A case of foodborne listeriosis linked to a contaminated food-production process

We report a case of listeriosis linked to consumption of contaminated ox tongue. A public health investigation identified intermittent contamination at a meat-production process and ox-tongue production was discontinued. Sensitive molecular subtyping methods are improving our ability to track sources of Listeria monocytogenes contamination through the food chain. Detailed investigation of sporadic cases of listeriosis can provide important public health information and its wider use is encouraged.

Hospital-acquired listeriosis associated with sandwiches in the UK: a cause for concern

BACKGROUND

Hospital-acquired outbreaks of listeriosis are not commonly reported but remain a significant public health problem.

AIM

To raise awareness of listeriosis outbreaks that have occurred in hospitals and describe actions that can be taken to minimize the risk of foodborne listeriosis to vulnerable patients.

METHODS

Foodborne outbreaks and incidents of Listeria monocytogenes reported to the Health Protection Agency national surveillance systems were investigated and those linked to hospitals were extracted. The data were analysed to identify the outbreak/incident setting, the food vehicle, outbreak contributory factors and origin of problem.

FINDINGS

Most (8/11, 73%) foodborne outbreaks of listeriosis that occurred in the UK between 1999 and 2011 were associated with sandwiches purchased from or provided in hospitals. Recurrently in the outbreaks the infecting subtype of L. monocytogenes was detected in supplied prepacked sandwiches and sandwich manufacturing environments. In five of the outbreaks breaches in cold chain controls of food also occurred at hospital level.

CONCLUSIONS

The outbreaks highlight the potential for sandwiches contaminated with L. monocytogenes to cause severe infection in vulnerable people. Control of L. monocytogenes in sandwich manufacturing and within hospitals is essential to minimize the potential for consumption of this bacterium at levels hazardous to health. Manufacturers supplying sandwiches to hospitals should aim to ensure absence of L. monocytogenes in sandwiches at the point of production and hospital-documented food safety management systems should ensure the integrity of the food cold chain.

Emergence of pregnancy-related listeriosis amongst ethnic minorities in England and Wales

Listeriosis is a rare but severe food-borne disease that predominantly affects pregnant women, the unborn, newborns, the elderly and immunocompromised people. Following a large outbreak in the 1980s, specific food safety advice was provided to pregnant women and the immunocompromised in the United Kingdom. Following two coincident yet unconnected cases of pregnancy-related listeriosis in eastern European women in 2008, a review of the role of ethnicity in pregnancy-related listeriosis in England and Wales was undertaken in 2009. Cases reported to the national listeriosis surveillance scheme were classified as 'ethnic', belonging to an ethnic minority, or 'non-ethnic' based on their name, and trends were examined. Between 2001 and 2008, 1,510 cases of listeriosis were reported in England and Wales and, of these, 12% were pregnancy-related cases. The proportion of pregnancy-related cases classified as ethnic increased significantly from 16.7% to 57.9% (chi-square test for trend p=0.002). The reported incidence among the ethnic population was higher than that among the non-ethnic population in 2006, 2007 and 2008 (Relative Risk: 2.38, 95% confidence interval: 1.07 to 5.29; 3.82, 1.82 to 8.03; 4.33, 1.74 to 10.77, respectively). This effect was also shown when analysing data from January to September 2009, using extrapolated live births as denominator. Increased immigration and/or economic migration in recent years appear to have altered the population at risk of pregnancy-related listeriosis in England and Wales. These changes need to be taken into account in order to target risk communication strategies appropriately.

Human listeriosis in England, 2001-2007: association with neighbourhood deprivation

Listeriosis is a rare but severe food-borne disease that predominantly affects pregnant women, the unborn, newborns, the elderly and immunocompromised people. Despite the high mortality rate of the disease, its socio-economic determinants have not been studied in detail, meaning that health inequalities that might exist in relation to this disease are not apparent. Laboratory surveillance data on listeriosis cases reported in England between 2001 and 2007 were linked to indices of deprivation and denominator data using patients' postcodes. Incidence relative to increasing quintiles of deprivation was calculated by fitting generalised linear models while controlling for population size. Patient food purchasing and consumption data were scrutinised and compared with commercial food purchasing denominator data to further quantify the observed differences in disease incidence. For all patient groups, listeriosis incidence was highest in the most deprived areas of England when compared with the most affluent, and cases were more likely to purchase foods from convenience stores or from local services (bakers, butchers, fishmongers and greengrocers) than the general population were. Patients' risk profile also changed with increasing neighbourhood deprivation. With increased life expectancy and rising food prices, food poverty could become an increasingly important driver for foodborne disease in the future. While United Kingdom Government policy should continue to focus on small food businesses to ensure sufficient levels of food hygiene expertise, tailored and targeted food safety advice on the avoidance of listeriosis is required for all vulnerable groups. Failure to do so may enhance health inequality across socio-economic groups.

Pooling raw shell eggs: Salmonella contamination and high risk practices in the United Kingdom food service sector

Salmonella contamination of pooled raw shelled egg mix (RSEM) used as an ingredient in lightly cooked or uncooked foods and high-risk kitchen hygiene practices in United Kingdom food service establishments using RSEM were investigated. Samples were collected from 934 premises. Salmonella was found in 1 (0.13%) of 764 RSEM samples, 2 (0.3%) of 726 samples from surfaces where ready-to-eat foods were prepared, and 7 (1.3%) of 550 cleaning cloths. Poor RSEM storage and handling practices were highlighted. Workers in 40% of the premises sampled failed to use designated utensils when RSEM was added to other ingredients, workers in 17% of the premises did not clean surfaces and utensils thoroughly after use with RSEM and before preparing other foods, only 42% of workers washed and dried their hands after handling eggs or RSEM, workers in 41% of the premises did not store RSEM at refrigeration temperature before use, and workers in 8% of the premises added RSEM to cooked rice at the end of cooking when preparing egg fried rice. Take-away premises, especially those serving Chinese cuisine, were least likely to have a documented food safety management system and awareness of the key food safety points concerning the use of RSEM compared with other food service premises (P < 0.0001). Food service businesses using RSEM must be aware of the continuing hazard from Salmonella, must adopt appropriate control measures, and must follow advice provided by national food agencies to reduce the risk of Salmonella infection.

Prevalence and level of Listeria monocytogenes and other Listeria species in selected retail ready-to-eat foods in the United Kingdom

Although listeriosis is a rare cause of human disease in the United Kingdom, an increase in the number of cases has been observed since 2001, almost exclusively in persons older than 60 years. This increase prompted this study on the microbiological safety of ready-to-eat (RTE) foods, which included those types potentially linked to cases of listeriosis. Between May 2006 and April 2007, 6,984 RTE foods were sampled (2,168 sliced meats, 1,242 hard cheese, 1,088 sandwiches, 878 butter, 725 spreadable cheese, 515 confectionery products containing cream, and 368 probiotic drinks). The food types with the highest prevalence of Listeria monocytogenes were sandwiches (7.0%) and sliced meats (3.7% within shelf life, 4.2% end of shelf life). L. monocytogenes at > 100 CFU/g (exceeding the European Commission's food safety criteria limit) only occurred in sandwiches (0.4%) and sliced meats (0.7% within shelf life, 1.0% end of shelf life). Contamination with L. monocytogenes at >100 CFU/g was more frequent in meats that were prepacked and/or of pack size > or = 300 g and in sandwiches that were supplied prepacked that contained salad vegetables as an ingredient. Satisfactory microbiological quality was associated with premises on which the management was trained in food hygiene and those that complied with hazard analysis and critical control point principles. This study provides important information about the microbiological safety of RTE foods and demonstrates that the control of L. monocytogenes in such foods, and in particular sandwiches and sliced meats, is essential in order to minimize the risk of this bacterium being present at levels hazardous to health at the point of consumption.

