Primary prevention

Primary prevention of Escherichia coli infection involves removing risk factors via proper preparation of food products at all stages from manufacturing, processing, packing, storage, transport, distribution, receiving, importation, and eventual consumption. Breaking the faecal-oral transmission route requires strict sanitation standards, particularly hand-washing.

Epidemiological data suggest that disrupting oral-faecal transmission through appropriate post-toilet hygiene (e.g., in residential care homes), and prevention of urinary tract infections by hydration and catheter care, may contribute to reducing the risk of extended-spectrum β-lactamase-producing E coli infection.[27]

National and international foodborne illness surveillance programmes have been designed to highlight, and attempt to control the risks of foodborne disease, with food safety being a World Health Organization priority[29][30]

Travellers can reduce the risk of transmission by avoiding raw fruits and vegetables, peeling foods, and avoiding exposure to contaminated water, such as ice or unbottled water.[31] Although generally not recommended, bismuth subsalicylate or rifaximin has been used to mitigate traveller's diarrhoea in high-risk patients.[32]

Secondary prevention

Adherence to sanitary standards is imperative for prevention at all stages of food preparation (including manufacturing, processing, packing, storing, transport, and importation).

The US Food and Drug Administration (FDA) has produced regulations to reduce the risk of foodborne illness.[65] These include requirements that:

  • Domestic and foreign facilities that manufacture, process, pack, or hold food to be consumed by humans or animals in the US are registered with the FDA

  • All facilities that manufacture, process, pack, hold, transport, distribute, receive, or import food must keep up to date records to assist the FDA in identifying the source and recipients of contaminated food.

Reduction of spread

The World Health Organization has produced guidelines to prevent spread of infection.[43] These include simple measures for people with diarrhoeal illnesses:

  • Avoid preparing food for other people

  • Thoroughly wash hands

  • Use a separate or disposable towel

  • Use separate toilet facilities, and/or thoroughly clean seats, taps, and door handles after use

  • Isolate hospitalised patients and use barrier contact isolation strategies

  • Strict decontamination or disposal of clothing and/or bedding.

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