1.1. Foodborne Illness Outbreak Data and Reporting Structure in the United States
1.2. Consumer Food Safety Concerns
1.3. Healthcare Professionals’ Roles and Knowledge
2.1. Data Collection and Study Population
2.1.2. Healthcare Professionals
2.2. Data Analysis
3.1. Consumer Results
|18–25 years old||5||14.3|
|26–34 years old||7||20.0|
|35–49 years old||6||17.1|
|50–64 years old||10||28.6|
|65–80 years old||7||20.0|
|Some high school||1||2.9|
|High school diploma||5||14.3|
|Bachelor’s or Associate’s degree||11||31.4|
|less than US$25,000||13||37.1|
|more than US$150,000||2||5.7|
|African-American or Black (Non-Hispanic origin)||2||5.7|
|Type of healthcare plan|
|Private paid by employer||16||39|
|Private, paid by myself||6||14.6|
|Do you have a food allergy?|
|Concern about safety of food purchased to prepare at home|
|Not at all concerned||4||11.4|
|Not very concerned||10||28.6|
|Concern about safety of food prepared away from home|
|Not at all concerned||1||2.9|
|Not very concerned||3||8.6|
|Type of food that poses the greatest risk for food poisoning|
|Grains and rice||1||2.9|
|Best approach to reduce the risk for food poisoning|
|Better quality control||27||77.1|
|Increased government oversight||6||17.1|
|Better consumer education||22||62.9|
|In the past 3 months have you become ill from something you ate?|
|For this illness did you seek medical treatment?|
|For this illness, what type of treatment did you seek?|
|(Some participants provided multiple responses)|
|Self-treated with over the counter medication||7||20|
|What did the medical provider do?|
|Asked for a stool sample||1||2.9|
|Recommended increased fluid intake||2||5.7|
|Have you ever gotten sick from something you ate as an adult|
|Did you seek medical treatment?|
|As an adult have you ever been asked to provide a stool sample|
|Did medical provider confirm diagnosis with stool sample?|
|Questions||Themes||Sample Illustrative Quotations|
|How did you know you had gotten ill from the food and not something else?|
|Symptoms: Severity and Duration||I think the symptoms, the, the diarrhea and the stomach pain and the, and the worst case is throwing up also.|
I was sick. I got really sick. Missed several days of work.
|Symptoms: Time after eating||We were eating at a restaurant, and within a few hours we were all violently sick.|
And about three the next morning, I just started retching and it went on and on for about three hours.
|Not like other illnesses||In the past when we’ve had the stomach flu, it’s not been like this. My daughter was puking every fifteen minutes for...a very, very long time so it just seemed very different than anything we’ve had before|
When you have the flu or something, you don’t, you feel kinda funny the whole week. But I was perfectly back to normal within twenty-four hours, or even less…
|Others got ill too||We all went out to dinner for a family dinner, and three of us had exactly the same symptoms at almost exactly the same time.|
And I was at a restaurant with friends. And there were four of us. We shared the appetizer, and then we all got sick the next day.
|Diagnosed as FBI||And I was diagnosed with cryptosporidium which can be a foodborne illness. Dramatic. Stool sample and diagnosed and confirmed.|
It was E. coli. It took them three months to get it finally out of my system.
|Only food eaten/no other diet changes||But I have a pretty routine diet. And when I ate something m-, that...I went out to eat...I had the runs for an extended period of time. It wasn’t concerned... that’s the only thing that I could appoint it to.|
I hadn’t ate all day. And then, we got tacos from a taco place in town, and I mean, I saw that the meat was pink but I figured it would be OK, and I went ahead and ate it. The first and last time I ate pink meat.
|What did you do?|
|Dealt with illness/suffered through/self-medicated||I just waited it out...at home… I was so sick…you know if you’re dry heaving and everything, you just feel like the lining of your stomach is coming out of you.|
But I was too busy throwing up and dying that I just... ...I just said, “No, that’s fine. I’ll just suffer.”
|Contacted a healthcare professional||And on the second or third day I went to the doctor, and I did take a stool sample, and it was diagnosed as salmonella.|
And I went up there (hospital). They took the stool sample, and took some blood work, and he said that I had food poisoning.
|Contacted food provider||Yeah, I reported it. I reported it to the restaurant.|
Other than going to the convenience store with that empty package and doing a little bitching... that was my only reporting. I laid in bed for two days.
|Did you report it and if so, to whom? Why wouldn’t you report a potential illness?|
|No: didn’t know who to report it to or did not think to contact someone||The first time that it happened to me, I never considered it, you know. Who would I report that to? Where would that go? I wasn’t gonna go back to that restaurant ever again… I didn’t want anything from them, so I didn’t bother with that. But it never even crossed my mind to contact someone else. |
I think it’s not knowing...I mean, I guess that my...the other reason was, I didn’t know if I should contact the restaurant themselves. I didn’t think that that would have done anything. But it also didn’t cross my mind to contact the health department. I don’t know why.
|No: too ill||And it burns and it’s just...bad. You have to like sit at, sit in the bathroom and have a garbage can in front of you.|
No, because my wife and I...the only thing we had the same that night was soup. And we both, within a half hour, were down. We were down for two days. And there was no leaving the house or anything just to go to the doctor.
|No: not sure where it (food) came from||I was like ninety-seven percent sure that I got it from that restaurant... but...if I’d been one hundred percent sure, then I would’ve called without a doubt but...I was sort of talked out of it by other people who thought maybe it could have been something else.|
Yeah, ‘cause you’re making a serious allegation if you’re saying that someone caused you to be sick. If there’s... if you don’t have proof, you could be wrong.
|No: not sure it was food poisoning||I think from like a health standpoint, most people don’t report like getting sick because the symptoms, it could be anything else like from a cold to a flu and so most people always assume the least of the issues and don’t really do anything about it…|
Or it might not necessarily be what got you sick…if you don’t a hundred percent know. ...if I’d been one hundred percent sure, then I would’ve called without a doubt but...
|No: wouldn’t do any good to report it or is not worth it to report it||I guess the only other thing that I would have to say is that, you know, when we take time to do something we’re always weighing out, is the time that we put in worth whatever outcome comes out? And so, we were traveling. We weren’t sure. So it’s like the time and energy and everything that it would’ve taken to report it at that time, we didn’t feel, was worth like whatever potential outcome we had.|
And then you’re thinking, once it’s over, well, I really don’t wanna do it now because... you know, what benefit is it to you personally? I did have the nagging thought, “Maybe I should go ahead and do it just to confirm it. Just so that there could be a confirmed report.” But, again, there wasn’t that personal—it sounds really selfish—but there wasn’t that personal incentive because it was done.
|No, not convenient||And I didn’t report it because, I was traveling back here and we were on the road and stuff.|
|Yes: reported it||I actually had a friend tell me, “Why don’t you report it?” And I go, “Oh! I, I didn’t think of that!” So first I called First Nurse because I was concerned about my daughter. She was the one who was the most sick, and, and then she said the same thing, “You need to report it.” And I don’t remember the number she gave me ‘cause I was really sick at the time, but whatever number she gave me, I called in and reported it.|
I called the FDA on ‘em. I’ve got sick there on three separate occasions… all three times it was for two days...at a time.
|What would make you seek medical treatment if you suspected you had gotten sick from eating a food?|
|Length/duration of illness||If it was over a week at this point, maybe I would think, OK, if it was over a week, then I should go to the hospital.|
…for me, that’s more than twenty-four hours. If it wasn’t subsided, then I’d definitely do something about it
|Severity of illness||And they threw up every fifteen minutes like all night long. And they were pretty sick. But First Nurse really encouraged us to...to look for the signs of dehydration and just some of the warning signs that things weren’t going well.|
If I had like blood like in vomit or a stool or anything like that or really dehydrated, then I definitely would go seek medical attention.
|Child||I think if a smaller child is involved, I think that I would seek help...|
Yeah, we called First Nurse because my daughter and my son were both sick, and they’re ten and six.
|Who would you report it to?|
|Poison Control||The more informed, I think the general public has a lack of knowledge what to do in those cases. Like most people wouldn’t know to call the poison control, you know.|
Like Poison Control. I didn’t even think about that. Is that something... ‘cause I think, when I think Poison Control, I think if you swallow something you’re not supposed to swallow.
|FDA||I would think the FDA. You see signs on, on the outsides of buildings that give them grades on, on their food quality.|
Either the FDA or...Poison, Poison Control possibly
|CDC||The doctor reported my case, and the CDC representative contacted me.|
|Healthcare provider||If you don’t know who to report it to, you could always do...what I did, just call your doctor and...talk to a nurse, and they’ll tell you...who you should report it to.…for me it’d be my healthcare provider...just because if it’s bad enough that I’m going there... |
if they had brochures or if I could seek advice or something like that.
|Restaurant/Grocery Store||I think it’s the responsibility of the restaurant or the grocery store. I would definitely report it to them, and it’s their responsibility to get the word out to the proper authorities and customers to, ‘cause they’re the ones like right there at the center. They can stop selling or producing the thing right then and there. I would definitely at least talk to a manager-, like a higher up, like the manager of the restaurant if I got sick there.|
|What would be the best way to get them (focus group participants) information about how to report food poisoning? What would make it easier to report?|
|Telephone number||I think just...an 800 number or, I mean, I would probably… I would just contact the Department of Public Health and... I don’t know...an easy 800 number or an easy person that I could talk to at the Department of Public Health.|
I think it has to do with exposure…what we were just talking about...because as far as exposure, you hear about 1-800-BETSOFF. But you ain’t never heard nothing about food
|Internet||I’m more likely to want to fill out a form online...rather than call.|
...the younger generation spends a lotta of their time on computers. So, of course, a lotta time is spent on Facebook …having something online that would be easily accessible to type in...“I got sick” and…
|Media (TV, Radio)/National Campaign||I would think a public service campaign or something that would tell people that it’s not, if you get ill and you think it’s from food, it’s not your responsibility to go to the restaurant and take care of it. It’s to call Public Health. Yeah, with an 800 number.|
But I do think that it would be a good idea for, for you know, somebody to make a PSA (public service announcement), have it on the TV stations, and say, “Hey, you know, if, suspect you have food poisoning,” ...my opinion is, the media doing a PSA.
|Restaurant||Yeah, if they could even put up posters up at restaurants.|
… maybe the easiest way would be to put it on those FDA signs. They’re on every building that serves food.
|others||Put it on the packaging if it’s...prepackaged food.|
And if you have suspected food poisoning or if you’re diagnosed with food poisoning, you give ‘em the brochurewhen they leave the hospital or the doctor’s office. And then it’s up to you as...the patient, to decide if you wanna call the health department and report it …
|What could make it easier to report an illness?|
|How: education||Well, it comes to education also…. I mean, do people know what they should be reporting? Like what is a real sign of a foodborne illness? …..most of us aren’t gonna be able to say, “For sure, this is what happens”……getting the information out there to what should be reported.|
I think one thing that would’ve maybe helped people is...I didn’t realize that if I went to the doctor that they could actually tell me for sure if that’s what I had or not. And I think lots of people would feel more comfortable reporting it if they knew for sure…
|Knowing someone cared/listened/do something/held accountable/ something in it for me||So it’s like the time and energy and everything that it would’ve taken to report it at that time, we didn’t feel, was worth like whatever potential outcome we had.Cause I think we, in our mind, thought, Well, we’ll probably call the restaurant and they’ll say, Oh, we’re so sorry that happened or something and then what would the outcome be?|
I would say just thinking that somebody cares, and that someone’s gonna listen and that there might be some action taken care of.
|Knowing for sure it was an FBI||And then going to the doctor gives them that confidence to report it ‘cause I know for sure that’s what I had.|
And what...like what tell-tale signs you should be looking for. To make sure that if, it’s not just the flu or...but that it did come from a foodborne illness.
|How concerned would you be if the medical provider asked you to supply a stool sample? Why?|
|Concerned: something bad/uncertainty||I think for me it’d be more of a concern of how serious is this because all the doctor’s visits I’ve ever gone to, they’ve never asked for that. So now that this is something new, it’s like does this mean it’s worse than everything I’ve encountered before?|
It would be scary at first to have your doctor probably say that, because my mind wouldn’t necessarily go to the food poisoning idea. It might go to a lot of other...areas.
|Concerned: inconvenient||How are you gonna set aside a whole another entire day just to point the finger at someone?|
my concern was I’m just too sick to do that.…But, when you’re that sick, you’re thinking, “I don’t wanna do it now because I don’t wanna leave the bathroom.”
|No Concern: previous experience||I wouldn’t be concerned. I wouldn’t want to, especially ‘cause my friends had to do it so I know how not...fun it is.|
Or if you’ve done stool samples before, I mean, some of us...it’s kind of routine with my doctor so I’m...I’m surprised you haven’t all been doing it…
|No Concern: this is way to diagnose/help you get better||I think if knowing that I did that it would help me feel better, I would probably do it.|
I was gonna say ‘cause I remember feeling like, “Oh, this is good. We’ll really get to the bottom of this.” And also that having missed a week of work, which put a big burden on to co-workers, it was kinda nice to say, “I have, the State of Iowa says I had salmonella.”
