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Blood Cultures and Clinical Importance

SUMMARY

Detection of microorganism in the patient's blood is very important not only for diagnosis but also for treatment and prognosis. Bacteria are present in the blood in three ways: temporary, intermittent or continuous. In order to make the most of the blood cultures in the clinic, timing, number of cultures, amount of blood, content of the culture medium and the method used are very important, starting with skin antisepsis. In addition, the patient's immune deficiency or presence of an intravascular catheter should be considered carefully. Not all positive blood cultures may be clinically relevant. In the interpretation of leather flora elements, it can sometimes be misleading to comment only on the number of cultures. Good communication between the clinician and the laboratory increases the usefulness of blood cultures.

Keywords: Blood cultures, Bacteremia

SUMMARY

Blood Cultures and Clinical Significance

The detection of a microorganism in the blood of a patient. Bacteria can persist in three manners in blood; transiently To provide a benefit from blood cultures, including skin antisepsis, timing and frequency of culture, amount of blood taken, content of culture and culture method used. In addition, the patient with immunodeficiency or intravascular catheter needs to be evaluated carefully. Every positive blood culture may not be clinically significant. In particular, in interpretation of skin flora elements, evaluation of the number of cultures taken into account. Good communication between the clinician and microbiology laboratory increases the usefulness of blood cultures.

Key Words: Blood Cultures, Bacteremia

Presence and Clinical Meaning of Bacteria in Blood

Detection of microorganism in the patient's blood is important not only for diagnosis but also for treatment and prognosis. It has been shown that the risk of death is 12 times higher in patients with positive blood culture during hospitalization than in patients with negative blood culture (1).

There are three forms of bacteria in the blood. This also reflects the path of the bacterium into the blood.

a. Transient bacteremia: Infected tissues, interventions, cystoscopy, tooth extraction, urethral dilatation, sigmoidoscopy, such as the removal of burns in the blood can be temporarily mixed bacteria. In this case, the amount of bacteria in the blood is very small and the duration of its presence in the blood is very short.

b. Intermittently: Generally, bacteria from tissue and organs with closed lesions (abscess, empyema) or diffuse infections (cellulitis, peritonitis, septic arthritis) first enter the lymphatic tract and occasionally into the blood.

c. Continuous: Endocarditis, intravascular infection foci, where there are infected catheters and separate from them in the early stages of infections such as typhoid fever, brucellosis. However, the source of microorganisms cannot be determined in 1/3 of bacteremia (2).

In order to make the most of the blood cultures in the clinic, the following points should be considered.

How to Get Blood Culture?

1. Hematological, biochemical, etc. Blood tests should not be taken when taking blood for tests such as. The risk of contamination increases with multi-purpose intake.

2. Each blood culture should be taken from a different vein. If the appropriate vein is not available for blood culture collection or catheter-induced sepsis is considered, then it can be removed from the catheter.

3. After the vein to be cultured is palpated, the skin is cleaned from the center to the periphery with 70% ethyl alcohol. Then 30 sec. 1-2% iodine tincture is applied. Excess iodine is removed with 70% alcohol. Poor cleansing of the skin results in coagulase negative staphylococci, Corynebacterium spp. and Propionibacterium spp. It is the most common reason for the growth of skin contaminants such as blood cultures.

4. It is preferable to work with sterile gloves for blood culture. A new set should be used if the first attempt at blood collection has failed.

5. Bottles with blood culture should be disinfected with alcohol or iodine tincture. Iodine tincture should not be used for septum cleaning of BACTEC bottles.

6. There is no need to change the needle at the tip of the syringe during blood culture collection. After the blood is placed in the culture flask, it is mixed by shaking gently to prevent clotting.

7. The blood culture request form must be written on which vein it was taken from, at what time it was taken and whether it was taken from the catheter (3-6).

When and how many blood cultures should be taken?

Ideally, the blood culture should be taken one hour before the fever rises. Usually this is not possible in practice. There was no optimal time for the second culture to be taken within 24 hours of the first culture uptake. This is often determined by the severity of antibiotic treatment (7).

In cases such as sepsis, meningitis, osteomyelitis, arthritis, pneumonia and pyelonephritis, blood cultures should be taken from two or three different veins within 15-20 minutes. In acute endocarditis, samples should be taken from three different veins within the first 1-2 hours. In subacute endocarditis, three samples should be taken at intervals of 15 minutes or more on the first day. In the patient with endocarditis under treatment, two more cultures can be taken after three successful days. In patients receiving antibiotics, six blood cultures should be taken within 48 hours, and antibiotics should be tried at the lowest level (gutter period) (4).

