Fear of Fresh A Primer on Produce Safety

1. Fear of FreshA Primer on Produce Safety Barbara Brown, Ph.D., R.D./L.D. Food Specialist Oklahoma Cooperative Extension Service Oklahoma Cooperative Extension Service

2. The Kyle Allgood story • Would have been 3 in December • Lived in Chubbuck, Idaho • Died September 30 from E. coli O156:H7 infection • Drank fresh spinach smoothie his mom made for him Oklahoma Cooperative Extension Service

3. Jillian Kohl • Graduate student in Milwaukee • Ran marathons • Ate fresh spinach • Suffered stomach cramps, muscle aches, fever, bloody diarrhea • 2-1/2 weeks in hospital • Discharged with less than 10% normal kidney function Oklahoma Cooperative Extension Service

4. It’s happened before • 2003 • 16 cases, 2 deaths from spinach contaminated with E. coli O157:H7 • Since 1995 • 19 outbreaks of E. coli O157:H7 associated with leafy greens • Most traced back to California Oklahoma Cooperative Extension Service

5. How bad is the foodborne illness problem? • 76 million illnesses/year • 5,000 deaths/year • High risk groups: elderly, young children, pregnant women & fetuses, immuno-compromised • Rate of foodborne illness is not rising • 29% decrease in infections related to meat/poultry Oklahoma Cooperative Extension Service

6. Definitions • Outbreak: • 2 or more people consumed same contaminated food & come down with same illness • Has an identified etiology & food vehicle • Must have occurred in U.S. or its territories • Can affect 100’s or 1,000’s • Case: 1 person with foodborne illness • May or may not be part of outbreak Oklahoma Cooperative Extension Service

7. 10 federal agencies involved in food safety • 2 inspect & regulate food • USDA—meat & poultry • FDA—all other foods • 2/3 outbreaks under FDA jurisdiction • Neither has power to recall food • Is voluntary Oklahoma Cooperative Extension Service

8. Foods that cause foodborne illness (source: CSPI 2005) Oklahoma Cooperative Extension Service

9. Is produce riskier now? • Yes • Outbreaks bigger & more frequent than 15-30 years ago • Partly because people eat more fresh fruits & vegetables Oklahoma Cooperative Extension Service

10. Why the risk with ready-to-eat fresh produce? • Generally grown in natural environment (field or orchard) • Often eaten without cooking or other treatments that could eliminate pathogens Oklahoma Cooperative Extension Service

11. Oklahoma Cooperative Extension Service

12. Routes of contamination • Water • Contaminated irrigation water • Run-off • Cleaning water Oklahoma Cooperative Extension Service

13. Routes of contamination • Direct application of inadequately processed manure to soil—by animals or as fertilizer • Nearby pasture, down hill from feedlot, wild animals roaming fields Oklahoma Cooperative Extension Service

14. Routes of contamination • Cross-contamination • Unwashed hands/surfaces • From raw foods in kitchen Oklahoma Cooperative Extension Service

15. Contamination compounded by: • Held too long in storage • Temperatures too high • Rough surface on produce hard to clean—even surfaces that appear smooth Oklahoma Cooperative Extension Service

16. Contamination compounded by: • Bacteria enter produce & cannot be washed away Oklahoma Cooperative Extension Service

17. Contamination compounded by: • Distribution process leaves difficult trace-back of process • Large boxes broken down & repackaged without point-of-origin info. • Parts of many plants in 1 bag Oklahoma Cooperative Extension Service

18. Symptoms of E. coli O157:H7 illness • Symptoms appear within 3-4 days • May take up to 10 days • Diarrhea, often with bloody stools, severe abdominal cramps • Some have no symptoms • Most healthy adults recover in a week • 3-8% of people develop hemolytic uremic syndrome (HUS) Oklahoma Cooperative Extension Service

19. HUS • Form of kidney failure • Most often in young children & elderly • Red blood cells destroyed • E. coli toxin damages blood vessels by creating small strands across the insides so as red blood cells go through they are sliced • 3-5% of those with HUS die Oklahoma Cooperative Extension Service

20. E. coli O157:H7 Outbreak Case Counts by State(As of 10/06/06: CDC) Oklahoma Cooperative Extension Service

21. Arizona 8 California 2 Colorado 1 Connecticut 3 Idaho 7 Illinois 2 Indiana 10 Kentucky 8 Maryland 3 Maine 3 Michigan 4 Minnesota 2 Nebraska 11 New Mexico 5 Nevada 2 New York 11 Ohio 25 Oregon 6 Pennsylvania 10 Tennessee 1 Utah 19 Virginia 2 Washington 3 West Virginia 1 Wisconsin 49 Wyoming 1 Number of persons with outbreak strain/state (CDC): Oklahoma Cooperative Extension Service

22. Investigation of outbreak • Widely dispersed illnesses indicated contamination early in distribution chain Oklahoma Cooperative Extension Service

23. State agencies workedclosely with FDA • Especially California Dept. of Health Services & Dept. of Food & Ag. • Western Institute for Food Safety & Security Oklahoma Cooperative Extension Service

24. Investigation found • Same strain of E. coli O157:H7 DNA as in the illness outbreak in samples taken from stream & feces of cattle & wild pigs present on ranches implicated in outbreak • Found evidence of wild pigs in spinach fields • Continue looking for more information on source & mechanism of contamination Oklahoma Cooperative Extension Service

25. Produce most apt to haveE. coli O157:H7 • Recurrent outbreaks from leafy greens, sprouts, unpasteurized juices & cider • Common factors: grown fairly close to ground or harvested from ground, not cooked, not acidic • Popular apple/tomato varieties are becoming less acidic & sweeter Oklahoma Cooperative Extension Service

26. Spinach not alone • Nov. 2006: FDA notifies consumers tomatoes in restaurants were linked to Salmonella Typhimurium outbreak Oklahoma Cooperative Extension Service

27. Salmonella Typhimurium outbreak • Reported in 21 states, 183 cases of illnesses to the CDC • Outbreak over by time of announcement Oklahoma Cooperative Extension Service

28. FDA actions to reduce risk • 1998—Guide to Minimize Microbial Food Safety Hazards for Fresh Fruits and Vegetables Oklahoma Cooperative Extension Service

29. FDA actions to reduce risk • 2004—FDA Produce Safety Action Plan objectives: • Prevent contamination of fresh • Minimize public health impact of contamination when it happens • Improve communication • Facilitate research relevant to contamination of fresh produce Oklahoma Cooperative Extension Service

30. 2006—Lettuce Safety Initiative • Assess current industry approaches & actions to address issue of improving lettuce safety • Stimulate segments of industry to further advance efforts in addressing all aspects of improving lettuce safety • Alert consumers early & respond rapidly in event of outbreak Oklahoma Cooperative Extension Service

31. 2006—Lettuce Safety Initiative • Document observations that identify practices that potentially lead to product contamination, develop &/or refine guidance & policy that will minimize opportunities for future outbreaks &/or identify research needs • Consider regulatory action based on conditions & practices that could lead to, or spread, contamination or when lettuce has been adulterated Oklahoma Cooperative Extension Service

32. Potential safeguards • Cooking to 160oF for 15 seconds • Irradiation? • FDA has been petitioned to allow • Suitability & efficacy to be determined Oklahoma Cooperative Extension Service

33. So what do consumers do? • Option: Quit eating raw produce Oklahoma Cooperative Extension Service

34. FDA advice: buying fresh produce • Purchase produce not bruised or damaged • Check package date • Eat greens by "Best if Used by Date" Oklahoma Cooperative Extension Service

35. Caution on greens • Do not buy prewashed salads with considerable amount of brown-edged pieces or if greens appear excessively wet Oklahoma Cooperative Extension Service

36. Consumer resource • Available at: • http://www.cfsan.fda.gov/~dms/prodsafe.html Oklahoma Cooperative Extension Service

37. Buying fresh produce • For fresh cut produce (such as 1/2 watermelon, bagged mixed salad greens) choose only those refrigerated or surrounded by ice Oklahoma Cooperative Extension Service

38. Buying fresh produce • Bag fresh fruits & vegetables separately from meat, poultry & seafood products when packing them to take home from market Oklahoma Cooperative Extension Service

39. Storage tips for fresh produce • Certain perishable fresh fruits & vegetables (like strawberries, lettuce, herbs, mushrooms) can be best maintained by storing in a clean refrigerator at 40°F or below Oklahoma Cooperative Extension Service

40. Refrigeration needed? • To maintain quality, safety • Ask grocer Oklahoma Cooperative Extension Service

41. Storage tips for fresh produce • All produce purchased pre-cut or peeled should be refrigerated within 2 hours to maintain quality & safety • Keep refrigerator at or below 40°F • Use refrigerator thermometer Oklahoma Cooperative Extension Service

42. Preparation of fresh produce • Pre-washed greens in sealed bags • Will be stated on packaging • Can use without further washing • Can wash again just before use as extra caution • Wash precut or prewashed produce in open bags Oklahoma Cooperative Extension Service

43. Preparation of fresh produce • Cut away damaged &/or bruised areas before preparing &/or eating • Discard produce that looks rotten Oklahoma Cooperative Extension Service

44. Preparation tips • All unpackaged fruits & vegetables & those packaged & not marked pre-washed, should be thoroughly washed before eating • Includes conventionally or organically grown, home grown & produce bought from grocery stores & farmer's markets Oklahoma Cooperative Extension Service

45. French lesson • French: salade • English: lettuce • Example Phrase Using Word: • French: Ah, Robert, est-ce que tu peux laver la salade? • English: Robert, can you wash the lettuce? Oklahoma Cooperative Extension Service

46. About washing produce • First wash hands • 20 seconds with warm water & soap • Before & after preparing fresh produce • Wash fruits & vegetables under running water just before eating, cutting or cooking • Even when planning to peel produce before eating, important to wash it first Oklahoma Cooperative Extension Service

47. About washing produce • Soap, detergent, commercial produce washes not recommended • Scrub firm produce with clean produce brush • Drying produce with clean cloth or paper towel may reduce bacteria that may be present Oklahoma Cooperative Extension Service

48. Does washing help? • Bacteria are sticky, can’t wash off greens even if bleach, detergent, commercial produce washes are used • Can’t wash off bacteria if inside produce • Enters apples through hole at bottom where flower used to be • Sliced into melons Oklahoma Cooperative Extension Service

49. Separate for Safety • Keep produce to be eaten raw separate from other foods, such as raw meat, poultry or seafood & kitchen utensils used for those products Oklahoma Cooperative Extension Service

50. Reducing cross-contamination risk • Wash cutting boards, dishes, utensils & counter tops with hot water & soap between preparation of raw meat, poultry, seafood & produce & preparation of produce that will not be cooked or only briefly cooked • Wash plastic & other non-porous cutting boards in dishwasher after use Oklahoma Cooperative Extension Service