|What’s in it for me/benefit to me (cost/benefit)||...you know, what benefit is it to you personally? I did have the nagging thought (that) maybe I should go ahead and do it just to confirm it…But, again, there wasn’t that personal… incentive…|
I mean, if you’re sick for four or five days in a row, the moment you’re not sick you have a million things that you have to catch up with. How are you gonna set aside another entire day just to point the finger at someone?
|Concerned: embarrassed||I don’t think it’s a question of concern. It’s probably a question of maybe... embarrassment or something? Yeah, there’s gotta be a certain amount of embarrassment to any kinda private question like that.|
|How hard/difficult do you think it is to collect a usable stool sample? Why do you think this?|
|Difficult: previous experience||After having given one stool sample, I would almost just rather tell them to assume that whatever you think I have, I have it. Let’s deal with it! And skip the stool sample. You are at the most wretched of your being, and you are asked to then do this. I looked at it and said, “I don’t know if it’s worth it”.|
It was very complicated.
|Difficult: handling||Well, and I would think contamination! I mean, you think about it.|
I thought it was difficult because I was concerned with what was safe handling of the material.
|Difficult: messy/inconvenient/process and equipment||I think it might be slightly more difficult when I had food poisoning, though.|
I’ve never done it, but I would probably think the same thing. My friend said she had to use a trash can, so... she said it wasn’t very easy to do.
|Difficult: doctor’s office vs. home(and mailing)||I definitely think the worst part is having to go to the post office. And everybody knows what you’re doing with your box that’s going in to the University of Iowa.|
And I think that should be done at a medical facility. They give it to you to take home and do at home. I feel like that could very well, easily be handled in that facility right there when they’re asking you to provide that.
|Not Difficult: previous experience||And I’ve done it, and it’s not that difficult. I don’t think it would be too hard. They have these little hats that fit in the toilet so you wouldn’t have to worry about...fishing it out.|
|Embarrassed||When it’s your own, it’s, it’s...the embarrassment factor is is up there. When you’re cleaning up after someone else, it’s their embarrassment, not yours.|
And, and our parents severely ingrained into our, our memories, at a very young age, that, Ooooh, that’s gross. It goes in the toilet and away from everyone else.
3.2. Healthcare Professional Results
|26–34 years old||5||31.3|
|35–49 years old||6||37.5|
|50–64 years old||5||31.3|
|Allied healthcare professional||2||12.5|
|Location of employment|
|Your concern about the safety of our food|
|Not at all concerned||0||0.0|
|Not very concerned||1||6.3|
|Your patients/clients’ concern about the safety of our food|
|Not at all concerned||1||6.7|
|Not very concerned||6||40.0|
|Greatest risk for acquiring a food-borne illness|
|Away from home (restaurant or other foodservice establishment)||11||68.8|
|Best approach for the industry to use to reduce the risk of food-borne illness|
|Better quality controls||11||68.8|
|Increased government oversight||2||12.5|
|Better consumer education||10||62.5|
|Better healthcare provider education||8||50.0|
|How often do you see patients/clients with complaints due to something they ate?|
|Less than one time per month||6||37.5|
|1–2 times per month||2||12.5|
|3–10 times per month||6||37.5|
|Have you ever had a patient/client who had a confirmed foodborne illness?|
|Barriers to diagnosing a foodborne illness|
|Lack of patient/client knowledge||14||87.5|
|Lack of healthcare provider knowledge||7||43.8|
|Unavailability of suspected food||8||50.0|
|Time between food ingested and treatment sought||15||93.8|
|Preferred communication method to receive updated information|
|Face to face, in person||4||25.0|
|Questions||Themes||Sample Illustrative Quotes|
|Tell me about your experiences working with patients with a suspected foodborne illness?|
|Patient gets admitted||Not unless the severe case is where someone actually got admitted and that’s, you know, that’s pretty far and few in between that they’re actually admitted. So, it probably goes very, very unreported at least...where I’ve been aware.|
Or they wait ‘til they’re so bad dehydrated, they’re in the hospital.
|Asked questions to patient||When I have several come in, you know, I always start with, oh, you know, “What did you eat? Did you all eat the same thing? You know, did the person that ate this get sick? Or this one not get sick?” …kinda work down the list of who ate what… But...and you have to think about time of onset.|
|Treat symptoms||Giving them IV fluids and trying to control… the vomiting and not wanting to stop, wanting em to get it …completely out of their system, but trying to make them comfortable at the same time.|
Yeah, generally our physicians will tell ‘em to do bed rest and liquids and wait it out three or four days and then come back for further testing.