In non-emergency cases, two to three blood cultures can be taken in 24 hours. 80-91.5% of the episodes are detected in the first blood culture and 99.3% are detected in the first two blood cultures (8,9).

If blood cultures taken at baseline are negative and there is no change in the patient's clinical and hemodynamic status, he should avoid taking blood culture at elevated fever several times a day. Repeated blood culture monitoring or monitoring after detection of true bacteremia is often unnecessary. Patients who do not respond to treatment or clinically worsen should be re-cultured (3).

What should be the amount of blood cultures taken?

Blood volume taken is the most important factor affecting the sensitivity of blood cultures. Generally, in 50% of bacteremia, the number of bacteria is 1 CFU or less in mL, and in 20% 0.1 CFU / mL. Each 1 mL of excess blood culture increases the positivity rate by 3% (10).

In adults, the recommended volume of blood for each different blood culture is 10-30 mL. If there is no anaerobic and fungal seeding in the protocol prepared for the patient, it is sufficient to take 10 mL for aerobic seeding. It should not be taken more than thirty mL because it causes nosocomial anemia (3).

The concentration of microorganisms during bacteremia in children is higher than in adults. It is sufficient to take 1-2 mL in newborns, 2-3 mL in infants and 3-5 mL in children (11).

What Should be the Approach in Immunodeficient Patients?

Ideally, aerobic and anaerobic bacteria, fungi, mycobacteria and some viruses (HIV, CMV) should be isolated in the culture to be taken in immunocompromised patients. This is not practical for today and is quite expensive (12).

If blood cultures remain negative despite the possibility of a strong infection in a patient with immunodeficiency, it should first be discussed whether appropriate blood culture techniques are used. It should be remembered that bone marrow and liver biopsy cultures are also very supportive in the diagnosis (13).

The higher the number of microorganisms circulating in the blood in patients with immunodeficiency, leads to an increase in the diagnostic value in direct microbiological examination of blood (14).

Blood Cultures in Catheterized Patients

When catheter-related bacteremia is considered, catheter tip culture should be performed. Maki's semi-quantitative technique is the most commonly used method (15).

Isolation of the same microorganism from both catheter tip and peripheral blood culture is highly supportive for catheter-related bacteremia (16).

For long-term catheters, bacteria are often found in the catheter. In this case, quantitative growth culture or quantitative culture of peripheral blood and catheter blood is more sensitive (17).

Clinical Microbiology Laboratory and Blood Cultures

Non-automated and automated methods for blood cultures are available in clinical microbiology laboratories.

Non-automated methods:

a. Conventional monophasic liquid media

b. Diphasic media (Castenada)

c. Lysis centrifugation method (4).

Conventional liquid media use media such as tryptic soy broth, brain-heart infusion broth, and sodium polyanethol sulfonate (SPS), also an anticoagulant. Here reproduction; turbidity, hemolysis, gas formation, Gram staining from culture or agar plate is detected by culture (18).

In the case of diphasic liquid media, in addition to the liquid culture medium, solid media containing agar is present on one side of the bottle. Thus, the liquid medium is brought into contact with the solid medium by inverting the bottle and thus the colonies are visible to the eye (5).

In the lysis centrifugation method, the blood is placed in a tube containing lysis fluid consisting of saponin, SPS, fluorinert and EDTA and centrifuged at high speed. The supernatant is discarded and the culture is made from the precipitate. It should be noted that contamination rate is high in addition to its important advantages (19).

Automatic methods can be divided into three generations:

1st generation: Radiometric blood culture systems: 14 C with radioactive label in medium. When the microorganism grows, it uses it and 14 CO 2 is formed in the medium. The system is based on radiometric reading of this.

2nd generation: Non-radiometric blood culture systems: The color change caused by the CO 2 released by the microorganism in the sensor dye in the bottle is measured spectrophotometrically or the resulting fluorescence is read.

3rd generation: Blood culture systems that monitor reproduction continuously: An important advantage of this method is the possibility of continuous monitoring of cultures under computer support. In addition, one of the important advantages of automatic methods is that they are very fast (20).

Microscopic Examination of Blood

Microscopic examination of blood blood protozoa, Borrelia and Leptospira can be searched (21).

