Health Law

Clostridium perfringens outbreaks frequently occur in institutional settings

By Drew Falkenstein

Clostridium perfringens outbreaks, like the one that caused 40 illnesses and 3 deaths in Louisiana earlier this month, are all too common in institutional settings where the preparation of large volumes of food means increased likelihood of foodhandling errors.  Unfortunately, residents in institutional settings like hospitals, long-term care facilities, and assisted living centers can often ill afford a severe foodpoisoning illness.  For this reason, it has long been recognized that foodhandlers in institutional settings need to exercise great caution and care in food preparation, storage, and service.

Several examples:

Of course, there is the sad outbreak that occurred at Central Louisiana State Hospital earlier this month.  Test results recently confirmed that clostridium perfringens was, in fact, the bacterial agent that caused the outbreak.  Dr. David Holcombe, medical director for Region 6 of the Louisiana Department of Health and Hospitals' Office of Public Health, stated that the contaminated food item appears to have been chicken salad served to both patients and staff.  Those who had the chicken salad at that time were 23 times more likely to show symptoms, which is a good indicator that the dish was the culprit.  Although environmental findings from the outbreak have not yet been released, it is probable that foodhandling errors--likely improper cooling--played a role in causing the outbreak. 

Another large C. perfringens outbreak occurred In November 1995 at a juvenile detention facility in California.  In a report on the outbreak, investigators concluded as follows:

Factors that may have contributed to the growth of C perfringens in the turkey and gravy included the inadequate cooking of large pieces of meat, slow cooling, and insufficient reheating. This outbreak may have been prevented if the following precautions had been taken:

* Using a thermometer to check that the turkey had been cooked and reheated (600-C) and cooled (4°C) to the optimal temperatures;

* Slicing the turkey into smaller portions, as opposed to piling large pieces in one stock pot, to facilitate rapid and evenly distributed cooling; and

* Cooling the gravy in smaller, shallower pots.

This outbreak illustrates the need for diligent precautions during food preparation, especially when handling foods of animal origin. The report is a reminder of the importance of ongoing food safety programs in institutional settings because of the potential for large outbreaks. It is recommended that food handler training include the prevention of food-borne illness and that such training be given regularly.

See (Parikh Al, Jay MT, Kassam D, Kociemba T, Dworkis B, Bradley PD, et al. Clostridium perfringens outbreak at a juvenile detention facility linked to a Thanksgiving holiday meal. West J Med 1997 June; 166:417-419)

Another large Clostridium perfringens outbreak occurred in Cedar Falls, Iowa linked to a Thanksgiving meal prepared by a Hy Vee store for Cedar Falls Church.  The meal was then delivered to senior citizens outside the church in a meals on wheels program.  Ultimately, the investigation into the large outbreak, which killed one person, concluded:

'The most plausible hypothesis for the Business A outbreak is that the turkey was cooked and stored at inappropriate temperature, which allowed for rapid development of Clostridium perfringens.'  

Full post as published by Food Poison Blog on May 29, 2010 (boomark / email).