In June of 1997, The Michigan department of community health bureau of epidemiology had noticed a growth in reportable cases of E. coli infection. With concerns of an outbreak, a team of experts collaborated together to determine the source of contamination. In order to obtain the information needed for their analysis, these experts created a specific definition for the E. coli infection which included clinical criteria and restrictions to consecutively exclude other diseases that were irrelevant in order to increase the case study specificity or sensitivity.
When the criteria was met, the team condensed the descriptive study by applying the information to an epidemic curve and spot map to determine the specific time and place of origin of exposure (Stehr-Green, Gathany, and Emde, 2004). To support the information obtained within the epidemiologic study, the team underwent many interviews with the people whom were infected and reviewed laboratory and environmental data to ensure that the evidence was accurate. From those facts, a case control study was then conducted using the same criteria and definition to carefully not bias the results.
Once the Alfalfa Sprouts was implicated as the source of the contamination, the team took further action to determine how the sprouts were processed and distributed across the state and traced the source to a primary location to permissibly terminate the spread of infection and cease the E. coli outbreak (Stehr-Green et al. , 2004). The purpose of this paper is to review the investigative processes the epidemiology team implemented within the 1997 Michigan E. coli study and determine if an increase in reportable cases of a certain disease should represent an outbreak.
This paper will discuss the disease factors that contributed to the outbreak, how the outbreak was identified, the initial response and prevention of the health care team, and the specific roles and responsibility of master degree nurses associated with infectious disease outbreaks within a population. Disease factors that contribute to the Outbreak The CDC states that each year it is estimated that millions of people are hospitalized or die from illnesses related to foodborne pathogens (CDC, 2011b). Historically, E. coli is a known pathogen that is typically a bacterium located in the digestive tract of animals and humans as normal flora.
It was founded by Dr. Theodor Escherichia as a prototype of Enterobacteriaceae (Nordqvist, 2007). There are many forms of the strain; the most common form mostly just causes bloody diarrhea and urinary tract infections (CDC, 2011c). However, in some cases the strain can cause severe anemia, kidney failure or even death, especially in the elderly and children. The transmission of the bacteria is usually from coming into contact of contaminated food, water, or from hand to hand contact of an infected person or object (Healthwise, 2010).
The onset of symptoms once in contact is typically 3-4 days and subsides within a week. Most people are not even aware that this bacterium is the source of their illness, until they consult a physician for further evaluation (Healthwise, 2010). However, E. coli does not discriminate and can affect any person who is exposed to the bacteria within any dimensions. In the Michigan E. coli outbreak case study, there was several place dimensions that influenced the identification of the disease.
Every person affected by the strain of bacteria were all located in different counties of Michigan and six of the seven individuals with different economic backgrounds reported to have eaten alfalfa sprouts with starting symptoms between June 15 and July 15. These symptoms included bloody diarrhea, abdominal cramps; with/without fever or vomiting (Stehr-Green et al. , 2004 step 2 p 17 ). According to the CDC, “the bacteria typically disappear from the feces by the time the illness is resolved, but may be shed for several weeks, even after symptoms go away” (CDC, 2011c, para 6).
With E. coli being a reportable disease, a spike in the infectious disease summary had prompted officials to further respond and review the Michigan cases. After several interviews, the officials had recognizing characteristics that contributed to the outbreak which impacted the response when investigators concluded that the infection was not initiated from a point source such as water or person to person contact (Stehr-Green et al. , 2004, step 2 p12).
Once officials identified the causative agent, different levels of preventive activities (primary, secondary, and tertiary) were aimed at stopping the spread of the bacteria. For example: * Primary: Any remaining seeds that were stored and processed from the Virginia and Michigan sprouting facilities were removed and destroyed. * Secondary: Sprouting Company notified distributors to remove the alfalfa sprouts from the grocery stores. * Tertiary: Nationwide media announcement was broadcast so individuals could destroy or return them to the stores from where they have purchased those (Stehr-Green et al. , 2004, step 6).
According to Nash, Reifsnyder, Fabius, and Pracilio (2011) “Prevention consists of the interlocking and mutually supportive strategies and interventions aimed at…. minimization or cessation of the disease and injury at population level” (p. 7 para 1). Outbreak Response, Investigation, Containment, and Prevention The outbreak in the E. coli case study was identified when the Michigan Department of Community Health surveillance officer was preparing the June 1997 monthly infectious reportable disease summary and noticed a 20 point increase in E.coli cases since June of 1996 (Stehr-Green et al. , 2004, step 1, p 1).
Reportable diseases are defined by the Center for Disease Control as data that is dependable and appropriate concerning a specific incident to prevent and control the spread of a disease (CDC, 2011a). The surveillance officer then alerted officials at the Michigan State Bureau of Epidemiology for further investigation of a possible outbreak (Stehr-Green et al. , 2005 step 1, p 5). The epidemiologist consulted with a microbiologist from the State Bureau of laboratories for further evaluation of the E.coli cultures to investigate if the bacteria may be associated.
An outbreak was confirmed when 29 cultures showed common patterns of bands (Stehr-Green et al. , 2004, step 1 p 9-10). To further investigate the outbreak, a team of experts that consisted of an Epidemiologist, Microbiologist, and Environmental health specialist developed clinical criteria and restrictions to conclude if a person met the specification of the disease. An epidemic curve and spot map was then created to confirm a geographical location (Stehr-Green et al. , 2004, step 2, p 7-8).
Through multiple interviews with the infected people and case control studies, a decision was concluded that alfalfa sprouts was the source for the E. coli outbreak (Stehr-Green et al. , 2004, step 2 & 3). In order to contain the bacteria from the alfalfa sprouts, the Environmental health specialist trace backed the contamination. The Michigan Department of Agriculture, Centers for disease control and Food Drug and administration were then notified of findings and all distribution and production of the seeds were ceased. The prevention and control of the E. coli bacteria have historically and contemporarily been consistent.
The CDC recommends that every individual in the community: performs proper hand hygiene, clean and cook foods thoroughly, do not consume any products that are unpasteurized, avoid foods prepared by street vendors and only consume water that has been treated by chlorine. Currently there is no vaccination for this disease and the only treatment is to stay well hydrated to prevent dehydration and consult a physician before taking antidiarrheal agents (CDC, 2012). However, the surveillance of the bacterium has changed. In the past, physician would diagnosis the bacterium from patient’s symptoms.
Now, it is required for providers to obtain stool cultures and specifically order the lab for evaluation. The results are then reportable to the State Department of health and epidemiology (Stehr-Green et al. , 2004, step 1 p. 8). Although there are mandated requirements on proper hand hygiene and safe food handling, there still continues to be a global problem with the prevention, surveillance, and control of outbreaks with E. coli infection. Due to economic differences and government infrastructures, the regulation of safe food handling and water supply is not implemented with the same agricultural practices as the United States (Smith, C.& Nadine, R. , 2005).
Although the World Health Organization works close at hand with the FDA and CDC, many people continue to travel and become exposed to this bacterium. From exposure, the symptoms typically do not appear for several days after ingestion of the organism and providers still do not perform stool cultures but continue to only treat symptomatically. Therefore, during this time cross contamination and outbreak is inevitable (CDC, 2012). Roles of MSN Prepared Nurses There are many roles that a Master degree nurse can perform in the prevention, surveillance and outbreak of infectious disease.
The MSN nurse can function not only as a provider, but can also operate as an educator and researcher in providing quality of care to the population that is being served. Each of one of these roles and functions assist in properly treating people and allowing them to become more aware of health promotion and disease prevention thus stopping the spread of illness. Conclusion In reviewing the CDC outbreak Case study for E. coli in Michigan, much knowledge was obtained in the response, detecting, and skills needed for investigating outbreaks within the community.
As a future Master Degree practitioner, the importance of the role of understanding data collection and recognizing reportable diseases specific characteristics is essential to the prevention and control of future epidemics.
Reference CDC (2011a). Summary of notifiable disease. Retrieved from http://www. cdc. gov/mmwr/preview/mmwrhtml/mm5853a1. htm CDC (2011b). Estimates of foodborne illness in the United States. Retrieved from http://www. cdc. gov/foodborneburden/ CDC (2011c). E. coli general information. Retrieved from http://www. cdc. gov/ecoli/general/index. html CDC (2012). Enterotoxigenic escherichia coli.
Retrieved from http://www. cdc. gov/nczved/divisions/dfbmd/diseases/enterotoxigenic_ecoli/ Healthwise (2011). E. coli Infection. Retrieved from http://www. webmd. com/a-to-z-guides/e-coli-infection-topic-overview Nordqvist, C. (2007). What is e. coli Retrieved from http://www. medicalnewstoday. com/articles/68511. php Smith, C. & Nadine, R. (2005). Food safety around the world. Retrieved from http://safefoodinternational. org/local_global. pdf Stehr-Green, J. , Gathany,N. , and Emde,E. , (2004). E. coli infection in Michigan. Retrieved from http://www. cdc. gov/epicasestudies/computer_ecoli. html.