Direct microscopic screening of blood or y buffy coat bakteri for bacteria is a time-consuming and insensitive method (22).

Gram staining from blood taken from the catheter of patients receiving total parenteral nutrition may help in the diagnosis of sepsis.

The presence of intracellular bacteria in peripheral blood smear taken from central venous catheters in immunosuppressive patients may be significant in terms of catheter infection (23,24).

How should blood culture results be evaluated in the clinic?

Not all positive blood cultures are clinically relevant. Even under optimal conditions, 2-3% contamination occurs. It is not always easy to distinguish true positivity from false positivity (3).

The following points should be observed to separate contaminant bacteria.

a. Type of microorganism

b. Compliance with the clinic

c. Reproduction time

D. How many blood cultures are produced

to. Presence of microorganisms belonging to many skin flora

f. Whether blood culture was taken during effective antibiotherapy

g. The number of non-reproductive blood cultures (25).

Generally, contaminant bacteria are skin flora elements. They do not exist in other or followed cultures. They are isolated after a long incubation (3,10).

Skin flora bacteria such as coagulase negative staphylococci, Corynebacterium spp, Propionibacterium acnes are considered contaminants when isolated from one of several blood cultures. However, accepting coagulase-negative staphylococci as contaminant in this way may also lead to the omission of a clinically significant episode (3,8).

Coagulase negative staphylococci are considered significant when isolated from two or more blood cultures. However, it is not always possible to say that this is true bacteremia without strains typing phenotypically and genotypically. These may be due to unrelated contaminated strains or recontamination. Therefore, when coagulase negative staphylococci are isolated from two or more blood cultures, at least antibiotic susceptibility should be compared. As can be seen, it can be misleading to adhere to the number of cultures in the interpretation of leather flora elements (25).

Generally, isolation of several different microorganisms from the blood culture promotes contamination. However, in one study, polymicrobial bacteremia was reported in 21% of septic episodes and it was shown to have higher mortality compared to monomicrobial bacteremia. Polymicrobial bacteremia is more common in patients with underlying serious disease, intraabdominal infections or obstructions and non-hematologic malignancies (9,26,27).

As a result, blood cultures go through different periods, each of which may have an impact on the diagnosis and treatment of the patient, starting with sampling from the patient, evaluating in the laboratory, monitoring and clinical interpretation of the results. Compliance with the rules and clinical-laboratory cooperation in all these periods increases the usefulness of blood cultures.


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An Important Step in Infection Prevention: Control

In this study, the extent to which the materials such as stretchers and tables in the health centers are the source of infection and the extent to which the controls to be performed on this subject can be investigated.

As a result of the evaluation of swab samples taken from tables and stretchers used in health centers and emergency service vehicles, the number of bacteria reproduction materials was 78.3% before unannounced inspection and 30.4% after informed inspection. The difference was statistically significant (p <0.01). When these bacteria were examined, S. aureus (34.3%), E. coli (15.2%), coagulase negative staphylococci (11.1%) and Klebsiella sp. (11.1%).

Keywords: Control, Infection.

We know that there are plenty and variety of microorganisms in every environment we live. In healthy people, microorganisms in the skin, upper respiratory tract, intestinal and genital systems are called normal flora. Some microorganisms are more susceptible to disease and are called pathogenic microorganisms and when infected, they cause disease. All microorganisms can cause infection when they find the appropriate environment.

It is impossible to create a fully sterile environment to prevent infection. However, it is possible to put protective barriers between the individual and microorganisms. A protective barrier is a physical, mechanical or chemical process that prevents infection from person to person, from healthcare workers or from contaminated tools and equipment. These processes are divided into three main categories: cleaning, disinfection and sterilization. Cleaning; removal of organic and inorganic substances with the help of water, soap and detergent. Sterilization; It is the complete removal of all microorganisms from the environment by using pressurized steam, dry hot, liquid or gas chemicals and gamma radiation. Disinfection; cleaning and sterilization. In high level disinfection, all bacteria, fungi and viruses in the environment are removed except for resistant bacterial spores. In low level disinfection, vegetative forms of many viruses and bacteria die, while spores, M. tuberculosis and some viruses remain alive.
Table: Distribution of Infection Sources by Risk Groups
Risk group Object Required action

High-grade risk Instrument, equipment, liquid Sterilization
Moderate risk In contact with solid skin, disinfection
tools, equipment, bedding surgery
and inspection tables, sliders, bathtubs
Low-grade risk Constant cleaning without contact with patient
surfaces, commode, ground, wall,


It is only possible to decide when and to which objects to perform for the correct application, only by knowing the risk levels of the sources of infection. Table 1 shows the differentiation of infection sources by risk groups. As can be seen in the table, some of the materials used in health centers are at risk for infection.
In-service trainings are provided within health centers to prevent infection in both resident and mobile health units. In our country, the duties related to the prevention of infection are mostly performed by non-physician health workers and assistants. The best way to measure the effectiveness of training on infection prevention is to conduct an audit. From this point of view, we planned to perform inspection of patient examination tables, gynecological tables and injection tables in the middle-risk group. As a result of this audit, we aimed to determine the bacterial species that can be transmitted to the patients from the health center and to determine how the informed and unannounced inspections affect the flora in the environment.

Materials and Methods
On 29.12.1998, swab samples were taken from the patient stretchers in Hızır Emergency Service vehicles and injection, dressing, examination tables and gynecological tables in 10 health centers and examined on blood and EMB media. The same transactions were repeated on 24.2.1999 with prior notice. Results were evaluated by chi-square test in dependent groups.

Results
In this study, swab samples were taken from 46 places, five of which were stretchers of Hızır Emergency Service ambulances and 41 of which were used in various jobs (injection, dressing, examination) in health centers. At least one bacterial growth was observed in 36 (78.3%) of the materials according to the results of the swab samples taken in the unannounced inspection and 14 (30.4%) of the materials taken in the informed inspection. There was a statistically significant difference between the two control results at different times (p <0.01). When the bacteria isolated before the control were evaluated, S. aureus (32.9%), E. coli (14.5%) and Klebsiella sp. (14.5%), S. aureus (39.2%), coagulase negative staphylococci (26.1) and Bacillus cereus (17.5%) were isolated.

Discussion
The service provided in health centers is a team service where all health workers take part. The person in charge of this service is the physician. When this is the case, the supervision of the service provided in the health center is among the duties of the physician and the health directorate. The main purpose of the audit is to find out the deficiencies in the service provision, to determine the reasons for this and to take the necessary precautions for these reasons. The health center physician should give the necessary importance to the cleaning of the place where he / she works as well as the services provided. Otherwise, it will endanger the health of both the patients coming to the health center and the staff of the health center.
In this study, dressing, examination, injection tables and swab samples taken from Hızır Emergency Department stretchers were evaluated in two different times, unannounced and informed. In the unannounced inspection, 78.3% of the tables and stretchers were smeared, while the frequency of bacterial isolation decreased to 30.4%. According to this, bacterial contamination was detected in health centers and Hızır Emergency Department tables and stretchers. The reason for this can be explained by the lack of importance given to cleaning, the lack of sufficient number of servants to do the cleaning work, or the lack of adequate training on this subject, and the responsible physician's failure to perform the audit duties.
S. aureus was the most frequently isolated bacteria in the study. More studies on this subject

It is very related to hospital and operating room environments. Staphylococci have been shown to be among the main causes of nosocomial infections, especially in recent studies.
An important feature of staphylococci is that they are common in the community and develop resistance to most antibiotics.
Since it is known that washing with water and detergent removes 80% of the microorganisms from the environment, a simple cleaning process in the health center environment will be effective in fighting infection. The most important task in this regard falls to the health center physician. The physician must first be knowledgeable about the subject. In a study conducted by Naçar et al., They reported that the knowledge of physician candidates about preventing infection was insufficient. Physicians who do not have sufficient knowledge at the time of graduation cannot show the necessary interest in their working life and do not inform their staff enough. However, according to the results of the study, it is sufficient to reduce the bacterial contamination by more than half, even if only the control work is given importance. The decrease in bacterial contamination in the pre-informed inspection can be explained by the fact that health center employees do not perform their duties more than their ignorance.

According to these findings, it is of great benefit to prevent infection in the health center environment by educating our physicians on the subject before graduation, educating physicians with in-service trainings and monitoring them regularly.




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What is Contamination? How Foods Are Contaminated?

As much as possible, I prepare my own bread almost every week and consume it for the rest of the week. As I was interested in pickles , vinegar and compost , as well as bread, I began to think more about the other living things in which we shared the common habitat, and we saw that the scope of what can be done in proportion to awareness increases. Why did I get off the road? As I mentioned on the page, I'm advancing the content in line with a plan and trying to address as many themes as possible. In line with these goals, I had to make some changes in my living space in the near future; In 2017, I will be able to share more detailed and detailed studies on a larger area. The subject I will touch upon in this article is again contamination which I pay special attention to during the change of place and production stage.

