Managing Foodborne Illnesses: What Nurses Need to Know

Foodborne illness is a big concern for public health officials in the United States. The CDC estimates that there are nearly 10 million cases of foodborne illnesses each year in the United States. In 2024, foodborne illnesses caused 53,300 hospitalizations and 931 deaths, with an estimated cost of $75 billion in just one year.

Related CE course for nurses: Challenges in Managing Foodborne Illness: A Public Health Concern

Regulation and surveillance of foodborne illnesses

While some foodborne illnesses cause severe symptoms, many cases go unreported. This can make it challenging for government and regulatory agencies to track cases and identify outbreaks. In addition, there are many different agencies involved in tracking these problems, which creates fragmentation and a lack of overall accountability.

Surveillance of outbreaks requires several monitoring systems and a lot of estimation. Tools used to monitor for outbreaks include:

Experts compile and compare data from each of these sources. This creates a more complete picture surrounding the actual number of illness cases around the country.

While the CDC, the U.S. Food and Drug Administration (FDA), and the U.S. Department of Agriculture’s (USDA) Food Safety and Inspection Service (FSIS) have all set goals related to foodborne illness prevention, many of these goals have not been met, and some of the goals have yet to be defined.

Risk of foodborne illnesses

Government agencies have made multiple attempts at reducing the rate of foodborne illness in the United States, but they have been largely unsuccessful. Healthcare providers, especially those working in family practice, pediatrics, and home health, can improve outcomes and reduce the rates of illness by offering education and encouragement to their patients.

Healthcare providers should be aware of patients at higher risk of foodborne illness. These include:

Age over 65 years
Age under 5 years
Pregnant women
Immunocompromised patients

Many of the pathogens responsible for foodborne illness can be eliminated by proper handwashing and food handling techniques. Patients should be taught to:

Wash hands for at least 20 seconds with warm water and soap before and after preparing and eating food.
Use separate utensils for preparing raw foods, and clean surfaces well after preparing raw meats.
Rinse fruits and vegetables well before consuming them.
Keep raw meat and their juices away from other foods while grocery shopping.
Cook meats until they have reached a safe internal temperature:
Whole cuts of beef, veal, lamb, and pork, including fresh ham: 145°F
Fish: 145°F
Ground meats, such as beef and pork: 160°F
All poultry: 165°F
Do not keep perishable food out of the refrigerator for longer than 2 hours.
Thaw food safely in the refrigerator or cold water. Do not thaw meat on an open counter.

Foodborne illness presentation

Foodborne illnesses in the United States are primarily caused by Salmonella, Listeria monocytogenes, Campylobacter, Clostridium perfringens, Shiga toxin-producing Escherichia coli (STEC), and norovirus.

Salmonella

Salmonella is primarily transmitted through poultry, raw eggs, unpasteurized milk, and contaminated fruits and vegetables. Symptoms of salmonella infection include fever, diarrhea, possible bloody stools, abdominal cramps, nausea, and vomiting. Symptoms typically begin 6 to 72 hours after exposure.

Listeria Monocytogenes

Listeria monocytogenes is one of the most virulent foodborne pathogens. It spreads easily and is capable of causing severe disease. It is typically found in soil, animal feces, deli meats, soft cheeses, and unpasteurized milk. Listeria Monocytogenes can cause a wide range of symptoms, from mild flu-like symptoms to meningitis and miscarriage of pregnancy.

Campylobacter

This is a bacterium often found in undercooked poultry and untreated water. Campylobacter infections usually cause stomach cramps and nausea. Most people recover within 7 days. Patients with weakened immune systems may develop secondary problems after an infection, including irritable bowel syndrome and nerve damage.

Clostridium Perfringens

Clostridium Perfringens often grows in foods that are left out at unsafe temperatures for extended periods of time (>2 hours). This bacterium releases a toxin that causes abdominal cramps and watery diarrhea. Most patients recover within 48 hours. However, Clostridium Perfringens can cause a serious condition called gas gangrene, which leads to tissue necrosis requiring surgical intervention.

Shiga toxin-producing Escherichia coli (STEC)

Shiga toxin-producing Escherichia coli (STEC), commonly referred to as E. coli, is a bacterium that is naturally found in the intestines of many animals and humans. This bacterium grows primarily in undercooked meat and contaminated produce, including lettuce, alfalfa sprouts, salami, and unpasteurized milk, juice, or cider.

Symptoms of E. coli include bloody diarrhea, stomach cramps, and vomiting. Symptoms can last from 1 to 10 days.

Norovirus

Norovirus is a highly contagious viral infection and the most common cause of gastrointestinal illness in the United States. It causes severe diarrhea and vomiting, leading to dehydration and possible need for hospitalization in very young or immunocompromised patients. Symptoms typically resolve within 1 to 3 days.

Poor hand-washing hygiene is the primary spreader of norovirus. It is especially common in areas with high concentrations of children, such as play-places and daycares.

Healthy People 2030 Food Safety Initiatives

The Healthy People 2030 Food Safety Initiatives aims to reduce the frequency of foodborne illnesses in the United States. The 20 objectives include reducing infections caused by: