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Food and Drink Safety,[object Object],4-10,[object Object], Hugh J. Davis RN, MHA,MPH     ,[object Object],  Betsy Christiansen BSN, RN,[object Object],AMLT - Honduras,[object Object],1,[object Object]
In the field, remember:,[object Object],1.Eat to stay healthy!,[object Object],2. Follow safe water protocols.,[object Object],3. Protect yourself from blood-borne,[object Object],                                      disease.,[object Object],4. Follow basic immunization schedules.,[object Object],5. Know how to diagnose & treat travelers’ ,[object Object],                                      diarrhea.,[object Object],6. Follow malaria protection protocols.,[object Object],7. Protect yourself from TB.,[object Object],4-10,[object Object],AMLT - Honduras,[object Object],2,[object Object]
Pathways to Infection,[object Object],Water,[object Object],Food,[object Object],Skin,[object Object],Mucous Membranes,[object Object],4-10,[object Object],4-10,[object Object],AMLT - Honduras,[object Object],3,[object Object]
4,[object Object],Universal Precautions…,[object Object],              …what’s wrong here?,[object Object],AMLT - Honduras,[object Object],4-10,[object Object]
Universal Precautions,[object Object],What’s right in this picture?,[object Object],5,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
It’s been said,“Travel broadens the mind  as it  loosens  the bowels!”,[object Object],6,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
MTW Medical Team Goal:,[object Object],4-10,[object Object],   0% incidence of diarrhea,[object Object],              and,[object Object],>90% of our medical teams  ,[object Object],    have achieved that goal!,[object Object],AMLT - Honduras,[object Object],7,[object Object]
THINK Before You Eat!!!,[object Object],Everything that looks good may not be safe.,[object Object],That which looks unpalatable may be safe.,[object Object],4-10,[object Object],AMLT - Honduras,[object Object],8,[object Object]
4-10,[object Object],AMLT - Honduras,[object Object],9,[object Object]
Boil it, Cook it,Peel it, or…Forget it!,[object Object],Giardia trophozoites,[object Object],No, No,[object Object],10,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Only 2% of travelers ,[object Object],             are compliant!,[object Object],53% use ice in drinks;,[object Object],71% consume uncooked,[object Object],               vegetables;,[object Object],40-60% get diarrhea!,[object Object],11,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
An Unwanted Part of the     ,[object Object],       Missionary Experience,[object Object],	Julie: 9 mo diarrhea,[object Object], 4-5 days per month,[object Object], 10% weight loss,[object Object],	Laurie: 1 year Giardia,[object Object],   2 week hospitalization,[object Object],4-10 ,[object Object],12,[object Object],AMLT - Honduras,[object Object]
4-10,[object Object],AMLT - Honduras,[object Object],Hepatitis ,[object Object],Polio ,[object Object],Typhoid fever ,[object Object],Protozoa ,[object Object],Bacteria ,[object Object],Viral enteritis,[object Object],What does Cipro cover?,[object Object],13,[object Object]
Your body is not your own; ,[object Object],you were bought with a price.,[object Object],1 Cor. 6:20,[object Object],14,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
‘Sacrificial gifts’ from donors,[object Object],     lead to loss of…,[object Object],[object Object]
a translator’s time
a transportation unit
a team’s productivity… or even
a potential cancellation of trip. 4-10,[object Object],15,[object Object],AMLT - Honduras,[object Object]
Wash your hands              before you eat!,[object Object],Water from any spigot, tube or pipe ,[object Object],          is considered contaminated!,[object Object],DON’T wash your dirty hands in,[object Object],          contaminated water and ,[object Object],          with contaminated soap;,[object Object],          don’t use a contaminated                   ,[object Object],          towel for drying!,[object Object],16,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Water Hygiene,[object Object],Water from spigot is ,[object Object],considered contaminated…,[object Object],…you don’t know the source!,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Safe Alternatives for                 Hand Washing,[object Object],Wash in disinfected “clean” water.,[object Object],Use antibacterial soap.,[object Object],Air dry or use your own ,[object Object],                      “camp towel”.,[object Object],Use jellied alcohol.,[object Object],Much better,[object Object],18,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Are We Ready to Eat?,[object Object],Eat with “clean hands”! ,[object Object],Don’t use dirty utensils,    ,[object Object],              dishes or cups!,[object Object],What’s dirty?,[object Object],What’s clean?,[object Object],19,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
