Community Health Nursing–I (2:1)

BSc. Nursing (4–Years Program)

Environment and its Impact on

Community Health

Food Sanitation
 Objectives

At the end of this unit, students will be able to;

• Define healthy foods.

• Discuss methods of food preservation.

• Describe principles of safe food handling.

• Explain prevention & transmission of food-borne

disease.
• Identify control of food-borne disease.
 Food Sanitation
A series of protocols designed to prevent contamination
of food, keeping it safe to eat & enhancing food quality.
Food quality is essential nutritional value, cost, & variety
of food available.
Prevents & delay microbial decomposition & damage
from mechanical causes, insects & rodents & ensures
more interesting & nutritionally adequate family meals
 Healthy Foods
Foods that provide essential nutrients & support health.
Any food believed to be ‘good for you’, especially if high in
fiber, natural vitamins, fructose, etc.
Healthy foods reduce cholesterol, reduce atherosclerosis &
risk of stroke, help control glucose, halt progression of
osteoporosis, & reduce risk of infections, cancer.
 Healthy Foods
A healthy food is a plant or animal product that provides essential
nutrients & energy to sustain growth, health & life while
satisfying hunger.
Fresh or minimally processed foods, naturally excess in nutrients,
when eaten in moderation & in combination with other foods,
sustain growth, repair & maintain vital processes, promote
longevity, reduce disease, strengthen & maintain body & its
functions.
It do not contain ingredients that contribute to disease or delay
recovery when consumed at moderation.
Hierarchy of Food Supplements
 Adulteration of Food
• It is mixing, substitution, abstraction or concealing original
quality of food by addition of some harmful
products/chemical agents/colors to food, which have
harmful effect on human health e.g. mixing of water to
milk, mixing of stones or wooden pieces to pulses &
cereals.
• Disadvantages:
– It degrades nutritional status of community
– It upsets the standard composition of food
– Skimming of milk is adulteration
 Fortification of Food

• It is addition of some beneficial items to food to

make it more healthy & useful e.g. vitamin A & D in
ghee & iodine in common salt.
• Advantages:
– It improves the nutritional status of community
– It is used to overcome dietary deficiencies.
– It maintains standard composition of food
– It improves the overall health status of community
 Method of Food Preservation
A process by which certain food like fruits & vegetables are
prevented from getting spoilt for a long period of time.
Color, taste & nutritive value of food are also preserved.
Purpose of Food preservation:
• Prevents/delay microbial decomposition & damage from
mechanical causes (insects, rodents).
• Ensures more interesting & nutritionally adequate family
meals.
• Ensure a safer food intake.
• Provides means of livelihood
• Availability of off-season products
• Prevents food wastage
 Temperature Control
Cold Temperatures (Freezing)
• Reduces the rate of growth of microorganisms
• Converts large percentage of water content of food to ice,
making it unavailable for microorganisms
• Prevents breakdown of cells caused by enzymes
• Freeze-dried foods last months to years examples of uses
are strawberries in muffin mixes, sea food, fruit juice.
 Temperature Control

Hot Temperatures (Heating/Cooking, Pasteurization)