|Nothing done||But with the fast pace, you don’t have that time to evaluate...|
I think sometimes with adults it gets passed off
|How did you know to suspect FBI?|
|Patient: severity of symptoms||Well, the cases where I’ve seen it… more violent vomiting and more violent diarrhea and abdominal pain. And often they do… you pass out or the fainting goes along with it|
People that have gotten the E. coli, they’ve been so ill that they’ve even died or come very close to dying. And their symptoms are even more so, you know, the, the extreme bloody diarrhea…
|Onset of symptoms||Uncontrollable vomiting and diarrhea and said “you know what” I just ate at this place twenty min ago.|
Usually within the first couple hours that usually you eat.
|Symptoms: multiple people ill||When I have several come in, I always start with, oh, “What did you eat? Did you all eat the same thing? Did the person that ate this get sick?”|
If our triage nurses triaged several people with the same symptoms, then when they come in you would have that knowledge so you could ask them at that point if…they’ve all ate at the same place.
|Personal experiences with FBI||And I became, oh, violently ill, within about a ten, twelve hour region. Ended up passing out. I ended up being hospitalized because I got so violently ill.|
I will say that I personally had food poisoning one time myself for a, a chicken pizza at a restaurant.
|Patients: self-diagnose||And patients anymore are getting very savvy with the Internet and are trying to self-diagnose. “I already know what it is. I don’t need to come see you. I just need medicine.” When the physician doesn’t know what it is yet until we do testing!|
Hey, this is what happened. I wondered if it’s food poisoning?” And...I don’t know if it’s addressed right away as that.
|Not diagnosed right away, often have to come back to get tested or not tested at all||Generally our physicians will tell ‘em to do bed rest and liquids and wait it out three or four days and then come back for further testing.|
Patient came in and I know he was seen a second time then ‘cause he wasn’t getting any better. And then they did some testing...stool samples...and they found it out. It was salmonella.
|Reporting||I’ve never had a patient report it|
|What did you do?|
|Made Calls||In the Poison Center where they would think...that would probably, was more of a link than actually just the straight emergency room was the Poison Center would get the call….And it was more accessible than probably Public Health|
|Ask questions to patient||And, you know, lots a times, whenever they go in and ask ‘em prompts ‘em to remember something so. I know the provider I work with, usually that’s the first word outta their mouth: “Well, who else at home is sick?” Or “Is, were you around anybody else that was sick?”|
Well, is anybody else at home sick? And they go, “Oh, no.” But then by the time the doctor gets in the room... they start to think about it. And then they go, “Oh, yeah, well so-and-so and so-and-so are whatever” or they don’t, or what they tell them is a totally different story than what they tell you anyway.
|What tests or procedures are usually done when you suspect a foodborne illness?|
|Blood and stool||I would imagine it would be the basics. It’d be stool studies and possibly a CBC to see if it’s...either eliminate viral illness or just say it’s a viral illness|
Taken stool samples just for… to make sure it wasn’t something else or if they can test that.
|Other diagnostic tests||Straight sigmoid scopes...to check the intestine to make sure that the actual walls of the intestine are staying hydrated|
I do know, in a few cases, of actual rectal exams, just to make sure in case of parasite infestation versus foodborne illness.
|When are stool samples taken?|
|Symptoms that trigger taking stool sample||When they’ve had the nausea and they’re having diarrhea frequent with stools.|
I think a lotta times it depends on how long they’re having the diarrhea for and how many episodes of the diarrhea they have a day.
|Vulnerable populations||The only time I think I’ve ever heard of that is in nursing home population, just because of the close proximity.Numerous episodes and lots of the kids were having blood in it. But we deal with babies on up and like I said, some of the babies are having blood in their stool. And sometimes that can indicate they’re not tolerating breast milk which could possibly be sorta foodborne in a way for a baby|
|Difficulty with stool samples||…you do your own stool sample. And then you either bring ‘em back or mail ‘em back. We prefer patients to bring ‘em back…|
Maybe the literacy of the patient to understand how to do it. If they didn’t say that they would really be able to do it right at all and it wouldn’t be beneficial, so they find other ways to diagnose them.
|If a stool sample is not taken but a foodborne illness is a potential diagnosis, what are the likely reasons for not taking the stool sample?|
|Cost||I mean, a lotta that stuff, even though it might be only fifteen or twenty dollars, a lotta the patients that we service, they don’t have that.|
And just like with this gentleman that came in, the reason he came in and the whole family didn’t come in, the ones that had that sickness, was because they didn’t have insurance.