Assessment of the microbiological safety of edible roasted nut kernels on retail sale in England, with a focus on Salmonella

There is little published information on the prevalence of Salmonella in edible nut kernels. A study in early 2008 of edible roasted nut kernels on retail sale in England was undertaken to assess the microbiological safety of this product. A total of 727 nut kernel samples of different varieties were examined. Overall, Salmonella and Escherichia coli were detected from 0.2 and 0.4% of edible roasted nut kernels. Of the nut varieties examined, Salmonella Havana was detected from 1 (4.0%) sample of pistachio nuts, indicating a risk to health. The United Kingdom Food Standards Agency was immediately informed, and full investigations were undertaken. Further examination established the contamination to be associated with the pistachio kernels and not the partly opened shells. Salmonella was not detected in other varieties tested (almonds, Brazils, cashews, hazelnuts, macadamia, peanuts, pecans, pine nuts, and walnuts). E. coli was found at low levels (range of 3.6 to 4/g) in walnuts (1.4%), almonds (1.2%), and Brazils (0.5%). The presence of Salmonella is unacceptable in edible nut kernels. Prevention of microbial contamination in these products lies in the application of good agricultural, manufacturing, and storage practices together with a hazard analysis and critical control points system that encompass all stages of production, processing, and distribution.

The microbiological quality of potable water on board ships docking in the UK and the Channel Islands: an association of Port Health Authorities and Health Protection Agency Study

Providing safe potable water onboard vessels presents particular challenges and contamination can occur directly from source waters as well as during loading, storage and distribution. Between May and October 2005, 950 potable water samples were collected from 342 ships docking at ports. Comparison with Guidelines found 9% of samples contained coliforms, Escherichia coli or enterococci and 2.8% had faecal indicators (E. coli or enterococci). Action levels of aerobic colony count (ACC) bacteria were detected in 20% (22 degrees C) and 21.5% (37 degrees C) of samples. ACC results from one-off sampling are not informative as this does not enable port health authorities to monitor ACC trends. They should be removed as a routine criterion for remedial action and vessels should adopt the WHO Water Safety Plan approach, whilst continuing to monitor water quality with public health-based indicators (e.g. chlorine residual, coliforms, E. coli and enterococci). Logistic regression analyses identified practices associated with water quality. Practices protective against coliforms, E. coli or enterococci in potable supplies were: good hose hygiene, processing water onboard, maintaining free chlorine residual at >or=0.2 mg/L. This emphasizes the importance of good hygiene during potable water loading and maintaining adequate disinfection of supplies onboard.

Prepared salads and public health

In recent years the importance of prepared salads as potential vehicles of gastrointestinal infection has been highlighted by several large outbreaks both nationally and across international boundaries. Between 1992 and 2006, 2274 foodborne general outbreaks of infectious intestinal disease were reported in England and Wales, of which 4% were associated with the consumption of prepared salads. In total, 3434 people were affected, with 66 hospitalizations and one death reported. The attribution of prepared salad types and pathogens among prepared salad associated outbreaks are presented and discussed. Findings from UK studies on salad vegetables, fruit and mixed salads from 1995 to 2007 (21 247 samples) indicate that most bacteria of concern with regard to human health are relatively rare in these products (98.6% of satisfactory quality); however, outbreaks of salmonellosis were uncovered associated with bagged salad leaves and fresh herbs during two such studies. Although it is known that fresh salad vegetables, herbs or fruit may become contaminated from environmental sources, only in recent years has the association of foods of nonanimal origin, such as salad vegetables, with foodborne illness become evident and recurrent, demonstrating that major health problems can arise from consumption of contaminated prepared salads if hygiene practices breakdown.

Microbiological safety of sandwiches from hospitals and other health care establishments in the United Kingdom with a focus on Listeria monocytogenes and other Listeria species

In the United Kingdom between 1999 and 2004, there were four outbreaks of Listeria monocytogenes infection associated with sandwiches purchased from or provided in hospitals. Elderly or immunocompromised individuals and pregnant women are particularly vulnerable to infection; therefore, the focus of this study was on sandwiches served in health care establishments. Of 3,249 sandwich samples collected between April 2005 and March 2006, 3.3% were of unsatisfactory microbiological quality because of high levels of Enterobacteriaceae (2.0%; > or = 10(4) CFU/g for sandwiches not containing salad), Escherichia coli (0.8%; > or = 10(2) CFU/g), Staphylococcus aureus (0.6%; > or = 10(2) CFU/g), and/or Listeria spp. (0.1%; two samples with L. welshimeri at 1.8 x 10(2) and 7.4 x 10(3) CFU/g and one sample with L. seeligeri at 1.8 x 10(3) CFU/g). Overall, 7.6% of sandwiches were contaminated with Listeria spp. L. monocytogenes was detected in 2.7% (88) of samples: 87 samples at < 10 CFU/g and 1 sample at 20 CFU/g. More frequent contamination with Listeria spp. and L. monocytogenes was found in sandwiches collected from hospital cafeterias, shops, or wards and in sandwiches stored and/or displayed at temperatures higher than 8 degrees C. The presence of Listeria spp. and L. monocytogenes also was associated with sandwiches that (i) were supplied from outside the establishment, (ii) were prepacked, (iii) had a main sandwich filling of poultry meat, or (iv) contained salad ingredients, soft cheese, and/or mayonnaise. Control of L. monocytogenes in sandwich manufacturing and within health care establishments is essential to minimize the potential for consumption of this bacterium at levels hazardous to health. The findings from this study support the proposal that manufacturers supplying sandwiches to health care establishments should follow the British Sandwich Association recommended guidelines of complete absence of L. monocytogenes in sandwiches at the point of production.

Survey of Salmonella contamination of raw shell eggs used in food service premises in the United Kingdom, 2005 through 2006

This survey was launched after an unusual number of Salmonella Enteritidis outbreaks associated with the use of eggs in food service premises in England and Wales. Between November 2005 and December 2006, 9,528 eggs (1,588 pooled samples of 6 eggs) were collected from 1,567 food service premises in the United Kingdom, most of which (89%) were produced in the United Kingdom. Salmonella was isolated from 6 (0.38%) pools of eggs. Of these, 5 (0.31%) were Salmonella Enteritidis, which were further characterized to phage types (PTs): PT 4 (0.19%), PT 8 (0.06%), and PT 12 (0.06%). Salmonella Mbandaka was also isolated (0.06%). Salmonella was detected from five and one of pooled eggs samples that were produced in the United Kingdom and Germany, respectively; these were from different producers. The study showed evidence of poor egg storage and handling practices in food service premises, in that 55% did not store eggs under refrigerated conditions; 20.7% of eggs had expired "best before" dates or were in use after 3 weeks of lay, indicating poor stock rotation; and 37.1% pooled eggs not intended for immediate service. Eggs are a commonly consumed food that may occasionally be contaminated with Salmonella at different rates, according to their country of origin. The food service sector needs to be aware of this continuing hazard, receive appropriate food safety and hygiene training on storage and usage of raw shell eggs, adopt appropriate control measures, and follow advice provided by national food agencies in order to reduce the risk of infection.

