What is the HACCP (hazard analysis critical control point) approach and how can it be applied to enteral tube feeding?

The HACCP (hazard analysis critical control point) concept is now widely applied in the food industry and provides a structured and critical approach to the identification and control of hazards that may affect food safety. It has shifted the emphasis for control from retrospective end-product testing to the effective control of raw materials and key processing operations.
This paper discusses how the HACCP approach can be applied to enteral feeding. This involves each unit assembling a multidisciplinary team of personnel involved in enteral feeding. This team will then carry out a detailed analysis of the process from selection of ingredients and feeding systems through to consumption of the feed by the patient by constructing a flow chart that relates specifically to each unit. They can then identify and assess the hazards associated with the handling of the product at each stage in the process. This will enable them to identify the points where control over an identified hazard can be achieved (critical control points, CCP) such as quality of ingredients, design of administration systems, preparation and distribution of the feeds and the procedures involved in the assembly and manipulation of the systems. Control and monitoring procedures can then be specified and implemented at relevant stages in the process. The major strengths of the HACCP procedure are that it entails a team effort from key personnel involved in the full range of activities associated with the product and each detailed analysis is specific to each unit's practices and resources and can be continually reviewed and modified in response to changing circumstances.     

细菌性食源性疾病实验诊断及关键控制点分析研究

目的：对扬州市近10年70起细菌性食源性疾病实验诊断结果进行分析，进行危害分析(HA)并寻找细菌性食源性疾病的关键控制点(CCPs)。方法：对引起70起细菌性食源性疾病病原菌、病原菌的来源、主要污染食物、发生季节进行分析。结果：由致病性弧菌引起食源性疾病占58．57％。厨师带菌引起食源性疾病占54．28％。熟食间检出的致病菌株占食品株的91．30％。7～9月份发生的食源性疾病占65．72％。结论：细菌性食源性疾病主要危害因素是致病性弧菌、沙门菌、金黄色葡萄球菌。冷盘(菜)是引起食源性疾病的主要食物。熟食间卫生管理、从业人员的健康体检及卫生素质培训、防止交叉污染、夏秋季节防止细菌繁殖是控制食源性疾病的关键控制点。     

Enterobacter sakazakii: epidemiology, clinical presentation, prevention and control

The Enterobacter sakazakii is considered an emerging pathogen and has been recently connected to neonatal cases of necrotizing enterocolitis and meningitis due to use of contaminated powdered infant formula. However its presence is not limited to powdered infant formula; it can also be found in a broad range of foods and in water, in a variety of areas, including hospitals and houses. Due to the gravity of the infections attributed to E. sakazakii, it is necessary to introduce rigorous control measures to reduce the risks of contamination at various levels: industrial, to prevent from production to marketing the contamination of products; at a domestic level by reducing the risk of contamination, during preparation, handling, and storage, of reconstituted products; and legislative by establishing guidelines and recommendations issued by competent authorities, to guarantee the safety of infant food.     

A nursing home outbreak of Clostridium perfringens associated with pureed food

OBJECTIVE: To investigate and ascertain the source of a nursing home outbreak of gastroenteritis in Melbourne in 1997. METHOD: A retrospective cohort study. We obtained fecal and food samples and environmental swabs, and reviewed food handling. RESULTS: There were 25 cases, and 21 of these had their meals pureed (liquidised). The relative risk for eating pureed food and becoming ill was 5.8 (95% CI 2.2-15.4). Clostridium perfringens and its enterotoxin was detected in nine fecal samples. Samples of pureed food tested positive for coliforms. CONCLUSIONS: This outbreak was caused by C. perfringens contaminating pureed food. Food liquidising provides opportunities for re-contamination of cooked food through the use of contaminated equipment and deficiencies in food handling practices. Pureed foods should be reheated to 70 degrees C after liquidising to inactivate pathogens. IMPLICATIONS: Health care facilities need to take specific precautions to manage the special hazards involved in preparing pureed food.     

Street foods in Accra,Ghana: how safe are they?

