September is Food Safety Education Month – a time set aside each year to increase general awareness about food safety and help prevent foodborne illness, which sickens 1 in 6 Americans each year.1 This year, we're choosing to highlight E. coli, fresh on the heels of the new Netflix documentary "Poisoned: The Dirty Truth About Your Food" which examines the food industry in the U.S., and in recognition of the 30th anniversary of the infamous Jack in the Box E. coli outbreak.
With this family of bacteria, it's important to understand that there are actually numerous ways you can be infected – it can be foodborne and waterborne. Knowing about this pathogen is vital in helping protect ourselves, our loved ones, and our businesses from its potential risk.
30th anniversary of famous E. coli outbreak
An essential part of the E. coli story in the United States is understanding the impact of the infamous E. coli outbreak at Jack in the Box 30 years ago, which sickened hundreds of people across four states and sadly led to the deaths of four children. This outbreak was a watershed moment in U.S. food safety that had far-reaching impacts on food safety practices and regulations – and greatly enhanced public awareness of the importance of safe food handling practices. It even led to the formation of some of the first consumer activist groups devoted to food safety.
What is E. coli?
E. coli, short for Escherichia coli, is a group of bacteria that normally lives in the intestines of people and animals (particularly ruminant animals like cattle, goats, sheep, and deer.) While most E. coli strains are harmless and part of a healthy intestinal tract, some strains can make people sick from food poisoning. There are six groups that cause diarrhea – the most common culprit of outbreaks is Shiga toxin-producing E. coli (or "STEC"). STEC infections are captured in public health surveillance data, such as the CDC's FoodNet Fast. Enterotoxigenic E. coli (ETEC) is a major cause of "traveler's diarrhea" when visiting developing countries.
How do I get infected with E. coli?
The infectious dose for E. coli is very low = < 100 bacterial organisms2 for some strains! This means even a person with a healthy immune system is at risk. In general, you get sick from E. coli by eating microscopic amounts of human or animal feces. This is primarily through eating contaminated food, like undercooked beef, contaminated fruits and vegetables, soft cheeses made from unpasteurized (raw) milk, or eating food prepared by someone who did not wash their hands well after using the restroom. Infection can also occur from drinking untreated water (or ice made from it) or unpasteurized (raw) milk and contact with the feces of an infected person (like after a diaper change). Some other sources are swallowing contaminated lake water while swimming and touching animals or their surroundings at a petting zoo. There are many possible sources of E. coli, so it is hard to know how someone got their case of infection, unless your local public health department can determine it is part of a recognized outbreak.
How common are E. coli infections?
E. coli infections are considered relatively common and are significant contributors to the burden of foodborne illnesses worldwide. The common strain STEC alone causes an estimated 265,000 infections annually in the U.S.3 – though, like many foodborne illnesses, the actual number of cases is likely much higher because many infected people don't seek medical care or may not provide a stool sample for testing. Travelers to certain developing countries are generally more at risk of getting sick from E. coli. You can get sick from E. coli year-round, but in the U.S., cases are highest in the warm summer months, peaking in July and August,4 because of changes in behavior in the summer – like grilling, swimming, and interacting with animals at fairs.
Who is most at risk for severe illness from an E. coli infection?
Groups at the highest risk of severe disease from E. coli infections include children under five years old, adults over 65, and immunocompromised individuals. According to the CDC, approximately five percent of those diagnosed with STEC develop hemolytic uremic syndrome (HUS) – a potentially life-threatening complication that can cause kidney failure.
What are the symptoms of an E. coli infection?
The most common symptoms of an E. coli infection are diarrhea (potentially bloody), stomach cramps, which can be severe, and vomiting. Some people develop a low fever. Symptoms and their severity may depend somewhat on which type of E. coli is causing the infection. Most people get better within 5-7 days, according to the CDC. Staying hydrated is key and remember antibiotics won't help.
What foods are commonly associated with E. coli contamination?
Undercooked meat is a major source of human illness from E. coli – particularly from eating undercooked ground beef. According to the FDA, fresh or raw produce like leafy greens or sprouts is particularly susceptible to E. coli because of potential contaminants in the field or processing areas, and these foods are often eaten raw – without the kill-step provided by cooking. Other potential sources include drinking unpasteurized (raw) milk, juice, or apple cider, eating dairy products made from raw milk (like some soft cheeses), or eating raw dough or batter made from contaminated flour. It's important to remember that food can also be contaminated during food preparation – through contaminated surfaces and kitchen utensils.
What businesses should be concerned about E. coli outbreaks?
Since E. coli can be transmitted through food, businesses and institutions with foodservice areas should ensure their staff are following food safety best practices, that includes restaurants, food trucks or street vendors, convenience stores, grocery stores, caterers, K-12 schools, colleges and universities, hospitals, long-term care facilities, casinos, hotels, prisons, and many others.
In addition, given that E. coli can spread via the fecal-oral route, or from person-to-person through hands or surfaces/objects contaminated with feces, long-term care facilities and daycares are other potential sites of outbreaks. Transmission in these settings may occur during diaper changes, while changing an older adult's incontinence undergarments, and through contaminated objects like toys.
What are some E. coli prevention tips?
As with other foodborne illnesses, following good food safety practices is key to prevention. E. coli prevention extends beyond just food safety though, so we're covering a few others here as well.
- Clean your hands and surfaces often while preparing food to prevent cross-contamination, especially if handling raw meat. Always wash your hands after using the restroom or changing a diaper. To clean surfaces, first, remove any soil or food debris and then apply an EPA-approved surface sanitizer that is effective against E. coli and other foodborne pathogens with realistic contact times, and preferably does not require a rinse step after use on food-contact surfaces.
- Keep raw meat and eggs separate from other foods, especially foods that have not been cooked or are ready to eat. Use different cutting boards, knives, and utensils for raw and uncooked food.
- Cook foods, especially raw meats and poultry, thoroughly and use a food thermometer to make sure meat has reached a safe internal temperature (160° F for ground beef and 165° F for chicken).
- Do not drink unpasteurized (raw) milk, juice, or apple cider.
- Do not eat raw dough, batter, or other products made from raw milk.
- Wash fruits and vegetables well under running water.
- Prevent waterborne transmission by not swallowing water while swimming – make sure to explain this to children.
- Wash hands thoroughly or use alcohol-based hand sanitizer after interacting with animals at farms, fairs, aquariums, or petting zoos.
- Be cautious of certain foods and drinks while traveling to certain countries abroad.
How can my foodservice establishment prevent E. coli outbreaks?
Ensure staff are trained and follow your establishment's protocols and procedures to prevent foodborne illness outbreaks – this should include best practices to prevent cross-contamination (moving pathogens around from a surface, food item, or person to another object) like:
- Ensuring employees comply with hand hygiene policies, including thoroughly washing all surfaces of their hands for at least 20 seconds after using the restroom, after handling raw meat/poultry/eggs, and other key moments. Emphasize proper glove use to avoid bare-hand contact with food.
- Cleaning and sanitizing cooking utensils and food-contact surfaces when switching between types of food.
- Ensuring staff follows hot and cold food handling requirements and proper cooking instructions (like cooking foods to safe internal temperatures).
- Providing sick leave policies and employee wellness screenings to encourage staff not to show up to work sick.
- Purchase food from suppliers with food safety programs in place.
For more on preventing cross-contamination, read the blog: "Contaminated Surfaces – A Cross-Contamination Risk in Retail and Foodservice Establishments."
For additional information on E. coli, visit the CDC's E. coli homepage. For additional food poisoning prevention tips, read about the CDC's "Four Steps to Food Safety" and our blog "Salmonella 101: Protecting Against Foodborne Illness."
Do PURELL® products kill E. coli?
The U.S. Food and Drug Administration (FDA) does not allow manufacturers of hand sanitizer or soap to make claims regarding the efficacy of these products against E. coli or any specific bacteria. A claim around the efficacy of PURELL® Hand Sanitizer against any specific virus or bacteria would be an off-label claim and not permitted under the FDA rules.
PURELL® Surface Sanitizers, Disinfectants, and Wipes are EPA-registered, safe for most hard surfaces (spray is also safe on most soft surfaces), and quickly kill 99.9% of viruses and bacteria, including E. coli, Salmonella, and norovirus (spray kills in 30 seconds), the flu virus, and human coronavirus (COVID-19). They earned the EPA's lowest allowable toxicity rating (Category IV), so they don't contain harsh chemicals or fumes and don't require gloves, handwashing, or rinsing after use – even on food-contact surfaces. PURELL® surface sprays are certified for the EPA's Design for the Environment (DfE) as part of the EPA's Safer Choice program.
Businesses interested in PURELL® products should contact their GOJO distributor click here to schedule a meeting with our representatives, or find a distributor now.