Prevalence and level of Listeria monocytogenes and other Listeria species in retail pre-packaged mixed vegetable salads in the UK

As part of the European Commission (EC) co-ordinated programme for 2005, a study of pre-packaged ready-to-eat (RTE) mixed salads containing meat or seafood ingredients from retail premises was undertaken in the UK to determine the frequency and level of Listeria monocytogenes in these products. Almost all (99.8%; 2682/2686) samples were of satisfactory/acceptable microbiological quality. Two (0.1%) samples exceeded EC legal food safety criteria due to the presence of L. monocytogenes in excess of 100 cfu g(-1) (1.7 x 10(2), 9.9 x 10(2)cfu g(-1)) while another two (0.1%) were unsatisfactory due to L. welshimeri levels over 100 cfu g(-1) (1.2 x 10(3), 6.0 x 10(3) cfu g(-1)). Overall contamination of Listeria spp. and L. monocytogenes found in samples of mixed salads in the UK was 10.8% and 4.8%, respectively. Almost twice as many salad samples with meat ingredients were contaminated with Listeria spp. and L. monocytogenes (14.7% and 6.0%, respectively) compared to samples with seafood ingredients (7.4% and 3.8%, respectively). Pre-packaged mixed salads were contaminated with Listeria spp. and L. monocytogenes more frequently when: collected from sandwich shops; not packaged on the premises; stored or displayed above 8 degrees C. This study demonstrates that the control of L. monocytogenes in food manufacturing and at retail sale is essential in order to minimize the potential for this bacterium to be present in mixed salads at the point of consumption at levels hazardous to health.

Survey of Salmonella contamination of non-United Kingdom-produced raw shell eggs on retail sale in the northwest of England and London, 2005 to 2006

This survey was prompted by a change in the epidemiology of Salmonella Enteritidis infections in England and Wales and elsewhere in Europe and, to our knowledge, is the first survey to provide information on Salmonella contamination of non-United Kingdom eggs on retail sale. Based on 10,464 non-United Kingdom eggs (1744 pooled samples of six eggs) purchased between March 2005 and July 2006, the total weighted prevalence estimate for all Salmonella detected in non-United Kingdom eggs was 3.3%. Of the eggs sampled, most were produced in Spain (66.3%), France (20.0%), or The Netherlands (7.4%). Salmonella was detected from 4.4 and 0.3% of eggs produced in Spain and France, respectively, with weighted prevalence estimates. Eight different Salmonella serotypes were recovered from non-United Kingdom eggs, of which Salmonella Enteritidis predominated, with an estimated prevalence of 2.6%. Salmonella Enteritidis was obtained only from Spanish eggs. Nine different phage types of Salmonella Enteritidis were identified, with phage type 1 found to be the predominant phage type. Most of the Salmonella Enteritidis isolates obtained from Spanish eggs in the survey were resistant to nalidixic acid with concomitant decreased susceptibility to ciprofloxacin (0.125 to 1.0 mg/liter) or ampicillin (8.0 mg/liter). Salmonella Enteritidis phage type 1 until now had not been detected in eggs examined as part of previous United Kingdom egg surveys but has been detected in eggs of Spanish origin examined during recent national outbreaks of Salmonella Enteritidis non-phage type 4 infections in England and Wales. Eggs are a commonly consumed food that may occasionally be contaminated with Salmonella. The rates of contamination may be linked to the origin of the eggs. Consumers and caterers need to be aware of this continuing hazard, adopt appropriate control measures, and follow advice provided by national food agencies in order to reduce the risk of infection.

Public health investigations of Salmonella Enteritidis in catering raw shell eggs, 2002-2004

AIMS

In response to a dramatic change in the epidemiology of Salmonella Enteritidis in England and Wales thought to be associated with raw shell eggs, the Health Protection Agency initiated public health investigations to establish the incidence of Salmonella contamination and origin of eggs used by catering premises implicated in outbreaks of Salm. Enteritidis.

METHODS AND RESULTS

Between October 2002 and November 2004, 16 971 eggs were sampled and Salmonella were recovered from 3.4%. Salmonella was isolated from 5.5% and 6.3% of Spanish and eggs of unknown origin, respectively, used in catering premises linked to outbreaks, a level significantly higher than that (1.1%) found in nonLion Quality UK eggs sampled. The small sample of UK Lion Quality eggs tested (reflecting their lack of use in premises visited) did not contain Salmonella. Several phage types of Salm. Enteritidis other than phage type 4 (PT 4) were identified with nonUK eggs.

CONCLUSIONS

Eggs from Spain were implicated as a major source of infection. Eggs were contaminated more frequently with Salmonella when shells were dirty and/or cracked, and stored at above 8 degrees C.

SIGNIFICANCE AND IMPACT OF THE STUDY

The use of Spanish eggs by the catering sector has been identified as a consistent significant factor in many of the outbreaks caused by Salm. Enteritidis nonPT4 in England and Wales during 2002-2004. Advice to caterers and hospitals that raw shell eggs should not be used in food that will either not be cooked or only lightly cooked should be reinforced.

Microbiological safety of retail vacuum-packed and modified-atmosphere-packed cooked meats at end of shelf life

A study of retail modified-atmosphere-packed and vacuum-packed cooked ready-to-eat meats was undertaken from September through mid-November 2003 to determine the microbiological quality at the end of shelf life and to establish any risk factors in the production, storage, and display of this product. Examination of 2,981 samples using Microbiological Guidelines criteria revealed that 66% were of satisfactory or acceptable microbiology quality, 33% were of unsatisfactory quality mainly due to high aerobic colony counts and Enterobacteriaceae concentrations, and 1% were of unacceptable quality due to the presence of Listeria monocytogenes at 100 CFU/g or higher (27 samples; range of 10(2) to 106 CFU/g) and Campylobacter jejuni (1 sample), indicating a risk to health. All samples at the end of the shelf life had satisfactory (<20 CFU/g) and/or acceptable (<102 CFU/g) levels of Staphylococcus aureus and Clostridium perfringens, four samples (<1%) had unsatisfactory levels of Escherichia coli (range of 102 to 106 CFU/g) and 5.5% of the samples contained L. monocytogenes at <20 CFU/g (4.8%) or between 20 and 100 CFU/g (0.7%). More samples of chicken (45%; 224 of 495 samples), beef (43%; 160 of 371 samples), and turkey (41%; 219 of 523 samples) were of unsatisfactory or unacceptable quality compared with ham (23%; 317 of 1,351 samples) or pork (32%; 67 of 206 samples). Twelve different L. monocytogenes typing characters (serotype-amplified fragment length polymorphism type-phage type) were evaluated for isolates recovered from samples of unacceptable quality, and the 1/2-IX-NT type was recovered from almost half (48%) of these samples. Salmonella was not detected in any samples examined. Risk factors identified for cooked meats that were microbiologically contaminated more frequently included vacuum packaging, packaging on retail premises, slicing, temperature not monitored in display units, and no hazard analysis system in place. Results from this study also suggest that the shelf life assigned to some modified-atmosphere-packed and vacuum-packed meats may not be appropriate.

