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July 5, 2017

Food Poisoning – The Wedding Crasher

Bride and groom

We’ve all been there, we know the pain. In terms of excruciating life events there is little to compare with the utter torment of being coerced into attending a wedding for folks you don’t know. Maybe it’s your spouse’s coworker or – heaven forbid – their boss. Or how about the relatives you have purposely avoided for years – that third cousin, once removed, on your crazy aunt’s side perhaps. And yes, the aunt will be at the celebration too. And if dealing with all of them isn’t enough to turn even the most social of butterflies into a curmudgeonly wallflower with social anxiety that even a hopper of Xanax won’t cure, there’s also the prospect of the annoying small talk, the interminable speeches, and the horror of the public dancing to contend with. And let’s not get into the food…

Actually scratch that, let’s get into the food. How is it that wedding planners seem to think that a green salad tossed in lemon juice – even if it is freshly squeezed from an actual, organic, biodynamic, compassionately-raised lemon – is an adequate meal option for those who eschew the de rigeur chicken or salmon options? Note to wedding planners: it is most decidedly not. But at least it is clean, healthy food, right? Something to counter-balance all of those free appletini cocktails you’re going to imbibe at the open bar. (Yes, you will regret those later.) And you may even regret the salad.

Of the 150 attendees, no fewer than 50 guests and the groom himself were struck down with severe gastroenteritis…

In March of last year, guests at a wedding reception in Brisbane, Australia had cause to complain about more than the lack of culinary choice on the menu. Of the 150 attendees, no fewer than 50 guests and the groom himself were struck down with severe gastroenteritis – a condition that causes bloody diarrhea, nausea, vomiting, and low grade fever, and which stems from poor food handling.(1) Likewise, closer to home in Syracuse, NY, a wedding party turned grim when 35 people were sickened by the bacterium Staphylococcus aureus, nine of whom needed emergency room attention.(2) Staph infections are spread by the inhalation of infected droplets (sneezes or coughs) or by the use of a contaminated object. The bacteria can cause skin blisters and abscesses and can impact vital organs, requiring the use of antibiotics to fight the illness.

And it is not uncommon. According to Food Poisoning News, an online repository of articles and legal resources, one in six Americans will become sick each year from the food they eat. Of these victims 128,000 will be hospitalized and 3000 will die. Among the survivors, many ‘will suffer lingering symptoms such as gastrointestinal irregularity, arthritis, other immune problems for months or even years.’(3) And if these figures seem high, it’s because there are more food pathogens than the common miscreants that spring most readily to mind. In addition to our old enemies E. coli and salmonella, there are also campylobacter, listeria, botulism, hepatitis A, norovirus, and shigella to take into account. And don’t underestimate the destructive forces of these pathogens. Shigella, for instance, can induce seizures, where salmonella offers over 2000 different strains, subjecting victims to vomiting, diarrhea, crippling head pain, and the potential to induce meningitis, endocarditis, and osteomyelitis. Listeriosis induces many of the same symptoms with the added extras of loss of balance, confusion, and convulsions, with diagnosis of the condition sometimes requiring a cerebral spinal fluid tap culture – adding to the misery and pain of the experience. Caused by three varieties of the Clostridium bacterium, botulism is another under-rated illness. The food-borne version of the sickness is not transmitted from person to person but via direct consumption of tainted food, and can only be detected (and therefore avoided) by inspecting the ingredients used in preparing a dish. Bulging packaging or leaking jar seals indicate problems, but unless you are cooking at home you may never know. Spreading from head to foot in the victim, botulism causes slurred speech, blurred vision, difficulty swallowing, weakness in limbs, and can also lead to paralysis of the muscles involved in breathing. Diagnosis may involve brain scans, cerebral spinal fluid tap culture, and nerve testing. Antitoxins and the use of a ventilator are part of the treatment of botulism cases – quite the price to pay for having unwittingly ingested a spoiled snack.

The Cheesecake Factory…

Depressingly, we could go on and on with the list of food-borne illnesses but to avoid being party poopers we’ll keep it short. And before you channel your inner curmudgeonly Ove by turning down that wedding invitation and proclaiming yourself fully-protected against food-borne pathogens, let’s remember that it isn’t only at private functions that contamination can occur. Just last week, two fatalities occurred in Utah when the victims, both children, contracted E. coli from an as yet unknown source. Since tests on the local water supply have returned negative results, the most likely source of the outbreak is thought to be contaminated food.(4) Equally, processed products often make the headlines in our industry due to issues of contamination during the production process. In the case of a pan-European scandal last month a rare strain of salmonella, 11:z41:enz15, was responsible for claiming 49 victims in five European countries.(5) The pathogen was linked to sesame seeds from Nigeria and Sudan that were processed in a tahini product in Greece, and experts are predicting that new cases will continue to come to light. Greece has a backlog of 200 samples that require testing and no fewer than 12 other EU countries have been exposed to the contaminated product. And then there’s the question of restaurant safety. Let’s look at a disturbing case of food fighting back at the popular eatery, The Cheesecake Factory…

Fish particularly prone to this are tuna, mackerel, and mahi-mahi that are stored above 4ºC, allowing spoilage to occur and bacteria to produce massive amounts of histamine.

Grilled Mahi-Mahi

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In 2013, a customer of the chain ‘began to sweat profusely and then passed out’ moments after finishing a meal of mahi-mahi, also known as dolphin fish.(6) After treatment in the ER, the victim – a 49 year old male – was diagnosed with scombroid poisoning, or ‘histamine fish poisoning.’ Despite having ‘histamine’ in the name, this type of poisoning is not an allergic reaction but is the result of consuming the flesh of fish with high levels of histamine.(7) A neurotransmitter produced during the local immune response, histamine accumulates in improperly refrigerated or handled sea creatures when bacteria such as E. coli metabolize histadine, an amino acid. Fish particularly prone to this are tuna, mackerel, and mahi-mahi that are stored above 4ºC, allowing spoilage to occur and bacteria to produce massive amounts of histamine. When concentrations reach 20mg per 100g extreme reactions present rapidly, often within minutes of consuming the tainted food. Histamine is a vasodilator that lowers blood pressure and increases capillary permeability meaning that lymph fluid and plasma proteins can leak out. And perhaps most worryingly, histamine also affects pulmonary contractility and cardiac conduction – the beating of our hearts.

In the case of The Cheesecake Factory poisoning, the victim recovered and accepted a financial compensation package in lieu of legal proceedings against the company. And litigation, unsurprisingly, is very common. Until recently, we at Berkshire were unaware that food poisoning law is a niche specialization within the legal profession with lawyers such as Houston, TX, firm Ron Simon & Associates, seeking to combat food poisoning: “by (1) holding accountable food manufacturers who fail to employ good food manufacturing and processing procedures; (2) holding accountable food importers who fail to adequately control and test food before they distribute it to the American consumer; (3) holding accountable restaurants that do not abide by good food preparation, including having high standards for personal hygiene, holding foods at appropriate temperatures, and keeping bugs and rodents far away from food supplies; (4) helping health agencies track down […] sources of food borne illnesses; and (5) helping victims of food poisoning recover from their losses while penalizing those who made them sick.”(8) And it seems they will always have clients. Why? Perhaps it is the nature of the food business.

HACCP is markedly similar to cleanroom protocols…

As with working in a contamination-controlled or cleanroom environment, good food hygiene practices should involve the proactive dissemination of a solid Hazard Analysis and Critical Control Points plan (HACCP).(9) Covering personal hygiene, food preparation and handling, a food safety checklist, receiving and storage protocols, procedures for sanitizing equipment and facilities, and pest control measures, the food industry HACCP is markedly similar to cleanroom protocols in terms of laying out cleaning methods, the operation of facilities, calibration of equipment, and the conduct of personnel. In a previous article on how the Internet of Things is working hand-in-glove to promote hygiene compliance in the healthcare industry, we outlined the ways in which the battle for contamination control is playing out in our hospitals and medical care facilities. In addition to sanitizing robots wielding germ-zapping ultra-violet light, the use of real-time location systems (RTLS) is enabling the tracking of hand washing by medical staff by logging their presence and correlating it to use of a sanitizer dispenser. Using these IoT technologies, performance can be tracked, analyzed and, in the advent of non-compliance with procedure, the employee may be flagged for additional training.

And, at the heart of the matter, compliance is key. In the absence of motivation by a restaurant’s staff or a cleanroom’s technicians to maintain an exemplary standard of contamination control, no HACCP or set of Standard Operating Procedures (SOPs) is going to prevent illness or injury. Employers carry the lion’s share of the burden of maintaining public safety insofar as they must be required to develop top-of-the-line protocols, train staff to the highest level, and take every measure to ensure that public safety is their #1 priority. But individual employees must also play their part. The weakest link in any chain is the human operative who is forced to come to work sick because s/he has bills to pay. It is simple human nature to prioritize our own tangible needs and self-interest – getting that paycheck, for instance – over altruistic, abstract concerns. The server who fails to wash her hands, the busboy with open wounds, the short order cook refreezing thawed food, all of these individuals jeopardize our safety without malice aforethought. They are simply motivated to do their job and collect their remuneration. But if they are sick, overworked, or incorrectly trained, their paycheck comes at a huge expense. To those they sicken and to the very foundations of our trust in the commercial food preparation industry.

Have you ever suffered from food poisoning at a catered affair like a wedding? Do you avoid eating in commercial restaurants because you cannot determine their standard of cleanliness? We’d love to know your thoughts!

References:

  1. http://www.dailymail.co.uk/news/article-3493403/Groom-50-wedding-guests-struck-suspected-food-poisoning-Hilton-Brisbane.html
  2. http://www.syracuse.com/health/index.ssf/2015/10/state_blames_illness_outbreak_at_brewerton_wedding_reception_on_food_poisoning.html
  3. http://www.foodpoisoningnews.com/48-million-illnesses-year-food-poisoning-food-poisoning-lawyer-works-reduce-number-illnesses-u-s/
  4. http://www.foodsafetynews.com/2017/07/hunt-for-source-of-two-deadly-e-coli-infections-underway-in-utah/#.WVqAbZKkxRI
  5. http://www.foodpoisoningnews.com/rare-salmonella-outbreak-hits-5-european-countries-salmonella-11z41enz15/
  6. https://patch.com/wisconsin/whitefishbay/cheesecake-factory-settles-food-poisoning-lawsuit-for-14k
  7. http://www.calpoison.org/hcp/2014/callusvol12no4.htm
  8. http://www.foodpoisoningnews.com/48-million-illnesses-year-food-poisoning-food-poisoning-lawyer-works-reduce-number-illnesses-u-s/
  9. For an example HACCP, see http://nutrition.dadeschools.net/procedures/HACCP/HACCP-4.pdf

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