OBJECTIVE: To investigate the microbial quality of foods sold on streets of Accra and factors predisposing to their contamination. METHODS: Structured questionnaires were used to collect data from 117 street vendors on their vital statistics, personal hygiene, food hygiene and knowledge of foodborne illness. Standard methods were used for the enumeration, isolation, and identification of bacteria. FINDINGS: Most vendors were educated and exhibited good hygiene behaviour. Diarrhoea was defined as the passage of > or =3 stools per day) by 110 vendors (94.0%), but none associated diarrhoea with bloody stools; only 21 (17.9%) associated diarrhoea with germs. The surroundings of the vending sites were clean, but four sites (3.4%) were classified as very dirty. The cooking of food well in advance of consumption, exposure of food to flies, and working with food at ground level and by hand were likely risk factors for contamination. Examinations were made of 511 menu items, classified as breakfast/snack foods, main dishes, soups and sauces, and cold dishes. Mesophilic bacteria were detected in 356 foods (69.7%): 28 contained Bacillus cereus (5.5%), 163 contained Staphylococcus aureus (31.9%) and 172 contained Enterobacteriaceae (33.7%). The microbial quality of most of the foods was within the acceptable limits but samples of salads, macaroni, fufu, omo tuo and red pepper had unacceptable levels of contamination. Shigella sonnei and enteroaggregative Escherichia coli were isolated from macaroni, rice, and tomato stew, and Salmonella arizonae from light soup. CONCLUSION: Street foods can be sources of enteropathogens. Vendors should therefore receive education in food hygiene. Special attention should be given to the causes of diarrhoea, the transmission of diarrhoeal pathogens, the handling of equipment and cooked food, hand-washing practices and environmental hygiene.     

Food fears: a national survey on the attitudes of Australian adults about the safety and quality of food

A national telephone survey of a representative sample of 1200 Australian adults was conducted in March 2002 in order to identify the factors of greatest concern to consumers in relation to the safety and quality of food, to measure recent trends in views about hazards in the food supply, to explore beliefs about the safety of additives and to discover whether consumers use food labels to check for ingredients of concern. Forty five percent of Australians responded that they were more concerned about the safety and quality of food than they were five years previously, while only 5% were less concerned. The most common potential hazards volunteered were additives and chemical residues (28%), followed by food processing/handling/freshness (21%), food hygiene or contamination (14%), and also genetic modification (14%). More than half of the respondents believe that additives and preservatives are harmful to your health and that many foods contain high levels of pesticides. A greater proportion of consumers claimed to be conscious of checking for additives, either general or specific, on food labels than for information on the salt or sugar content of products. Food regulators, journalists, the food industry and health professionals need to work together to correct misconceptions about the risks to health posed by common food additives and pesticide residues.     

A review of the studies on fungi and mycotoxins in foodstuffs in Beijing during 1976-1986

Fungi and mycotoxins contaminating foods in Beijing during 1976-1986 were studied. A total of more than 5,000 food samples classified into 104 kinds of 16 types were examined of analysed. The results showed that the natural occurrence of Aflatoxin B1 in foods in Beijing was not serious, but from the results of analysis 59 cases of food poisoning and food seriously contaminated with moulds, the hazards of fungal contamination of food should receive serious consideration. In order to improve food hygiene and facilitate supervision the author suggested that a mycological standard should be established for marketing foods in China, such as grain, and beverage which are highly susceptible to fungal contamination.     

Large outbreaks of Salmonella Typhimurium phage type 135 infections associated with the consumption of products containing raw egg in Tasmania

This report describes one of the largest egg-associated outbreaks of foodborne illness in Australia for many years. Between June and December 2005, five outbreaks of Salmonella Typhimurium phage type 135 were identified in Tasmania, leading to 125 laboratory-confirmed cases. Public health investigations included case and food handler interviews, cohort studies, environmental health investigations of food businesses, microbiological testing, traceback, and inspections and drag swabbing of an egg farm. These investigations enabled identification of foods containing raw egg or foods contaminated through inadequate food handling and/or storage procedures as possible vehicles for infection. A particular poultry farm was reported as the common source of eggs. Interventions targeting the general public and food handlers to promote better handling of egg products, and advice to egg producers regarding harm minimisation strategies led to the series of outbreaks being brought under control.     

Bacterial contamination of stored water and stored food: a potential source of diarrhoeal disease in West Africa

The food and water hygiene in two Liberian communities was studied in a house-to-house diarrhoea survey. The level of contamination with enterobacteria of drinking water stored in the households was significantly higher than at the water sources. Food hygiene standards were low, particularly in the urban slum where storage of cooked food for long periods led to bacterial multiplication at high levels. Infant foods were particularly heavily contaminated. It is concluded that when water supply programmes are planned, the presence of other risk factors for water-related diseases should be investigated. To ensure maximum health benefits, water projects should as a rule be accompanied by other interventions.     