Food-borne botulism in the United Kingdom

Food-borne botulism is a rare but serious disease caused by ingestions of neurotoxin [botulinum neurotoxins (BoNTs)] produced as a result of the growth of the bacterium Clostridium botulinum in foods before consumption. The disease is rare in the United Kingdom, and only 62 cases have been recognized between 1922 and 2005. This report provides a brief review of C. botulinum and food-borne botulism as well as descriptions of the six episodes (33 cases with three deaths) of this disease that occurred in the United Kingdom between 1989 and 2005. The six incidents illustrate the importance of the risk factors of poor processing or storage of commercially prepared foods, improper home preservation of foods and travel to countries where botulism is much more common than in the United Kingdom. Even small outbreaks of food-borne botulism can precipitate a national emergency and inundate public health and acute care provision. This report provides a reminder to public health professions of the occurrence, diagnosis, treatment and control of this rare but serious food-borne disease.

Prevalence of Listeria monocytogenes and other Listeria species in butter from United Kingdom production, retail, and catering premises

Two recent listeriosis outbreaks involving butter prompted this first cross-sectional study on the prevalence, levels, and types of Listeria species in 3229 samples of butter from production, retail, and catering premises in the United Kingdom during May and June 2004. When the criteria of the Microbiological Guidelines were used, 99.4% of samples were found to be of satisfactory microbiological quality, 0.5% were of acceptable quality, and 0.1% were of unsatisfactory quality as a result of high levels (>100 CFU/g) of Listeria spp. The butter samples with Listeria spp. present at more than 100 CFU/g were negative for L. monocytogenes. L. monocytogenes was detected in 0.4% (n=13) of samples, all at levels of less than 10 CFU/g, and were therefore of acceptable quality. Butter was contaminated more frequently with Listeria spp., including L. monocytogenes, when packed in plastic tubs, when in pack sizes of 500 g or less, when stored or displayed above 8 degrees C, when a hazard analysis system was not in place, and when the manager had received no food hygiene training. This study demonstrates that although butter is regarded as a low-risk product, it may provide an environment for the persistence and growth of Listeria spp., including L. monocytogenes. The control of L. monocytogenes in food processing and supply systems is critical in order to minimize the potential for this bacterium to be present in foods at the point of consumption at levels hazardous to health.

Sesame seed products contaminated with Salmonella: three outbreaks associated with tahini

In November 2002, the first of three outbreaks of Salmonella Montevideo infection in Australia and New Zealand was identified in New South Wales, Australia. Affected persons were interviewed, and epidemiologically linked retail outlets inspected. Imported tahini was rapidly identified as the source of infection. The contaminated tahini was recalled and international alerts posted. A second outbreak was identified in Australia in June-July 2003 and another in New Zealand in August 2003. In a total of 68 S. Montevideo infections, 66 cases were contacted. Fifty-four (82%) reported consumption of sesame seed-based foods. Laboratory analyses demonstrated closely related PFGE patterns in the S. Montevideo isolates from human cases and sesame-based foods imported from two countries. On the basis of our investigations sesame-based products were sampled in other jurisdictions and three products in Canada and one in the United Kingdom were positive for Salmonella spp., demonstrating the value of international alerts when food products have a wide distribution and a long shelf life. A review of the controls for Salmonella spp. during the production of sesame-based products is recommended.

Prevalence of Campylobacter, Salmonella, and Escherichia coli on the external packaging of raw meat

During September and October 2002, 3,662 prepackaged raw meat samples were collected to evaluate the extent and nature of microbiological contamination on external surfaces of the packaging, which could potentially cross-contaminate ready-to-eat foods during and after purchase. Salmonella was detected on two (<1%) samples of external packaging (both from raw chicken), and Campylobacter was detected on 41 (1.1%) samples of external packaging. The external packaging of game fowl exhibited the highest Campylobacter contamination (3.6%), followed by raw chicken (3.0%), lamb (1.6%), turkey (0.8%), pork (0.2%), and beef (0.1%); Campylobacter jejuni and Campylobacter coli accounted for 59% (24 of 41) and 24% (10 of 41) of the contaminating Campylobacter species, respectively. C. coli isolates from the external packaging were more multiresistant to antimicrobial drugs, including quinolones such as ciprofloxacin, than was C. jejuni. Escherichia coli (an indicator of fecal contamination) was isolated from the external packaging on 4% of the raw meat samples at levels of 40 to 10(5) CFU per swab. The external packaging of raw meats is a vehicle for potential cross-contamination by Campylobacter, Salmonella, and E. coli in retail premises and consumers' homes. The external surface of heat-sealed packaging was less frequently contaminated with Campylobacter and E. coli compared with other types of packaging (e.g., overwrapping, bag, and tie tape) (P < 0.0001 to 0.01). In addition, external packaging of raw meats was contaminated less frequently with Campylobacter and E. coli when packaging was intact, packaging and display areas were visually clean, display temperatures were below 8 degrees C, and hazard analysis systems were in place.

Salmonella and raw shell eggs: results of a cross-sectional study of contamination rates and egg safety practices in the United Kingdom catering sector in 2003

This study was prompted by epidemiological investigations of the unusual number of Salmonella Enteritidis outbreaks associated with the use of eggs in catering premises in England and Wales during 2002. The aims of the study, performed between April and May 2003, were to establish the rate of Salmonella contamination in raw shell eggs from catering premises, investigate any correlation between the origin and type of eggs and the presence of particular serotypes or phage types (PTs) of Salmonella, and examine the use of raw shell eggs in catering premises in the United Kingdom. A total of 34,116 eggs (5,686 pooled samples of six eggs) were collected from 2,104 catering premises, most of which were eggs produced in the United Kingdom (88%). Salmonella was isolated from 17 pools (0.3%) of eggs. Of these, 15 were Salmonella Enteritidis, which were further characterized to PTs as follows: PT6 (0.1%), PT4 (0.07%), PT12 (0.04%), PT1 (0.04%), and PT14b (0.02%). Salmonella Livingstone and Salmonella Typhimurium definitive type 7 resistant to ampicillin, streptomycin, sulfonamides, and tetracycline were also isolated. The Salmonella contamination rate of eggs produced in the United Kingdom appears to have decreased significantly since 1995 and 1996. This trend is reflected in the decrease of Salmonella Enteritidis and, in particular, Salmonella Enteritidis PT4. The impact of the United Kingdom Food Standards Agency's advice on the use of eggs, issued in January 2003, is discussed.

Microbiological quality of pre-cut fruit, sprouted seeds, and unpasteurised fruit and vegetable juices from retail and production premises in the UK, and the application of HAACP

A study of ready-to-eat pre-cut fruit, sprouted seeds, and unpasteurised fruit and vegetable juices from retail and production premises was undertaken in the UK to determine the microbiological quality of these products, and to verify the application of hazard analysis and critical control points (HACCP) procedures by food operators. Almost all (99%; 2,075/2,096) samples were of satisfactory/acceptable microbiological quality. Two (0.1%) samples (melon, beansprouts) were of unacceptable quality due to the presence of Listeria monocytogenes at 102 cfu/g or more while a further 19 (0.9%) were unsatisfactory due to Escherichia coli levels in the range of 102 to 106 cfu/g. Neither Salmonella spp. nor E. coli O157 were detected in samples examined. A hazard analysis system was in place in most (85%) premises visited, and in 80% it was documented. Most managers (83%) had received some form of food hygiene training. Minimally processed produce is exposed to a range of conditions during production and distribution, and this may increase the potential for microbial contamination, highlighting the need of applying good hygiene practices from farm to fork to prevent contamination and/or bacterial growth. Such products should be stored and displayed at or below 8 degrees C.

