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Food Safety

Unit 9 Lesson 2

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Student Learning Outcomes

Explain the global importance of food safety and its impact on public health
Identify common foodborne illnesses and their contributing factors across different regions
Discuss the role of international organizations and regulatory bodies in ensuring global food safety standards
Analyze the challenges in maintaining food safety in diverse socioeconomic and cultural contexts
Describe evidence-based strategies for promoting food safety practices in various settings
Examine the nurse's role in promoting food safety and preventing foodborne illnesses in healthcare and community setting

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Lack of Food Safety

Impacts public health worldwide
Responsible for over 200 diseases (from diarrhea to cancer)
Annually:

600 million people fall ill
420,000 die from contaminated food

Burdens healthcare systems
Hinders social and economic development

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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Food Safety and Sustainable Development Goals

Linked to multiple SDGs:

Ending hunger and promoting sustainable agriculture
Ensuring healthy lives and wellbeing
Promoting sustainable economic growth
Ensuring sustainable consumption and production

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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Importance of Global Food Safety Systems

Food supply chains are increasingly globalized
Robust food safety systems needed in all countries
Effective food safety measures:

Protect public health
Reduce economic burden of foodborne illness
Facilitate international trade

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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Globalization of food supply chains:

Explain how food products now often cross multiple borders before reaching consumers

Highlight the increased complexity and potential risks in global food supply chains

Need for robust food safety systems:

Stress the importance of strong national food safety regulations and enforcement

Effective food safety measures and their benefits:

Public health protection

Economic benefits of reducing foodborne illnesses

Facilitation of international trade through harmonized standards

Global Food Safety System: A global food safety system refers to the interconnected network of international standards, national regulations, and private sector initiatives that work together to ensure the safety of food products as they move through global supply chains. Key components include:

a) International Standards:

Codex Alimentarius: Established by FAO and WHO to develop harmonized international food standards

ISO 22000: International standard for food safety management systems

b) Regulatory Cooperation:

Agreements between countries to recognize each other's food safety systems

Information sharing between national food safety authorities

c) Traceability Systems:

Technologies and processes that allow tracking of food products from farm to fork across international borders

d) Harmonized Risk Assessment:

Standardized approaches to identifying and assessing food safety risks globally

e) Capacity Building:

Programs to help developing countries improve their food safety systems to meet international standards

f) Rapid Alert Systems:

Global networks for quick communication of food safety issues, such as the International Food Safety Authorities Network (INFOSAN)

g) Private Sector Initiatives:

Global Food Safety Initiative (GFSI): A business-driven initiative for the continuous improvement of food safety management systems

h) Laboratory Networks:

International networks of food testing laboratories to ensure consistent and reliable food safety testing

i) Border Control Cooperation:

Coordinated efforts between countries to manage food safety risks at border entry points

Challenges in implementing a global food safety system:

Varying levels of technological and regulatory capacity among countries

Cultural and linguistic differences in food safety practices

Balancing trade facilitation with stringent safety measures

Benefits of a global approach:

More efficient use of resources through reduced duplication of efforts

Faster identification and response to food safety threats

Improved consumer confidence in the global food supply

Future trends:

Increasing use of blockchain and AI in food traceability and safety management

Growing emphasis on sustainability alongside safety in global food systems

Role of international organizations:

Highlight the work of WHO, FAO, and WTO in promoting global food safety

Importance of consumer education:

Stress the role of informed consumers in supporting effective food safety systems

Continuous improvement:

Emphasize the need for ongoing research and adaptation of food safety measures to address emerging risks in the global food supply

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Critical Thinking Question

A nurse is conducting a food safety seminar for a group of pregnant women. Which of the following foods should the nurse emphasize as potentially high-risk for listeriosis?

