The main problems contributing to food poisoning outbreaks in institutional settings and a home were reviewed and analyzed through the epidemiological investigations of food poisoning. The major documented factors included improper holding temperatures, inadequate cooking, poor personal hygiene, cross-contamination and contaminated equipment, food from unsafe sources, failure to follow food hygiene policies, and lack of education, training, monitoring and superivision. Usually more than one factor contributed to the development of an outbreak. (1) Use of improper holding temperatures was the single most important factor contributing to food poisoning. They included improper cooling, allowing a laps of time (12 hours or more) between preparing food and eating it, improper hot holding, and inadequate or improper thawing. Food thermometers were not used in most of the instances. (2) In inadequate cooking, the core temperature of food during and after cooking had not been measured, and routine monitoring was limited to recording the temperature of plated meals. Compared with conventional methods of cooking, microwave ovens did not protect against food poisoning as effectively. Centralized food preparation potentially increased the risk of food poisoning outbreaks. (3) Poor personal hygiene both at the individual level (improper handwashing and lack of proper hygienic practices) and at the institutional level (poor general sanitization) increased the risk of transmission. Person to person transmission of enteric pathogens through direct contact and via fomites has been noted in several instances. (4) Obtaining food from unsafe sources was a risk factor in outbreaks of food poisoning. Food risks were high when food was grown or harvested from contaminated areas. Possibilities included contamination in the field, in transport, at the retail site, or at the time it was prepared for serving. (5) Cross-contamination and inadequate cleaning/handling of equipment became potential vehicles of food poisoning. Failure to separate cooked food from raw food was also a risk factor. (6) Failure to follow food hygiene policies also provided opportunities for outbreaks of food poisoning. It included improper hygienic practices during food preparation, neglect of personnel policies (involvement of symptomatic workers in food preparation), poor results on routine inspections, and disregarding the results and recommendations of an inspection. (7) Lack of formal and in-service education, training, monitoring, and supervision of food handlers or supervisors were critical and perhaps neglected elements in occurrences of food poisoning.
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