The ‘Tupperware Alternative’ A sealed container with your own                       utensils inside;A 3-step wash using disinfectant.,[object Object],4-10,[object Object],AMLT - Honduras,[object Object],20,[object Object]
What’s For Supper?,[object Object],Ascaris			  Giardia,[object Object],Amoebas		  Taenia,[object Object],Hepatitis,[object Object],21,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
ALWAYS Unsafe…                 …NEVER eat!,[object Object],Salads (lettuce),[object Object],Custards ,[object Object],Potato salad ,[object Object],Mayonnaise,[object Object],22,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
23,[object Object],4-10,[object Object],4-10,[object Object],AMLT - Honduras,[object Object],23,[object Object]
More Unsafe Foods,[object Object],Milk products…,[object Object],butter,[object Object],ice cream ,[object Object],unpasteurized cheese ,[object Object],Raw or undercooked meat & fish,[object Object],24,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
         Safe Foods,[object Object],MUST be well-cooked cooked to   ,[object Object],       158º & hot at serving time,[object Object],MUST be reheated to 158º if ,[object Object],                  previously cooked ,[object Object],Jellies & breads (covered - no flies!),[object Object],AMLT - Honduras,[object Object],25,[object Object],4-10,[object Object]
4-10,[object Object],26,[object Object],AMLT - Honduras,[object Object],26,[object Object],4-10,[object Object]
4-10,[object Object],27,[object Object],AMLT - Honduras,[object Object],27,[object Object],4-10,[object Object]
Dry Things are Safe…,[object Object],…If packaged ,[object Object],             or protected properly!,[object Object],28,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Staphylococcal Food Poisoning  ,[object Object],    is from a heat-stable Toxin.,[object Object],MUST keep hot foods hot (> 140ºF)…,[object Object],          …and cold foods cold (<40ºF).,[object Object], Heat Kills Germs!,[object Object],Yum Yum,[object Object],29,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Initial symptoms:,[object Object],Staph Toxin  1-8 hrs,[object Object],E Coli 0157  4 +days,[object Object],   Giardiasis  1-2 wks,[object Object], Amoebiasis  2-4 wks,[object Object],Hepatitis A  2-6 wks,[object Object],   Ascariasis  4-16 wks,[object Object],Taeniasis  2 mo,[object Object],30,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Thursday, Day 4,[object Object],4-10,[object Object],AMLT - Honduras,[object Object],31,[object Object]
4-10,[object Object],32,[object Object],AMLT - Honduras,[object Object],4-10,[object Object],32,[object Object]
  What About Fruit?,[object Object],Is the outside of the fruit clean?,[object Object],  Was the knife clean that cut the,[object Object],    fruit? (2-knife method?),[object Object],  Were the hands clean that ,[object Object],    prepared the fruit?,[object Object],33,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Not all Fruit is Created Equal!,[object Object],Best = fruit with rind or skin   ,[object Object],          that can be peeled,[object Object],Easy,[object Object],Very easy,[object Object],AMLT - Honduras,[object Object]
Difficult or impossible to clean,[object Object],   Difficult,[object Object],Almost impossible,[object Object],35,[object Object],4-10,[object Object],AMLT - Honduras,[object Object],Not all Fruit is Created Equal!,[object Object]
Raw vegetables such as lettuce, spinach, tomatoes and onions were responsible for the illness or deaths of nearly 19,000 people nationwide over a 5-year period.,[object Object],36,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
What is Safe to Drink?,[object Object],Hot beverages: boiled water,   ,[object Object],                  tea or coffee,[object Object],Soda & carbonated beverages,[object Object],Coconut water or milk,[object Object],Pasteurized milk & juices,[object Object],37,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
