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26 Cards in this Set

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150 people become ill following a banquet suffering from a rapid onsset of nausea vomiting and prostration, 3-4 hours after eating the meal. What would you suspect was the cause of this illness. How would you go about investigating this outbreak of illness? What information or evidence is needed for confirmation of a food-borne illness?
Noro virus or B. Cereus.
A women calls and has bought unpasteurized milk at a local farmer's market and believes that it is healthier and tastier than pasteurized milk.

What is the concern?
What are the public health actions?
Concern is bacterial contamination (e. coli, listeria, campylobactor), violation of the food premises regulations.

Actions:
1 Inform consumer not to drink unpasteurized milk.
2 Inform outside agency (CFIA)
3 Stop the sale of the product by the operator.
4 Destroy the product under sect 19 HPPA under reasonable ground of a health hazard.
5 Determine if distributed to other operations or suppliers.
6 Monitor.
7 Charge.
Inspection of a food premises you find mice droppings, live mice and a bag of rice with holes in it. What actions do you take?
concern - infestation and possible health hazard.

mice can transmit:

Encephalomyocarditis
Leptospirosis
Salmonella
Swine dysentery
Plague

Preventative action:

Good sanitation is essential for effective long term control. Mice can enter any opening larger than 1/4 inch, making it virtually impossible to completely mouse proof a building.

The control of mice can be widely varied, depending on the individual situation. It may range from physically altering the conditions allowing the infestation, such as covering holes, filling cracks, etc. to baiting or trapping.

removing garbage of sources of food.
What is food poisoning. Give an example of each
A common flu-like illness typically characterized by nausea, vomiting and diarrhea, due to something the victim ate or drank that contained noxious bacteria, viruses, parasites, metals or toxins.
If botulism is suspected in food what do you advise the consumer?
These foods should be disposed of immediately and never tasted or eaten!

Eating
foods that contain this toxin
causes the illness botulism. One
of the most severe foodborne
illnesses, botulism can be fatal if untreated.
What are the steps invovled in a food poisoning investigation.
1. Investigating officer should attempt to gather a complainant's details and if known, any other contact details of affected persons.
Importantly:
• Full name
• Date of birth (DOB)
• Address,
• Phone number,
• Foods consumed,
• The time of onset,
• Symptoms experienced,
• GP seen / faecal sample submitted? (if applicable)

2. Identify probable source of the infection.
-obtain 72 hour history of foods eaten
-helpful to obtain menu from establishment.
-restaurant booking list.

3. Faecal specimens needed to confirm causative agent.

4. Obtain relevant food samples.

5. Identification of causative pathogen. Laboratory identification is definitive step.

6. Recommend and Implement control measures.
• Seizure of remaining foodstuffs / overseeing destruction of remaining foodstuffs
• Directing cleaning and sanitising of a food premises
• Implementing changes in food handling practices in a food business
• Obtaining EDPH consent to exclude a food handler from work
• Seeking EDPH consent to close a food business
• Ensuring water supply is safe to drink (if water borne)
• Suggesting the implementation of a food safety plan within the food business, to control risks.

7. Generate a report
How would you prevent salmonella in a food premises?
Foods: Poultry, eggs, salads, meat and meat products, sliced tomatos, custards

Prevention: Always wash hands in hot, soapy water for 20 seconds before preparing or eating food, and after using the bathroom, changing
diapers and handling pets.

Wash cutting boards, counter tops, knives and utensils in hot, soapy water after they come in contact with raw meat, poultry and seafood, and before preparing
other foods.

Decrease the risk of crosscontamination,
keep raw meat,poultry and seafood and their juicesÑaway from ready-to-eat
foods

use one cutting board for raw meat products and another for salads
and other ready-to-eat foods.
Never place cooked food on a
plate that previously held raw meat, poultry or seafood.
Cooking foods to proper temperatures will kill the harmful bacteria that cause foodborne illness.
You receive a call on Friday afternoon from the hospital emergency ward. They've seen 16 people in the last 2 hours with diarrhea; four of the have blood in their stool. How would you proceed?
1. An investigating officer should attempt to gather a complainant's details and if known, any other contact details of affected persons.
Importantly:
• Full name
• Date of birth (DOB)
• Address,
• Phone number,
• Foods consumed,
• The time of onset,
• Symptoms experienced,
• GP seen / faecal sample submitted? (if applicable)

2. Identify probable source of the infection.
-obtain 72 hour history of foods eaten
-helpful to obtain menu from establishment.
-restaurant booking list.

3. Outbreak commitee:
-gowns
-visitation
-infection control practices

4. Faecal specimens needed to confirm causative agent.

4. Obtain relevant food samples.

5. Laboratory identification of causative pathogen.

6. Recommend and Implement control measures.
- Seizure of remaining foodstuffs
- overseeing destruction of remaining foodstuffs
- Directing cleaning and sanitising of a food premises
- Implementing changes in food handling practices in a food business
- Obtaining EDPH consent to exclude a food handler from work
- Seeking EDPH consent to close a food business
- Ensuring water supply is safe to drink (if water borne)
- Suggesting the implementation of a food safety plan within the food business, to control risks.

7. Follow up with other hospitals to determine if other similar outbreaks have occured

8. Generate a report
You receive a call on Friday afternoon from the hospital emergency ward. They've seen 16 people in the last 2 hours with diarrhea; four of the have blood in their stool. You follow up with patients and find that they have not attended a common event recently. What might this indicate and how would you investigate?
Possible water

Call utility to see if there is a problem.

look at distribution of cases throughout town.

Outbreak/illness in any institutions in village.
What is sufficient grounds for closing a food premises and what regulations give you the authority.
sewage
overrun rodents, pests,
no hot/cold running water.
proper refridgeration were required.