|Lack of knowledge: Healthcare Professionals||I think maybe a little bit of both. Or, if they come in and they just say, “Ohhh, I’m not feeling well,” and maybe they don’t ...fully describe it or if they’re the only one that there is sick and... I’ve triaged lots of phone calls. And off the top of my head, I’ve never thought of foodborne illness.|
With food poisoning, is it ever to where they don’t have the diarrhea but they’re just vomiting? Would that be where they wouldn’t do stool samples? They might...I don’t know. Do they ever take like samples of the vomit? Or no? Or would it not be in that?
|Lack of knowledge: Patients||So there’s also that factor that you just don’t know that ten other people that walked outta that restaurant that night became ill. So you just say, “Oh, OK. Well, I musta picked up a bug somewhere.” So I think that’s the, and even our, ourselves, I think if I were to become sick, I’d think, “Well, I just have a bug.” We just don’t assume that, you know.|
I think, this goes back to patient education, patients who think they have foodborne illness, that means diarrhea. So if their stools become formed, at all, even if they’re still loose, even if they’re still very frequent, if they become formed at all, they feel, “Oh, it must not have been that.” Unless it stays the diarrhea, they don’t feel it needs to be tested.
|Patient: mess/embarrassed||And I think some people are just shy and embarrassed and don’t wanna bring back their stools.|
They don’t wanna touch that to smear it on a card.
|Stool sample collection challenges||Maybe the literacy of the patient to understand how to do it. If they didn’t say that they would really be able to do it right at all and it wouldn’t be beneficial, so they find other ways to diagnose them.|
The specimen containers themself, when you’re instructing a patient on proper collection procedures, the lids of the containers have spoons on them so that if the bowels are more formed, that they can actually use it to fill the container.
|Patient: non-cooperation||You can order everything you wanna order and their insurance’s gonna possibly pay for it. But if your patient’s mother or father or whomever doesn’t take them up to the lab to go get that stuff and get that done, you will never know what they had.|
I don’t know how many times a year a doctor would write that: “Come back with the stool samples “or” Once you can get a stool sample,” and I can guarantee you most of them didn’t come.
|Treat Patient and move on||But as you can see as a practitioner, you know, it’s just better to treat the symptoms and say follow-up if you don’t improve in the next couple days.|
Yeah. And they may walk in the door acting like they’re just so, you know, worried, worried, worried. But yet, once they got a little piece of paper with an antibiotic written on it or whatever, there was their fix. They were, they were satisfied and...bye, bye.
|Symptoms not severe||Possibly the beginning of the illness and then they waited too long to be treated. And it’s possible that the amount of active infection has already been fought, and they’re already on the downhill of it.|
When there’s just been nausea and vomiting and no diarrhea.
|What information or tools would aid you in doing your job related to patients with suspected foodborne illnesses?|
|Patient information: flyers||Flyers about that to, that could kind of simplify how to take care of, you know, their foods in their own home and what, you know, to wash your hands. And it would be beneficial for our clinic is if we had it in Spanish too.|
Flyer, “if you suspect a FBI, please call this number”.
|Public education||You look at employees in the workforce…. Those that are hired in restaurants… do they really have the education.|
I think with the public, a lot of teaching food storage and how long to keep food for and all that. I mean, some people think you can keep it a week, some three days, you know. Like she said, some ‘til there’s mold on it.
|Healthcare professional knowledge||In talking about foodborne illnesses, we’re all relating to four or five different symptoms. And … there may be other things we should be looking for that we’re not identifying.|
In most foodborne illnesses, the time of ingestion to time of illness, what should we be looking for?
|Algorithm/decision making tool||Where you initiate getting the information about whether or not it is a foodborne illness at that decision-making point.|
So I liked the fact that it said, you know, ask ‘em if they have this, this, and this. If they say yes to these, you go down to here and you ask this lump of questions. It helps you narrow it down.
|Easy stool sample collection||But, you know, like a food, like just some kind of testing kit that if, you know, if you’re suspecting that, it has the equipment that you need right there as far as the lab slips and the, the tubes and the culture vials.|
So it is very difficult. And I can understand that, that’s why you would just give up, especially if you are feeling better. I don’t know how you could fix that because there’s only certain ways you can collect certain things.
|Web-based resources||If they (pamphlets) could be available for download for use, I think that would be a great help.|
Policies and procedures website where you could go to print off stuff.