 The Story on Bottled Water,[object Object],11 of 14 randomly-selected bottles ,[object Object],representing 8 brands in Nepal ,[object Object],were contaminated with Coliforms!,[object Object],Poop!,[object Object],38,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Outbreaks of diarrheal illness are common from “safe” bottled water.,[object Object],[Wisconsin, Lima, Mexico and Peru’s “San Antonio”],[object Object],39,[object Object],4-10,[object Object],AMLT - Honduras,[object Object],The Story on Bottled Water,[object Object]
Is it safe or… ,[object Object],Has it been rebottled? …refilled? ,[object Object],Safety designation e.g., reverse  ,[object Object],                              osmosis,[object Object],Bottle dirty? …wet? ,[object Object],Cap secure? …new or replaced?,[object Object],Do you trust your life & your,[object Object],           team’s health with it ?!,[object Object],40,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Drinking-water on Airplanes,[object Object],A substantial number of aircraft,[object Object],going to / returning from,[object Object],developing countries serve,[object Object],contaminated drinking water.,[object Object],Travel with “Sweet Water” drops, ,[object Object],    Iodine or Chlorine Dioxide tabs, ,[object Object],            or a “Steri-Pen”.,[object Object],41,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
        Coconut Water…,[object Object],42,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
…it’s always in good taste        …& all over the world!,[object Object],43,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Cleaning Dishes…      a Triple Process,[object Object],44,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
  Other Water Challenges,[object Object],Brushing teeth,[object Object],Showering,[object Object],Swimming pool,[object Object],Ocean,[object Object],45,[object Object],AMLT - Honduras,[object Object]
High Risk Behavior,[object Object],Bad information,[object Object],    or ignorance,[object Object],Non-compliancy,[object Object],Eating in “dirty”,[object Object],    restaurants,[object Object],Whoa!,[object Object],46,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Prevention… Active vs Passive Dietary Restrictions,[object Object],47,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
 Prevention   Active     vs   Passive,[object Object],48,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Active verses Passive         Restrictions,[object Object],Passive = everybody orders for themselves, then leader must tell them no! ,[object Object],49,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Active =,[object Object],Eat everything,[object Object],     that is put in ,[object Object],     front of you,[object Object],50,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
So-o-o…   what-R-U-gonna-eat?,[object Object],Spoon?,[object Object],Banana?,[object Object],Iced tea?,[object Object],Hot soup?,[object Object],Lettuce?,[object Object],Tomato?,[object Object],Silverware?,[object Object],Napkin?,[object Object],Hamburger?,[object Object],Bun?,[object Object],51,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
What if you are served                unsafe food?,[object Object],52,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
What if you are served                  unsafe food?,[object Object],Try not to offend.,[object Object],Eat small portions. ,[object Object],   [risk of diarrhea linked ,[object Object],                     to size of inoculum],[object Object],Have a designated eater. ,[object Object],   [someone w/ indigenous bowel flora],[object Object],53,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Taking 500mg Cipro ,[object Object], after eating will NOT protect you ,[object Object], from crypto, Hepatitis A, rotovirus, etc.,[object Object],54,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
If you can’t live without ,[object Object],cut fruit, salad, ice or ,[object Object],fruit juice for 2 weeks…,[object Object],   …stay home!!!,[object Object],55,[object Object],4-10,[object Object],AMLT - Honduras,[object Object]
Food at luxury hotels no ,[object Object],     safer than the food in     ,[object Object],     standard hotels.,[object Object],Flies are important vectors ,[object Object],     of disease. ,[object Object],Watch for flies in the    ,[object Object],     restaurant & on food!,[object Object],4-10,[object Object],AMLT - Honduras,[object Object],56,[object Object],  Shangri-La Hotel in New Delhi,[object Object]

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Food and drink safety