An outbreak due to peanuts in their shell caused by Salmonella enterica serotypes Stanley and Newport--sharing molecular information to solve international outbreaks

Salmonellosis is a global problem caused by the international movement of foods and high incidence in exporting countries. In September 2001, in an outbreak investigation Australia isolated Salmonella Stanley from imported peanuts, which resulted in a wider investigation in Canada, England & Wales and Scotland. Patients infected with Salmonella serotypes known to be isolated from peanuts and reported to surveillance systems were interviewed to determine exposure histories. Tagged image file format (TIFF) images of pulsed-field gel electrophoresis (PFGE) patterns of Salmonella isolates were shared electronically amongst laboratories. Laboratories tested packets of 'Brand X' peanuts from various lots and product lines. In total, 97 cases of S. Stanley and 12 cases of S. Newport infection were found. Seventy-three per cent (71/97) of S. Stanley cases were in persons of Asian ethnicity. Twenty-eight per cent of cases recalled eating Brand X peanuts and a further 13% had peanuts in their house in the previous month or had eaten Asian-style peanuts. Laboratories isolated S. Stanley, S. Newport, S. Kottbus, S. Lexington and S. Unnamed from Brand X peanuts. Isolates of S. Stanley from peanuts and human patients were indistinguishable by PFGE. This international outbreak resulted from a product originating from one country affecting several others. Rapid sharing of electronic DNA images was a crucial factor in delineating the outbreak; multinational investigations would benefit from a harmonized approach.

The effect of information and behavioural training on endoscopy patients' clinical outcomes

This study was designed to examine the effects of preparatory information and behavioural training on patients about to undergo an endoscopy procedure. Forty-five first-time endoscopy patients (aged 20-70 years), were randomly assigned to one of three groups (cognitive, cognitive/behavioural and control group). The cognitive group received a 12 min preparation with sensory and procedural information relating to the sensations and sequence of events associated with the endoscopy procedure. The cognitive/behavioural group received, in addition, instruction in deep breathing exercises, tongue depressor task and swallowing technique. Results indicated that patients in the two experimental conditions experienced significantly fewer signs of behavioural distress during endoscopy. The cognitive group required a significantly shorter time to induce the scope. There were no statistical differences between the groups however, for mood, physiological and anxiety measures, although a positive trend was evident for the two intervention groups.

Microbiological examination of ready-to-eat cold sliced meats and pate from catering and retail premises in the UK

AIMS

To establish the microbiological quality of cold ready-to-eat sliced meats and pâté from catering and retail premises, and investigate links hypothesized between foodborne Campylobacter infection and the consumption of cold sliced meats.

METHODS AND RESULTS

A total of 4078 cold meat and pâté samples were collected and examined according to a standardized protocol. Comparison with published microbiological guidelines revealed that most ready-to-eat meat and pâté samples (75%) were of satisfactory/acceptable microbiological quality and 25% were of unsatisfactory/unacceptable quality. Two cold meat samples (<1%) were of unacceptable microbiological quality because of the presence of Campylobacter jejuni in 25 g and Listeria monocytogenes at 3.4 x 104 CFU g-1.

CONCLUSIONS

Acceptable microbiological quality was associated with premises where the management was trained in food hygiene and those that had hazard analysis in place. Poor microbiological quality was associated with storage above 8 degrees C, presliced meats, infrequent cleaning of slicing equipment and poor control of practices that may lead to cross contamination.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provides important information about the microbiological quality of cold ready-to-eat meats and pâté. It also assists caterers, retailers, enforcement officers and policy makers to understand how different food safety practices affect microbiological quality.

Microbiological quality of food in relation to hazard analysis systems and food hygiene training in UK catering and retail premises

A meta-analysis of eight UK food studies was carried out to determine the microbiological quality of food and its relationship with the presence in food businesses of hazard analysis systems and food hygiene training. Of the 19,022 premises visited to collect food samples in these studies between 1997 and 2002, two thirds (66%) were catering premises and one third (34%) were retail premises. Comparison with PHLS Microbiological Guidelines revealed that significantly more ready-to-eat food samples from catering premises (20%; 2,511/12,703) were of unsatisfactory or unacceptable microbiological quality compared to samples from retail premises (12%; 1,039/8,462) (p < 0.00001). Three quarters (76%) of retail premises had hazard analysis systems in place compared with 59% of catering premises (p < 0.00001). In 87% of retail premises the manager had received some form of food hygiene training compared with 80% of catering premises (p < 0.00001). From premises where the manager had received no food hygiene training a greater proportion of samples were of unsatisfactory and unacceptable microbiological quality (20% retail, 27% catering) compared with premises where the manager had received food hygiene training (11% retail, 19% catering) (p < 0.00001). Where the manager of the premises had received food hygiene training, documented hazard analysis systems were more likely to be in place (p < 0.00001). Higher proportions of samples of unsatisfactory and unacceptable microbiological quality (17% retail, 22% catering) were from premises where there was no hazard analysis system in place compared to premises that had a documented hazard analysis system in place (10% retail, 18% catering) (p < 0.00001). Our meta-analysis suggests that the lower microbiological quality of ready-to-eat foods from catering premises compared with those collected from retail premises may reflect differences in management food hygiene training and the presence of a hazard analysis system. The importance of adequate training for food handlers and their managers as a pre-requisite for effective hazard analysis and critical control point (HACCP) based controls is therefore emphasised.

Microbiological quality of open ready-to-eat salad vegetables: effectiveness of food hygiene training of management

During September and October 2001, a microbiological study of open, ready-to-eat, prepared salad vegetables from catering or retail premises was undertaken to determine their microbiological quality. The study focused on those salad vegetables that were unwrapped and handled either by staff or customers in the premises where the sample was taken. Examination of salad vegetables from food service areas and customer self-service bars revealed that most (97%; 2,862 of 2,950) were of satisfactory or acceptable microbiological quality, 3% (87) were of unsatisfactory microbiological quality because of Escherichia coli levels in the range of 10(2) to 10(5) colony-forming units per gram. One (<1%) sample was of unacceptable microbiological quality because of the presence of Listeria monocytogenes at 840 colony-forming units per gram. The pathogens E. coli O157, Campylobacter spp., and salmonellas were not detected in any of the samples examined. The display area for most food service and preparation areas (95%) and self-service salad bars (98%) that were visited was judged to be visibly clean by the sampling officer. Most self-service bars (87%) were regularly supervised or inspected by staff during opening hours, and designated serving utensils were used in most salad bars (92%) but in only a minority of food service areas (35%). A hazard analysis system was in place in most (80%) premises, and in 61%, it was documented. Most (90%) managers had received food hygiene training. A direct relationship was shown between increased confidence in the food business management and the presence of food safety procedures and the training of management in food hygiene.

