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VACATION
INJURIES
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The U.S. Food and Drug Administration (FDA) establishes the
foundation for food safety in its Model Food Code, officially revised
and published every four years. We will refer to the current (FDA,
2013) version in our brief discussion here. Food safety depends on
strong partnerships. The Centers for Disease Control and Prevention
(CDC), the FDA, and U.S. Department of Agriculture’s (USDA)
Food Safety Inspection Service collaborate at the federal level to pro-
mote food safety. State and local health departments and food in-
dustries also play critical roles in all aspects of food safety. CDC
provides the vital link between illness in people and the food safety
systems of government agencies and food producers. Note that in-
dividual states’ legislatures write the enforceable laws and delegate
enforcement responsibilities to local health departments, so while
there is uniformity across the nation, some states adopt more restric-
tive standards.
Food safety hazards are divided into three major categories: bio-
logical, chemical, and physical. Biological hazards are microorgan-
isms such as bacteria, viruses, parasites, and fungi. Chemical hazards
are delineated in two major categories: naturally-occurring and man-
made. The several foods identified as potential allergens are catego-
rized as chemical hazards. Physical hazards are usually foreign
materials improperly incorporated into foods, but also natural sub-
stances left due to improper processing.
Bacterial hazards grow in foods, so a very small amount of con-
tamination can quickly become significant problems. Good tem-
perature control is essential to preventing growth, but it must be
practiced along with other clean and sanitary handling techniques.
Some bacteria, like Campylobacter, Listeria, Vibrio, Salmonella, and
Shigella directly infect because they are present as naturally occurring either anaerobes or facultative anaerobes; therefore, vacuum-packed
flora in various categories of foods that are usually improperly
cooked or mishandled after cooking. Several others, such as Staphy-
lococcus aureus, Clostridium botulinim, Bacillus cereus, Clostrid-
ium perfringens, and Shiga-toxin producing strains of Escherica coli
produce toxins that quickly cause symptoms to appear. These toxins
are heat stable, so cooking foods will not remedy a situation where
food was mishandled in its raw state. The most common viral haz-
ards include Hepatitis A and Norovirus (the most common of the
FBI). Common parasites include Trichinella and Anasakis. Fungi
(molds and yeasts) become FBI sources in improperly stored, aged
foods. Most are also toxin producers.
Chemical hazards that occur naturally are toxins found in certain
types of seafood, mushrooms, rhubarb leaves, potato sprouts, and
fava beans. Proteins found in peanuts, egg products, milk products,
fish, shellfish, crustaceans, wheat gluten, and soy products are aller-
genic chemicals. Man-made chemical hazards include agricultural
chemicals such as herbicides and pesticides, cleaning and sanitizing
agents, reactive metals and plastics improperly used as food contact
20 San Antonio Medicine • May 2016
surfaces, and medications. The best ways to deal with these is knowl-
edge of their presence, proper use, and avoidance.
Various physical hazards can cause a choking or laceration hazard
if ingested; they may also be a source of biological or chemical haz-
ards. Common physical hazards include: glass, jewelry, plastic (wrap-
pings, containers), wood (cutting boards, spoons), stones/pits/seeds,
metal fragments from can openers, eggshells, and hair. Proper han-
dling and preparation procedures should prevent the presence of
these types of hazards.
Knowing what the various types of hazards causing FBI are, we
can now address their prevention or control.
The most serious FBI cases are caused by bacteria, so our discus-
sion will focus on this particular type of hazard. Proper temperature
control focuses on a simple axiom: keep hot food hot, keep cold
food cold, and keep frozen food frozen, or don’t keep it! The FDA
considers various high-protein, neutral pH, high-water activity foods
as Time and Temperature Control for Safety (TCS) Foods. Foods
traditionally known as “perishable”: meat, dairy, poultry, eggs,
seafood, soy, leafy greens, prepared rice and beans, even potatoes
and tomatoes fit in this category.
The FDA Temperature Danger Zone (TDZ), a range of 94 de-
grees on the Fahrenheit scale, illustrates the versatility of bacterial
growth. Therefore, keeping foods out of the TDZ or rapidly pro-
cessing through the TDZ should be a primary goal. The total time
food is allowed to be in the TDZ should not exceed four hours; this
is all the time it takes for enough bacteria to be generated to cause
illness. Acidification and lowering the available water in a food also
helps prevent bacterial growth. Most of the FBI-causing bacteria are
foods and canned foods offer little protection from bacterial growth.
Fig. 1, Temperature Standards
The CDC and FDA recommend four essential actions to keep
foods safe: COOK-CHILL-CLEAN-SEPARATE (CDC, 2015).
These practices may be paired: cooking and chilling maintain proper