The following feedback for the chapter case study is meant to provide guidance for your own practice. The answers provided are suggestions, and you may have additional ideas which are not covered below. Then, the resolution of the case as it occurred in real life is provided for your reference.
What information should Zoe record for the Public Health Investigator?
- What food and drink was consumed, and how much food was consumed?
- Who prepared the foods?
- When were those foods eaten?
- When did your symptoms begin?
- What are the symptoms?
- How long did the symptoms continue?
- When did the symptoms resolve?
What illness do you think Zoe has?
The possible illnesses include:
- Salmonella. The incubation period ranges from several hours to two days. Most salmonella infections can be classified as stomach flu (gastroenteritis). Possible signs and symptoms include: nausea, vomiting, abdominal cramps, diarrhea, fever, chills, headache, or blood in the stool. Causes are raw or contaminated meat, poultry, milk, or egg yolks. Salmonella survives inadequate cooking, and can be spread by knives, cutting surfaces or an infected food handler. (Mayo Clinic, 2020)
- Escherichia coli (E. coli). Symptoms begin in 1-8 days. Possible signs and symptoms include: nausea, vomiting, abdominal cramps, diarrhea, fever, chills, headache, or blood in the stool. E. coli is spread mainly by undercooked ground beef. Other sources include unpasteurized milk and apple cider, alfalfa sprouts, and contaminated water. (Mayo Clinic, 2020)
- Clostridium perfringens. Symptoms begin in 8-16 days. Possible signs and symptoms include: nausea, vomiting, abdominal cramps, diarrhea, fever, chills, headache, or blood in the stool. Causes are meats, stews and gravies. Clostridium perfringens is commonly spread when serving dishes don’t keep food hot enough or food is chilled too slowly.
How could this incident have been prevented?
For the clients who prepared the food, they could have prevented this situation by following proper cooking and refrigeration procedures. The day care could have also prevented this incident if they had one of the following policies in place:
- no personal food can be served to clients
- clients can only bring in food items from a list of approved food items that are not likely to spread illness
- clients must purchase food from the in-house cafeteria if they want to share it, or
- clients can only bring in sealed and packaged food items purchased from a store.
The preliminary investigation determined that the infection was likely food borne. The inspector requested fecal specimens from several person still actively suffering symptoms from the infection, and learned that the cause of the infection was salmonella. The food causing the infection was the egg salad made with homemade mayonnaise. The eggs in the egg salad and mayonnaise were not cooked long enough to kill the bacteria inside of the eggs. The symptoms resolved on their own in approximately five days; however, three persons needed to be rehydrated. The policy on allowing personal food to be shared was rescinded at the day care.