Salmonellosis primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Jolanta Marszalek, M.D. [3]
Overview
The transmission of Salmonella can be limited by implementing preventive measures which include: wash hands after contact with animals such as reptiles, chickens or other birds; ensure food is properly washed and cooked; avoid raw milk and its derivatives; and avoid eating raw eggs and food in which they are involved. Food handlers should maintain high level of hygiene when preparing, washing and cooking foods. Whenever suffering from fever, diarrhea, and vomiting, food handlers should report to their employers immediately. Fruits and vegetables producers should also practice good hand hygiene, protect fields from fecal contamination, evaluate quality of water and hygiene of storage equipment. The public health department should be informed about all cases of salmonellosis, therefore clinical laboratories should send their isolates of Salmonella to the city, county, or State Public Health laboratories, so that the specific type of bacteria can be determined, and compared with other Salmonella in the community. The CDC monitors the frequency of Salmonella infections in the country, and assists the local and State Health Departments to investigate outbreaks and devise control measures.[1][2]
Primary Prevention
According to the WHO, the following measures should be applied in the prevention of salmonellosis:[1]
Contact with Animals
- People should wash their hands after contact with animal feces.
- Because reptiles are particularly likely to have Salmonella, and it can contaminate their skin, everyone should immediately wash their hands after handling reptiles. Reptiles (including turtles) are not appropriate pets for small children and should not be in the same house as an infant.
- Salmonella carried in the intestines of chickens and ducklings contaminates their environment and the entire surface of the animal. Children can be exposed to the bacteria by simply holding, cuddling, or kissing the birds. Children should not handle baby chickens or other young birds.
- Everyone should immediately wash their hands after touching birds, including baby chicks and ducklings, or their environment.
Recommendations for the Public and Travelers
Prevention requires control measures at all stages of the food chain, from agricultural production, to processing, manufacturing and preparation of foods in both commercial establishments and at home.
- Ensure food is properly cooked and still hot when served.
- Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk.
- Raw eggs may be unrecognized in some foods, such as:
- Homemade Hollandaise sauce
- Caesar and other homemade salad dressings
- Tiramisu
- Homemade ice cream
- Homemade mayonnaise
- Cookie dough
- Frostings.
- Avoid ice unless it is made from safe water.
- When the safety of drinking water is questionable, boil it or if this is not possible, disinfect it with a reliable, slow-release disinfectant agent.
- Wash hands thoroughly and frequently using soap, in particular after contact with pets or farm animals, or after having been to the toilet.
- Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled.
- Cross-contamination of foods should be avoided. Uncooked meats should be kept separate from produce, cooked foods, and ready-to-eat foods. Hands, cutting boards, counters, knives, and other utensils should be washed thoroughly after touching uncooked foods. Hand should be washed before handling food, and between handling different food items.
- For newborns, breast-feeding prevents salmonellosis and many other health problems.[2]
Recommendations for Food Handlers
- Both professional and domestic food handlers should be vigilant while preparing food and should observe hygienic rules of food preparation.
- Professional food handlers who suffer from fever, diarrhea, vomiting or visible infected skin lesions should report to their employer immediately.
- The WHO Five Keys to safer food, serve as the basis for educational programmes to train food handlers and educate consumers. They are especially important in preventing food poisoning. The five keys are:
- Keep clean
- Separate raw and cooked
- Cook thoroughly
- Keep food at safe temperatures
- Use safe water and raw materials
Recommendations for Producers of Fruits and Vegetables
- The WHO "Five keys to growing safer fruits and vegetables" is an educational manual for rural workers, including small farmers who grow fresh fruits and vegetables for themselves, their families and for sale in local market. It provides them with key practices to prevent microbial contamination of fresh produces during planting, growing, harvesting and storing.
- The five keys practices are:
- Practice good personal hygiene
- Protect fields from animal fecal contamination
- Use treated fecal waste
- Evaluate and manage risks from irrigation water
- Keep harvest and storage equipment clean and dry
Public Health
It is important for the public health department to know about cases of salmonellosis. Clinical laboratories should send isolates of Salmonella to the City, County, or State Public Health Laboratories so that the specific type of bacteria can be determined and compared with other Salmonella in the community. If many cases occur at the same time, it may mean that a restaurant, food or water supply has a problem which needs correction by the public health department.[2]
Prevention by the Government
The Centers for Disease Control and Prevention (CDC) monitors the frequency of Salmonella infections in the country and assists the local and State Health Departments to investigate outbreaks and devise control measures. CDC also conducts research to better identify specific types of Salmonella. The Food and Drug Administration inspects imported foods, milk pasteurization plants, promotes better food preparation techniques in restaurants and food processing plants, and regulates the sale of turtles. The FDA also regulates the use of specific antibiotics as growth promotants in food animals. The US Department of Agriculture monitors the health of food animals, inspects egg pasteurization plants, and is responsible for the quality of slaughtered and processed meat. The US Environmental Protection Agency regulates and monitors the safety of our drinking water supplies.[2]
Vaccination
There is no vaccine to prevent salmonellosis.[1]