What is Sanitation?

UNESCO defines sanitation as "Maintaining clean, hygienic circumstances that help avoid disease through services such as waste collection and waste water removal". Sanitation essentially looks at controlling all the possible factors in the environment that surrounds us, that could threaten society's survival or development.

Sanitation is a term generally used with respect to health and undertaken in order to protect oneself from disease or illness. It could imply a number of things such as: the timely and correct disposal (or recycling) of waste. Sanitation systems gain even more importance as far as water supply and sewage discharge is concerned.

Sanitation and cleanliness go hand in hand, but today have come under a lot of cloud in most of the under-developed countries. The root cause for this is the fact that these places suffer not only from over population and over crowding issues, but also that they lack the basic funds and infrastructure required to build an effective sanitation model.

E-Coli

An estimated 73,000 cases of infection and 61 deaths occur each year in the
United States alone caused by E-coli. Infection often leads to bloody diarrhea, and occasionally to kidney failure. Most illness has been associated with eating undercooked, contaminated ground beef, drinking unpasteurized milk, swimming in or
drinking contaminated water and contaminated vegetables. The bacteria can
also be spread by person-to-person contact.

Symptoms
- Diarrhea (watery or bloody)
- Severe abdominal pain
- Vomiting

Sources
- Animals
- Human intestinal tract
- Intestinal tract of cattle

Foods Involved
- Raw & undercooked ground beef
- Imported cheeses
- Unpasteurized milk, apple cider, apple juice

Prevention
- Thoroughly cook ground beef to 167°F (75°C) for 15 seconds
- Avoid crosscontamination
- Practice good personal hygiene

Botulism

All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism can be especially dangerous as a public health problem because many people can be poisoned from a single contaminated food source.

In the United States for example an average of 110 cases of botulism are reported each year. Of these, approximately 25% are foodborne, 72% are infant botulism, and 3%
are wound botulism. Outbreaks of foodborne botulism involving 2 or more people occur during most years and are commonly caused by eating from contaminated home-canned foods.

SYMPTOMS
ONSET
- Vomiting
- Constipation
- Diarrhea

LATER
- Fatigue
- Weakness
- Vertigo
- Blurred vision

SOURCES
- Animals
- Vegetables
- Soil
- Water

FOODS INVOLVED
- Under-processed foods
- Temperature-abused stored foods
- Canned low-acid foods
- Untreated garlic-and-oil products

PREVENTION
- Do not attempt to use home-canned products
- Use careful time temperature control for sous vide and bulky foods

Staphylococcal Food Poisoning

Staphylococcal toxins are a common cause of food poisoning as it can grow in improperly stored food. Although the cooking process kills them, the enterotoxins are heat resistant and can survive boiling for several minutes. Staphylococci can grow in foods with relatively low water activity (such as cheese and salami)

SYMPTOMS
- Nausia
- Retching
- Abdominal cramps
- Diarrhea

SOURCES
- Skin
- Hair
- Noset
- Throat
- Infected sores
- Animals

FOODS INVOLVED
- Reheated foods
- Ham & other meats
- Poultry
- Egg products
- Other proteins

PREVENTION
- Wash hands
- Practice good personal hygiene

Salmonellosis

Salmonellosis is an infection with the Salmonella bacteria. Most people infected with Salmonella develop diarrhea, fever, vomiting and abdominal cramps 6 to 72 hours after infection. In most cases, the illness lasts 3 to 7 days. The majority of affected people actually recover without treatment, although its very unpleasant.

The type of salmonella commonly associated with infections in humans is called Non-
Typhoidal Salmonella. It is usually contracted by ingesting raw or undercooked eggs, or from sources such as:
• Poultry and cattle,
If the meat is prepared incorrectly or becomes infected with the bacteria somehow.
• Infected eggs and milk
As well as egg products, when not prepared, handled, or refrigerated correctly.
• Reptiles
Such as turtles, lizards and snakes, as they can carry the bacteria on their skin.
• Pet Rodents

SYMPTOMS
- Abdominal cramps
- Headaches
- Nausia
- Fever
- Diarrhea

SOURCES
- Water
- Soil
- Insects
- Animals
- Human intestinal tract

FOOD INVOLVED
- Poultry
- Meat
- Fish & Shrimps
- Eggs & egg products
- Milk

PREVENTION
- Avoid cross-contamination
- Refrigerate foods
- Cook poultry to 167°F (75°C) for at least 15 seconds

Major foodborne Illnesses caused by bacteria

Here below is the definitive list of bacteria's that potentially could cause a major foodbrone illness on board a Cruise ship.

• Salmonellosis
• Shigellosis
• Bacillus cereus gastroenteritis
• Botulism
• Listeriosis
• Staphyloccocal food poisoning
• Campylobacteriosis
• E. Coli O157:H7
• Clostridium perfringens enteritis
• Yersiniosis
• Vibrio gastroenteritis

Foodborne infections and intoxications

1) Foodborne Infections
Result of eating food contaminated by live pathogens that will reproduce and grow in intestines (Shigella, Salmonella).

2) Foodborne Intoxications
Result of eating food containing poisonous toxins (Staphylococcus, Botulism, Bacillus cereus).

Sanitation definitions

POTENTIALLY HAZARDOUS FOOD
Foods that requires temperature control because it is a form capable of supporting the rapid and progressive growth of infectious or toxigenic microorganisms. These foods
are generally rich in proteins and carbohydrates.

FOODBORNE ILLNESS
A disease that is carried or transmitted to people by food.

OUTBREAK
An incident in which two or more people experience the same illness
after eating the same food.

Consequences of foodborne illnesses on board Cruise ships

Unquestionably the practice of good sanitation is a top priority on board Cruise Ships. As covered in a previous article there are 8 significant Public Health challenges on board a Cruise ship. If a Cruise Line fails to overcome these such challenges could lead to any of the following drastic consequences...

1. Loss of Customers & Sales
2. Increased Insurance Premiums
3. Loss of Prestige & Reputation
4. Lawsuits Resulting in costly Lawyer & Court Fees
5. Lowered Crew Morale
6. Potential Crew Absenteeism
7. Need for Retraining Employees
8. Public Embarrassment

8 Public Health challenges on board a cruise ship

1) CLOSED MICRO-COMMUNITY
Guests and crew alike live and work in a close environment hence, the risk of illnesses is higher.

2) DENSELY POPULATED
In addition to the close environment there are big numbers of guests and crew in a relatively small surface area.

3) INTERNATIONAL GUESTS AND CREW
Guests and crew on board come from different countries hence, the risk of carrying illnesses are greater.

4) MOBILE & INTERACTIVE POPULATION
Much of the population on board is moving around and interaction levels are high.

5) RAPID TURNOVER
Guests and crew alike change (embark/disembark) frequently.

6) VARIABLE QUALITY AND SAFETY OF PROVISIONS
As food provisioning needs to arrive in very high volumes, its nigh impossible to check if all food items consumed are of best quality all the time.

7) POTENTIAL FOR EXPLOSIVE DISEASE OUTBREAKS
This is due to a close environment, whereby the risk for exposure concerning disease outbreaks may be high.

8) NO STANDARDIZED MEDICAL CARE SYSTEM
Even though there are hospitals on board their capabilities may be not adequate to treat certain diseases and incidents.

HIGH RISK POPULATION

Each year in the United States, food-borne illnesses cause approximately 76 million illnesses and 5000 deaths mainly among the high risk population. Depending on the contaminant, symptoms can vary from mild to severe gastric upset to even death in very serious situations.

The top 5 high risk populations are:-
1) Infants and young children.
2) Pregnant women.
3) Elderly people.
4) People taking certain medications.
5) People with weakened immune systems.

Storing refrigerated foods safely

Maintain food temperature at 40°F (4 - 5°C) or lower. Follow these guidelines...
- Store raw foods below ready-to-eat or cooked foods.
- Cool hot foods before refrigerating.
- Label and date prepared foods.
- Non-food items must be stored at a minimum distance of 30 inches (76 cm)from food.