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A Mixed Foodborne Outbreak With Salmonella heidelberg and Campylobacter jejuni in a Nursing Home

Published online by Cambridge University Press:  02 January 2015

Marcelle C. Layton ,
Susan G. Calliste ,
Thomas M. Gomez ,
Charlotte Patton  and
Steven Brooks
Marcelle C. Layton*
Affiliation:
Bureau of Communicable Disease, New York City Department of Health, New York City, New York, and the Epidemic Intelligence Service, Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Susan G. Calliste
Affiliation:
Health Research Training Program, New York City Department of Health, New York City, New York
Thomas M. Gomez
Affiliation:
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia US Department of Agriculture, Animal and Plant Health Inspection Service, Riverdale, Maryland
Charlotte Patton
Affiliation:
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Steven Brooks
Affiliation:
Microbiology Laboratory, Kingsbrook Jewish Medical Center, Brooklyn, New York
*
Bureau of Communicable Disease, New York City Department of Health, 125 Worth St, Room 300, Box 22A, New York City, NY 10013
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Abstract

Objective:

To investigate a mixed Salmonella heidelberg and Campylobacter jejuni foodborne outbreak in a nursing home.

Design:

Retrospective cohort study with a nested case-control design. Cases were defined by positive stool-culture results. Controls needed to be both asymptomatic and culture-negative.

Setting and Patients:

Residents of a 580-bed nursing home in Brooklyn, New York.

Results:

Of the 580 residents, 119 (21%) developed illness. Of the 93 symptomatic patients who submitted specimens, cultures were positive for S heidelberg in 24 (26%), C jejuni in 14 (15%), and both microorganisms in 25 (27%).

Only the pureed diet was associated highly with infection by either Salmonella (odds ratio [OR], 17.6; 95% confidence interval [CI95], 4.8-68.7; P<.001), Campylobacter (OR, 13.3; CI95, 3.2-59.2; P<.001), or both organisms (OR, 8.9; CI95, 2.7-30.3; P<.001). Among the 52 pureed foods served during the 5 days before the outbreak, five meat or poultry items were associated most strongly with culture positivity.

Of these five meat items, only a chopped-liver salad was implicated by the two employees reporting illness. A reported food-handling error occurred when ground, cooked chicken livers were placed in a bowl containing raw chicken-liver juices.

Intervention:

Recommendations for proper cleaning and sanitizing of kitchen equipment to prevent cross-contamination between raw and cooked foods.

Conclusions:

Mixed foodborne outbreaks occur rarely. During this outbreak, contamination of a single food item with multiple bacterial pathogens was the likely source of transmission. Improper food-handling techniques that promote growth of one microorganism also allow growth of other pathogens that may be present. Because different sources and routes of transmission may be implicated for different pathogens, specific preventive measures may vary depending on the organisms involved.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 2 , February 1997 , pp. 115 - 121
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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