|What do you think is the best way to get information to your fellow healthcare providers?|
|CEU’s (continuing education unit)||Sounds like a good CEU topic. You know, what are the different...foodborne illnesses that we’re gonna see more commonly in this area? And what are the onset times and, and the symptoms they might display? And then, what do we do about it?|
You know, it just kinda leads you in, you know, into that process. Yeah. I don’t know if, it sounds to me like this would be a really good topic for some CEUs.
|But I love getting the notices like through the email...|
If they wanted to do a short...day-by-day learning thing or, I know they could do some emailing.
|Face to face information sessions||Everybody learns differently. I mean, some people are, you know, visual learners. Some people are auditory. Some people read and they know it.|
getting information out, I think a lotta people do like to do these small groups. I know we do… I think it helps just to be…I don’t know, be able to, openly discuss things.
|Web-based resources||You know, that we could do this webinar or, you know, if your clinic is interested in setting up a time with...|
…go to this site, you know. This is where we’re gonna give all our patient information from this site and this site only.
- Clear understanding of foodborne illness not indicated—how it might occur and what it might entail
- Clear understanding of food system controls and prevention not indicated
- Severity of symptoms appear to guide treatment and testing (further steps)
- Past experiences in responding to an outbreak and experiences of preceptors/mentors/trainers with an outbreak appear linked to raised awareness—not from formal education
- Food safety at the food service establishment level seems to be a concern or seen as the cause of foodborne illness rather than home
- Desired resources include more contact with Public Health Department (PHD) and resource to aid in easily identifying potential symptoms and causes
4. Discussion and Conclusions
Conflicts of Interest
- Scallan, E.; Hoekstra, R.M.; Angulo, F.J.; Tauxe, R.V.; Widdowson, M.; Roy, S.L.; Jones, J.L.; Griffin, P.M. Foodborne illness acquired in the United States—Major pathogens. Emerg. Infect. Dis. 2011, 17, 7–15. [Google Scholar]
- Centers for Disease Control and Prevention. Surveillance for foodborne disease outbreaks United Sates, 2009–2010. Morb. Mortal. Wkly. Rep. 2013, 62, pp. 41–47. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6203a1.htm?s_cid=mm6203a1_w (accessed on 13 May 2013).
- Centers for Disease Control and Prevention. Incidence and trends of infection with pathogens transmitted commonly through food—Foodborne diseases active surveillance network, 10 U.S. sites, 1996–2012. Morb. Mortal. Wkly. Rep. 2013, 62, pp. 283–287. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6215a2.htm?s_cid=mm6215a2 (accessed on 13 May 2013).
- Centers for Disease Control and Prevention. Foodborne Illness Surveillance Systems Fact Sheet. Available online: http://www.cdc.gov/foodborneburden/PDFs/FACTSHEET_G_SURVEILLANCE.pdf (accessed on 1 June 2013).
- Brewer, M.S.; Rojas, M. Consumer attitudes toward issues in food safety. J. Food Saf. 2008, 28, 1–22. [Google Scholar] [CrossRef]
- Wilcock, A.; Pun, M.; Khanona, J.; Aung, M. Consumer attitudes, knowledge and behavior: A review of food safety issues. Trends Food Saf. Technol. 2004, 15, 55–66. [Google Scholar]
- Bruhn, C.M.; Schutz, H.G. Consumer food safety knowledge and practices. J. Food Saf. 1999, 19, 73–87. [Google Scholar] [CrossRef]
- Williamson, D.; Gravani, R.; Lawless, H. Correlating food safety knowledge with home food preparation practices. Food Technol. 1992, 46, 94–100. [Google Scholar]
- Knight, A.J.; Worosz, M.R.; Todd, E.C.D. Serving food safety; Consumer perceptions of food safety at restaurants. J. Contemp. Hosp. Man. 2007, 19, 476–484. [Google Scholar] [CrossRef]
- Reuters, R. Thomson Reuters-Npr Health Poll: Food Safety. 2011. Available online: http://healthcare.thomsonreuters.com/npr/assets/NPR_report_FoodSafety.pdf (accessed on 30 May 2013).
- U.S. Department of Health and Human Services,Food and Drug Administration. Report of the FDA Retail Food Program Database of Foodborne Illness Risk Factors. Available online: http://vm.cfsan.fda.gov/~dms/retrsk.html (accessed on 24 January 2008).
- U.S. Food and Drug Administration. FDA Report on the Occurrence of Foodborne Illness Risk Factors in Selected Institutional Foodservice, Restaurant, and Retail Food Store Facility Types. Available online: http://www.cfsan.fda.gov/~dms/retrsk2.html (accessed on 24 January 2008).
