title: Foodhandler-associated Salmonella outbreak in a university hospital despite routine surveillance cultures of kitchen employees.
abstract: OBJECTIVE
  To describe an outbreak of salmonella food poisoning that probably was due to contamination of mashed potatoes by a foodhandler, which occurred despite a policy for routine surveillance stool cultures of kitchen employees.
  
  
  METHODS
  A case control study of 223 individuals who ate the lunch meal on September 23, 1989, at the Jordan University Hospital (JUH) cafeteria.
  
  
  METHODS
  Tertiary care university hospital in Amman, the capital of Jordan.
  
  
  METHODS
  Individuals who developed loose stool or vomiting 6 to 72 hours after eating the lunch meal of September 23, 1989, at the JUH cafeteria.
  
  
  RESULTS
  Of 619 individuals, 183 fit the case definition (attack rate, 19.6%); 150 were employees, 26 were inpatients, and seven were visitors. Twelve other employees became sick 4 to 6 days later and probably were infected secondarily. The incubation period ranged from 16 to 72 hours in 183 instances. Symptoms included diarrhea (88%), fever (71%), abdominal pain (74%), dehydration (34%), and bloody stool (5%). Eighty-four were hospitalized. Cultures of eight food items were negative, but stool culture on 90 of 180 patients and 11 of 61 kitchen employees yielded Salmonella enteritidis group D. A cohort study of 223 individuals revealed a food-specific attack rate of 72% for the steak and potato meal and 18% for the rice and meat meal (RR, 4; CI95, 2.62 to 6.24; P < 0.01). Stratified analysis of the steak and potato meal revealed that the potatoes were implicated most strongly (RR, 1.93; CI95, 1.42 to 2.64; P < 0.01). Cultures were obtained from all kitchen employees, and 11 of 61 grew Salmonella enteritidis group D. One asymptomatic, culture-positive employee prepared the mashed potatoes on September 23. All of these employees had negative stool cultures 3 months earlier.
  
  
  CONCLUSIONS
  This outbreak probably was caused by massive contamination of mashed potatoes by the contaminated hands of the foodhandler. Routine stool culture of foodhandlers is not cost-effective and should not be used as a substitute for health education and proper hygienic practices.
authors.affiliation: Department of Pediatrics, Jordan University Hospital, Amman.
authors.forename: N A
authors.initials: NA
authors.lastname: Khuri-Bulos
authors.forename: M
authors.initials: M
authors.lastname: Abu Khalaf
authors.forename: A
authors.initials: A
authors.lastname: Shehabi
authors.forename: K
authors.initials: K
authors.lastname: Shami
mesh_terms: D001431:Bacteriological Techniques; D016022:Case-Control Studies; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005243:Feces / Q000382:microbiology; D005511:Food Handling; D005516:Food Microbiology; D005521:Food Service, Hospital; D006785:Hospitals, University; D006801:Humans; D007597:Jordan; D010564:Personnel, Hospital; D011159:Population Surveillance; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000635:transmission; D012477:Salmonella enteritidis / Q000302:isolation & purification