A) Pasteurized milk

B) Cooked chicken

C) Soft cheeses made from unpasteurized milk

D) Thoroughly washed fresh fruits

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Common Foodborne Pathogens

Norovirus

Highly contagious
Causes severe gastroenteritis

Salmonella

Causes salmonellosis
Found in raw/undercooked eggs, meat, poultry

Campylobacter

Causes campylobacteriosis
Found in raw/undercooked poultry, unpasteurized milk

(UH, 2020)

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Norovirus: Disease: Viral Gastroenteritis (often called "stomach flu")

Highly contagious virus that causes inflammation of the stomach and intestines

Symptoms: Nausea, vomiting, diarrhea, abdominal pain, sometimes fever and body aches

Transmission: Contaminated food or water, contact with infected persons or surfaces

Duration: Usually 1-3 days

Prevention: Proper hand hygiene, thorough cleaning of contaminated surfaces, avoiding food preparation when ill

Salmonella: Disease: Salmonellosis

Bacterial infection of the intestinal tract

Symptoms: Diarrhea, fever, abdominal cramps, sometimes vomiting

Transmission: Consuming contaminated food (especially raw or undercooked eggs, meat, poultry), contact with infected animals

Duration: Usually 4-7 days

Prevention: Proper cooking of food, avoiding cross-contamination, pasteurization of dairy products

Campylobacter: Disease: Campylobacteriosis

Bacterial infection of the intestinal tract

Symptoms: Diarrhea (often bloody), abdominal pain, fever, sometimes nausea and vomiting

Transmission: Consuming contaminated food (especially raw or undercooked poultry), unpasteurized milk, contaminated water

Duration: Usually about 1 week

Prevention: Proper cooking of poultry, avoiding cross-contamination, pasteurization of dairy products, safe water sources

Additional points:

Importance of these diseases:

These are among the most common causes of foodborne illness globally

They can lead to significant health and economic burdens

Vulnerable populations:

Young children, elderly, pregnant women, and immunocompromised individuals are at higher risk for severe illness

Complications:

While most cases resolve on their own, severe cases can lead to dehydration, hospitalization, and rarely, long-term health effects

Antibiotic resistance:

Growing concern, especially for Salmonella and Campylobacter

Global impact:

These pathogens are found worldwide and can affect international trade of food products

Food safety measures:

Highlight the importance of proper food handling, cooking, and storage in preventing these infections

Public health surveillance:

Explain the role of disease surveillance systems in tracking outbreaks and implementing control measures

One Health approach:

Discuss the interconnection between human, animal, and environmental health in controlling these pathogens

Consumer education:

Stress the importance of educating the public about safe food handling practices to prevent these infections

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Common Foodborne Pathogens continued…

Listeria monocytogenes

Causes listeriosis
Found in soft cheeses, unpasteurized milk, deli meats

E. coli (Escherichia coli)

Some strains cause severe diarrhea
Found in contaminated water, raw vegetables, undercooked beef

Vibrio cholerae

Causes cholera
Found in contaminated water or seafood

(UH, 2020)

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Listeria monocytogenes: Disease: Listeriosis

Bacterial infection that can be particularly dangerous for pregnant women, newborns, elderly, and immunocompromised individuals
Symptoms: Fever, muscle aches, nausea, diarrhea; in severe cases, it can cause meningitis or septicemia
Transmission: Consuming contaminated food, especially ready-to-eat foods, soft cheeses, unpasteurized dairy products, and deli meats
Duration: Varies; can be severe and long-lasting in high-risk groups
Prevention: Avoid high-risk foods during pregnancy, proper food handling and storage, thorough cooking of meats

E. coli (Escherichia coli): Disease: Varies by strain, but can include Hemorrhagic Colitis and Hemolytic Uremic Syndrome (HUS)

Several strains exist, with some (like E. coli O157:H7) causing severe illness
Symptoms: Range from mild to severe diarrhea (often bloody), abdominal cramps, vomiting; HUS can cause kidney failure
Transmission: Contaminated food or water, especially undercooked ground beef, raw vegetables, unpasteurized milk or juice
Duration: Usually 5-10 days for uncomplicated cases
Prevention: Proper cooking of beef, safe food handling practices, drinking treated water

Vibrio cholerae: Disease: Cholera

Acute diarrheal infection that can be life-threatening if untreated
Symptoms: Profuse watery diarrhea, vomiting, leg cramps; rapid dehydration can occur
Transmission: Consuming contaminated water or food, especially in areas with poor sanitation
Duration: Without treatment, can be fatal within hours; with proper treatment, most people recover within 3-6 days
Prevention: Access to clean water and proper sanitation, thorough cooking of seafood, proper hygiene practices

