Akademik Veri Yönetim Sistemi
Turk Hijyen ve Deneysel Biyoloji Dergisi, cilt.75, sa.3, ss.277-286, 2018 (Scopus)
Objective: In this study, it was aimed to evaluate the food poisoning outbreak after lunch given in a hospital cafeteria. Methods: This study was conducted as a retrospective cohort study following the outbreak investigation steps. A survey of eighteen questions was designed in order to collect data on food poisoning dated 08/08/2017. Considering the factors that may lead to food poisoning during the preparation and presentation of food, microbiological analyzes of employees' portraits and swab samples from the kitchen environment were carried out. In addition, it was determined that necessary notifications were made to official institutions and also food and water samples used for food washing and preparation were taken. Binary Logistic Regression analysis was performed to evaluate the risk factors according to the survey results. Relative Risk (RR) was considered statistically significant when p < 0.05 for 95% confidence interval. Results: A total of 279 volunteers from staff, interns and patient companions in the hospital answered the questionnaire. The average age of all participants was 36.7±9.5 years and 64.6% were female. The most frequently reported complaints were diarrhea(55.2%), abdominal pain (54.8%) and nausea (43.0%). It was determined that 79% of the total 153 people complaining of diarrhea had watery diarrhea. The mean duration of incubation according to the onset of first complaints was 8.7±3.4hours. There was only one peak of the outbreak epidemic, and it showed that this epidemic was a singlesource epidemic. The 171 (61.3%) participant were determined as "case" and 108 (38.7%) participant were determined as "healthy" in the evaluation based on the presence and number of their complaints. In the regression analysis according to the foods consumed by the case and the healthy ones, RR=20.9(p=0.004) for the "chicken in the oven" and RR=2.2(p=0.019) for the"salad". While the attack rates calculated for food ranged from 5.8 to 66.6%. In the microbiological analyzes made, it was determined that there was no reproduction in the food washing and preparation water, only the salads were Bacillus cereus urea among the food samples taken, and the results of the portraits of the cafeteria workers were found to be normal. It was determined that B.cereus was found in the samples of taken from the hospital kitchen examples. Conclusion: As a result of the evaluations made, it was determined that the outbreak agent was B. cereus. It has been concluded that the probable route of contamination is that raw vegetables used in making salads should not be washed sufficiently or that contamination has occurred through the consumption of the salad, which is contaminant, due to the fact that the food preparation areas and/or materials in the kitchen have not been sufficiently cleaned. Amaç: Bu çalişmada bir hastane yemekhanesinde verilen öğle yemeği sonrasi ortaya çikan gida zehirlenmesi salgininin değerlendirilmesi amaçlanmiştir. Yöntem: Bu çalişma salgin inceleme basamaklari takip edilerek retrospektif bir kohort arastirmasi olarak yapildi. çalişmada 08/08/2017 tarihli gida zehirlenmesi hakkinda veri toplamak amaciyla 18 soruluk bir anket hazirlandi. Gida hazirlanmasi ve sunulmasi asamasinda besin zehirlenmesine yol açabilecek faktörler göz önüne alinarak çalişanlarin portörlük incelemeleri ve mutfak ortamindan sürüntü örneklerinin mikrobiyolojik analizleri yapildi. Ayrica, resmi kurumlara gerekli bildirimlerin yapildiği, gida örneklerinin ve gida yikama-hazirlama için kullanilan su örneklerinin alindiği belirlendi. Anket sonuçlarina göre risk faktörlerinin değerlendirilmesi için Binary Lojistik Regresyon analizi yapildi. Rölatif Risk (RR) %95 güven araliğinda p < 0,05 ise istatistiksel anlamli kabul edildi. Bulgular: Söz konusu tarihte hastanede bulunan personel, intörn ve refakatçi toplam 279 gönüllü kisinin anketi yanitladiği belirlendi. Tüm katilimcilarin yaş ortalamasi 36,7±9,5 yildi ve %64,6'si kadindi. En sik ifade edilen şikayetlerin sirasiyla ishal (%55,2), karin ağrisi (%54,8) ve bulanti (%43,0) olduğu belirlendi. Ishal şikayeti olan toplam 153 kişinin %79'unda sulu ishal oldugu tespit edildi. Ilk sikayetlerin baslama süresine göre ortalama inkübasyon süresi (IS): 8,7±3,4 saatti. çizilen salgin eğrisinin tek bir tepe noktasinin olmasi bu salginin tek kaynakli bir salgin olduğunu göstermekteydi. Şikayetlerinin varliği ve sayisi dikkate alinarak yapilan değerlendirmede katilimcilardan 171 kisinin (%61,3) "vaka" ve 108 kişinin ise (%38,7) "sağlam" oldugu belirlendi. Vaka ve sağlam olarak belirlenenlerin tükettikleri yemeklere göre yapilan regresyon analizinde "firinda tavuk" için RR=20,9 (p=0,004) ve "salata" için RR=2,2 (p=0,019) olarak hesaplanirken, besinler için hesaplanan atak hizlari ise %5,8 ile 66,6 arasinda degisiyordu. Yapilan mikrobiyolojik analizlerde ise gida yikama ve hazirlama suyunda üreme olmadiği, alinan gida örneklerinden sadece salatada Bacillus cereus üremesi oldugu, yemekhane çalişanlarinin portörlük incelemesi sonuçlarinin normal olduğu tespit edildi. Yemekhaneden alinan çevre örneklerinden ekmek doğrama tahtasi, robot açma düğmesi ve firin açma koluna ait örneklerde de B. cereus üremesi oldugu belirlendi. Sonuç: Yapilan değerlendirmeler sonucunda salgin etkeninin B. cereus olduğu belirlendi. Muhtemel bulaş yolunun salata yapiminda kullanilan çiğ sebzelerin yeterince yikanmamasi veya mutfaktaki gida hazirlama alanlarinin ve/veya malzemelerin yeterli düzeyde temizlenmemesi nedeniyle kontamine olan salatanin tüketimi oldugu kanaatine varilmistir.