportation unit• a team’s productivity… or even • a potential cancellation of trip.

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Wash your hands before you eat!

Water from any spigot, tube or pipe

is considered contaminated!DON’T wash your dirty hands in

contaminated water and with contaminated soap; don’t use a contaminated

towel for drying!

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Water Hygiene

Water from spigot is considered contaminated…

…you don’t know the source!

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Safe Alternatives for Hand Washing

Wash in disinfected “clean” water.

Use antibacterial soap.Air dry or use your own “camp towel”.Use jellied alcohol.

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Are We Ready to Eat?

Eat with “clean hands”! Don’t use dirty utensils,

dishes or cups!What’s dirty?What’s clean?

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The ‘Tupperware Alternative’ A sealed container with your own utensils inside;

A 3-step wash using disinfectant.4-10 AMLT - Honduras 20

What’s For Supper?

Ascaris Giardia

Amoebas Taenia

Hepatitis

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ALWAYS Unsafe… …NEVER eat!

Salads (lettuce)

Custards Potato salad Mayonnaise

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More Unsafe Foods

Milk products…butterice cream unpasteurized cheese

Raw or undercooked meat & fish

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Safe Foods

MUST be well-cooked cooked to

158º & hot at serving time

MUST be reheated to 158º if previously cooked Jellies & breads (covered - no

flies!) 254-10 AMLT - Honduras

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Dry Things are Safe…

…If packaged or protected properly!

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Heat Kills Germs!

Staphylococcal Food Poisoning is from a heat-stable Toxin.

MUST keep hot foods hot (> 140ºF)… …and cold foods cold (<40ºF).

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Initial symptoms:

Staph Toxin 1-8 hrs

E Coli 0157 4 +days Giardiasis 1-2 wks

Amoebiasis 2-4 wks

Hepatitis A 2-6 wks Ascariasis 4-16

wksTaeniasis 2 mo

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Thursday, Day 4

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What About Fruit? Is the outside of the fruit clean?

Was the knife clean that cut the

fruit? (2-knife method?) Were the hands clean that prepared the fruit? 334-10 AMLT - Honduras

Not all Fruit is Created Equal!

Best = fruit with rind or skin

that can be peeled

Easy Very easy

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Difficult or impossible to clean

DifficultAlmost impossible 354-10 AMLT - Honduras

Not all Fruit is Created Equal!

Raw vegetables such as lettuce, spinach, tomatoes and onions were responsible for the illness or deaths of nearly 19,000 people nationwide over a 5-year period.

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What is Safe to Drink?

Hot beverages: boiled water,

tea or coffeeSoda & carbonated beverages

Coconut water or milkPasteurized milk & juices

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11 of 14 randomly-selected bottles representing 8 brands in Nepal were contaminated with Coliforms!

The Story on Bottled Water

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Outbreaks of diarrheal illness are common from “safe” bottled water.

[Wisconsin, Lima, Mexico and Peru’s “San Antonio”]

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The Story on Bottled Water

Is it safe or… Has it been rebottled? …refilled? Safety designation e.g., reverse osmosisBottle dirty? …wet? Cap secure? …new or replaced?

Do you trust your life & your team’s health with it ?!404-10 AMLT - Honduras

Drinking-water on AirplanesA substantial number of aircraft

going to / returning fromdeveloping countries serve

contaminated drinking water.

Travel with “Sweet Water” drops,

Iodine or Chlorine Dioxide tabs, or a “Steri-Pen”. 414-10 AMLT - Honduras

Coconut Water…

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…it’s always in good taste …& all over the world!

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Cleaning Dishes… a Triple Process

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Other Water Challenges

Brushing teethShowering

Swimming poolOcean

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High Risk Behavior

Bad information or ignoranceNon-compliancyEating in “dirty” restaurants

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Prevention… Active vs Passive

Dietary Restrictions

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Prevention Active vs Passive

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Active verses Passive Restrictions

Passive = everybody orders for themselves, then leader must tell them no!

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Active = Eat everything that is put in front of you

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So-o-o… what-R-U-gonna-eat?

Iced tea?Hot soup?

Lettuce?Tomato?

Banana?

Hamburger?Bun?

Silverware?Napkin?

Spoon?

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What if you are served unsafe food?

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What if you are served unsafe food?Try not to offend.Eat small portions. [risk of diarrhea linked

to size of inoculum] Have a designated eater. [someone w/ indigenous bowel

flora]

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Taking 500mg Cipro after eating will NOT

protect you from crypto, Hepatitis

A, rotovirus, etc.

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If you can’t live without cut fruit, salad, ice or fruit juice for 2 weeks…

…stay home!!!

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Food at luxury hotels no safer than the food in standard hotels.Flies are important vectors of disease. Watch for flies in the restaurant & on food!

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Food consumed on aircraft home was likely prepared in country of origin of the flight. If eating is unavoidable, limit intake [inoculum]!

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Epilogue

If you can sleep well & eat well, you can endure almost anything!

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Let’s Eat !!!

Good, Safe Food in Jungle Kitchen

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You CAN stay healthy!

1. Think, Think, THINK !!!2. Think as a group !3. Look out for each other !4. Choose food carefully !5. Treat water appropriately !

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