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Contributing Factors to Foodborne Illnesses

Lack of clean water and sanitation
Poor hygiene practices
Inadequate food safety regulations
Limited food safety education
Unsafe food handling and preparation
Improper food storage and temperature control
Environmental contamination

(UH, 2020)

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Environmental contamination: Environmental contamination refers to the presence of harmful substances in the environment that can enter the food chain and cause foodborne illnesses. Types of contamination include:

a) Microbial contamination:

Bacteria (e.g., E. coli, Salmonella) from animal waste in soil or water
Viruses (e.g., Norovirus) from human waste in water sources
Parasites (e.g., Cryptosporidium) in contaminated water

b) Chemical contamination:

Pesticides and herbicides from agricultural runoff
Heavy metals (e.g., lead, mercury) in soil or water
Industrial pollutants in air, water, or soil
Naturally occurring toxins (e.g., aflatoxins produced by molds)

c) Physical contamination:

Soil particles on produce
Dust or debris in the air that settles on food
Microplastics in water or soil that can be ingested by animals or absorbed by plants

d) Biological contamination:

Animal droppings on crops
Insects or rodents in food storage areas
Cross-contamination from wildlife in agricultural areas

e) Radionuclide contamination:

Radioactive materials in soil or water from nuclear accidents or weapons testing

f) Antibiotic-resistant bacteria:

Spread through animal waste, contaminated water, or soil

g) Emerging contaminants:

Pharmaceuticals and personal care products in water sources
Nanomaterials in the environment

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Regional Differences Contributing Factors to Foodborne Illnesses

Low- and middle-income countries

Unsafe water
Poor sanitation
Insufficient hygiene

High-income countries

Cross-contamination during food processing

(UH, 2020)

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Critical Thinking Question

A nurse is educating a client who frequently travels internationally for work. Which foodborne pathogen should the nurse emphasize as a risk when consuming unpasteurized dairy products?

A) Norovirus

B) E. coli

C) Listeria monocytogenes

D) Vibrio cholerae

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International Organizations involved in Food Safety

World Health Organization (WHO)

Provides scientific assessments on food hazards
Supports countries in preventing and responding to outbreaks
Promotes "Five Keys to Safer Food" campaign

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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The Five Keys:

1. Keep clean

Wash hands before handling food and often during food preparation
Wash hands after going to the toilet
Wash and sanitize all surfaces and equipment used for food preparation
Protect kitchen areas and food from insects, pests, and other animals

2. Separate raw and cooked foods

Separate raw meat, poultry, and seafood from other foods
Use separate equipment and utensils such as knives and cutting boards for handling raw foods
Store food in containers to avoid contact between raw and prepared foods

3. Cook thoroughly

Cook food thoroughly, especially meat, poultry, eggs, and seafood
Bring foods like soups and stews to boiling to make sure that they have reached 70°C
Reheat cooked food thoroughly

4. Keep food at safe temperatures

Do not leave cooked food at room temperature for more than 2 hours
Refrigerate promptly all cooked and perishable food (preferably below 5°C)
Keep cooked food hot (more than 60°C) prior to serving
Do not store food too long even in the refrigerator
Do not thaw frozen food at room temperature

5. Use safe water and raw materials

Use safe water or treat it to make it safe
Select fresh and wholesome foods
Choose foods processed for safety, such as pasteurized milk
Wash fruits and vegetables, especially if eaten raw
Do not use food beyond its expiry date

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International Organizations involved in Food Safety

Food and Agriculture Organization (FAO)

Improves agricultural practices and food production systems
Provides technical assistance on food safety
Operates Food Safety and Quality Unit

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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The Food Safety and Quality Unit supports the strengthening of systems of food safety and quality control at national, regional and international levels. This involves:

