IMPORTANCE OF FOOD SAFETY AND SANITATION (Mehezabin and Shraddha)

Food safety and sanitation is an important public health concern. In the United States, it is estimated that 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths are attributed to foodborne illness each year. The annual cost of foodborne illness is estimated to be from $10 to $83 billion (1). For some individuals, foodborne illness may result in a mild, temporary discomfort. Because older adults are a highly susceptible population, foodborne illness may have serious or long-term consequences, and may be life threatening. Older adults are vulnerable to foodborne illness for several reasons.  Some of these include (2):

1. Weakened immune systems: As part of the aging process, the ability of the immune system to function at normal levels decreases. A decrease in the level of disease-fighting cells is a significant factor in making the average older adult highly susceptible to harmful microorganisms in food.

2. Inflammation of the stomach lining and a decrease in stomach acid: The stomach plays an important role in limiting the number of bacteria that enter the small intestine. During the natural aging process, an older persons stomach tends to produce less acid. The decrease or loss of stomach acidity increases the likelihood of infection if a pathogen is ingested with food or water.

3. Decline in sense of smell and taste:  Many contaminated foods do not smell or taste bad. However, for foods like spoiled milk, a person who does not notice "off" odors and flavors is more likely to eat the food and more likely to become ill.

4. Living on their own: For an older person, preparing meals may pose special challenges. A widower who has not cooked for himself may not know how to prepare food safely. A person receiving home-delivered meals may not be familiar with safe handling and storage practices for meals and leftovers.

The causes of foodborne illness are multifaceted. Some major risk factors of foodborne illness are related to employee behaviors and preparation practices in food service establishments. The principle known risk factors include:

• Improper holding temperatures,
• Inadequate cooking, such as undercooking raw shell eggs,
• Contaminated equipment,
• Food from unsafe sources,
• Poor personal hygiene, and
• Others (such as, pest and rodent infestation and improper food storage).

There are a number of foodborne disease organisms, toxins, and chemicals that affect the public’s health. It is important for SUAs to provide the OANP with general information about new emerging concerns that relate to foodborne diseases. For example, Noroviruses are the most common cause of gastroenteritis in the US. They cause an estimated 23 million cases of acute gastroenteritis (AGE) annually (3). The Norwalk virus has received recent attention as a number of outbreaks of AGE were reported on cruise ships sailing into US ports between June and December 2002 (3). Since October 2002, several states have noted an increase in outbreaks of AGE consistent clinically and epidemiologically, with norovirus infection, particularly in institutional settings such as nursing homes (CDC, unpublished data, 2002). Although attention has been drawn recently to outbreaks of norovirus on cruise ships, an estimated 60%-80% of all AGE outbreaks occur on land, particularly in institutional settings, through nonfoodborne modes of transmission (4-6). CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data on about 10 foodborne diseases in nine US sites to quantify and monitor foodborne illnesses (7). Some other common foodborne infections are those caused by the bacteria Campylobacter,Salmonella, Listeria and E. coli O157:H7. It is important for SUAs to inform OANPs about the emergence of these foodborne diseases and provide the necessary resources to assist OANPs in minimizing the risk of foodborne illness outbreaks.