Study of cleaning standards and practices in food premises in the United Kingdom

A study was undertaken to determine the microbiological status of surfaces used in the preparation of ready-to-eat foods, and to assess cleaning standards and practices in food premises in the UK. A total of 6,533 environmental samples were examined from 1,502 catering (such as restaurants, cafés, and sandwich bars) or retail premises (such as butchers, delicatessens, and bakers): 2,033 samples from chopping/cutting boards, 2,009 from worktop surfaces, 1,359 from food containers, and 1,132 from cleaning cloths. Cleaning cloths were more heavily contaminated with bacteria (Aerobic Colony Count (ACC), Enterobacteriaceae, E. coli, and Staph. aureus) compared to surfaces sampled. Campylobacter spp. were detected in two (0.2%) and Salmonella spp. from one (0.1%) of the cleaning cloths. Surfaces that were visually dirty, wet, last cleaned over 24 hours ago, and boards that were scored or damaged were found to have higher levels of bacteria. A hazard analysis system was in place in most (70%) food premises visited, and in 52% it was documented. Most managers (89%) had received some form of food hygiene training. Documented cleaning schedules and cleaning records were only present in approximately half (55% and 44%, respectively) of the premises. Most did not have separate implements for cleaning raw and ready-to-eat food areas (67%), or stored cleaning equipment for high risk (ready-to-eat food) areas away from those used in low risk (raw, non ready-to-eat food) areas (70%). Deficiencies in the correct use of cleaning products, such as the minimum contact time for disinfectants, were identified. Surface samples (chopping/cutting boards, worktops, and food containers) and cleaning cloths with ACC levels in excess of 10(3) cfu/cm2, swab or ml were associated with premises that did not have management food hygiene training, hazard analysis, cleaning schedules or cleaning records in place, and with little or no confidence in the food business management of food hygiene as indicated by Local Authority Inspectors' Confidence in Management scores.

The microbiological quality of ready-to-eat foods with added spices

A microbiological study of ready-to-eat foods with added spices or spice ingredients was undertaken to identify any risk factors in the production, storage and display of this product and to establish their effect on microbiological quality. Examination of 1946 ready-to-eat foods from sandwich bars, cafés, public houses, restaurants, specialist sandwich producers, bakers, delicatessens, market stalls and mobile vendors found that 1291 (66%) were of satisfactory/acceptable microbiological quality, 609 (32%) were of unsatisfactory quality, and 46 (2%) were of unacceptable quality. Unacceptable results were due to high levels of B. cereus and/or other Bacillus spp. (>/=10(5) cfu g(-1)). Unsatisfactory results were mostly due to high Aerobic Colony Counts (up to >/=10(7) cfu g(-1)), Enterobacteriaceae (>/=10(4) cfu g(-1)), Escherichia coli (>/=10(2) cfu g(-1)), and Bacillus spp (>/=10(4) cfu g(-1)). Examination of 750 spices and spice ingredients revealed that B. cereus were present in 142 (19%) samples, other Bacillus spp. in 399 (53%) samples, and Salmonella spp. (S. enteritidis PT 11) in one (<1%) sample. Approximately a third (222) of spice and spice ingredients examined contained high counts (>/=10(4) cfu g(-1)) of B. cereus and/or other Bacillus spp., and appeared to be associated with the corresponding ready-to-eat foods containing similar high counts of these organisms (P<0.0001). Acceptable microbiological quality of ready-to-eat foods to which spices or spice ingredients have been added was associated with premises that had management food hygiene training and hazard analysis in place. Poor microbiological quality was associated with preparation on the premises, premises type, little or no confidence in the food business management of food hygiene, and small premises as indicated by local authority inspectors' confidence in management and consumer at risk scores.

Microbiological study of ready-to-eat salad vegetables from retail establishments uncovers a national outbreak of salmonellosis

The increasing availability of bagged prepared salad vegetables reflects consumer demand for fresh, healthy, convenient, and additive-free foods that are safe and nutritious. During May and June 2001 a study of retail bagged prepared ready-to-eat salad vegetables was undertaken to determine the microbiological quality of these vegetables. Examination of the salad vegetables revealed that the vast majority (3,826 of 3,852 samples; 99.3%) were of satisfactory or acceptable microbiological quality according to Public Health Laboratory Service microbiological guidelines, while 20 (0.5%) samples were of unsatisfactory microbiological quality. Unsatisfactory quality was due to Escherichia coli and Listeria spp. (not Listeria monocytogenes) levels in excess of 10(2) CFU/g. However, six (0.2%) samples were of unacceptable microbiological quality because of the presence of Salmonella (Salmonella Newport PT33 [one sample], Salmonella Umbilo [three samples], and Salmonella Durban [one sample]) or because of a L. monocytogenes level of 660 CFU/g, which indicates a health risk. In each case, the retailer involved and the UK Food Standards Agency were immediately informed, and full investigations were undertaken. Nineteen cases of Salmonella Newport PT33 infection were subsequently identified throughout England and Wales. The outbreak strain of Salmonella Newport PT33 isolated from the salad and from humans had a unique plasmid profile. Campylobacter spp. and E. coli O157 were not detected in any of the samples examined. The presence of Salmonella, as well as high levels of L. monocytogenes, is unacceptable. However, minimally processed cut and packaged salad is exposed to a range of conditions during growth, harvest, preparation, and distribution, and it is possible that these conditions may increase the potential for microbial contamination, highlighting the necessity for the implementation of good hygiene practices from farm to fork to prevent contamination and/or bacterial growth in these salad products.

Collaborative investigation of an outbreak of Salmonella enterica serotype Newport in England and Wales in 2001 associated with ready-to-eat salad vegetables

In June 2001, as part of a microbiological study of bagged, ready-to-eat salad products, Salmonella enterica serotype Newport was isolated from a sample of pre-packed green salad distributed by a major supermarket retailer. The strain was characterised by phage typing, plasmid profile typing and pulsed-field gel electrophoresis. Other isolates of S. Newport from cases of human infection in England and Wales in the first six months of 2001 were similarly characterised. Of 60 strains from cases of human infection, 19 were found to be indistinguishable from that isolated from the salad product. This study highlights the benefits of an integrated approach to outbreak investigations, involving the various elements of the PHLS and the Food Standards Agency, and acknowledges the full co-operation of the retailer in ensuring the rapid withdrawal of the contaminated product.

Microbiological quality of take-away cooked rice and chicken sandwiches: effectiveness of food hygiene training of the management

During August 2001 a microbiological study of ready-to-eat cooked rice from take-aways and of chicken sandwiches made on the premises from sandwich bars was undertaken. The intention was to identify risk factors in the production, storage and handling of cooked rice and sandwiches, and to establish their effect on microbiological quality. Examination of cooked rice revealed that the majority of samples (87%; 442 of 508) were of satisfactory/acceptable microbiological quality; 50 (10%) were unsatisfactory, and 16 (3%) were of unacceptable quality due to Bacillus cereus and/or other Bacillus spp in excess of 10(5) cfu/g. The microbiological quality of cooked rice was associated with cuisine type (p < 0.00001), rice type (p < 0.01), cooking (p < 0.01), serving methods (p < 0.00001), and management food hygiene training (p < 0.01). Examination of chicken sandwiches found that most (75%; 335 of 449) were of satisfactory/acceptable microbiological quality and 114 (25%) were unsatisfactory. Acceptable microbiological quality of sandwiches was associated with sandwich bars that had hazard analysis in place (p < 0.05). Smaller businesses, as indicated by Local Authority Inspectors' Consumer at Risk scores, were more likely to have samples classified as unsatisfactory or unacceptable compared to larger businesses (p < 0.001). The majority (90%) of premises had hand-washing facilities accessible and available for use, although only over half (55%) were correctly used as judged by the sampling officer. Where the manager of the premises had received some form of food hygiene training, food safety procedures such as the hazard analysis system were more likely to be in place (p < 0.0001).

