Certain Diamond Pet Foods products have been recalled due to contamination with the bacterium Salmonella Infantis
CDC podcast on this topic

At least fourteen people in nine states have been infected with Salmonella Infantis as a result of contact with contaminated dry dog food, according to a report from the Centers for Disease Control and Prevention (CDC).  Although no deaths have been reported, five of the patients were hospitalized.  Those infected range in age from less than one year to 82 years old.  No dogs have been reported sickened.

CDC determined that all of the ill individuals had handled dry Diamond Pet Foods produced in one Gaston, South Carolina, plant.  A list of products recalled can be found on this Food & Drug Administration (FDA) website and on the Diamond Pet website.  Pet owners can learn how to obtain a refund for recalled products here.  For questions on the recall, CDC has posted the following telephone number for Diamond Pet Foods:  (800) 442-0402.

I blogged last November on the issue of pet products and Salmonella contamination, and said that FDA had announced a year-long effort to collect and analyze samples of pet products for Salmonella bacteria.  The program began last October and will extend until September, 2012. An FDA statement notes the agency became involved in the outbreak investigation early last month when the Michigan Department of Agriculture and Rural Development detected Salmonella during retail surveillance sampling. Salmonella was also detected in Ohio by the state Department of Agriculture and in South Carolina during an FDA inspection. In addition to those states, recalled products were distributed in Alabama, Florida, Georgia, Kentucky, Maryland, North Carolina, New York, Pennsylvania, Tennessee, and Virginia.  According to the FDA, Diamond Pet Foods is working directly with distributors and retailers to remove recalled products as quickly as possible.  Meanwhile, pet owners can reduce the ever-present risk of illness from contaminated pet products:

Pet Owner Safety Tips

Purchase and Storage

• Purchase products in good condition (with no damage to packaging).
• Store dry products in a cool, dry place (under 80 °F).

Pet Boundaries

• Keep pets away from household food storage and preparation areas.
• Keep pets away from garbage and household trash.
• Supervise young children around pets and keep them away from pet feeding areas.

Clean up after your pet: Dispose of pet feces in a tightly sealed plastic bag.

Food/Preparation

• Wash your hands for 20 seconds with hot water and soap before and after handling pet products.
• Use a clean, dedicated scoop or spoon to transfer pet food to feeding bowl; do not use your pet’s feeding bowl as a scooping utensil.
• Wash pet food bowls thoroughly with hot, soapy water to clean.
• Disinfect feeding bowls periodically (see downloadable poster):
• Wash with hot soapy water to clean; thoroughly rinse off soap
• Sanitize with chlorine bleach solution (1/4 cup bleach + 1 gallon water); leave wet for 10 minutes
• Rinse and dry.

Linda Golodner is President Emeritus of the National Consumers League and Vice Chair of the Water Quality & Health Council.

Rocky Ford cantaloupe being planted at Hirakata Farms, Colorado (Photo courtesy of BCDemocratOnline.com)

Spring cantaloupe planting is under way in Colorado, and following a tragic foodborne disease outbreak last year, growers are determined to regain consumer confidence. In 2011, over 30 people died and at least 146 were sickened during a Listeria outbreak traced to contaminated cantaloupe (see January 20, 2012 blog). Jensen Farms, the source of the Listeria outbreak, is located near Holly, Colorado, about 100 miles east of the Rocky Ford region, which was initially identified in news reports as the “epicenter” of the outbreak. Those reports took an economic and reputational toll on all Rocky Ford cantaloupe growers. This spring, as cantaloupe seeds are being pressed into Colorado soil, growers are taking aggressive measures to shore up their practices to avoid a repeat of last season’s catastrophe.

Rocky Ford Growers Association: According to The Durango Herald, growers have formed an association with self-imposed rules to promote safe cantaloupe production. The newspaper reports farmers who join the association must agree to twice-a-year safety audits—one announced and one unannounced—conducted by state Agricultural Department inspectors. Only association members will be allowed to use the Rocky Ford trademark. According to the newspaper article, Jensen Farms will not be asked to join the association reportedly due to its distance from the Rocky Ford region. It is unclear, according to the newspaper, whether Jensen Farms will resume cantaloupe production this year.

