microbial quality of ice machines and relationship to facility inspections in the toledo, ohio, area.
It is estimated that 3,000 people die and 128,000 are hospitalized each year in the United States. S. A major public health threat ( Center for Disease Control and Prevention [CDC], 2011. ) Pathogenic agents foodborneilles\' are often uncertain and prevented with central DiseaseControlCDC) Overall, only 44% of offshore disease cases have known causes, the report said. In cases where pathogens have been identified, the Noreg virus is associated with 58% of the disease and 4 bacteria ( Salmonella, B. Wei, B. bending and S. aureus) 33% of the diseases are collectively responsible. The CDC also reported that the main type of food associated with these diseases is agricultural products (46%) Meat and poultry (22%) Milk and eggs (20%) Fish and shellfish (6. 1%). Although the evidence documented in the literature is sufficient to demonstrate that the risk of contaminated ice to health is a potential factor contributing to the disease, there are few reports. For example, contaminated commercial ice is considered to be the cause of Norwalklike-viruses- Stomach problems related to a cruise ship in Hawaii (Herwaldt et al. , 1994). Another outbreak on the cruise ship is linked to eating ice contaminated with intestinal toxin E. coli (ETEC). During the outbreak, water from Mexico or Guatemala was fully chlorine and ETEC was introduced into ice-making machines (Koo et al, 2010). It is reported that several venueses related to ice also have a norlike virus outbreak. Improperly set up and disinfected community dispensers contaminated water and ice in a community in Arizona in 2004 triggered an outbreak of the norlike virus intestinal stomach disease ( Stratus, Stratman, Ludwig, 2004). In 1987, in a match between the University of Pennsylvania and Cornell, ice made from good water contaminated with sewage containing the norlike virus was the cause of the outbreak of football players ( Baker, Department of Education, Southwick, and MacCormack, 2000). In a holiday town in Italy, ice made from contaminated iron materials is the cause of the outbreak of the norlike virus (Boccia et al. , 2002). Commercial ice made of water contaminated by the environment and/or improperly treated water is the cause of diarrhea. E. coli outbreak in a community in Brazil in 2004 ( Falcao, Falcao, Gomez, 2004). Ice contaminated with the norlike virus in restaurants further proves that ice may become an important source of disease transmission (CDC, 2011). Other studies that are not directly related to the outbreak of the disease suggest that ice contamination is likely to cause the disease. A study by the University of Taman, Malaysia shows that about 36% of the ice samples from 30 food service stores have fecal coliform bacteria ( Mahat, Meor Ahmed and Abdul Wahab 2015). Real son andcoauthors (2014) The report said that their level of coliform bacteria in 37% of ice pack samples at retail locations and vending machines in Georgia was not satisfactory, compared with ice cubes manufactured by companies monitored by the International Ice pack Association, the frequency of serious pollution is higher. Ice collected from retail outlets in Greece contains large amounts of coliform bacteria and pathogenic bacteria ( Gerokomou, et al, 2001). Another study reported that poor hygiene caused the ice in the hospital ice machine to be contaminated by norlike virus ( Gebo, et al, 2002). Viral load in ice is considered large enough to cause immune system disease Compromised with patients, but not with disease patients unrelated to immune suppression. Similar results were found in hospitals outside the United States. S. ( Zhou Burnett, Harris 1994; Wilson, Hogg and Bal, 1997). Food service facilities are licensed on a regular basis and operate as required by the state, usually based on the Food and Drug Administration (FDA)Food Code. This code contains terms related to the production and handling of ice in food service facilities. This study is located in Ohio, where all food service facilities that provide potentially dangerous foods--including ice-- A license is required. This requirement includes the fact that ice is the only facility for food that is potentially dangerous. In general, the evaluation of icemachine is limited to visual examination, although suchinspection may not be sufficient in terms of identifying the presence of pathogens ( Harrington, Bissey, Kudel, 2001). Past work has proven that ice machines have a potential risk of disease transmission, although ice machines have not been tested enough to determine the size of this risk. Our study explored this potential risk by investigating microbial contamination of ice-making machines in food service facilities in Toledo, Ohio. We have also designed this study to provide information recorded in the inspection records of food service facilities that may link ice machine pollution to public health protection practices. Materials and methods we sampled ice makers of various bacteria and fungi in the summer and fall of 2013 at the licensed food service facility in oledo, Ohio. Although all potential types of contaminants are not included (e. g. , viruses) This inspection should provide potentially useful information to reveal the scope of contaminated pesticides regulated by the typical food service licensing program. Facility selection facility was selected by developing Toledo\'s research database Lucas County Health Department (TLCHD) A list of 2,439 risk categories 2, 3 and 4 food service facilities that can legally handle unpackaged ice cubes to serve consumers. The classification of facilities into different licensing classes is based on their relative health risks to public health, and the higher the number of categories, the higher the level of risk ( Ohio executive coded. ). The Tlcad database is exported to an Excel spreadsheet and accepted \"study random generator\" to select a potential sampling pool for 150 license numbers. If no ice is generated during our sample collection and/or walking, the facilities in this initial pool are not included During the inspection, if they have sealed the icemaking/dispensing system, if they permanently close or change their business plan before the end of the license period, if the facility inspection report is unclear, or the management is unwilling to participate. According to these criteria, we have included 115 facilities in this study. In the sampling procedure for each food service facility, we collect swab samples from Annis warehouse wall, ice spoon and ice machine door pad enclosure. Two doctors working in the food protection department and trained in the sampling programme registered the samples used in this study. For each facility, a sample collection kit consisting of three test tubes is provided, each containing two sterile swabs and ascrew- Cap tube containing 1 ml sterile phosphate buffer salt water (PBS). The cotton swab of each cotton swab tube is placed in a plastic cap, and the registered sanitarians only processes the cap at the time of sampling. The swab was moistened before sampling ( Not wet) By contacting the surface of PBS. After collecting each sample, the registered sanitarians returned swabsto to the test tube and marked the test tube with the agency\'s health department license number and sampling area ( Ice bucket wall, ice spoon or gasket. ) For ice bucket wall samples, an area of about 3x6. Ice cubes below normal levels. For ice scoopsample, the area is about 3x6. It is fried to the surface with a hard concaveice. Determine the area by visualizing 3x6 in. Sample area based on previous training. For these samples, swabs rubbed each other at least 60 degrees in three directions, and during the sampling, the cotton swab was flipped at least once to use the cotton swab surface as much as possible. For icemachine washers, the cotton swab is rubbed along the entire length of the gasketin inside the tank, especially in any area where suspicious form growth and/or debris accumulation occurs. On each sampling day, a blank space was prepared for a sterile examination in a registered nursing home. They removed the cotton swab from the test tube, moistened the cotton swab with PBS, and immediately put the cotton swab back into the test tube. After sampling, they immediately put the test tube into a cooler with a frozen package and return to the microbiology laboratory before the end of the day. The swab was inoculated into the isolation medium on the same day. Culture medium of microbial culture plate ( Soybean AgarTSA] , Blood qiongjiao, saburod qiongjiao, maconji qiongjiao) Inoculation by rolling the swab to about 20% of the surface of the medium- \"The original inoculumarea. \"Sterile disposable plastic rings are used to strip non-parallel lines from the initial inoculation zone into the other three quadrants on the surface of the medium. Culture the \"field blank\" swab in the same way as the sample. As a further sterility test for PBS, three or four PBS tubes used were randomly selected and cultured for each sampling day. TSA, blood agar and MacConkey agar plates were vaccinated with oxygen at [35 °c]degrees] C, Sabouraud agar plate incubated at 25 [degrees]C. After 2 and 3 days of incubation, TSA blood and MacConkey agar plates were examined for growth and maintained for 5 days and then reported as \"no growth \". \"Sabouraud agar plates were examined after 2, 3 and 5 days and maintained for 7 days before reporting\" no growth. For each isolated organism, a semi-quantitative transplant protocol is followed (Table 1) As a measure of the number of microorganisms. According to the growth rate, colony morphology and pigmentation, and microscopic examination of the structure of fungi and spores, the isolated fungi were identified as genus or species by standard Mycological standards. The silk fungus with sterile Silk was identified as \"zygmycete\" with no further genus features. \"Unknown fungus\" refers to fungi that do not observe spores on the original Sabouraud agar separation medium or on the potato glucose agar. Pigment-free yeast Cultures of similar organisms were cultured in rice extract agar in a ratio of 0. 1% Tween 80, observed Candida production at room temperature. In the event of the production of C. , The isolate is identified as C; It is classified as \"yeast/yeast-if NOP bacteria are observed-like. Table 2 summarizes the protocol for identifying bacteria (seeKassa et al. 2001 for more details. ) Results at least one sampling point for all food service operations studied had microbial growth. In general, microorganisms are typical pathogenic types in fecal flora, water, human skin, mucus membranes, and ambient air and dust. Table 3 provides a list of the prevalence of isolates. The amount of contamination present as a function of the sampling location ( Ice bucket wall, ice spoon and washer) The inspection was carried out as a measure of relative risk. Existence and relative abundance ( Determined by measuring the growth of grades 0 to 4, as shown in Table 1) In general, the function of bacteria varies significantly depending on the location ( Ice bucket wall, ice spoon or gasket) , The largest number of fungi and bacteria found on the gasket (Table 4. ) The only exception to this model is in secondary food service agencies, where there is no obvious difference. Establish a basic understanding of possible differences in microorganisms Based on the risks of different types of food service agencies, we checked the quantity and type of food services recorded by the Health Department in previous inspections (Table 5). Analysis of variance shows that there are significant differences between facilities in the three categories (p