- U.S. Food and Drug Administration. FDA Report on the Occurrence of Foodborne Illness Risk Factors in Selected Institutional Foodservice, Restaurant, and Retail Food Store Facility Types. Available online: http://www.fda.gov/downloads/Food/FoodSafety/RetailFoodProtection/FoodborneIllnessandRiskFactorReduction/RetailFoodRiskFactorStudies/UCM224682.pdf (accessed on 20 June 2013).
- Strohbehn, C.; Sneed, J.; Paez, P.; Meyer, J. Handwashing frequencies and procedures used in retail foodservices. J. Food Prot. 2008, 71, 1641–1650. [Google Scholar]
- Hesse, B.W.; Nelson, D.E.; Kreps, G.L.; Croyle, R.T.; Arora, N.K.; Riber, B.K.; Viswanath, L. Trust and sources of health information: The impact of the internet and its implications for healthcare providers: Findings from the first health information national trends survey. Arch. Intern. Med. 2005, 165, 2618–2624. [Google Scholar] [CrossRef]
- Wong, S.; Marcus, R.; Hawkins, M.; Shallow, S.; McCombs, K.G.; Anderson, B.; Shiferaw, B.; Garman, R.; Noonan, K.; van Gilder, T. Physicians as food-safety educators: A practices and perceptions survey. Clin. Infect. Dis. 2004, 38, 212–218. [Google Scholar] [CrossRef]
- Ross, D.; Rasmussen, S.A.; Cannon, M.J.; Anderson, B.; Kilker, K.; Tumpey, A.; Schulkin, J.; Jones, J.L. Obstetrician/gynecologists’ knowledge, attitudes, and practices regarding prevention of infections in pregnancy. J. Women’s Health 2009, 18, 1187–1193. [Google Scholar] [CrossRef]
- Morales, S.; Kendall, P.A.; Medeiros, L.C.; Hillers, V.; Schroeder, M. Health care providers’ attitudes toward current food safety recommendations for pregnant women. Appl. Nurs. Res. 2004, 17, 178–186. [Google Scholar] [CrossRef]
- MacDonald, P.D.; Torok, M.R.; Salyers, M.; Wolf, L.; Nelson, A.L. Practices around acute diarrheal illness diagnosis, counseling, and reporting: Laboratory and health-care practitioners in North Carolina, 2004. Foodborne Pathog. Dis. 2007, 4, 359–365. [Google Scholar] [CrossRef]
- Buffer, J.L.; Medeiros, L.C.; Kendall, P.; Schroeder, M.; Sofos, J. Health professionals’ knowledge and understanding about Listeria monocytogenes indicates a need for improved professional training. J. Food Prot. 2012, 75, 1310–1316. [Google Scholar] [CrossRef]
- Wohlgenant, K.C.; Cates, S.C.; Godwin, S.L.; Speller-Henderson, L. The role of healthcare providers and caregivers in educating older adults about foodborne illness prevention. Educ. Gerontol. 2012, 38, 753–762. [Google Scholar] [CrossRef]
- Medeiros, L.C.; Chen, G.; Hillers, V.N.; Kendall, P.A. Discovery and development of educational strategies to encourage safe food handling behaviors in cancer patients. J. Food Prot. 2008, 71, 1666–1672. [Google Scholar]
- Mayo Clinic. Food Poisoning. Available online: http://www.mayoclinic.com/health/food-poisoning/DS00981 (accessed on 20 June 2013).
- WebMD. Food Poisoning Health Center. Available online: http://www.webmd.com/food-recipes/food-poisoning/default.htm (accessed on 20 June 2013).
- Centers for Disease control and Prevention. When Food Bites Back: Protecting Those at Risk for Listeria Food Poisoning. Available online: http://www.cdc.gov/features/vitalsigns/listeria/ (accessed on 20 June 2013).
- Saldaňa, J. The Coding Manual for Qualitative Researchers; SAGE Publications: Los Angeles, CA, USA, 2009. [Google Scholar]
- Li, J.; Smith, K.; Kaehler, D.; Everstine, K.; Rounds, J.; Hedberg, C. Evaluation of a statewide foodborne illness complaint surveillance system in Minnesota, 2000 through 2006. J. Food Prot. 2010, 73, 2059–2064. [Google Scholar]
- Minnesota Department of Health. Reporting Suspected Foodborne Illness. Available online: http://www.health.state.mn.us/divs/idepc/dtopics/foodborne/reporting.html (accessed on 6 August 2013).
© 2013 by the authors; licensee MDPI, Basel, Switzerland. This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).