Draft risk assessment of the public health impact of Escherichia coli O157:H7 in ground beef

An assessment of the risk of illness associated with Escherichia coli O157:H7 in ground beef was drafted in 2001. The exposure assessment considers farm, slaughter, and preparation factors that influence the likelihood of humans consuming ground beef servings containing E. coli O157:H7 and the number of cells in a contaminated serving. Apparent seasonal differences in prevalence of cattle infected with E. coli O157:H7 corresponded to seasonal differences in human exposure. The model predicts that on average 0.018% of servings consumed during June through September and 0.007% of servings consumed during the remainder of the year are contaminated with one or more E. coli O157:H7 cells. This exposure risk is combined with the probability of illness given exposure (i.e., dose response) to estimate a U.S. population risk of illness of nearly one illness in each 1 million (9.6 x 10(-7)) servings of ground beef consumed. Uncertainty about this risk ranges from about 0.33 illness in every 1 million ground beef servings at the 5th percentile to about two illnesses in every 1 million ground beef servings at the 95th percentile.

Risk assessment for Clostridium perfringens in ready-to-eat and partially cooked meat and poultry products

An assessment of the risk of illness associated with Clostridium perfringens in ready-to-eat and partially cooked meat and poultry products was completed to estimate the effect on the annual frequency of illnesses of changing the allowed maximal 1-log growth of C. perfringens during stabilization (cooling after the manufacturing heat step). The exposure assessment modeled stabilization, storage, and consumer preparation such as reheating and hot-holding. The model predicted that assuming a 10- or 100-fold increase from the assumed 1-log (maximal allowable) growth of C. perfringens results in a 1.2- or 1.6-fold increase of C. perfringens-caused illnesses, respectively, at the median of the uncertainty distribution. Improper retail and consumer refrigeration accounted for approximately 90% of the 79,000 C. perfringens illnesses predicted by the model at 1-log growth during stabilization. Improper hot-holding accounted for 8% of predicted illnesses, although model limitations imply that this is an underestimate. Stabilization accounted for less than 1% of illnesses. Efforts to reduce illnesses from C. perfringens in ready-to-eat and partially cooked meat and poultry products should focus on retail and consumer storage and preparation methods.

Overview and Summary of the Food Safety and Inspection Service Risk Assessment for Salmonella Enteritidis in Shell Eggs, October 2005

In 1998, the United States Department of Agriculture's Food Safety and Inspection Service (FSIS) and the Food and Drug Administration completed a risk assessment that indicated multiple interventions along the farm-to-table chain were needed to reduce the risk of human illness from Salmonella Enteritidis in shell eggs. Based on newly available data and improved modeling techniques, FSIS completed an updated risk assessment to examine the effect of pasteurization and refrigeration on reducing human illnesses from S. Enteritidis in shell eggs. The risk assessment model was written in Visual Basic for Applications (Microsoft, Redmond, WA) and run using Monte Carlo methods. The model estimated that if all shell eggs produced in the United States were pasteurized for a 3-log10 reduction of S. Enteritidis, the annual number of illnesses from S. Enteritidis in eggs would decrease from approximately 130,000 to 40,000. Pasteurization for a 5-log10 reduction of S. Enteritidis was estimated to reduce the annual number of illnesses to 19,000. The model also estimated that if all eggs produced in the United States were stored and held at 7.2 degrees C within 12 hours of lay, the annual number of illnesses from S. Enteritidis in eggs would decrease from 130,000 to 28,000. As a result, rapid cooling and pasteurization of shell eggs were predicted to be highly effective mitigations for reducing illnesses from consumption of S. Enteritidis in shell eggs.

Listeria monocytogenes in Retail Delicatessens: an Interagency Risk Assessment-model and baseline results

The Interagency Risk Assessment-Listeria monocytogenes (Lm) in Retail Delicatessens provides a scientific assessment of the risk of listeriosis associated with the consumption of ready-to-eat (RTE) foods commonly prepared and sold in the delicatessen (deli) of a retail food store. The quantitative risk assessment (QRA) model simulates the behavior of retail employees in a deli department and tracks the Lm potentially present in this environment and in the food. Bacterial growth, bacterial inactivation (following washing and sanitizing actions), and cross-contamination (from object to object, from food to object, or from object to food) are evaluated through a discrete event modeling approach. The QRA evaluates the risk per serving of deli-prepared RTE food for the susceptible and general population, using a dose-response model from the literature. This QRA considers six separate retail baseline conditions and provides information on the predicted risk of listeriosis for each. Among the baseline conditions considered, the model predicts that (i) retail delis without an environmental source of Lm (such as niches), retail delis without niches that do apply temperature control, and retail delis with niches that do apply temperature control lead to lower predicted risk of listeriosis relative to retail delis with niches and (ii) retail delis with incoming RTE foods that are contaminated with Lm lead to higher predicted risk of listeriosis, directly or through cross-contamination, whether the contaminated incoming product supports growth or not. The risk assessment predicts that listeriosis cases associated with retail delicatessens result from a sequence of key events: (i) the contaminated RTE food supports Lm growth; (ii) improper retail and/or consumer storage temperature or handling results in the growth of Lm on the RTE food; and (iii) the consumer of this RTE food is susceptible to listeriosis. The risk assessment model, therefore, predicts that cross-contamination with Lm at retail predominantly results in sporadic cases.

Tracking cross-contamination transfer dynamics at a mock retail deli market using GloGerm

Ready-to-eat (RTE) deli meats are considered a food at high risk for causing foodborne illness. Deli meats are listed as the highest risk RTE food vehicle for Listeria monocytogenes. Cross-contamination in the retail deli market may contribute to spread of pathogens to deli meats. Understanding potential cross-contamination pathways is essential for reducing the risk of contaminating various products. The objective of this study was to track cross-contamination pathways through a mock retail deli market using an abiotic surrogate, GloGerm, to visually represent how pathogens may spread through the deli environment via direct contact with food surfaces. Six contamination origination sites (slicer blade, meat chub, floor drain, preparation table, employee's glove, and employee's hands) were evaluated separately. Each site was inoculated with 20 ml of GloGerm, and a series of standard deli operations were completed (approximately 10 min of work). Photographs were then taken under UV illumination to visualize spread of GloGerm throughout the deli. A sensory panel evaluated the levels of contamination on the resulting contaminated surfaces. Five of the six contamination origination sites were associated with transfer of GloGerm to the deli case door handle, slicer blade, meat chub, preparation table, and the employee's gloves. Additional locations became contaminated (i.e., deli case shelf, prep table sink, and glove box), but this contamination was not consistent across all trials. Contamination did not spread from the floor drain to any food contact surfaces. The findings of this study reinforce the need for consistent equipment cleaning and food safety practices among deli workers to minimize cross-contamination.

Occurrence of Listeria monocytogenes in Ready-to-Eat Meat and Poultry Product Verification Testing Samples from U.S. Department of Agriculture-Regulated Producing Establishments, 2005 through 2017

ABSTRACT

Ready-to-eat (RTE) meat and poultry product samples collected between 2005 and 2017 from RTE-producing establishments for the U.S. Department of Agriculture, Food Safety and Inspection Service (FSIS) ALLRTE/RTEPROD_RAND (random) and RTE001/RTEPROD_RISK (risk-based) sampling projects were tested for Listeria monocytogenes (Lm). Data for 45,897 ALLRTE/RTEPROD_RAND samples collected from 3,607 distinct establishments and 112,347 RTE001/RTEPROD_RISK samples collected from 3,283 distinct establishments were analyzed for the presence of Lm. These data were also analyzed based upon the percentages of establishments with positive samples, annual production volume, sanitation control alternatives, geographic location, and season or month of sample collection. Results revealed low occurrence of Lm-positive samples from the random and risk-based sampling projects, with 152 (0.33%) positive samples for ALLRTE/RTEPROD_RAND and 403 (0.36%) positive samples for RTE001/RTEPROD_RISK. The percentage of positive samples significantly decreased over time, from about 0.7% in 2005 and 2006 to about 0.2% in 2017 (P < 0.05). From 2005 to 2017, 3.9% of establishments sampled under the ALLRTE/RTEPROD_RAND sampling project had at least one Lm-positive sample. Similarly, 10.0% of establishments sampled under the RTE001/RTEPROD_RISK sampling project had at least one positive sample. Samples positive for Lm were found in all geographic regions in all months. Thus, in 13 years of RTE product sampling in FSIS-regulated establishments (2005 through 2017), <0.4% of samples were positive for Lm in both risk-based and random sampling projects. The low prevalence of Lm in these products suggests that the combination of FSIS policies and industry practices may be effective for controlling Lm contamination. Information obtained from these sampling projects is relevant to the ongoing prevention of foodborne Lm illnesses from RTE meat and poultry products.

HIGHLIGHTS

Bilateral subcapital neck of femur fractures after eclamptic seizures

A previously healthy female sustained bilateral subcapital femur fractures during an eclamptic seizure. This complication has not been previously described in association with eclampsia. Clinicians need to be aware of this potential complication and investigate postseizure hip pain appropriately.

The impact of consultant-delivered multidisciplinary inpatient medical care on patient outcomes

Consultant-delivered care has been shown to improve outcomes for acute medical patients. However, the ideal composition of a medical team to support consultant-delivered care is not clear and little is known about the effect of continuing consultant-delivered care until the patient is discharged. Between December 2011 and April 2012, 260 general medical patients requiring inpatient care were managed by a consultant-delivered multidisciplinary team (CD-MDT) and 150 patients by a standard consultant-led team of trainee doctors. The length of hospital stay was significantly lower for patients managed by a CD-MDT than for those managed by a standard team (4-5 days vs 7 days, p<0.001). No difference between the groups was seen for readmission rates, patient safety or mortality. In conclusion, a CD-MDT is a safe and effective model of inpatient medical care and is associated with a shorter length of hospital stay.

Typical bronchial carcinoid tumour presenting as pneumomediastinum

The authors present a case of a 44-year-old man who presented with acute onset shortness of breath. He had severe subcutaneous emphysema and his chest x-ray and CT scan confirmed presence of air in mediastinum. Rigid bronchoscopy revealed a bronchial tumour which was proven to be a carcinoid on histology. Patient recovered following the surgical excision of the tumour.

Extracorporeal membrane oxygenation in the management of severe thoracic trauma: a case report

We describe a case where extracorporeal membrane oxygenation was used for seven days to facilitate surgery and respiratory therapy in a multi-trauma patient with severe pulmonary contusions, bilateral bronchopleural fistulae with recurrent pneumothoraces. The patient made a good recovery and was discharged from hospital after three months.