Microbiological examination of ready-to-eat burgers sampled anonymously at the point of sale in the United Kingdom

During May and June 1999 a microbiological study of ready-to-eat burgers purchased anonymously from burger outlets (combined take-away and burger restaurants, take-away-only fixed premises, mobile vendors, temporary stalls and other burger outlets) was undertaken. The intention was to determine the microbiological quality of ready-to-eat burgers as purchased by customers of take-away premises and to ascertain, where information was available, whether the Chief Medical Officer's advice on cooking burgers was being followed. Examination of 3,128 ready-to-eat burgers found that 2,868 (92%) were of acceptable quality and 260 (8%) were of unsatisfactory quality. Unsatisfactory results were mostly due to high aerobic colony counts (ACCs). Salmonella spp., Campylobacter spp. and Escherichia coli O157 were not detected in any of the samples examined. Acceptable microbiological quality of ready-to-eat burgers was associated with outlets, such as combined take-away and burger restaurants and in particular national franchise outlets, which had management food hygiene training and hazard analysis in place. Poor microbiological quality was associated with undercooking and local outlets as indicated by Local Authority Inspectors' Consumers at Risk scores.

The microbiological examination of ready-to-eat organic vegetables from retail establishments in the United Kingdom

AIMS

A microbiological study of uncooked ready-to-eat organic vegetables was undertaken to determine the microbiological quality of these vegetables on retail sale in the UK.

METHODS AND RESULTS

Organic vegetables were collected and examined according to a standardized protocol. The majority (3185 of 3200; 99.5%) of samples were found to be of satisfactory/acceptable quality whilst only 15 (0.5%) were of unsatisfactory quality. Unsatisfactory results were due to Escherichia coli and Listeria spp. (not L. monocytogenes) levels in excess of 102 cfu g-1.

CONCLUSIONS

The absence of pathogens (L. monocytogenes, Salmonella, Campylobacter and E. coli O157) and the low incidence (1.5%) of E. coli and Listeria spp. associated with these organic vegetables indicates that overall agricultural, hygiene, harvesting and production practices were good.

SIGNIFICANCE AND IMPACT OF THE STUDY

There has been a significant expansion of the UK organic market since 1998/99. Of the various commodity sectors making up the organic market, fruit and vegetables is the largest sector and this has been reflected in an increased interest in their microbiological safety. This is the first study to provide information on the microbiological quality of organic vegetables.

Microbiological examination of ready-to-eat quiche from retail establishments in the United Kingdom

A microbiological study of ready-to-eat quiche from retail establishments was undertaken to identify risk factors in the production, storage and handling of quiche and to establish their effect on microbiological quality. Examination of cold ready-to-eat quiche from supermarket and other delicatessens, bakers, butchers, cafés, sandwich bars and other retail premises revealed that most (2354 of 2513; 94%) were of acceptable quality; 157 samples (6%) were of unsatisfactory quality and two (< 1%) were unacceptable. Unsatisfactory results were mostly due to high aerobic colony counts. Unacceptable results were due to high levels (> 10(4) cfu/g) of Escherichia coli in two samples. Salmonella spp. were not detected in any of the samples. Satisfactory microbiological quality of ready-to-eat quiche was associated with premises that had management food hygiene training and hazard analysis in place. The microbiological quality of this food was also associated with premises type, quiche type, slicing and serving methods, and existing Local Authority Inspectors' Consumer at Risk scores.

The microbiological quality of cooked rice from restaurants and take-away premises in the United Kingdom

The microbiological quality of 4,162 samples of cooked rice from restaurants and take-away premises in the United Kingdom was examined, including ready-to-eat rice purchased at point-of-sale and rice that was stored precooked for reheating on demand. The majority of point-of-sale cooked rice samples (1,855 of 1,972; 94%) were of acceptable microbiological quality, but 15 (1%) samples were of unacceptable quality (Bacillus spp. and B. cereus, > or = 10(5) CFU/g; Escherichia coli, > or = 10(4) CFU/g), indicating a potential risk to health. The prevalence of Bacillus spp., B. cereus, and E. coli was significantly greater in precooked stored rice than in point-of-sale cooked rice (P < 0.005 to 0.0005). Bacillus spp. (> or = 10(4) CFU/g), B. cereus (> or = 10(4) CFU/g), and E. coli (> or = 10(2) CFU/g) were present in 7%, 2%, and 9% of precooked stored samples, respectively, compared to 2%, 0.5%, and 1%, respectively in point-of-sale samples. Although final heating at the point of sale reduces the levels of microorganisms present in rice it will not inactivate the B. cereus emetic toxin if present. Rice from Indian premises was of poorer microbiological quality than that from Chinese and other premises. Although most point-of-sale cooked rice samples (94%) were of an acceptable microbiological quality, evidence from this study indicates that the microbiological quality of cooked rice sold from certain outlets in the UK is of concern.

Health risks associated with unpasteurized goats' and ewes' milk on retail sale in England and Wales. A PHLS Dairy Products Working Group Study

A pilot study to determine the microbiological quality of unpasteurized milk from goats and ewes sampled from farm shops, health food shops, and other retail premises found that 47%, (47/100) of goats' and 50% (13/26) of ewes' milk samples failed the standards prescribed by the Dairy Products (Hygiene) Regulations 1995. In addition, Staphylococcus aureus, haemolytic streptococci or enterococci, were present in excess of 10(2) c.f.u./ml in 9 (7 %) 2 (2 %) and 19 (15%) samples, respectively. Salmonella, campylobacter, verocytotoxin-producing Escherichia coli O157:H7 and Listeria monocytogenes were not detected in the samples. At the time of purchase approximately half of the milk samples (58 %) were frozen, the rest were liquid. Farm outlets sold predominantly liquid milk, other retail premises sold a frozen product. The microbiological quality of goats' and ewes' milk, whether frozen or liquid, was not significantly different. Milk sold from farm shops was of lower quality than that from health food shops and other retail premises. In this pilot study most producers (92 %) supplied, and most retailers (76 %) sold unpasteurized goats' and ewes' milk that contained unacceptable levels of indicator organisms. The study was carried out during the winter when goats' milk production is reduced. The results indicate the need for a full representative study of unpasteurized goats' and ewes' milk on retail sale throughout the year.

