Salmonella, hygiene measures

Preventive measures (according to the current guidelines of the RKI).

General preventive measures: Salmonella multiply in the temperature range of 10 - 47°C, in some cases already from 6 - 8°C. In the environment and in or on various foods, they can survive for up to several months. Freezing does not kill them. In addition to creating and maintaining the conditions for the production of Salmonella-free food and strict compliance with hygienic conditions during the extraction, treatment and processing, storage, transport and sale of food, especially of animal origin, the following individual measures can have a preventive effect:

• All food and foodstuffs containing a lot of protein and water must be kept either hot (> 70°C) or below 10°C, i.e. in the refrigerator. Raw meat and sausages, slaughtered poultry, sea animals, eggs, creams, salads and mayonnaises with raw egg as well as ice cream must always be kept in the refrigerator after purchase.
• Food must not be kept warm, i.e. below 60°C, for long periods. Safe killing of salmonella is achieved at temperatures above 70°C for at least ten minutes cooking time.
• In the case of precooked food, the cooling time must be kept short, between 60°C and 10°C. Hot food should be consumed within 2 hours after the last heating.
• When thawing frozen poultry and game, the thawing water often contains salmonella. Collect thawing water separately and dispose of immediately (rinse hot). Thoroughly clean all items that have come in contact with it and hands immediately afterwards with water that is as hot as possible.
• When cooking with the microwave, do not select cooking times that are too short, so that the food is also sufficiently heated inside. When reheating food, 70°C must be exceeded.
• Instant products should always be prepared just before consumption. Instant infant foods should be prepared with water heated to at least 70°C, then cooled rapidly to the desired consumption temperature and consumed as soon as possible, but definitely within no more than 2 hours.
• Strict attention to hand hygiene.
• Use and frequently change boilable kitchen towels.
• Reptiles should not be kept in households with children under 2 years of age.
• Note: Further consumer tips for protection against foodborne infections in private households can be found on the website of the Federal Institute for Risk Assessment.

Community facilities (according to § 33 IfSG, including kindergartens, schools, homes)

The most important measure for prophylaxis of transmission is hand washing, especially after each visit to the toilet, after contact with presumably contaminated objects (e.g. diapers), food (e.g. poultry) and before preparing meals. Hand washing does not eliminate pathogens, but it does drastically reduce the number of germs on the hands. In communal facilities for young children, special attention should be paid to staff compliance with hygiene measures.

Food establishments and facilities for communal catering (in accordance with Section 42 (1) IfSG)

In food establishments, further measures are indicated in addition to hand washing: alcohol-based disinfectants are suitable for hand disinfection. The disinfectant is rubbed into the hands according to the manufacturer's instructions; nail folds and fingertips must be treated with particular care. Suitable agents are listed in the list of disinfectants and disinfection methods tested and approved by the Robert Koch Institute (RKI list) and the list of disinfectants of the Association for Applied Hygiene (VAH list). For disinfection measures ordered by the authorities, the RKI list must be consulted. Water and soap may only be used after the specified exposure time has elapsed.

Hospitals and other health care facilities: Measures to prevent the spread of Salmonella from person to person are based on three pillars:

• strict adherence to hand hygiene
• targeted disinfection of all hand contact surfaces
• if necessary (taking into account the individual situation on site) isolation of patients.

Measures in case of individual illnesses: symptomatically ill patients are usually not fit for work and should stay at home.

Community facilities (according to § 33 IfSG, including kindergartens, schools, homes): Children cared for in community facilities who have not yet reached the age of 6 and are ill with or suspected of having infectious gastroenteritis may not enter the rooms used for the operation of the community facility, may not use facilities of the community facility and may not participate in events of the community facility. Re-admission for children ill with/suspected of being ill with infectious gastroenteritis who have not yet reached the age of 6 is possible 48 hours after clinical symptoms have subsided. The level of pathogen excretion is the key criterion for secondary infections. This may be prolonged but decreases exponentially. Re-admission after the listed 48 hours should not usually result in secondary infections as long as the affected individuals are asymptomatic and the listed hygiene measures are followed. Hygiene compliance is limited in young children, but most transmissions occur at this age, especially during diaper changes, and further spread can be prevented here with the hygiene skills of the educators (For more information, see the recommendations of the RKI for re-admission to community facilities according to § 34 IfSG).

Note: The competent authority may, in agreement with the health authority, allow exceptions from the prohibitions mentioned in § 33 for the facilities mentioned, if measures are being or have been implemented to prevent the transmission of the listed disease or the louse:

• There is no ban on visiting children older than 6 years of age who are ill with salmonellosis and those suspected of having it, or on activities in the facility by caregivers who are ill with salmonellosis and those suspected of having it.
• The restriction on activity or attendance at the community facility shall apply until a medical judgment indicates that further spread of the disease is no longer feared.
• The medical judgment may be the judgment of the attending physician or a physician from the appropriate health department. The medical opinion may be given orally. § Section 34 IfSG does not require a written certificate of the medical judgment, but it may still be appropriate for the protection of all parties involved.

Food establishments and institutions for communal catering (according to § 42 para. 1 IfSG): According to § 42 IfSG, persons suffering from or suspected of suffering from salmonellosis or other infectious gastroenteritis, as well as persons excreting salmonella, may not work or be employed:

• (a) in the manufacture, handling or placing on the market of the foodstuffs referred to in Section 42(2) (see below) if they come into contact with them in the process; or
• b) in kitchens of restaurants and other establishments with or for communal catering.

Remark. Foodstuffs within the meaning of Section 42 (2) IfSG are:

• meat, poultry meat and products thereof
• milk and milk-based products
• fish, crustaceans or molluscs and products thereof
• Egg products
• food for infants and young children
• Ice cream and ice cream semi-products
• Baked goods with fillings or toppings that are not baked through or heated through
• Delicatessen, raw vegetable and potato salads, marinades, mayonnaises, other emulsified sauces, nutritional yeasts
• Sprouts and sprouting seeds for raw consumption and seeds for the production of sprouts and sprouting seeds for raw consumption.

Reference to EU Regulation 852/2004 on food hygiene: According to Annex 2, Chapter VIII ("Personal Hygiene") No. 2, first sentence of Regulation (EC) No. 852/2004, which lays down general food hygiene rules for food business operators, persons suffering from or carrying a food-borne disease, as well as persons with, for example, infected wounds, skin infections or lesions, or diarrhea, aregenerally prohibited from handling food and from entering areas where food is handled if there is a possibility of direct or indirect contamination.

Contact handling: No special measures are required for contact persons as long as no enteritic symptoms occur.

Measures to be taken in case of outbreaks: In case of outbreaks, the identification of the source of infection or the transmitting vehicle as soon as possible is of primary importance in order to be able to initiate prompt measures for the registration of infected persons and for the prevention of further spread. The responsible public health department must be informed immediately. If transmission through certain foodstuffs is suspected, the competent food control authority must be informed immediately. For further typing and characterization, isolated strains should be sent immediately to the NRZ for Salmonella and other bacterial enteritis pathogens (information on the management of outbreak situations in hospitals can be found in the recommendation of the Commission for Hospital Hygiene and Infection Prevention Outbreak Management and Structured Procedure for Frequent Occurrences of Nosocomial Infections).

Legal basis: Obligation to report according to IfSG: According to § 7 para. 1 IfSG, direct or indirect detection of Salmonella serovars, as far as it indicates an acute infection, is reported by name to the public health department. Furthermore, according to § 6 para. 1 no. 2 IfSG, the suspicion of and illness from acute infectious gastroenteritis must be reported:

• if the person concerned handles food or is employed in communal catering facilities (e.g. kitchens, restaurants) (see measures for patients and contact persons), or
• when two or more diseases of the same type occur where an epidemic link is likely or suspected.
• The notifications must be submitted to the public health department no later than 24 hours after they become known. Section 8 IfSG specifies the persons obliged to report (https://www.gesetze-im-internet.de/ifsg/__8.html). Section 9 IfSG specifies the information that may be included in the notification to the health authority by name(https://www.gesetze-im-internet.de/ifsg/__9.html).
• Obligation to notify according to IfSG: According to § 34 para. 6 IfSG, managers of community facilities have to notify the responsible public health department immediately if children under the age of 6 who are cared for in their facility have contracted infectious gastroenteritis or are suspected of having contracted infectious gastroenteritis.
• Transmission: In accordance with § 11 para. 1 IfSG, the public health department only transmits cases of illness or death and evidence of pathogens to the competent state authority that correspond to the case definition in accordance with § 11 para. 2 IfSG.
• The case definitions prepared by the RKI are published on the RKI website at www.rki.de/falldefinitionen.