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FDA: Consumers should not eat Sally Jackson cheese due to risk of Escherichia coli O157:H7

FDA NEWS RELEASE

For Immediate Release: Dec. 17, 2010
Media Inquiries: Siobhan DeLancey, 301-796-4668, siobhan.delancey@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA
FDA: Consumers should not eat Sally Jackson cheese due to risk of Escherichia coli O157:H7
Cheese was sold in multiple states
Fast Facts
  • Sally Jackson Cheese of Oroville, Wash., has agreed to voluntarily recall all of its cheeses.
  • All Sally Jackson cheeses on the market should be avoided because the products were processed under conditions that create a significant risk of contamination, and because Sally Jackson cheeses have been identified as one possible source of several cases ofEscherichia coli (E. coli) O157:H7 infections. All Sally Jackson cheese is made from unpasteurized raw milk.
  • Consumers who have any Sally Jackson cheese should not eat it. Restaurant operators and any other food-service operations that have any Sally Jackson cheese should not serve it. Distributors should stop distribution. To prevent people or animals, including wild animals, from eating the cheese, cheese that is not returned to the place of purchase should be disposed of in a closed plastic bag placed in a sealed trash can.
  • People infected with E. coli O157:H7 can develop diarrhea (often bloody) and abdominal cramps for about 3-4 days, after ingesting the organism, but some illnesses may last longer and are more severe. Infection is usually diagnosed by culture of a stool sample. While most people recover within a week, some may develop a severe infection. A type of kidney failure called hemolytic uremic syndrome (HUS) can begin as the diarrhea is improving; this can occur among persons of any age but is most common in children under 5 years old and the elderly. Signs and symptoms of HUS may include: fever, abdominal pain; pale skin tone; fatigue and irritability; small, unexplained bruises or bleeding from the nose and mouth; decreased urination and swelling of the face, hands, feet, or entire body. Persons who experience these symptoms and believe they are at risk for HUS should seek emergency medical care immediately.
  • FDA is inspecting the facility in collaboration with an investigation being conducted by the Washington State Department of Agriculture (WSDA). This inspection has identified conditions that create a significant risk of contamination.
What is the Problem?
The FDA, in cooperation with other state and local public health agencies, is warning consumers not to eat any Sally Jackson cheeses. The products were processed under conditions that create a significant risk of contamination of the unpasteurized raw milk and finished cheese, and Sally Jackson cheeses have been identified as one possible source of eight cases of E. coli O157 infections in an ongoing investigation.
Earlier this month, FDA was informed of an outbreak of E. coli O157:H7 infections by the Oregon Public Health Department (OPHD), WSDA, and the Washington Department of Health (WDOH). An investigation by these three state agencies and Public Health – Seattle and King County has identified eight ill persons with the outbreak strain who were ill between September and November. Of the seven patients for whom food history is available, one person reported consuming Sally Jackson cheese, and four others may have consumed Sally Jackson cheese. Three of the four ill persons who may have consumed Sally Jackson cheese ate cheese from two restaurants serving Sally Jackson cheese, while the fourth tasted several cheeses that may have included Sally Jackson cheese. The remaining two patients consumed artisanal cheeses but do not know if it was Sally Jackson cheese. Analysis of cheese samples is currently in progress. This warning is to protect consumers until more information becomes available.
FDA completed its inspection today and issued a Form 483, Inspectional Observations, which is not a final agency determination regarding compliance. The inspectional observations include problems related to the sanitation of the facility, its employees, equipment, and utensils as well as problems with facility construction and maintenance.
Unpasteurized raw milk in raw milk cheese is obtained from cows, sheep, or goats and is not pasteurized to kill harmful bacteria. This raw, unpasteurized milk can carry dangerous bacteria such as Salmonella, E. coli and Listeria, which are responsible for causing numerous foodborne illnesses. These harmful bacteria can seriously affect the health of anyone who drinks raw milk or eats cheese and other foods made from raw milk. The bacteria in raw milk can be especially dangerous to pregnant women, children, the elderly, and people with weakened immune systems.
What are the Symptoms of Illness/Injury?
Most people who develop illnesses caused by E. coli O157:H7 develop diarrhea (often bloody) and abdominal cramps for about 3-4 days, after ingesting the organism. Some illnesses may last longer and are more severe. Infection is usually diagnosed by culture of a stool sample. While most people recover within a week, some may develop a severe infection. A type of kidney failure called hemolytic uremic syndrome (HUS) can begin as the diarrhea is improving; this can occur among persons of any age but is most common in children under 5 years old and the elderly. Signs and symptoms of HUS may include: fever, abdominal pain; pale skin tone; fatigue and irritability; small, unexplained bruises or bleeding from the nose and mouth; decreased urination and swelling of the face, hands, feet, or entire body. Persons who experience these symptoms and believe they are at risk for HUS should seek emergency medical care immediately.
What Do Consumers Need To Do?
Based on currently available information and as a precaution to safeguard public health, FDA, OPHD and WSDA recommend that consumers not eat any Sally Jackson cheeses. To prevent people or animals, including wild animals, from eating the cheese, cheese that is not returned to the place of purchase should be disposed of in a closed plastic bag placed in a sealed trash can.
Where is it Distributed?
Sally Jackson cheeses have been distributed in several places, listed below. This list may not be complete. Numerous resellers can be found on the internet. The products include cow, sheep and goat cheeses produced by Sally Jackson Cheese of Oroville, Wash. The products do not have labels or codes, and are wrapped in plain brown paper, twine and either grape or chestnut leaves.
Places where Sally Jackson cheeses are known to have been distributed or subdistributed include:
  • California
  • Colorado
  • Connecticut
  • District of Columbia
  • Hawaii
  • Illinois
  • Massachusetts
  • Minnesota
  • Missouri
  • Montana
  • New York
  • Oregon
  • Pennsylvania
  • Rhode Island
  • Texas
  • Virginia
  • Washington
What is Being Done to Protect Consumers?
Sally Jackson Cheese has agreed to voluntarily recall the products and to notify its customers directly. The FDA, WSDA, WDOH, OPHD, and public health agencies continue to collaborate in this ongoing investigation. Instructions to consumers may change as more information becomes available.
Source:  fda.gov

Nursing Home Negligence

Falls in Nursing Homes

Litigators who work with cases involving long term care know how significant the issue of falls can be. Falls are the leading cause of injury and death by injury in adults over 65. Approximately half of the 1.6 million nursing home residents in the U.S. fall each year, and a report by the Office of the Inspector General found that about 10% of Medicare skilled nursing residents experience a fall resulting in significant injury; and, more than 1/3 of hospital falls result in injury. In the rehab setting, rates are often higher – for example, fall rates among stroke patients have been shown to be very high. Immobility and falls can lead to poor outcomes.

Fear of falling is defined as a geriatric syndrome. It not only occurs in older adults who have fallen, but in those with impaired mobility and is associated with decreased physical ability and depression. Care of older adults requires that clinicians be aware of the myriad of issues related to falls including knowledge of this syndrome, increased risk and interventions needed to prevent injury related to falls.

Just about every resident in a long term care setting, including assisted living and sub-acute rehab, is at risk for falling. Between medications, functional and medical issues and advancing age, older adults in most settings are prone to falling.

There are well established standards of care related to fall prevention; but, as I continue to review records related to issues like falls, I am amazed at how often these basic standards are not being practiced. The basics of a fall prevention program include assessment and ongoing reassessment of risk, ensuring a safe environment, medication review, providing therapy as needed, individualized interventions, and staff education.

Basic nursing practice includes assessment, planning (Care plan), putting interventions in place and then evaluating outcomes to determine if those interventions are appropriate and effective. Assessment includes completing fall risk assessments on admission and then as needed. Very often, the fall risk assessments completed by nurses in LTC are inaccurate. The tools utilized in long term care typically include these risk factors: history of falling, use of ambulatory aids, gait/balance issues, medications, secondary diagnoses (i.e. diabetes) and mental status. Care planning is the next step in nursing care - it is the standard of care that as the resident’s status changes, assessments and care plans must be updated, and often, are not. For example, with each fall, there should be updates, or if there is a new diagnosis, i.e. stroke, or worsening dementia, updated interventions should be put into place, with ongoing evaluation of effectiveness.

Care planning and interventions very often are generic and not individualized. For example, a toileting schedule that includes only after meals and before bedtime may not be appropriate. If a resident has issues with constipation or incontinence, this may lead to the need for more frequent toileting to prevent falls. The “make certain call bell is within reach” for residents with dementia is an example of a generic intervention. Older adults with dementia may not recognize a call bell or remember to use it. The debate about use of bed and chair alarms go on – they are a part of an individualized care plan, not a solution to preventing falls. Often, I see delays in putting interventions in place, i.e. with the resident who is incontinent NOT being put on a toileting plan immediately. The other common issue I see when reviewing records is the lack of updating care plans as the resident’s status changes – with every fall, with worsening dementia, physical decline, or new medical diagnosis (i.e. Parkinsonism).

Nurses reviewing records need to pay attention to the MDS, risk assessments, care plans and Interdisciplinary notes with attention to where the standard of care is not being met.
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