Friday, July 25, 2008

Australia's Nursing Home Ills

Australia's nursing home residents have suffered several outbreaks of food-borne disease recently. Dr. Steve Corbett, public health director for the Sydney West Area Health Service told (a News Corporation outlet) that five nursing homes have experienced gastroenteritis outbreaks so far this month. And that's just in west Sydney.

According to Dr. Corbett, Clostridium perfringens is suspected in two of the outbreaks – four residents in those two locations tested positive for the microbe. The cause of the remaining outbreaks is still under investigation.

This is not the first time that C. perfringens has been implicated in an Australian nursing home outbreak. Just last month, 80 residents of the Endeavour Nursing Home in New South Wales were stricken with gastroenteritis after eating food that was contaminated with this pathogen. Ten residents died, although some of those deaths might not have been outbreak-related.

Nursing home residents – usually elderly and often frail – are easy prey for bacteria and viruses that cause gastroenteritis. One of the most common culprits is Norovirus, a highly contagious and very rugged virus that often is carried into the nursing home by visitors. Norovirus outbreaks are unpredictable and difficult to prevent.

But there is no excuse for outbreaks of Clostridium perfringens. This microbe is easily controlled by correct food-handling procedures, especially proper attention to cooking, holding and serving temperatures.

C. perfringens is a spore-forming bacterium. When a food that contains C. perfringens spores is cooked, the spores are shocked into germinating. This is not a problem, if the food is cooled promptly to ≤45ºF (≤7ºC). Otherwise, the germinating spores begin to grow and, within just a few hours, can multiply to the millions per gram of food.

When food that contains this high level of C. perfringens is eaten, the microbe makes a home for itself in the intestines, and produces a toxin. Within 24 hours of having eaten the contaminated food, the victim begins to experience severe stomach cramps and diarrhea, lasting for a day or two.

In most people, C. perfringens symptoms are self-limiting and, while unpleasant, are not life-threatening. The very young and the elderly, though, are very susceptible to dehydration caused by severe diarrhea. In rare cases, the dehydration can be severe enough to be fatal.

Outbreaks due to C. perfringens, such as the ones that took place recently in Australia, are an indication that food preparers and food handlers have not been trained properly. Especially in institutions that cater to the elderly, formal training in safe food preparation and serving practices should be mandatory. And kitchen and dining hall facilities should be inspected regularly to ensure that the staff is following correct procedures.

Institutions have a responsibility to provide a clean and safe environment for their residents. The nursing homes that experienced C. perfringens outbreaks fell short, and their residents paid the price.

1 comment:

  1. Increasing numbers of terminally ill patients are admitted to nursing homes. Quality palliative care requires good communication skills, but certified nursing assistants, who spend the most time with residents, are inadequately trained. They receive little education in communication during training programs or as in-services in the nursing home.


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