Food Safety in Childcare Centers

Food Safety in Food Safety in Childcare CentersChildcare Centers

Maggie RyanMaggie RyanUT Public Health InternUT Public Health Intern

Monica Kingsley, MentorMonica Kingsley, Mentor

IntroductionIntroductionIntroduction

Foodborne Disease

• U.S. Rates per Year:– 76 million illnesses– 325,000

hospitalizations– 5,000 deaths

Etiology of Foodborne Illness in the United States

Parasites, 3%

Bacteria, 30%

Viruses, 67%

Campylobacter spp.

• 47% of Bacterial Foodborne illnesses

• Infectious dose of 100 microorganisms

• Spread via a fecal-oral route

• Inadequate cooking or cross-contamination

Enterobacteriaceae• Cause 38.3% of bacterial foodborne

illnesses each year• Gram-Negative Bacilli

– Ferment glucose– Oxidase negative– Reduce nitrate

• Frank Pathogens of this Family include:– Salmonella, Shigella, Escherichia

Salmonella spp.• Hardy bacteria• Infectious dose of

10,000+ • Animal Reservoir

except S. typhi• Spread via a fecal-oral

route• Inadequate cooking or

cross-contamination• Mild to severe illness

Shigella spp.• Infectious dose of 10

microorganisms• No known animal

reservoir• Spread via a fecal-oral

route• Poor personal hygiene or

cross-contamination• Bacillary dysentery

Escherichia spp.• E. coli O157:H7• Infectious dose of less

than 10 cells• Cattle reservoir• Spread via fecal-oral

route• Inadequate cooking or

cross-contamination• Bloody Diarrhea and

H.U.S.

U.S. Childcare Centers

• 15 million children• Provide an

environment for multiple children of varying ages to interact

Risk in Childcare Centers

• Children in childcare centers have an increased risk of gastrointestinal illness.

• The rate of diarrhea has been found to vary between centers, with an average incidence of 0.44 cases per child per year.

Economic Impact

• A Houston study found that parents lost an estimated average of 4.7 days of work per year due to diarrhea of a child that attended day care.

• The Harris County economy, therefore, lost $33 million per year.

Implicated Organisms

• Outbreaks of diarrheal illness in childcare centers have been found to be caused by:

– Salmonella– Shigella– E. coli O157:H7

Accounting for increased risk

• Practices that lead to environmental contamination– Allowing staff to change diapers and

prepare or serve food• Improvement in infection control

found to reduce diarrheal episodes by 50%.

Foodborne Disease in Childcare Centers

• Study of Childcare Centers inTexasand Iowa

• Dr. Margaret Briley and Ms. Deanna Staskel, Department of Human Ecology, University of Texas at Austin

Study Goal

• Assess the existing food handling practices in childcare centers

• Reassessment after training of food service workers in childcare centers by Registered Dietitians (RD) to assess the impact of education

Two Year Study

• First Year– 36 Childcare Centers– Bacteriological analysis of several food

preparation and service areas in the Childcare Centers by Zahra Kazerani at TDSHS

- Education of foodservice workers by a Registered Dietician (RD)

Two Year Study

• Second Year– 32 Childcare Centers– Second bacteriological analysis of

several food preparation and service areas in the Childcare Centers at TDSHS

– Direct comparison with first year results to assess the effectiveness of education on childcare center employees

MethodsMethodsMethods

First Year Protocol

• 36 Childcare Centers– Initial microbiological analysis specific

to Shigella, Salmonella, and E. coli O157:H7

– Not recovered in the first 11 childcare centers

– Protocol expanded to include all members of family Enterobacteriaceae

Second Year Protocol

• 32 Childcare Centers– All Microbiological Analysis under the

expanded protocol– 21 Centers Matched

Project Protocol

Sample Collection

Sample Enrichment

Primary Plating Media

Screening Biochemicals

Final Identification

Data Analysis

Sample Collection

Sample Enrichment

Primary Plating Media

Screening Biochemicals• Biochemical Tests

used:– Triple Sugar Iron Agar

(TSI)– Lysine Iron Agar (LIA)– Lysine Decarboxylase

Broth (LDB)– Acetate Medium– Complex Test Medium

(CTM)– Urea slant– Levine eosin methylene

blue plate– EC with MUG broth

Final Identification

ResultsResultsResults

Comparison of Positive SamplesCollected from 21 Childcare Centers in 2004 and 2005

8559Total Species Identified

1312Total Genera Identified

47.62%42.54%Percent Positive Samples

6057Number of Positive Samples

126134Total Number of Samples

Fall 2005Fall 2004

Percent of Identified Organisms from Food Preparation and Service Areas within

Childcare Centers Identified as Enterobacteriaceae, 2004 and 2005

Non-Enterobacteriaceae, 8.42%

Enterobacteriaceae, 91.50%

2005

Non-Enterobacteriaceae, 11.88%

Enterobacteriaceae, 88.22%

2004

Frank Pathogens Identified from Food Preparation and Service Areas Within Childcare Centers in 2004 and 2005

• 2004– 1 : S. paratyphi A– 0 : E. coli– 0 : Shigella

• 2005– 1 : S. arizonae– 1 : E. coli– 0 : Shigella

Other Enterobacteriaceae Identified from Food Preparation and Service Areas Within

Childcare Centers in 2004 and 2005

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Enterobacter cloacae other Enterobacter spp Klebsiella spp Serratia spp Pantoea spp Erw inia spp OtherEnterobacteriaceae

genera

Genera of Enterobacteriaceae

Perc

enta

ge o

f Ide

ntifi

ed O

rgan

ism

s

2004

2005

Non-Enterobacteriaceae Identified from Food Preparation and Service Areas Within Childcare Centers in 2004 and 2005

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

Pseudomonas spp Other Non-Enterobacteriaceae genera

Genera of Non-Enterobacteriaceae

Perc

enta

ge o

f Ide

ntifi

ed O

rgan

ism

s

2004

2005

Percentage of Identified Organisms present in Food Preparation and Service Areas within 21

Childcare Centers, 2004

7.0%

8.8%

19.3%

17.5%8.8%

8.8%

10.5%

5.3%

3.5%

5.3%3.5% 1.8%

Hands

Garbage Cans

Handw ashing Sinks

Dishw ashing Sinks

Refrigerator Handles

Food Preparation Tables

Cart/Tray Wagon

Cutting Board

Freezer Handles

Misc. Kitchen Surfaces

Counter Top

Table Children Eat From

Percentage of Identified Organisms present in Food Preparation and Service Areas within 21

Childcare Centers, 2005

5.0%

16.7%

18.3%

11.7%11.7%

11.7%

10.0%

5.0%

1.7%8.3%

0.0%

0.0%

Hands

Garbage Cans

Handw ashing Sinks

Dishw ashing Sinks

Refrigerator Handles

Food Preparation Tables

Cart/Tray Wagon

Cutting Board

Freezer Handles

Misc. Kitchen Surfaces

Counter Top

Table Children Eat From

0.0%3033.3%31Table Children Eat From

0.0%7028.6%72Counter Top

12.5%8122.2%92Freezer Handles

63.6%11766.7%1510Dishwashing Sinks

61.1%181164.7%1711Handwashing Sinks

50.0%6350.0%84Hands

% Positive# Sampled# Positive% Positive# Sampled# PositiveSource

20052004

Comparison of Positive Rates at Sample Locations within 21 Childcare Centers

(2004 and 2005)

Comparison of Positive Rates at Sample Locations within 21 Childcare Centers

(2004 and 2005)

45.5%11523.1%133Misc. Kitchen Surfaces

60.0%5350.0%63Cutting Board

60.0%10650.0%126Cart/Tray Wagon

53.8%13745.5%115Food Preparation Tables

35.0%20725.0%205Refrigerator Handles

71.4%141038.5%135Garbage Cans

% Positive# Sampled# Positive% Positive# Sampled# PositiveSource

20052004

Percent Positive Samples from Food Preparation Areas within Childcare Centers,

2004 and 2005

0%

20%

40%

60%

80%

100%

3104 3108 3173 3206 3604 3189 3194 3621 3182 3183 3701 3305 3176 3167 3172 3202 3313 3209 3193 3505 3159

Childcare Center Code

Perc

ent P

ositi

ve S

ampl

es

200

200

Data Analysis Complications

• Small number of centers • Small number of samples • Education was 1 date of extended

training with follow-up newsletters for only 7 months

• Personnel turnover of food handlers

Study Complexity• Limited to 2 Counties

– “Better” counties with yearly inspections done by a County Health Department

• Centers agreed to participate– Centers thought they were doing well – Centers that were motivated to learn

• Centers represent Businesses– Budgets with limited Funds – High Personnel Turnover

Future Studies

• Collect more samples in areas this study identified as consistently contaminated

• More extensive education• Investigate rates of diarrheal illness

at the Childcare Centers in which the environmental samples are taken

Consumer Microbiology TeamMonica Kingsley – Mentor

Terry Campbell, Natalie Perryman-Hale, Chris Malota, Crystal Van Cleave,

Tom Ridpath, Maile McCharen, and Chris Melton

Consumer Microbiology TeamConsumer Microbiology TeamMonica Kingsley Monica Kingsley –– MentorMentor

Terry Campbell, Natalie PerrymanTerry Campbell, Natalie Perryman--Hale, Chris Hale, Chris MalotaMalota, Crystal Van Cleave, , Crystal Van Cleave,

Tom Tom RidpathRidpath, , MaileMaile McCharenMcCharen, , and Chris Meltonand Chris Melton

I would like to acknowledge the I would like to acknowledge the following individuals for their following individuals for their tireless aid and mentorship: tireless aid and mentorship:

Dr. Leanne Field,Dr. Suzanne Barth,

Dr. Margaret Briley, and Ms. Deanna Staskel

Dr. Leanne FieldDr. Leanne Field,,Dr. Suzanne Dr. Suzanne BarthBarth,,

Dr. Margaret Dr. Margaret BrileyBriley, , andand Ms. Deanna Ms. Deanna StaskelStaskel

I would like to acknowledge the I would like to acknowledge the following individuals for their following individuals for their tireless aid and mentorship: tireless aid and mentorship:

Texas Health Foundationand

The Centers for Disease Control and Prevention,

Epidemiology and Laboratory Capacity for Infectious

Diseases Program (04040).

Texas Health FoundationTexas Health Foundationandand

The Centers for Disease The Centers for Disease Control and Prevention, Control and Prevention,

Epidemiology and Laboratory Epidemiology and Laboratory Capacity for Infectious Capacity for Infectious

Diseases Program (04040).Diseases Program (04040).

Special Thanks to the Special Thanks to the generous sponsors of this generous sponsors of this

program:program: