October 20, 2005
More than 10 percent of all food-poisoning incidents in the United States occur in schools — a danger because food-borne illness in children, as in the elderly, can be deadly.
In the late 1990s the federal government formed a special committee on the safety of food in schools, involving school nurses to serve a larger role in preventing and monitoring symptoms of food poisoning, said Elaine Brainerd, director of the Food-Safe Schools project for the American Nurses Foundation.
“In Rhode Island, about 10 years ago, a central kitchen had been preparing school lunches that were later transported to the local schools,” Brainerd told UPI’s Caregiving. “One day, they baked hams for the next day and one employee who apparently had a cold stayed late to peel the skins off the hams once they were cool enough to handle.”

The large hams were stacked together in a large pan and were refrigerated, she said.
“The next day the hams were sliced and served in several schools and there were several sick children,” she continued. “The worker must have sneezed or coughed into his hand and then touched some of the hams (and) the Staphylococcus toxin grew (on those slices).”
Only some of the children got sick, and it took a while to figure out that only the contaminated slices contained the toxin, Brainerd explained.
“Many food-service workers do not get sick days or healthcare, are not well paid, and many go to work sick,” she said.
A school nurse for many years, Brainerd edited the recently released “Food-Safe Schools Action Guide” as a food-borne-illness resource. The booklet is available at
A lot has changed since baby boomers bought Untidy Josephs — aka Sloppy Joes — in the school cafeteria or took their lunch to school in a Partridge Family metal lunchbox.
“It’s amazing what we did back then,” Brainerd said. “We used to keep our tuna-fish sandwiches on the radiator. There were food-borne illness outbreaks, but unless someone died or got chronically ill — we thought we had ‘stomach flu.’ Even today, it’s hard to track. Many get sick but don’t go to the doctor. The American Medical Association had to make a primer for doctors on what to look for, tests that have to be specially ordered and how to report food-borne illness to the health department.”
Chemicals, heavy metals, parasites, fungi, viruses and bacteria all can cause food-borne illnesses, but bacteria are the most common culprits, with Staphylococcus aureus, Salmonella, Clostridium perfringens, Campylobacter, Listeria monocytogenes, Vibrio parahaemolyticus, Bacillus cereus and Escherichia coli — better known as E. coli — the most common.
Some of the bacteria have become easier for health officials to identify, but food also travels longer distances, from places such as China, and may become contaminated from unhygienic workers or contaminated irrigation water.
E. coli O157:H7 is an emerging cause of food-borne illness, with an estimated 73,000 cases of infection and 61 deaths occurring in the United States each year, according to the Centers for Disease Control and Prevention in Atlanta. Some acquire hemolytic uremic syndrome, a life-threatening condition often requiring blood transfusions and kidney dialysis. About one-third with hemolytic uremic syndrome develop abnormal kidney function and a few require long-term dialysis, while others have lifetime complications including high blood pressure, seizures, blindness, paralysis and bowel removal, according to the CDC.
Most E. coli infections have been associated with eating undercooked contaminated ground beef, although it also can be caused by consuming raw milk, eating uncooked alfalfa sprouts and after swimming in or drinking sewage-contaminated water.
CDC officials recommend cooking ground beef until it reaches an internal temperature of 160 degrees Fahrenheit, although some supermarkets advise cooking to 180 degrees F.
“Most professional kitchens know to prepare foods and to keep foods under 40 degrees and over 140 degrees F, but the meals to watch out for are the potluck suppers and picnics,” Brainerd said. “We recommend against them or to give parents the information they need on preparing and transporting food — especially anything with protein such as meat, milk, eggs, cheese and mayonnaise, on which bacteria can easily grow.”
Meanwhile, the CDC is getting set to implement an electronic system that will track where the food is grown and processed that is transported to schools. The old system was a paper trail that required quarterly reports and had a lag time of 18 months.
Brainerd recommends that parents wash all produce used in school lunches, use insulated lunchboxes and cooling packs and, most important, require children to wash their hands or use a hand wipe before eating.

Alex Cukan is an award-winning journalist, but she always has considered caregiving her primary job. E-mail: