OzFoodNet, Australian Capital Territory Health Protection Service, Canberra, Australia.
Foodborne Pathog Dis. 2011 Jul;8(7):791-6. doi: 10.1089/fpd.2010.0785. Epub 2011 Mar 7.
Clostridium perfringens food poisoning is a commonly cited cause of gastroenteritis outbreaks among elderly long-term care facility (LTCF) residents, yet little is known about the natural history of disease in this vulnerable group. In July 2009, an investigation into diarrheal illness among LTCF residents was commenced.
An environmental health investigation and retrospective cohort study were undertaken to confirm the outbreak, to identify a source and mode of transmission, and to implement public health measures to prevent further cases. Menu listings and food safety program details were obtained and food-handling practices were observed. Clinical notes of all residents were reviewed. A possible case was defined as any resident developing one or more acute loose stool episodes between the evenings of 23 July and 27 July.
Fifty-two residents (41%) had been ill with diarrhea, and eight residents had fecal samples positive for C. perfringens enterotoxin. LTCF staff failed to perform routine temperature checks on hot foods before the outbreak. A sweet-and-sour pork lunch served on 23 July was implicated in causing residents' illness, but no residual food remained for microbiological testing. Independent associations with illness were demonstrated among residents living in two wings of the facility that received a standard level of service, whereas an inverse association with illness was shown among residents living in an "extra service" wing. Male residents were also more likely to become ill. Illness was mild with case patients reporting a median of two loose stools (range 1-12).
C. perfringens is an important cause of both foodborne and nonfoodborne gastroenteritis outbreaks in LTCF, but may be missed due to the often mild nature of illness. This investigation highlights the potential burden of C. perfringens disease among vulnerable LTCF populations. To prevent C. perfringens outbreaks, facilities must adhere to food safety plans and ensure high standards of infection control practice.
产气荚膜梭菌食物中毒是老年人长期护理机构（LTCF）居民中常见的肠胃炎暴发原因，但人们对这一弱势群体疾病的自然史知之甚少。2009 年 7 月，对 LTCF 居民腹泻病进行了调查。
进行环境卫生调查和回顾性队列研究以确认暴发，确定来源和传播方式，并采取公共卫生措施预防进一步发生病例。获取菜单清单和食品安全计划详细信息，并观察食品处理操作。审查所有居民的临床记录。可能病例定义为在 7 月 23 日晚上至 7 月 27 日之间出现一次或多次急性稀便发作的任何居民。
52 名居民（41%）患有腹泻病，8 名居民粪便样本产气荚膜梭菌肠毒素阳性。在暴发前，LTCF 工作人员未能对热食进行常规温度检查。7 月 23 日供应的糖醋猪肉午餐被怀疑引起居民患病，但没有剩余食物进行微生物学检测。在接受标准服务的设施的两个翼楼中，独立的关联与疾病有关，而在提供“额外服务”的翼楼中，与疾病的关联呈反比。男性居民也更有可能患病。患病程度较轻，病例患者报告中位数为两次稀便（范围 1-12 次）。
产气荚膜梭菌是 LTCF 中食源性和非食源性肠胃炎暴发的重要原因，但由于疾病通常较轻，可能会被忽视。该调查强调了脆弱的 LTCF 人群中产气荚膜梭菌疾病的潜在负担。为了预防产气荚膜梭菌暴发，设施必须遵守食品安全计划并确保高标准的感染控制实践。