– Destroy microorganisms & enzymes
– Yeast, mold, enzyme – easily destroyed at boiling temp.
(100⁰C)
– Bacteria – sometimes heat resistant
Pasteurization – A food preservation process that heats liquids
to 160°F (71°C) for 15 sec, or 143°F (62°C) for 30 min, in order
to kill bacteria, yeasts, & molds. Food is heated in a closed
system, cooked fast & placed in a sealed container.
– Ex: milk
 Drying
One of the oldest methods of food preservation
• Reduction of moisture content thus preventing
microbial growth
• Exposure to air/artificial heat
• Dried foods are lightweight and easier to store
• Sun dry, room dry, oven dry, dehydrators
Canning Packing food in tightly sealed tin cans or canning jars &
heated at high temp.
• Heating destroys harmful microorganisms
• Sealing prevents the growth of aerobic organisms
• Botulism bac. is most resilient to heat due to endosperm
coating
Irradiation Foods are subjected to gamma rays, still being
researched to ensure safety of treated product
• Helps food maintain chemical make-up
• After exposure, microbes cannot reproduce or make toxins
• Increased radiation increases preservation effect
Smoking Usually combined with salting & drying, used to
preserve fish & meat, gives food good look, flavor & odor.
Pickling Generally applies to food that is preserved in brine
or vinegar
– Fruits & vegetables (firm, flesh, free of blemishes)
– Vinegar (renders a distinctive flavor, preserves by
inhibiting growth of microbes)
– Sugar (acts as a preservative, adds sweetness)
– Spices (gives flavor)
– Other preservatives (alum/tawas- crispness)
Salting
Commonly used in meat, fish, less in fruits & vegetables, in
some foods, salting is combined with other methods like
smoking, fermenting, drying, freezing. Sodium Chloride
(NaCl) preserves food by removing water content thru
osmosis. Examples: ham, bacon, salted eggs, & sausage.
Sugar Preservation
Draws out water through osmosis, Commons sugar
preserves are Jelly, Jam, Marmalade, Conserve, & Candied.
 Fermentation
Not all microbes are harmful to food, some organisms are able to
produce acid which can stop growth of harmful microbes
Fermentation– it is the process in which a substance breaks down
Into a simpler substance. Microorganisms like yeast bacteria usually
Play a role in fermentation process. E.g. wine, bread, yogurt, beer
Alcoholic Fermentation
A process in which some sugars are converted into alcohol and
Carbon dioxide by the action of various yeasts, molds, or bacteria
On carbohydrate materials
Acetous Fermentation
A form of oxidation in which alcohol is converted into vinegar
Or acetic acid.
 Fermentation
Lactic Acid Fermentation
Lactic acid fermentation is a metabolic process by which glucose
And other six carbon sugars are converted into cellular energy
And the metabolite lactate, which is lactic acid in solution.
 Principles of Safe Food Handling
• Purchase foods from safe sources
• Cook food adequately
• Hold foods at correct temperatures
• Sanitize all equipment & tools before preparing foods
• Practice proper hygiene
• Prevent cross contamination
• Control time & temperature
• Heat foods & cool foods properly
• Defrost foods properly
• Develop & follow a Hazard Analysis & Critical Control Points
(HACCP) program.
 Food Borne Diseases

• Food borne diseases (FBD) are acute illnesses

associated with recent consumption of food.
• Food involved is usually contaminated with a disease
pathogen or toxicant.
• Such food contains enough pathogens or toxicant
necessary to make a person sick.
Symptoms
• Abdominal cramps, headache, vomiting, diarrhea (may
be bloody), fever, death
 Food Poisoning
• Acute gastroenteritis caused by ingestion of food or drink
contaminated either with living bacteria, their toxins,
inorganic chemical substances & poisons derived from
plants or animals. It may be of two types:
• Bacterial (Salmonella, staph, botulism, Cl. Perfringnes
& Bacillus Cereus)
• Non-bacterial (chemicals like arsenic, certain
plants/sea food/fertilizers & pesticides)
• S/S nausea, vomiting, dysphagia, diplopia, ptosis,
blurring of vision, muscle weakness
 Types of Food Hazards

• Biological: bacteria, viruses, parasites

• Chemical: heavy metals, natural toxins,

pesticides, antibiotics

• Physical: nails, hair, bone, rocks, metal

Biological Hazards in Food
Pathogens causing Food borne illness
• Staph Aureus Mycotic food borne
infections
• Campylobacter • Candida spp.,
• Salmonella • Sporothrix spp.,
•
• Clostridium Wangiella spp. etc),
botulinum Viral food borne infections
• Hepatitis A ,
• Bacillus cereus • Noro virus
• E. coli • Norwak virus
•
• Vibrio cholerae poliomyelitis virus
 Biological Hazards in Food
Biological = Living Organisms
In Meat & Poultry:
– Salmonella bacteria (poultry & eggs)
– Trichinella spiralis parasite (pork)
On Fruits & Vegetables:
– E. coli bacteria (apple juice)
– Cyclospora parasite (raspberries)
– Hepatitis A virus (strawberries)
 Chemical Hazards in Food

Chemical hazard: A toxic substance that is produced naturally,

added intentionally or un-intentionally
• Naturally-occurring:
– Natural toxins (aflatoxins, marine toxins)
• Added intentionally:
– Antibiotics, preservatives

• Added non-intentionally:
– Cleaning agents, Pesticide Residues
 Physical Hazards in Food

Physical hazard: a hard foreign object that can cause

illness or injury
• Inherent to the food or ingredient

– Bone fragment, feathers

• Contaminant during processing

– Stones, rocks, dirt, fingernails

Prevention Of Food-borne Illnesses
1. COOK

2. SEPARATE

3. CHILL

4. CLEAN

5. REPORT
 COOK

• Thoroughly cook meat (145–165ºF), poultry (165ºF),

eggs (145ºF).
• Use a thermometer to measure internal temp of
meat.
• Cooked food should be reheated to 165ºF.
• Hot foods should be kept hot at 135ºF or above.
• Cook food immediately after defrosting.
 SEPARATE

• Wash hands, utensils, and cutting boards after

they have been in contact with raw meat or
poultry and before they touch another food.
• Put cooked meat on a clean platter.
• Use different dishes and utensils for raw and
cooked foods.
 CHILL

• Refrigerate leftovers promptly.

• Set refrigerator temperature at 40ºF (4ºC)
• Set freezer temperature at 0ºF (-18 ºC)
•
Separate large volumes of food so they will cool more
quickly.
• Cold foods should be kept at a temperature of 41ºF
or below.
• Keep purchased food chilled until you get home from
store.
 CLEAN
Clean any items that come into contact with fresh foods:
• Knives, Cutting Boards, hands
• Wash produce under running water.
• Remove & discard outer leaves from cabbage.
• Wash hands before preparing food, between types of
food, and after preparation.
• The single most important method of preventing
infectious diseases is to handwashing & hand hygiene.
• Regularly clean & disinfect refrigerator & freezer.
• Clean & disinfect countertops regularly.
 REPORT
• Report suspected foodborne illnesses to your
local health department.
WASH YOUR HANDS

When preparing food.

After using the bathroom.
Avoid direct contact with public toilet doorknobs. (use
paper towel to open door)
Use warm, soapy running water.
Rub your hands thoroughly, scrubbing b/w fingers &
nails for 10–15 SECONDS.
 Fruits & Vegetables
Do’s & Don’ts

Do wash your hands with Do not prepare food for

soap & water before
preparing food.
Do rinse fresh fruits &
vegetables with cold water.
Do refrigerate at a temp of
40o F or less.
Do throw away items that
have come into contact with
raw meat or chemicals.
others if any one have
diarrhea.
Do not use bleach or soap
on fruits & vegetables.
Do NOT eat fresh cut items
left un-refrigerated for > 2
hours.
Do not eat bruised or
damaged fruits &
 References
• COMMUNITY & PUBLIC HEALTH NURSING-Promoting the Public’s

Health. Judith Ann Allender, Cherie Rector, Kristine D. Warner.

Wolters Kluwer Health-Lippincott Williams & Wilkins. 2014.
• Community Health Nursing: BT Basvanthappa, 2nd Ed. 2008-reprint

2013, Jaypee Publishers, New Delhi

• Community Medicine. Ilyas. Ansari. 2008

• Excel Community Medicine: M. Naveed Alam, 8th Ed. 2015, Faisalabad

• Community Medicine for All. Brig. Javed Iqbal. 2014.