河北省食品中沙门氏菌的耐药性研究

目的:了解河北省食品中沙门氏菌的污染状况和耐药水平。方法:根据GB4789·4-2003和全国食品污染物监测致病菌检测方法进行沙门氏菌的分离鉴定,用K-B法测定沙门氏菌的耐药性。结果:2005年从河北省6个市的生肉、水产品和奶粉共387份食品中分离到81株沙门氏菌,分离率为20·9%。91·3%的沙门氏菌对1种以上抗生素耐药,16·1%的对5种以上抗生素耐药,8株对10种以上抗生素耐药,耐药最多的一株菌耐17种抗生素。结论:河北省生肉及水产品中沙门氏菌的污染率和耐药性较高,应限制抗生素在食源性动物饲养过程中的应用,保障食品安全。     

Foodborne diseases in developing countries: aetiology,epidemiology and strategies for prevention

Our knowledge of diseases caused by biologically and chemically contaminated food varies considerably between developing countries. While in Latin America and the Caribbean some information regarding foodborne hazards, high-risk foods and the extent of any resulting disease is available, in many other developing countries little is known about the nature and extent of such diseases. Systematic foodborne surveillance activities, including epidemiological studies, are rarely undertaken. Public health authorities and the public frequently learn about the more dramatic disease outbreaks from news media. A good indication of the importance of food contamination for health and well-being is the information available about infant diarrhoea, infant/child and adult malnutrition. Both conditions are closely related to contaminated food and drinking water, and are particularly important public health problems in most developing countries, as is cholera. With regard to chemicals, little information is available in developing countries on the occurrence of food contamination. Without such information, the health of hundreds of millions of people may be threatened. Improving the safety of the food supply and reducing foodborne diseases requires the concept of shared responsibility to be adopted. All of society needs to accept that food is not only an agricultural and trade commodity but a public health issue. Consequently, Ministries of Health in all countries must integrate food safety as an essential public health function into their work.     

Safety of vendor-prepared foods: evaluation of 10 processing mobile food vendors in Manhattan

OBJECTIVES: Unsanitary food handling is a major public health hazard. There are over 4,100 mobile food vendors operating in New York City, and of these, approximately forty percent are processing vendors--mobile food units on which potentially hazardous food products are handled, prepared, or processed. This pilot study assesses the food handling practices of 10 processing mobile food vendors operating in a 38-block area of midtown Manhattan (New York City) from 43rd Street to 62nd Street between Madison and Sixth Avenues, and compares them to regulations stipulated in the New York City Health Code. METHODS: Ten processing mobile food vendors located in midtown Manhattan were observed for a period of 20 minutes each. Unsanitary food handling practices, food storage at potentially unsafe temperatures, and food contamination with uncooked meat or poultry were recorded. RESULTS: Over half of all vendors (67%) were found to contact served foods with bare hands. Four vendors were observed vending with visibly dirty hands or gloves and no vendor once washed his or her hands or changed gloves in the 20-minute observation period. Seven vendors had previously cooked meat products stored at unsafe temperatures on non-heating or non-cooking portions of the vendor cart for the duration of the observation. Four vendors were observed to contaminate served foods with uncooked meat or poultry. CONCLUSIONS: Each of these actions violates the New York City Code of Health and potentially jeopardizes the safety of these vendor-prepared foods. More stringent adherence to food safety regulations should be promoted by the New York City Department of Health.     

深圳市2004年部分食品中镉污染情况分析

目的：了解深圳市食品中镉的污染情况，发现关键性问题并进行分析，为制定相应的标准和针对性措施提供切实可靠的依据。方法：按照《深圳市食品污染物监测体系项目工作方案》的要求，在全市范围内采集9类共211份样品，参照GB5009．15-2003方法进行测定。结果：蛋类、禽肉、畜肉、饮料、豆制品等5类食品的情况较好，蔬菜和鱼类存在一定程度的镉污染问题，猪肝和猪肾受镉污染的情况比较严重。结论：尽快增订和修订我国国家食品卫生标准中关于镉限量的标准，并加大对食品中镉污染的监测力度，督促企业加强食品中镉的监测和管理，强化健康教育工作，指导市民科学饮食。     

Contamination of weaning foods and transmission of enterotoxigenic Escherichia coli diarrhoea in children in rural Bangladesh

In longitudinal studies of infectious diseases and nutrition in Bangladesh, we determined the degree of bacterial contamination of traditional weaning foods and evaluated the role of these foods in the transmission of diarrhoeal diseases. 41% of samples of food items fed to weaning aged children contained Escherichia coli; these organisms were used as indicators of faecal contamination. Milk and foods prepared particularly for infants were more frequently and heavily contaminated with E. coli than was boiled rice, and E. coli levels were found to be related to the storage of cooked foods at high environmental temperatures. 50% of drinking water specimens also contained E. coli, but colony counts were approximately 10-fold lower than in food specimens. The proportion of a child's food samples that contained E. coli was significantly related to the child's annual incidence of diarrhoea associated with enterotoxigenic E. coli. This observation underscores the importance of seeking locally available foods that are hygienic as well as nutritious to supplement the diets of breastfeeding children in developing countries.     

