Foodborne illness is occurring with increasing frequency among the general population. A foodborne illness is any illness caused by eating a food that is contaminated with bacteria or a virus, mold or parasite. Examples of organisms that can cause a foodborne illness are E. coli, Salmonella and Listeria. Sources of foodborne illness, or food poisoning, may be the food handler, the environment (such as a contaminated work surface) or the food itself.
Bacteria and other organisms exist in most common foods. Most of these organisms are of little risk to the average healthy person. However, people undergoing chemotherapy, radiation or a bone marrow or stem cell transplant are at increased risk for infections, including foodborne illness. By following safe food practices, patients and caregivers can reduce the risk of foodborne illness.
All people are advised to follow the food-safety guidelines discussed below. In addition, transplant patients are davised to follow the Diet Guidelines for Immunosuppressed Patients.
If you have any questions regarding food safety and diet guidelines, talk to your dietitian.
Elements of Food Safety
- Wash hands and surfaces often.
- Avoid cross-contamination.
- Keep foods at safe temperatures.
Tools for Food Safety
- Food and refrigerator thermometers
- Hand soap
- Clean towels (cloth or paper)
- Dilute bleach solution for washing countertops, cutting boards and other items (1/3 cup unscented household bleach with 3 1/3 cups water)
- Wash hands frequently with soap and warm, running water and rubbing motion (friction) for 15 seconds before and after every step in food preparation. This is critical before and after handling raw meat, seafood and poultry.
- Wash hands before eating and after using the rest room, handling garbage or touching pets.
- Dry hands with a paper towel or cloth hand towel that is changed daily.
- Replace dishcloths and dishtowels daily. They should be laundered in the hot cycle of your washing machine.
- Sanitize sponges daily in a dilute bleach solution (see above); soak for five minutes. Or heat sponges in a microwave oven on high for one minute, or run them through the dishwasher.
- Use liquid dish soap and very warm water when hand-washing dishes, pans and utensils. You may air-dry dishes instead of towel-drying them.
- Wash counters, utensils and can openers with soap and hot water immediately after use. After washing, they can be sanitized using the dilute bleach solution.
- Keep the refrigerator clean. Clean spills immediately. Wash shelves and doors weekly using the dilute bleach solution.
- Make sure food storage areas remain clean.
- Rotate food stock so older items are used first. Check expiration dates. Do not use foods past the expiration dates.
- Throw away (without tasting) any bulging, leaking or cracked cans, or those deeply dented in the seam area.
- Keep appliances free of food particles (including the microwave oven, toaster, can opener, blender and mixer blades). Blender blades and the bottom ring should be removed from the blender after each use and washed in hot, soapy water.
- Do not store any food supplies under the sink. Do not store chemicals and cleaning solutions over or near food supplies.
- Plastic or glass surfaces should be used for cutting raw meat and poultry. However, wooden cutting boards are considered safe if they are used exclusively for raw meat and poultry. Use a different board for cutting other foods, such as produce and bread.
- Wash cutting boards with hot, soapy water after each use. Then rinse and air-dry or pat dry with fresh paper towels. Nonporous acrylic, plastic or glass boards and solid wood boards can be washed in a dishwasher. (Laminated boards washed in the dishwasher may crack or split.)
- Sanitize both wooden and plastic cutting boards with the dilute bleach solution. This should be done every time the board is used for raw meat, fish or poultry. Sanitize cutting boards used for other purposes at least once weekly. Flood the surface with the bleach solution and allow it to stand for at least 2 minutes, then rinse and air-dry or pat dry with fresh paper towels. Alternatively, use a commercial sanitizing agent (such as Clorox Disinfectant Wipes) and follow the directions on the product.
- Replace worn cutting boards, including boards with cracks or grooves.
Safe Food Handling: From the Grocery Store to Your Home
- Shop for shelf-stable items first. (Shelf-stable refers to unopened canned, bottled or packaged food products that can be stored at room temperature before opening; the container may require refrigeration after opening.)
- Select frozen and refrigerated foods last, especially during the summer months.
- Check “sell by” and “use by” dates on dairy products, eggs, cereals, canned foods and other goods. Select only the freshest products.
- Check packaging dates and “use by” dates on fresh meats, poultry and seafood. Do not purchase if they are outdated.
- Do not use damaged, swollen, rusted or deeply dented cans. Check that packaged and boxed foods are properly sealed.
- Select fruits and vegetables that are not moldy, bruised or damaged. Fresh fruits and vegetables should look fresh. Wilted salad greens may be an indication that the product is old and not properly handled.
- Avoid unpasteurized juice (unless prepared at home with washed produce).
- Choose shelf-stable salsa rather than salsas found in the refrigerator section of the grocery store.
- Avoid unpasteurized milk, yogurt or cheese, and other unpasteurized milk products, including Mexican-style cheese made from unpasteurized milk (such as queso fresco).
- Do not use foods with any mold present.
- Avoid unrefrigerated, cream- and custard-filled pastry products, such as fresh bakery cream pies, éclairs, cream-filled doughnuts and pastries. Commercial, shelf-stable items such as Danish pastries, Hostess fruit pies, Twinkies and Ding Dongs are allowed. Follow the “use by” date, and store them according to the manufacturer’s guidelines after opening.
- Avoid foods from “reach-in” or “scoop” bulk food containers. Avoid food from any type of bulk food container if it will not be cooked prior to consumption.
- Do not taste free, unpackaged food samples.
- Choose eggs that are refrigerated in the store. Do not use cracked eggs. Pasteurized eggs, liquid pasteurized egg products (such as EggBeaters) and powdered egg whites may be used in recipes calling for raw eggs in foods that will not be cooked.
- Place meat, poultry and fish in plastic bags. Ask to have these items placed in separate bags from the fresh produce and ready-to-eat foods when at the checkout stand.
- Never leave perishable foods in the car. Refrigerate or freeze them promptly.
- Wash the tops of canned foods before opening. Clean the can opener after each use.
- Throw away eggs with cracked shells.
- Throw away foods older than their “use by” or expiration dates.
- Throw away entire food packages or containers with any mold present, including yogurt, cheese, cottage cheese, fruits (especially berries), vegetables, jelly, bread, cereal and pastry products.
- Children less than 1 year of age should never consume honey or foods made with honey.
Fruit and Vegetable Handling
All fresh produce (whether organic, natural or general produce) may carry dangerous bacteria or other organisms that can cause foodborne illness. Bacterial contamination can occur in the fields from the use of natural fertilizers (such as animal manure) or from human contact during produce harvesting or transporting and in the grocery store. The terms “organic” and “natural” refer to growing without the use of chemical fertilizers or pesticides, and they have no relationship to the cleanliness of the produce.
Use the following guidelines for handling all raw produce, including organic, organically grown, “natural” and general produce:
- Refrigerate fruits and vegetables promptly.
- Do not purchase produce that has been cut at the grocery store (such as melon or cabbage halves). This is particularly true for produce that will not be cooked prior to eating.
- Rinse produce thoroughly under clean, running water just before use, including produce that is to be peeled (such as bananas, melons and oranges) or cooked. Do not wash fruits and vegetables with soaps, detergents or chlorine bleach solutions. Produce can absorb these cleaning agents.
- Commercial produce rinses (such as Fit Fruit and Vegetable Spray) are not recommended since they have not been shown to be more effective for removing bacteria off the produce than washing under running water.
- Scrub produce that has a thick, rough skin or rind (such as cantaloupe or potatoes) or has visible dirt on the surface using a clean vegetable scrubber.
- Rinse leaves of leafy vegetables (such as lettuce, spinach and cabbage) individually under running water.
- Packaged salads, slaw mixes and other prepared produce, even when marked pre-washed, should be rinsed again under running water; a colander can be used to may this easier. Check for “use by” dates.
- Do not eat any type of raw vegetable sprouts (including alfalfa sprouts, clover sprouts, mung bean sprouts and others) due to high risk of Salmonella and E. coli contamination. Cooked mung bean sprouts are acceptable.
- Throw away fruits and vegetables that are slimy or show mold.
- Review the processing procedure if preparing home-canned foods. Be sure the procedure is appropriate for the acidity of the food, size of the bottle and elevation above sea level. Look for mold and leaks. Check seals. If you suspect a home-canned food may not have been properly processed (for example, if the lid bulges or if the food has any bad odor or unusual characteristics after opening), THROW IT AWAY. Use home canned foods within one year of canning as chemical changes may occur.
Do Not Cross-Contaminate
- Use a clean knife for cutting different foods (for example, use different knives for cutting meat, produce and bread).
- During food preparation, do not taste the food with the same utensil used for stirring. Use a clean utensil each time you taste food while preparing or cooking.
- In the refrigerator, store raw meat separately from ready-to-eat foods.
- When grilling, always use a clean plate for the cooked meat.
Keep Foods At Safe Temperatures
Proper Thermometer Use
- Insert the meat thermometer into the middle of the thickest part of the food to test for doneness. The entire part of the stem, from the dimple to the tip, must be inserted into the food. For thin foods, insert the thermometer sideways. (Also, follow the manufacturers instructions.)
- Test a thermometer’s accuracy by putting it into boiling water. It should read 212°F.
- A refrigerator thermometer should be placed on a shelf toward the back of the refrigerator. It should read 40°F or less.
- Keep the refrigerator temperature between 34°F and 40°F.
- Keep the freezer temperature no higher than 2°F.
- Never leave perishable food out of the refrigerator for more than hours. Throw away food left out longer than two hours.
- Marinate foods in the refrigerator.
- Never thaw foods on the counter.
- Thaw meat, fish or poultry in the refrigerator away from raw fruits and vegetables and other prepared foods. Place on a dish to catch drips. Cook defrosted meat right away; do not refreeze. If you are in a hurry you can thaw meat in the microwave, but the meat must be cooked immediately after thawing.
- Cool hot foods uncovered in shallow containers in the refrigerator. Cover storage containers after cooling. Make sure that covers seal tightly.
- Throw away all prepared food after 72 hours, or three days. Date foods placed in the refrigerator to keep track of their age.
- Freeze foods that will not be used within two to three days.
- NEVER TASTE FOOD THAT LOOKS OR SMELLS STRANGE!
Cook Foods Adequately
- Cook meat until it is no longer pink and the juices run clear. These are signs that the meat may be cooked to a high-enough temperature. However, the only way to be sure that the meat has been cooked to the proper temperature is to use a food thermometer. (See table below.)
- Thoroughly heat until steaming (165°F) all hot dogs and ready-to-eat luncheon meats, cold cuts and deli-style meats before eating.
- Do not eat raw or lightly cooked eggs or soft-boiled eggs
- Do not eat uncooked foods containing raw or undercooked eggs, such as raw cookie dough, cake batter or salad dressings containing raw or coddled eggs.
- Pasteurized eggs and liquid pasteurized egg products (such as EggBeaters) may be used in recipes calling for raw eggs in foods that will not be cooked.
- Hold food at safe temperatures: Hot food should stay above 140°F.
Recommended Minimum Cooking Temperatures for Meats and Poultry
|Eggs, Egg Dishes and Casseroles|
|Eggs||Cook until yolk and white are firm|
|Casseroles, foods containing eggs, custards and egg sauces||160°F|
|Veal, Beef, Pork, Lamb, Rabbit, Goat, Game|
|Whole pieces meat, hot dogs||160°F|
|Ground veal, beef, lamb, pork, rabbit, goat, game||160°F|
|Poultry (Chicken, Turkey, Duck, Goose)|
|Chicken and turkey: whole bird and dark meat (thigh, wing)||180°F|
|Ground chicken, turkey||165°F|
|Stuffing (always cook in separate container outside of bird)||165°F|
|Pre-cooked (to reheat)||160°F|
|Fin fish (such as salmon, cod, halibut, snapper, sole, bass, trout)||Cook until opaque and flakes easily with a fork|
|Shrimp, lobster, crab||Should turn red and flesh should become pearly opaque|
|Scallops||Should turn milk white or opaque and firm|
|Clams, mussels, oysters||Cook until shells open (may be high-risk food for people with low white count or immunosuppressed)|
|Hot dogs, luncheon meat||Steaming hot|
- Microwave cooking can leave cold spots in food where bacteria can survive. Rotate the dish a quarter turn once or twice during cooking if there is no turntable in the appliance.
- When heating leftovers, use a lid or vented plastic wrap to cover them. Stir several times during reheating. When the food is heated thoroughly (to a minimum of 165°F), cover and let sit for two minutes before serving.
Dining Out Safely
- Eat early to avoid crowds.
- Ask that food be prepared fresh in fast-food establishments. (For example, a hamburger should be fresh off the grill, not one that has been sitting under heat lamps.)
- Ask if fruit juices are pasteurized.
- Avoid raw fruits and vegetables when dining out. Eat these items when prepared at home, where you can wash them thoroughly and prepare them safely.
- Ask for single-serving condiment packages. Do not use public self-serve condiment containers, including salsa.
- Avoid salad bars, delicatessens, buffets and smorgasbords, potlucks and sidewalk vendors.
- Be sure that utensils are set on a napkin or clean tablecloth or placement, rather than directly on the table.
- Check the general condition of the restaurant. Are the plates, glasses and utensils clean? Are the restrooms clean and stocked with soap and paper towels? How clean the restaurant looks may tell the amount of care taken while preparing the food.
- If you want to keep your leftovers, ask the server to bring you a box into which you can transfer the food yourself, rather than having your food transferred into a box in the restaurant kitchen. Be sure to take home and refrigerate the leftovers immediately.
General Oncology Patients
- Do not eat soft cheeses such as feta, Brie, Camembert, blue-veined, Stilton or Mexican-style cheese (queso fresco).
- Cut tofu into one-inch cubes or smaller and boil five minutes in water or broth before eating or using in recipes. (Note: This process is not needed if using pasteurized tofu or aseptically packaged, shelf-stable tofu, such as Mori-Nu silken tofu.)
- Avoid fresh fruit or vegetable salsas and salad dressing found in the refrigerated section of the grocery store. Choose shelf-stable salsas and salad dressing instead. (Shelf-stable refers to unopened canned, bottled or packaged food products that can be stored at room temperature before opening; the container may require refrigeration after opening.)
- Do not consume raw honey or honeycomb. Choose grade A honey.