Post-harvest Produce Processing 

Growers in the new association will adhere to stringent food safety standards developed by Colorado State University and California researchers to avoid the problems that led to Listeria contamination at Jensen Farms. In particular, cantaloupe post-harvest processing will include rapid cooling and chlorine disinfectant in wash water.  Both measures help curtail the growth of Listeria and other bacteria; both were lacking in the Jensen Farms packing shed.

Seed-to-Store Tracking

In an effort to provide increased transparency for customers, including consumers, the Rocky Ford Growers Association has hired a tracking company to monitor cantaloupe from seed to store, identifying any problems along that path.  KOAA.com reports consumers can use smartphones to read a QR code on a sticker that tracks produce back to the seed and farm from which it originated and the date of its harvest.  In some cases the sticker will be on individual melons, in other cases they may be on packing crates.

Going Forward

Rocky Ford cantaloupe growers are to be commended for their aggressive food safety measures, which could serve as a model for other growers. The only good that can come from a tragedy as serious as last year’s outbreak is earnest determination to increase the safety of food processing.  Consumers should remember that they can play a role in food safety too:

• Wash fresh produce thoroughlyunder running water just before eating, cutting or cooking, paying special attention to the convoluted outer skin of produce such as cantaloupe. (see www.FoodSafety.gov for more information).
• Clean and sanitize food-contact surfaces (see the FDA web page, “Keep Listeria out of Your Kitchen”).

Linda Golodner is President Emeritus of the National Consumers League and Vice Chair of the Water Quality & Health Council.

¹QR codes are small, 2-dimensional, square icons on products and advertising material that one can hold a smart phone up to in order to access product information instantly.

This downloadable poster for healthcare providers is available on the CDC website in English or Spanish. Would you consider presenting it to your healthcare provider?

It’s a well-known fact that hand-washing is one of the most important measures for reducing the spread of infection. Yet, healthcare workers, of all people, often fail to wash their hands!  One potential approach to this problem is to encourage patients, before submitting to treatment, to confirm verbally that doctors and nurses have indeed washed their hands.  But a new pilot study published in the Journal Infection Control and Hospital Epidemiology finds many patients are reluctant to question the hand hygiene of medical personnel.

According to an article on the study in Infection Control Today, patients in an Australian hospital were provided a brochure giving them permission to inquire if healthcare workers had washed their hands.  This small study found patients were willing to confront doctors only 43 percent of the time and nurses 67 percent of the time.  The report adds that “doctors consistently have the lowest [hand hygiene] compliance of all [healthcare workers].”  What’s going on?

Why Don’t Patients Speak Up?

Putting aside the problem of poor hand-washing rates among medical professionals, patients are often reticent to question those with whom they entrust their healthcare.  As a society we revere physicians and are usually confident they are acting in our best interests. One of the principal precepts of medical ethics, summarized in the phrase, “first, do no harm” renders inexcusable a doctor’s behavior that may lead to an infection in a patient; dare we call them on it?

Additionally, patients may fear offending their healthcare provider, thereby inadvertently reducing the level of care received.  Unfortunately, this may lead to a situation in which, instead of concentrating on the actual purpose of the visit, patients may be calculating the relative risks and benefits of speaking up on a matter unrelated to the reason for the appointment.

How Do We Fix Healthcare Hygiene?

One study of hospital intensive care unit healthcare workers found employing positive feedback raised hand-washing rates dramatically.  In situations where patients observe a lapse in hand hygiene, whether the hands belong to a doctor, nurse, or anyone else who is about to make skin contact, a tactful reminder is in order.  The patient may do this by inquiring as to the hand hygiene policy of the organization.  Alternatively, patients might point out in a friendly way that the CDC website encourages patients to remind doctors and nurses to wash their hands (CDC podcast).

Patients deserve the peace of mind that their medical visit will not result in a preventable infection. Let’s hold all those employed in healthcare to a reasonable standard of hygiene.  Patients, speak up!

Barbara M. Soule, R.N. MPA, CIC, is an Infection Preventionist and a member of the Water Quality & Health Council.

Image of hand sores associated with Hand, foot and mouth disease; image courtesy of CDC

Hand, foot and mouth diseaseⁱ is a viral illness caused by coxsackievirus. Afflicting mostly children, coxsackievirus normally causes mild fever and rash or sores on the palms of the hands and soles of the feet, and sores or blisters in the mouth. Recently, the US Centers for Disease Control and Prevention (CDC) reported coxsackievirus A6 in four states. Previously seen only in some European and Asian countries, the “A6” strain causes more severe symptoms and more hospitalizations. An April 20 article in USA Today states the virus “can hit kids and adults hard, causing fingernails and toenails to fall off two to three weeks after the illness has passed.”

The Reno Gazette-Journal cited 30 cases of hand, foot and mouth disease in Nevada’s Washoe County in a March 30 article. According to the article, in addition to the Nevada cases, 46 other cases had been reported in California, Connecticut and Alabama. The April 20 USA Today article indicates the virus is spreading around the country and that, according to one physician, about 25 percent of cases are in adults.

According to CDC, the cases were identified as unusual by healthcare providers or by health departments that contacted CDC for diagnostic assistance. Coxsackievirus A6 was identified in clinical specimens collected from 25 of 34 patients. The majority of those infected, 70 percent, had exposure to a child care facility or school. Hand, foot and mouth disease is not a “reportable” illness in the United States, meaning that physicians are not obliged to report diagnoses of the illness to government agencies. However, as healthcare providers and health departments contacted CDC with questions, and the significance of clinical results became clear, attention was focused on this uncommon strain of coxsackievirus.

Coxsackievirus is spread by person to person contact, especially during summer and autumn months. According to WebMD, there is no treatment for hand, foot and mouth disease other than pain relievers, such as acetaminophen. Infection usually lasts about one week. CDC notes that transmission of the virus can be reduced by maintaining good hygiene, including frequent hand-washing and disinfecting surfaces in child care settings.

Advice for Preventing Hand, Foot and Mouth Diseaseⁱⁱ

• WASH YOUR HANDS often and carefully, especially after using the bathroom, preparing food or drinks and changing diapers.
• DISINFECT ITEMS AND HARD SURFACES by washing them with hot, soapy water, then applying a solution of two tablespoons of bleach and four cups of water; rinse with clear water and dry.
• LIMIT CONTACT WITH INFECTED PERSONS by avoiding hugging, kissing or sharing cups or utensils.

Finally, CDC recommends contacting your health provider if you suspect a severe case of hand, foot and mouth disease.

Fred Reiff, P.E., is retired from the Pan American Health Organization, and lives in the Reno, Nevada area.

ⁱVesicular pharyngitis and vesicular stomatitis with exanthema
ⁱⁱBased on recommendations from the Washoe County, Nevada Health District

Recycle a clean, clear plastic, one-liter beverage bottle by filling it with water and three tablespoons of chlorine bleach, secure the bottle in a hole in a metal roof, and you have all the technology needed to illuminate the dark interiors of thousands of homes of the world’s poorest people. In an ingenious use of optics and chlorine chemistry, and for very little money, 55 watts of solar energy are streaming into formerly unlit homes in communities in Brazil and the Philippines. Many of the homes being outfitted with the device were perpetually dark due to the close, side-by-side construction of rudimentary dwellings. Now the spirits of residents are brightening along with their interior dwellings: Daylight is penetrating their living quarters.

The solar bottle bulb was invented by a group of resourceful Massachusetts Institute of Technology students; bulbs take approximately an hour to install. Solar bottle bulbs are positioned to rest partly above and partly below the roof surface, protruding from the interior ceiling. During the daytime sun rays stream into the water bottle, bending (refracting) and internally reflecting to produce a bright light source that does not depend on an electrical connection. As an example of the physical phenomena responsible for this lighting technology, the brilliance and “fire” of diamonds are caused by light refracting and reflecting throughout the crystal.

Chlorine Bleach Helps Light up the Darkness

Good sunlight refraction and reflection depend upon a clear water medium, just as a diamond’s brilliance depends on its clarity. Chlorine bleach plays the role of destroying the microorganisms that could proliferate inside the bottles, reducing the clarity of the water. As for maintenance, water and bleach must be replaced, but only every five years. It is not clear how long the beverage bottles hold up in this role (caps are protected from cracking with sealant—see the video), but replacing them should not be too great a hurdle.

Solar bottle bulbs are a wonderfully safe, cheap, energy-efficient lighting technology being supplied to those who need it most! Kudos to the inventors and the installers!

Bruce Bernard, PhD, is President of SRA International, Inc. and Associate Editor of the International Journal of Toxicology.

A significant global public health milestone has been reached: In the two decades between 1990 and 2010, over two billion people worldwide gained access to clean drinking water sources,ⁱ according to the United Nations (press release). This raises to 6.1 billion the number of people on Earth with access to clean drinking water, a full 89 percent of the world’s population.

In 2000, the United Nations Millennium Declaration vowed to reduce extreme poverty in the world by meeting a series of time-sensitive goals known as the Millennium Development Goals (MDGs). One of those goals was to halve by 2015 the fraction of the world population that lacked sustainable access to safe drinking water in 1990. That fraction has been more than halved from an estimated 24 percent to 11 percent, and it was accomplished five years ahead of schedule! Nearly half of these gains were made in China and India.

According to a joint report by UNICEF and the United Nations, of the 783 million people still without safe drinking water, the majority live in countries that are not among the world’s poorest. More than 40 percent of the global population without access to safe drinking water lives in sub-Saharan Africa. The graph below illustrates where the roughly 11 percent of the world population without the benefit of safe drinking water reside. In the US, overall 99 percent of the population has access to safe drinking water; the remaining one percent reside in rural areas and include some Native American populations, which according to at least one account, may be approximately 10 percent underserved.

We Can’t Stop Now

The global public health gains achieved with respect to drinking water between 1990 and 2010 are laudable. Yet, there is much work left to be done. According to the UNICEF/UN joint report, given rapid population growth, it is estimated that over 780 million people could be without safe drinking water by 2015. That would represent essentially zero progress since 2010. In addition, while access to improved sources has increased, poor water quality means access to safe water has not been guaranteed and thus more monitoring and disinfection may be warranted. Intensive efforts are needed to keep pace and address the last segment of humanity without safe water.

Joan Rose, PhD, is the Homer Nowlin Chair in Water Research at Michigan State University and a member of the Water Quality and Health Council.

ⁱActually called “improved” water sources, this denotes water sources protected from outside contamination by virtue of pipe delivery or protected well water, for example

According to the online article Water and Your Body, water serves many critical purposes in the human body: It carries waste and toxins from the body, participates in critical chemical reactions, lubricates and cushions joints, serves as a “shock absorber” inside the eyes and spinal cord, aids in the body’s temperature regulation and maintains blood volume. Researchers suspect 75 percent of Americans have mild, chronic dehydration, believed to be a common cause of daytime fatigue.

Facts on Dehydration and Drinking Water

• Know How Much Water You Need on a Daily Basis
• The old guideline of 8 glasses of water per day for adults is not far off. According to the Mayo Clinic, the Institute of Medicine determined men need about 13 cups (3 liters) and women need about 9 cups (2.2 liters) of water every day from all sources, including fluids contained in fruits and vegetables. Foods can provide about 20 percent of total water intake.
• A guide to water requirements for children from the Institute of Medicine:

• Raise your water intake…
• When you exercise
• In hot or humid weather, heated indoor air or high altitudes
• If you are vomiting or having diarrhea
• If you are pregnant or breast-feeding

• Know the Common Causes of Dehydration¹:
  • Diarrhea (This is especially common in the developing world where poor water quality results in waterborne disease.)
  • Vomiting
  • Exercise that induces sweating
  • Warm weather outdoor activities
  • Air travel (Low humidity cabin air can dry the skin and mucous membranes.)
• Know the Warning Signs of Dehydration that Can Lead to Heat Exhaustion or Stroke
  • A body temperature over 102 degrees Fahrenheit or severe cramps in the abdomen, arms or legs
  • Dark yellow or odorous urine
  • Dry or sticky mouth
  • Excessive loss of fluid through vomiting, diarrhea or sweating
  • Fatigue
  • Thirst
  • Headache or light-headedness
  • Dry, warm skin

According to Water and Your Body, after oxygen, water is the human body’s most important need. It’s simple and healthful, so make it a habit: drink water!

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

¹NOTE: A person can become dehydrated not only from loss of water but also from the loss of electrolytes, salts and minerals needed for bodily functions. Sports drinks can help replace electrolytes.

Rice field in the south of Haiti

The Artibonite department is one of the most important regions of Haiti. For centuries, its thousands of acres of luxuriant vegetation carried the weight of the nation’s national production of rice, which once totaled 210,000 metric tons annually. As the most important and appreciated element of the country’s diet, the rice market single handedly supported the rural economy, helped famers prosper, and supplied rice to the entire country.

Today the once lush acres of the Artibonite Valley are austere and unused. The irrigation dams and canal, crucial to the production of rice, are either dry or deteriorated. Consequently, Haitian rice farmers are left poor, struggling, and in debt. There are several reasons for this. Trade policies, environmental degradation, unsustainable farming techniques, poor irrigation, and poor mechanization are factors that have likely contributed to its demise.

But one problem has stood above them all: the ability to manage water resources effectively.

Today, water can be a blessing, and other times, a curse for the region. Due to deforestation, the usual and expected heavy rainfall during the rainy season immediately ends up in the valleys, flooding fields and villages. As the old adage goes, when it rains it pours. Rainstorms often leave whole towns under water and rice fields resembling lakes.

During the dry season, usually lasting from November until March, there is little farming activity in most parts of the country. Unused and clogged irrigation canals play no role in agricultural production. However, despite the erratic consequences of the seasons, one thing that is certain is that Haiti needs a better balance between food supply and population growth to enhance its food security.

Reforestation can help restore natural water catchments. Moreover, trees can also help mitigate the effects of extreme weather events by controlling the flow of surface water and reducing the runoff of soil. Lastly, trees can also reduce the risk of droughts by retaining water in the local environment and cooling local temperatures by shading the soil.

Better technology can also help. One of the most exciting and newest technologies in irrigation –drip irrigation—saves water and helps farmers get more crops per drop. Irrigated agriculture can help Haiti once again produce more rice, of better quality, with less water. Significant improvements are already technologically possible in water delivery and application efficiency to ensure the best crop yield and water conservation.

Today on World Water Day 2012, we celebrate the significant progress that has been made and acknowledge the challenges that we face as a world. Water can be a key catalyst in the revival of Haiti’s Artibonite Valley. Initiatives such as repairing and scaling up irrigation canals, introducing new irrigation technologies, reforesting bare lands, combined with the right mechanization and strategy, can give the Artibonite Valley a desperately needed shot in the arm. These simple strategies can help everyone leverage our most important resource for our most basic needs.

Wesley Laîné is a graduate of the College of the Holy Cross and Program Manager for International Action, which is rebuilding the water system in Port-au-Prince, Haiti following the disastrous 2010 earthquake. International Action has developed a tank and chlorination system that can supply safe water to thousands of people, neighborhood by neighborhood, helping to prevent cholera, hepatitis, typhoid and chronic diarrhea, the leading killers of children in Haiti.