Strengthening national food control regulatory capacities and global trade facilitation by providing leadership in supporting countries in the assessment and progressive development of food control systems, including food safety policy and food control regulatory frameworks;
Supporting development of institutional and individual capacities for food control and food safety management, including the management of food safety emergencies;
Supporting science-based food safety governance and decisions by providing sound scientific advice (through the JECFA and JEMRA expert bodies) to underpin food safety standards at national, regional and international levels;
Enhancing food safety management along food chains to prevent diseases and trade disruptions by supporting developing countries to apply risk-based food safety management along food chains that are appropriate for national and local production systems and in compliance with Codex texts;
Providing food safety platforms, databases and mechanisms which support networking, dialogue and global access to information and facilitating effective communication internationally on key food safety issues;
Developing food safety intelligence and foresight by becoming a major actor in the collection, analysis and communication of food chain intelligence; and
Evaluating new technologies to improve food safety and protect public health. (Food safety and quality)

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International Organizations involved in Food Safety

Codex Alimentarius Commission

Develops harmonized international food standards
Creates guidelines for food hygiene, additives, contaminants

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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International Organizations involved in Food Safety

World Trade Organization (WTO)

Overseas Agreement on Sanitary and Phytosanitary Measures
Sets basic rules for food safety standards in international trade

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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Critical Thinking Question

A nurse is working with a local food producer who wants to export products. Which international organization should the nurse suggest the producer consult for food safety standards in international trade?

A) World Health Organization (WHO)

B) Food and Agriculture Organization (FAO)

C) Codex Alimentarius Commission

D) World Trade Organization (WTO)

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Challenges around Food Safety

Low-income countries

Limited infrastructure for food inspection and testing
Lack of continuous cold chain for perishables
Widespread informal food sector with limited regulation

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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A cold chain refers to the uninterrupted series of refrigerated production, storage, and distribution activities, along with associated equipment and logistics, which maintain a desired low-temperature range for perishable foods. The lack of a continuous cold chain is a significant problem in many parts of the world, particularly in developing countries. This issue:

Increases the risk of foodborne illnesses due to bacterial growth in improperly cooled foods
Leads to significant food waste and economic losses
Affects the quality and nutritional value of perishable foods
Limits the ability to distribute certain types of foods, especially in rural or remote areas
Is particularly problematic for dairy products, meats, fruits, and vegetables
Can be caused by inadequate infrastructure, unreliable electricity supply, or lack of appropriate transportation

The informal food sector refers to food vendors and small-scale producers who operate outside of formal regulatory systems. This sector is particularly prevalent in developing countries and urban areas worldwide. The limited regulation of this sector:

Makes it difficult to ensure consistent food safety standards
Increases the risk of foodborne illnesses due to improper food handling and preparation
Often lacks proper facilities for food storage, preparation, and waste disposal
May use ingredients of unknown origin or quality
Presents challenges for food safety education and training
Can be economically important for low-income populations but poses public health risks
Is difficult to monitor and control due to its decentralized and often transient nature
May contribute to the spread of zoonotic diseases due to close contact between humans and animals in some settings

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Challenges around Food Safety

Middle-income countries

Rapid changes in food systems and dietary patterns
Need to scale up food safety management
Balancing food security needs with safety standards

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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Challenges around Food Safety

High-income countries

Complex, globalized food supply chains
Emerging pathogens and antimicrobial resistance
Consumer demand for minimally processed foods

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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Challenges around Food Safety

Cultural factors

Traditional food preparation methods may not align with modern safety guidelines
Need to consider local contexts and cultural norms

(WHO, 2019; Global Nutrition Report, 2020; UH, 2020.)

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Critical Thinking Question

A nurse is volunteering in a low-income country. Which food safety challenge should the nurse anticipate as most prevalent in this setting?

A) Limited infrastructure for food inspection and testing

B) Consumer demand for minimally processed foods

C) Complex, globalized food supply chains

D) Rapid changes in food systems and dietary patterns

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Evidence-Based Strategies for Food Safety

Education and behavior change

Train food handlers in hygiene and safe handling
Public awareness campaigns

Improving infrastructure

Upgrade water and sanitation systems
Enhance cold chain facilities and transportation

(UH, 2020)

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Evidence-Based Strategies for Food Safety continued…

Strengthening food safety systems

Implement risk-based food inspection programs
Enhance disease surveillance and outbreak response

Technological innovations

Utilize blockchain for food traceability
Implement Hazard Analysis and Critical Control Points (HACCP) systems

(UH, 2020)

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Blockchain for food traceability:

Blockchain is a decentralized, digital ledger technology that records transactions across many computers in a way that is secure, transparent, and resistant to modification. In the context of food traceability:

It creates an immutable record of a food product's journey through the supply chain
Each transaction or transfer of the product is recorded as a "block" in the chain
It allows for real-time tracking of food products from farm to table
Enhances transparency and accountability in the food supply chain
Can help quickly identify the source of contamination in case of a foodborne illness outbreak
Improves consumer trust by providing verifiable information about food origins and handling

HACCP (Hazard Analysis and Critical Control Points):

HACCP is recognized internationally as a tool for controlling food safety hazards

It's used in the food industry to identify potential food safety hazards, so that key actions can be taken to reduce or eliminate the risk of the hazards occurring

Many countries require HACCP implementation for certain food industries, especially meat and poultry processing

HACCP is a systematic preventive approach to food safety that identifies physical, chemical, and biological hazards in production processes that can cause the finished product to be unsafe. It designs measurements to reduce these risks to a safe level. Key aspects of HACCP include:

It's a management system in which food safety is addressed through the analysis and control of biological, chemical, and physical hazards
It covers all stages of food production from raw material production, procurement and handling, to manufacturing, distribution and consumption of the finished product
It consists of seven principles:

Conduct a hazard analysis
Determine the critical control points (CCPs)
Establish critical limits
Establish monitoring procedures
Establish corrective actions
Establish verification procedures
Establish record-keeping and documentation procedures

Implementing HACCP systems helps food businesses:

Ensure food safety
Meet regulatory requirements
Improve product quality
Reduce the risk of foodborne illness outbreaks
Enhance consumer confidence in their products

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Evidence-Based Strategies for Food Safety continued…

Policy and regulatory measures

Establish and enforce food safety standards
Require food safety management systems in businesses

*Note: Combining strategies tailored to local contexts is most effective

(UH, 2020)

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Critical Thinking Question

A community health nurse is developing a food safety program. Which evidence-based strategy would be most effective in promoting long-term behavior change?

A) Implementing blockchain for food traceability

B) Training food handlers in proper hygiene and safe food handling

C) Upgrading water and sanitation systems

D) Establishing food safety standards

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Nurse's Role in Food Safety

(UH, 2020)

Healthcare Settings

Ensure proper food handling and storage in hospitals
Educate clients on safe food practices, especially high-risk groups
Recognize and report potential foodborne illness outbreaks

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Nurse's Role in Food Safety continued…

(UH, 2020)

Community Settings

Conduct food safety education programs
Advocate for improved food safety policies and practices
Participate in foodborne illness investigations

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What Should the Nurse Do?

A community health nurse is working in a low-income area with limited access to clean water and refrigeration. Many residents frequently experience gastrointestinal issues.

How should the nurse approach food safety education in this context?

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Answer: The nurse should consider the unique challenges of the community and tailor the food safety education accordingly. Key points to address include:

Emphasize the importance of clean water and proper sanitation.
Teach safe food handling practices that don't rely on refrigeration, such as consuming food quickly after preparation.
Educate about proper handwashing techniques and their importance in preventing foodborne illnesses.
Discuss alternative food preservation methods suitable for the local context.
Address cultural food practices while promoting safer alternatives when necessary.
The nurse should use simple, clear language and visual aids to enhance understanding.
Collaborating with local community leaders can help ensure the education is culturally appropriate and well-received.

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur
Health customs: In some cultures family members play a large role in health care decision-making
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations

(AHRQ, 2020)

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Cultural Considerations continued…

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health seeking behavior and willingness to accept treatment
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be appropriate in some cultures but inappropriate or offensive in others

(AHRQ, 2020)

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References

World Health Organization (WHO). (2019). Nutrition.

https://www.who.int/health-topics/nutrition#tab=tab_2

Global Nutrition Report. (2020). Inequalities in the Global Burden of Malnutrition. https://globalnutritionreport.org/reports/2020-global-nutrition-report/inequalities-global-burden-malnutrition/

University of Hawai‘i at Mānoa Food Science and Human Nutrition Program and Human Nutrition Program (UH). (2020). The Major Types of Foodborne Illness. Pressbooks. https://pressbooks.oer.hawaii.edu/humannutrition2/chapter/17-the-major-types-of-foodborne-illness/

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