title: A mixed foodborne outbreak with Salmonella heidelberg and Campylobacter jejuni in a nursing home.
abstract: OBJECTIVE
  To investigate a mixed Salmonella heidelberg and Campylobacter jejuni foodborne outbreak in a nursing home.
  
  
  METHODS
  Retrospective cohort study with a nested case-control design. Cases were defined by positive stool-culture results. Controls needed to be both asymptomatic and culture-negative.
  
  
  METHODS
  Residents of a 580-bed nursing home in Brooklyn, New York.
  
  
  RESULTS
  Of the 580 residents, 119 (21%) developed illness. Of the 93 symptomatic patients who submitted specimens, cultures were positive for S heidelberg in 24 (26%), C jejuni in 14 (15%), and both microorganisms in 25 (27%). Only the pureed diet was associated highly with infection by either Salmonella (odds ratio [OR], 17.6; 95% confidence interval [CI95], 4.8-68.7; P < .001), Campylobacter (OR, 13.3; CI95, 3.2-59.2; P < .001), or both organisms (OR, 8.9; CI95, 2.7-30.3; P < .001). Among the 42 pureed foods served during the 5 days before the outbreak, five meat or poultry items were associated most strongly with culture positivity. Of these five meat items, only a chopped-liver salad was implicated by the two employees reporting illness. A reported food-handling error occurred when ground, cooked chicken livers were placed in a bowl containing raw chicken-liver juices.
  
  
  METHODS
  Recommendations for proper cleaning and sanitizing of kitchen equipment to prevent cross-contamination between raw and cooked foods.
  
  
  CONCLUSIONS
  Mixed foodborne outbreaks occur rarely. During this outbreak, contamination of a single food item with multiple bacterial pathogens was the likely source of transmission. Improper food-handling techniques that promote growth of one microorganism also allow growth of other pathogens that may be present. Because different sources and routes of transmission may be implicated for different pathogens, specific preventive measures may vary depending on the organisms involved.
authors.affiliation: Bureau of Communicable Disease, New York City Department of Health, NY 10013, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Layton
authors.forename: S G
authors.initials: SG
authors.lastname: Calliste
authors.forename: T M
authors.initials: TM
authors.lastname: Gomez
authors.forename: C
authors.initials: C
authors.lastname: Patton
authors.forename: S
authors.initials: S
authors.lastname: Brooks
mesh_terms: D002169:Campylobacter Infections / Q000175:diagnosis / Q000209:etiology*; D016123:Campylobacter jejuni; D016022:Case-Control Studies; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology*; D005517:Foodborne Diseases / Q000175:diagnosis; D006801:Humans; D009519:New York City; D009735:Nursing Homes; D012189:Retrospective Studies; D012478:Salmonella Food Poisoning / Q000175:diagnosis