Primary prevention
Access to clean water is a priority. There are increasing numbers of different techniques to attempt to improve access, particularly in remote rural communities in financially poorer populations.[30][31]
General educational information on food safety is available from a number of sources. CDC: food safety Opens in new window Fight Bac! Partnership for Food Safety Education Opens in new window US Government Food Safety Information Opens in new window Food Standards Agency Opens in new window
Proper hygiene, food preparation handling and storage, and appropriate consumption behaviour are effective preventive measures. This is particularly important for food workers. Alcohol-based hand cleansers are a useful adjunct.[32][33]
Attention should be paid to expiration dates of food products.
Recommended safe food-handling and consumption behaviours, according to food type, include:[34]
Seafood
Avoid eating raw or undercooked seafood
Cook seafood to 63°C (145°F) and reheat leftovers to 74°C (165°F); or cook shellfish until the shell opens and the flesh is fully cooked, and cook fish until the flesh is opaque and flakes easily with a fork[35]
Obtain shellfish from approved sources
Food poisoning from marine toxins can occur even if fish is adequately cooked as the toxins are heat-stable; avoiding or limiting consumption of certain fish and shellfish may be advised in high-risk areas or for patients at higher risk of complications.[36]
Meat, poultry, and dairy foods
Wash knives, cutting boards, and food preparation surfaces with hot water and soap after contact with raw poultry, meat, and seafood
Do not wash raw meat or poultry before cooking (this does not prevent illness and can spread bacteria to other surfaces)
Cook meat and poultry thoroughly to a safe internal temperature and use a cooking thermometer to check
Refrigerate leftover meat and poultry at 4.4°C (40°F) or colder within 2 hours
Avoid raw, unpasteurised milk and dairy products made from it, including soft cheeses (e.g., brie, camembert, queso fresco)
Eggs and raw flour
Avoid eating foods containing raw or undercooked eggs
Avoid eating raw flour (e.g., in raw batter or dough)
Store eggs in the refrigerator at 4.4°C (40°F) or colder
Cook eggs until both the yolk and white are firm; use a thermometer to make sure that foods containing eggs are cooked to 71°C (160°F).
Vegetables and fruits
Avoid eating raw or lightly cooked sprouts
Drink only pasteurised fruit juices; avoid juices with warning labels
Thoroughly rinse fresh fruits and vegetables under running water before eating.
People at higher risk
This advice is applicable for the general public, but immunocompromised people (e.g., people with HIV, those receiving cancer chemotherapy treatment, and people receiving long-term oral corticosteroids or immunosuppressive agents) are more susceptible to infection with a variety of enteric pathogens, and are often more likely to develop illness of greater severity and more frequently accompanied by complications. It is especially important that such people reduce their risk by learning and following safe food-handling and preparation practices.
Most viral pathogens are transmitted by the faecal-oral route. Frequent, thorough hand washing is the most effective prevention. Other effective barrier methods include gloves and gowns. In a nursing home or long-term facility setting, isolating affected people can decrease transmission and antibacterial alcohol-based hand sanitisers have better results in these settings.
People in some regions may require additional education about food safety. However, changes in practice, particularly in resource-poor settings, should be backed with good education, otherwise the risk of illness may increase.[37]
Specific patient populations at increased risk of food poisoning
People with alcohol-use disorder and people with chronic liver disease (haemochromatosis or cirrhosis) are at increased risk of infections due to Vibrio vulnificus from raw shellfish.[22]
People with impaired immune defences are at increased risk for infection with Listeria monocytogenes from soft cheeses; deli cheeses and salads; unheated deli meats, cold cuts, hot dogs, and fermented or dry sausages; pate or meat spreads; cold-smoked fish; sprouts and pre-cut melons; and raw (unpasteurised) milk and dairy products.[38]
Pregnant women should avoid undercooked meats because of the risk of infection with Toxoplasma gondii and should avoid foods that carry an increased risk of Listeria monocytogenes infection (see list above); both organisms are associated with miscarriage.[38][39]
Among older people, illness caused by infection with Salmonella or Escherichia coli can be particularly devastating but is potentially preventable by following safe food practices.
Vaccination
Vaccines may have some preventive value in certain situations, including:[1][17][40][41]
For travellers to endemic areas. See Hepatitis A (Prevention), Typhoid infection (Prevention), and Cholera (Prevention).
For people at increased risk of exposure or serious complications from specific conditions (e.g., hepatitis A).
During outbreaks and high-risk humanitarian crises for some infections (e.g., cholera).[42]
The rotavirus vaccine is part of routine immunisation in the US, UK, and most other countries.
Secondary prevention
Symptomatic food-handlers or healthcare workers should be excluded from directly handling food and from caring for high-risk patients.
Diarrhoeal illnesses in daycare employees should be managed carefully because of the high likelihood of person-to-person spread of common pathogens, such as Shiga toxin-producing Escherichia coli (e.g., O157:H7) and Shigella sonnei. Effective hand washing in the units, ready availability of sinks, and provisions for hand washing are recommended.[70]
Some regions require negative stool cultures prior to return to work or group social activities following certain infections (e.g., Shiga toxin-producing Escherichia coli, Salmonella, or Shigella).[40] Specific requirements vary; local public health policies should be sought and followed.
In traveller's diarrhoea, care of food and drink is the mainstay of prevention with empirical therapy effective if diarrhoea occurs. Chemoprophylaxis is not recommended for most travellers, but may be beneficial in selected circumstances. See Traveller’s diarrhoea (Prevention).
If a foodborne disease outbreak is suspected, local health officials should be contacted. Guidelines on the investigation of a suspected foodborne disease outbreak are available from the World Health Organization.[2]
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