People repair and replace many things throughout their lives including shoes, clothing, automobile tires, household appliances and the like and sometimes even hips, knees, lungs, and kidneys. Generally, the longer the useful life, the greater the reliability, and the more something is out of sight, the less prepared people become when major renovation or replacement becomes necessary.

This is precisely the case of the massive US buried water piping infrastructure. In this sense it is a victim of its reliability and durability. Many of the systems have exceeded their expected useful life by several decades and a few by more than a century. Numerous systems throughout the US are now nearing or have already reached their expected useful life and are in dire need of replacement or extensive repair.

The continuing postponement and failure to carry out the renovation or replacement will have extremely serious, perhaps even disastrous consequences. One has only to look at the water systems in lesser developed countries that have failed to keep up with repair and replacement to obtain a preview of the hardship, inconvenience, illness, and monetary and social costs associated with failing to replace and renovate this essential infrastructure in a timely manner. The following list cites the most prominent examples.

The Costs of Ignoring Drinking Water Infrastructure Needs

An ample available supply of clean water is indeed the lifeblood of our society. As costly as replacement and renovation of the buried water pipeline infrastructure will be, it will be far more expensive in numerous ways for US cities, towns, and communities to ignore this issue and continue to postpone the needed upkeep of possibly their most valuable asset.

Fred Reiff, P.E., is retired from the Pan American Health Organization, and lives in the Reno, Nevada area.

¹Includes norovirus, cholera, typhoid fever, bacillary dysentery, giardiasis, infectious hepatitis, cryptosporidiosis, rotovirus

PVC pipe infrastructure project
Photo courtesy of the Vinyl Institute

There is a complex, buried system of more than a million miles of pipe under our feet.  Through these pipes, clean drinking water flows to points of use, servicing millions of homes, businesses and institutions.  Unfortunately, this hidden but essential asset has reached its sunset years in many cities and towns.  In some places, such as Washington, D.C., certain components are more than 100 years old, and frequently the expected useful life of the pipes has been greatly exceeded.  It could be said that such facilities are “living on borrowed time”.

According to a report by the American Water Works Association (AWWA), the underground drinking water infrastructure is in need of massive, costly renovation:  over the next 25 years, an estimated $1 trillion will be required.  This includes finding and fixing leaks, replacing aging and corroded pipe, and expanding water delivery to areas of new development.  The bulk of the cost will be met through local fees and doubling and even tripling consumer water bills, states AWWA.

Infrastructure renovation needs vary by region.  AWWA notes community growth will drive the need for new infrastructure in the South and West.  Older water systems in the Northeast and Midwest require miles of pipeline replacement among other improvements.  Small communities with the fewest residents to share the “pain at the pipe” will often bear the highest per capita costs.

As costly as it will be, America cannot afford to ignore this issue because its drinking water infrastructure is essential to:

• Public health protection by supplying clean water for drinking, bathing and cooking and a system of sanitation to remove wastewater without contaminating the water supply or the environment.

• Public safety through fire protection.

• Economic activity that supports a high standard of living.

Leaks in the current infrastructure waste seven billion gallons of water every day, according to the American Society of Civil Engineers.  In addition, aging infrastructure can reduce drinking water quality.  Whereas EPA drinking water regulations over the past decades have caused an increase in the quality of water leaving the treatment plant, those improvements could be negated as water travels through a corroding pipeline.

Clean water is the lifeblood of society.  Let’s invest in the goal of keeping it flowing cleanly and efficiently for generations to come.

Buried No Longer:  Confronting America’s Water Infrastructure Problems (American Water Works Association, 2012) can be found online at:  http://www.awwa.org/files/GovtPublicAffairs/GADocuments/BuriedNoLongerCompleteFinal.pdf

Next week:  Pain at the Pipe- Part 2:  The Consequences of Ignoring US Water Infrastructure Needs

Fred Reiff, P.E., is a retired official of the Pan American Health Organization.