The microbiological examination of butchery products and butchers' premises in the United Kingdom

In a study of 1400 manufacturing butchers' premises, 2330 raw prepared meats, 2192 cooked meats and 4635 environmental samples were examined. Verocytotoxin-producing Escherichia coli O157:H7 (O157 VTEC) was isolated from five of 1400 (0.4%) premises. Three raw meat products contained O157 VTEC, and two raw meat preparation areas and two items of equipment used exclusively for cooked meats were contaminated with O157 VTEC. Salmonella spp. and Campylobacter spp. were detected in 84 of 2330 (4%) and 15 of 2330 (0.6%) raw meat products, respectively. Of the cooked meats examined, seven of 2192 (0.3%) samples were of unacceptable microbiological quality and a further 352 (16%) were of unsatisfactory quality. Of the unacceptable samples, two contained Salmonella spp. (Salm. typhimurium DT193, Salm. typhimurium PT104), three contained Staphylococcus aureus in excess of 10(4) cfu g-1, and two contained E. coli in excess of 10(4) cfu g-1. Neither Campylobacter spp. nor O157 VTEC were detected in cooked meats. In the majority of premises, raw and unwrapped cooked meat products were physically separated in displays (94%) and refrigerators (81%), and dedicated equipment/utensils (69-89%) were used for raw meat and unwrapped cooked meat products and other ready-to-eat foods. In approximately half (48%), there were separate serving counters and in 13%, separate staff for raw and cooked meats. Most managers (75%) had received some food hygiene training. However, in 29% of premises, one or more members of staff handled raw and then cooked or ready-to-eat foods without washing their hands, and in 11%, one or more staff members handled raw and cooked meats directly with bare hands. A documented hazard analysis and critical control point (HACCP) system was present in 17% of premises and in a further 31%, an undocumented HACCP system was in place. The low incidence of food-borne pathogens in cooked meat products and in the environmental areas examined, together with a high level of physical separation of raw and cooked meats, indicate that most manufacturing butchers' premises have appropriate physical control measures in place. However, HACCP and hygienic practice are areas that require improvement to reduce the risk of cross-contamination with food-borne pathogens from raw to cooked meats.

Evaluation of a 20 minute 14C urea breath test for the diagnosis of Helicobacter pylori infection

The use of 14C-urea breath testing for diagnosis of Helicobacter pylori infection in gastric mucosa has gained widespread acceptance and utilisation. We evaluated a 14C urea breath test (UBT) in 116 patients undergoing endoscopy. Seventy four patients were administered 185 kBq (5 mCi-conventional dose), and 42 patients reduced dose (92.5 IBq, 2.5 mCi) of 14C-urea. All were tested for H. pylori using culture, direct microscopy of gastric biopsies and histological evaluation of paraffin stained sections. Using the mean + three standard deviations as the cut-off value, a sensitivity of 96% and specificity of 100% was found for the conventional dose test. At reduced dose, sensitivity was 100% and specificity 96%. Positive and negative predictive values were 100% and 93% for the conventional dose test, and 96% and 100% for testing at reduced dose. We conclude that the UBT is a simple, non-invasive and useful diagnostic alternative for detection of H. pylori in infected patients. We advocate its use in patients less than 45 years of age without alarm symptoms, and also in cases where the need for endoscopic evaluation is not vital, such as after eradication therapy.

Growth and survival of Yersinia enterocolitica, Salmonella and Bacillus cereus in Brie stored at 4, 8 and 20 degrees C

The potential of stabilised Brie to support growth of the food-borne pathogens, Yersinia enterocolitica serotypes 0:3 and 0:9, Salmonella typhimurium, S. dublin (both dairy isolates), S. thompson, and Bacillus cereus (3 dairy isolates), after contamination on opening the cheese package was evaluated. Growth kinetics of the different pathogens was determined in relation to inoculum size and storage temperature (4 degrees C, 8 degrees C and 20 degrees C). Only Y. enterocolitica was found to grow on the surfaces (outer and exposed) of Brie at all three storage temperatures. Growth of this pathogen during refrigerated storage must be avoided to ensure safety. The numbers of B. cereus and Salmonella increased at 20 degrees C but declined at a slow rate during storage at 4 degrees C and 8 degrees C. However, survival of these two pathogens for extended periods at abuse temperatures could pose a health hazard. Predictions from a predictive modelling program (MFS model) and a modelling database (Food Micromodel) were compared to observed growth values in Brie. Although accurate in the case of B. cereus at 20 degrees C, predicted generation times were in general found to be considerably shorter than the observed values, i.e., overall they were 'fail safe'. Predicted lag times, however, were generally longer compared to observed values in the case of Y. enterocolitica and at low inocula for Salmonella, and would 'fail dangerous' if used for predictive purposes.

Mathematical modelling of the growth, survival and death of Yersinia enterocolitica

This paper discusses the development of a novel mathematical equation capable of handling the growth, survival and death of microorganisms. The equation was used in combination with second-order polynomials to fit a response surface to data representing the growth, survival and death of Yersinia enterocolitica as affected by temperature (0-30 degrees C), sodium chloride (0-10.5% w/v), pH (3.5-7.0) and undissociated lactic acid (0-9.63 g/l). The resulting predictive model showed a good correlation over the entire range of the experimental data. Predictions from the model have been compared with independent data from both published literature and inoculated food studies. Analysis of the results showed a good correlation, particularly for data from milk and meat products.

Application of a log-logistic model to describe the survival of Yersinia enterocolitica at sub-optimal pH and temperature

A log-logistic model previously used to describe the thermal inactivation of microorganisms has been applied to predict accurately the survival of Yersinia enterocolitica under conditions of sub-optimal temperatures (0-23 degrees C) and growth inhibitory pH values for a number of different acidulants. Predictions from the model were also compared to observed survival times of Y. enterocolitica in mayonnaise and were found to be in excellent agreement. However in yoghurt the model overestimated survival of this organism at both 20 and 4 degrees C but would 'fail safe' if used for predictive purposes. The discrepancy in yoghurt is discussed.

Modelling the effect of pH, acidulant and temperature on the growth rate of Yersinia enterocolitica

Growth of two pathogenic and one environmental serotype of Yersinia enterocolitica under acidic conditions and at 4 and 25 degrees C was investigated. At both temperatures the maximum growth inhibitory pH depended on the acidulant used and was in the order acetic greater than lactic greater than citric greater than sulphuric. At the lower temperature the maximum growth inhibitory pH was 0.3-0.5 pH units higher than at 25 degrees C. No difference was observed between the behaviour of pathogenic and environmental serotypes in this respect. Measurement of growth at a number of sub-optimal temperatures and pH values showed that the variation of growth rate with temperature could be represented by a square root plot. The effect of different pH values could be incorporated into the model by replacing the regression coefficient b by its relationship with pH. Values of maximum growth inhibitory pH derived from the model were in good agreement with experimental values with the exception of acetic acid.

External ventricular drainage for initial treatment of neonatal posthemorrhagic hydrocephalus: surgical and neurodevelopmental outcome

Thirty-seven infants were treated for posthemorrhagic hydrocephalus (PHH) with external ventricular drainage (EVD) in 1977-1985. The mean age at EVD placement was 13 days; the mean duration of drainage was 21 days, and an average of 1.8 drains was used per patient. Complications were apnea (10%), hemorrhage (8%) and ventriculitis (6%). Ten infants died from pulmonary disease unrelated to the surgery. Thirty-two percent of the survivors did not require a permanent shunt. Neurodevelopmental outcome was evaluated at a mean age of 38 months. Eighteen of the twenty-seven survivors (67%) had normal cognitive function, 3 had borderline and 6 (22%) had moderate to profound mental retardation. Nine of the children (33%) had a normal neuromuscular exam. One child had mild, 11 had moderate and 6 had severe cerebral palsy. Four children had serious visual impairment. The worst outcomes were in the children with parenchymal or large intraventricular hemorrhages.