食源性金黄色葡萄球菌流行特征、产肠毒素特性及耐药性研究

目的：了解食源性金黄色葡萄球菌流行特点及产肠毒素特性及其耐药性，为制定HACCP以防止金黄色葡萄球菌的食源性疾病提供依据。方法：采集8类食品1243件分离金黄色葡萄球菌并进行产肠毒素A—E试验及药物敏感试验。结果：从生肉、熟食、生奶、及水产品中分别分离出40株（10．96％）、12株（3．13％）、34株（16．27％）及1株（1．12％）金黄色葡萄球菌，相应的产肠毒素率分别达到52．50％、58．33％、61．76％、0．oo％；对青霉素、四环素、凝固酶阴性苯唑西林耐药率分别高达93．10％、49．43％、37．93％；79．31％菌株对2种以上的药物多重耐药，最多耐药种类达7种，表现出30种耐药谱。结论：扬州市食品中存在着较严重的金黄色葡萄球菌潜在的危害，主要来源于生肉、生奶及熟食；食源性金黄色葡萄球菌产毒素能力较强。金黄色葡萄球菌对多种药物的耐药性提示安全应用治疗药物的重要性。     

Compatibility of computed and chemically determined macronutrients and energy content of traditional Greek recipes

The analyses of composite recipes are frequently missing in nutrient databases and their inclusion presupposes expensive and fairly complicated chemical analyses. The nutritional composition of traditional Greek composite foods was determined through chemical analyses and by the computerized program, Unilever Dietary Analysis Program (UNIDAP). The chemical analyses followed standard procedures and were also performed on all the raw ingredients used for preparation for the composite foods. The UNIDAP system was originally based on the British Food Composition Tables, but has been enriched over the years with compositional data representative of Greek food items, derived from chemical analyses conducted in the context of research projects.Some discrepancies were observed between the nutrient values of the raw ingredients that were used for the preparation of the recipes and the UNIDAP database nutrient values for the same ingredients, but despite that, a very good agreement was deduced for the macronutrients and energy content of the composite foods. It is concluded that the UNIDAP generates reliable data on macronutrients and energy content of Greek food recipes. This provides the foundation for developing more up-to-date nutrient database in Greece and supplies health professionals with an important tool for dietary planning, nutrient and food database development, and policy implementation.     

2011年宿迁市食源性致病菌监测分析

目的了解宿迁市各类食品中常见食源性致病菌污染情况,为食品安全风险评估及预警提供依据。方法依照国标和《江苏省食源性致病菌监测工作手册》,对采集样品进行病原菌分离鉴定。结果 891份样品中检出78株致病菌,检出率8.8%,其中沙门菌67株,占85.9%,单增李斯特菌5株,占6.4%,金黄色葡萄球菌3株,占3.8%,阪崎杆菌2株,占2.6%,O157:H7大肠杆菌1株,占1.3%,副溶血性弧菌未检出;10类食品中,生畜禽肉类致病菌检出率最高,为34.2%。结论宿迁地区主要消费食品存在食源性致病菌污染,主要以生畜禽肉类食品为主,应加强监管措施,定期提供预警信息。     

Studies of food hygiene and diarrhoeal disease

Contamination of weaning foods and water with enteropathogenic micro-organisms has been recognised in the past, but its link with the development of diarrhoea by young children in developing countries is lacking. This may explain the unavailability of effective interventions to reduce the risk of diarrhoeal diseases from this contamination. The frequency of contamination of weaning foods with enteropathogens is high in developing countries, and is dependent on the food type, storage time and ambient temperature of storage, the method used, and the temperature reached on re-warming before re-feeding. Other considerations are the bacterial content of cooking and feeding utensils. Fruit and raw vegetables can become contaminated with enteropathogenic micro-organisms by sewage-containing irrigation water, by washing produce and fruits in contaminated water, and how they are processed at home. In most studies reviewed, the level of contamination is higher in weaning foods than in drinking water. Since there is a need to reach a critical level of contamination before illness can occur after the ingestion of an enteropathogen, it is postulated that weaning foods are probably more important than drinking water for transmission of diarrhoeal diseases in developing countries. Several potential interventions have been identified, which should be developed and tested in controlled trials in developing countries. These interventions are needed to reduce contamination of weaning foods in households from developing countries, while adequate facilities for the provision of clean water and sanitation to those communities are placed.     

An outbreak of viral gastroenteritis associated with adequately prepared oysters.

Over Christmas 1993, an outbreak of food poisoning occurred among guests in a hotel in South West Scotland. Evidence from a cohort study strongly suggested that raw oysters were the vehicle for infection, probably due to a Small Round Structured Virus (SRSV). Detailed enquiry about the source and preparation of the oysters revealed no evidence of any unsafe handling at any stage in the food chain, nor any evidence of bacterial contamination. It is suggested that the present standards of preparation and monitoring are inadequate to protect the consumer, and that bacteriophage monitoring may be a useful method of screening for viral contamination in future.