HPPA section 13
What procedures would you follow if an operator of a restaurant failed to comply with an order/action outlined in previous inspection report?
Ticket under POA section 3. Based on violation of the food premises regulations and based on a health hazard outlined the the HPPA.

Fine

Closure if constituted a health hazard
150 people become ill at a banquet suffering from vomiting, diarhea, prostration 3-4 hours after eating. How do you investigate. What do you suspect as cause. What evidence is needed to confirm illness?
1. Investigating officer should attempt to gather a complainant's details and if known, any other contact details of affected persons.
Importantly:
• Full name
• Date of birth (DOB)
• Address,
• Phone number,
• Foods consumed,
• The time of onset,
• Symptoms experienced,
• GP seen / faecal sample submitted? (if applicable)

2. Identify probable source of the infection.
-obtain 72 hour history of foods eaten
-helpful to obtain menu from establishment.
-restaurant booking list.

3. Faecal specimens needed to confirm causative agent.

4. Obtain relevant food samples.

5. Identification of causative pathogen. Laboratory identification is definitive step.

6. Recommend and Implement control measures.
• Seizure of remaining foodstuffs / overseeing destruction of remaining foodstuffs
• Directing cleaning and sanitising of a food premises
• Implementing changes in food handling practices in a food business
• Obtaining EDPH consent to exclude a food handler from work
• Seeking EDPH consent to close a food business
• Ensuring water supply is safe to drink (if water borne)
• Suggesting the implementation of a food safety plan within the food business, to control risks.

7. Generate a report

B. Cereus.

Lab identification
What organism causes haemorrhagic colitis. What foods have been implicated with outbreaks of this illness? What are the symptoms? How can it be prevented?
E. coli 0157: H7
Hamburger
Bloody diarrhea

Prevention:
reaching proper cooking temps
avoiding cross contamination.
proper storage.
proper refridgeration
proper freezing
What would you do if you went to inspect a meat cutting operation where you suspected that an operator was illegally processing wild game, and you were refused entry to the premises? What would you do if the operator physically assaults you or threatens you with personal harm?
Under section 41 of the HPPA a Health Inspector has the right to enter a premises during a reasonable time if a health hazard has been determined

If threatened leave, consult supervisor and come back with police.
You receive a call from a lady who bought unpasteurized mild at the farmers's market , the advertisement for the milk stated that it is good and tastes better than pasteurized milk. This lady wants to know if this was true? What actions do you take and why?
Inform lady that pasteurized milk may contain bacteria (listeria, e. coli, salmonella). Pasteurization is the process of removing bacteria from milk. So it is safer to drink pasteurized milk.

Actions:
Ask lady where bought milk. Contact CFIA.
Destroy milk under section 19 of the HPPA.
Ask for other milk distribution routes.
Fine
What is botulism?
Clostridium botulinum is the name of a group of bacteria commonly found in soil. These rod-shaped organisms grow best in low oxygen conditions. The bacteria form spores which allow them to survive in a dormant state until exposed to conditions that can support their growth. There are seven types of botulism toxin designated by the letters A through G; only types A, B, E and F cause illness in humans.

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. There are three main kinds of botulism. Foodborne botulism is caused by eating foods that contain the botulism toxin. Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin. All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism can be especially dangerous because many people can be poisoned by eating a contaminated food.
Discuss the procedure on closing a restaurant.
Advise operator the restaurant will be closed. Give written notice, placard front of restaurant with closure sign, follow-up with section 13 order under the HPPA.

Order must contain:
Who is responsible.
What is reason for order (health hazard)
Where (address)
Corrective action
When
Right to appeal.
What is food intoxication?
This type of illness is caused by toxins. Under favorable conditions certain bacteria produce chemical compounds called toxins, which, if ingested, cause food intoxication. Staphylococcus is the most commonly reported food intoxication.
What are the dangers of rodent infestation in a food premises?
Rats can transmit directly or indirectly to human diseases such as plague, Hantaviral infection, scrub typhus, murine typhus and boutonneuse fever.
High temperature dish washer sanitation/rinse water is at 60 C. What do you tell operator?
Rinse/Sanitation required to be 82 C. Use 3 compartment until fixed or use single service.
What organisms cause bloody diarrhea?

What foods are involved?

How would you narrow down foods involved in outbreak?

What is the severe form of e. coli called?
E. coli

Hamburger

Food sample/fecal sample

HUS (heamolitic uremic syndrome) = kidney failure.
You are inspecting a restaurant that has raw meat over fresh vegs. Owner says that meat is out of danger and he plans to cook raw vegs to 77 C and therefore out of danger. What do you tell him?
Some organisms produce toxins that do not respond to heat
What is Scombroid Poisoning?
Scombroid Poisoning is an allergic type reaction to high levels of histamine in fish.
When certain fish, especially scombroid fish, start to decompose, histamine is formed.
The presence of high levels of histamine always indicates that decomposition has occurred, even if the decomposition is not obvious. Toxic amounts of histamine can form before a fish smells or tastes bad.
What are the symptoms of scombroid poisoning?
Rash, flushed skin, facial swelling, nausea, vomiting, diarrhea, headache, dizziness, a peppery taste in the mouth, burning throat, stomach pain, itchy skin, tingling, and palpitations.
Symptoms can occur immediately to several hours after consumption of food with high levels of histamine. They typically last for a few hours, but in certain cases can last for several days, and may require administration of antihistamines.
How do you avoid scrombroid poisoning?
transport and store fish under refrigeration.
Cooking or other heat treatments (such as canning or smoking) do not destroy histamine.
What is the difference b/w sanitation, disinfection and sterilization?
Sterilization kills everything.

Disinfectant does not kill spores.

Sanitiztion kills bacteria and also removes dirt/grease.