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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
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IntroductionIntroductionIntroduction
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Foodborne Disease
• U.S. Rates per Year:– 76 million illnesses– 325,000
hospitalizations– 5,000 deaths
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Etiology of Foodborne Illness in the United States
Parasites, 3%
Bacteria, 30%
Viruses, 67%
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Campylobacter spp.
• 47% of Bacterial Foodborne illnesses
• Infectious dose of 100 microorganisms
• Spread via a fecal-oral route
• Inadequate cooking or cross-contamination
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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
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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
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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
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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.
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U.S. Childcare Centers
• 15 million children• Provide an
environment for multiple children of varying ages to interact
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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.
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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.
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Implicated Organisms
• Outbreaks of diarrheal illness in childcare centers have been found to be caused by:
– Salmonella– Shigella– E. coli O157:H7
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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%.
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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
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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
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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)
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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
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MethodsMethodsMethods
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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
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Second Year Protocol
• 32 Childcare Centers– All Microbiological Analysis under the
expanded protocol– 21 Centers Matched
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Project Protocol
Sample Collection
Sample Enrichment
Primary Plating Media
Screening Biochemicals
Final Identification
Data Analysis
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Sample Collection
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Sample Enrichment
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Primary Plating Media
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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
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Final Identification
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ResultsResultsResults
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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
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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:
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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:
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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:
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