In the third month of my Kombucha tea, when the mother and the baby were contaminated with SCOBY , I had to discard them, I cannot tell about my astringency . Although SCOBY is highly resistant to foreign bacteria and fungi, in some cases, contamination can often occur in contact with the surface / lid. It's easy to understand. If the surface of the SCOBY is covered with hair, often colored spots and molds, and the smell has become pungent and unpleasant, then the job has passed. Therefore, I had to move the fermentation area to a suitable point where there would be no entry-exit, except for the areas where there was continuous movement, and to prepare more balanced and restrained foods by considering kombucha and other fermented foods. Of course, there were many arrangements from lighting to the arrangement of shelves, planning the area where the materials will be located and separating the usage areas. Before mentioning these regulations, I will mention the contamination on which the article will be based. Then I can continue with answers to the question of how to conserve food in a healthier way, how to use ingredients and techniques.

First of all, I want to give you a basic knowledge. Roughly, a bacterium can be cleaved again in about 20 minutes under appropriate conditions (warm, moist and nutrient rich). A single bacterium that grew at this rate would have produced a bacterial mass weighing approximately 2000 tons per 24 hours if there were no limiting factors and the process proceeded in a geometric sequence. Luckily, the situation is not so alarming. Because bacteria are consuming water and nutrients in this favorable environment in a very short time. Along with this consumption, alcohol and acidic compounds and other residues that are unfit for bacteria start to form.

These substances, which are formed and accumulated in the environment, serve as a limitation by causing bacteria to become insufficiently fed, damaged and killed. Thus, this increase in bacterial density is compensated by the activities of the bacteria themselves. In some cases, depending on the concentration of toxic substances in the environment, the mortality rate may increase and cause all the bacteria to die. Let me not forget, many bacteria die at + 100 ° C, but endospores (the shape a bacterium takes to protect the environment from external influences) can show long-lasting resistance. (see Control of Microbial Growth ).

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What is Cross Contamination?

Cross-contamination occurs when bacteria and viruses are transferred from a contaminated surface to another surface that has not been exposed to contamination. Cross-contamination is a key word for foodborne diseases and food poisoning. Cross-contamination has four main sources: Foods, people, equipment and work areas.

Food

Raw and spoiled foods may contain harmful bacteria. for example, raw meat may naturally contain high amounts of harmful bacteria that may form the basis of foodborne diseases such as Salmonella, Campylobacter and Listeria.
If careful bacteria are not treated, these bacteria can easily be transmitted from raw food to cooked and ready-to-eat food. Some examples are:
With the wrong preservation, the blood or juice of raw meat may drip onto cooked foods such as salami, sausages, or ready-to-eat foods such as salads, pastries.
If raw and cooked foods are used together to prepare sandwiches and mixed salads, harmful bacteria are easily transported from these greens to other foods (such as meat, cheese and eggs).

People

Harmful bacteria can live in and on the human body. especially in the hands and face area and clothing. However, they do not cause diseases because of their low rates. If these bacteria are contaminated by food from the body or clothing and there are conditions that are susceptible to growth, these foods become unsafe for consumption.

Equipment

Bacteria can survive and multiply in cracks and crevices of equipment. Of these equipment, they can especially live on the surface of cutting boards. After the equipment has been used, some parts of food carrying bacteria may remain on the surface of the equipment. If these equipment are not washed properly, the bacteria can be transported to other foods for later use.

Working places

Work areas such as table surfaces are in constant contact with people, raw foods, uncleaned equipment or other things such as cardboard placed on the floor. If the desks are not cleaned properly, the food placed on them can easily become contaminated.

Types of cross contamination:

- Food contamination from staff

- Food-to-food contamination

- Contamination from the surface in contact with the equipment or food


Especially in the studies carried out in businesses;

- Packages placed on the counter,

- Fridge etc. Refrigeration equipment,

- Simultaneous cutting of more than one type of food on the same cutting board,

- Do not wash hands before using gloves,

- Disinfection of work benches,

- Disinfectant concentrations are not at the correct concentration and

- Cross-contamination caused by failure to reach final rinse temperature.


At this stage, it is important to prepare standard operating procedures to prevent cross-contamination. The focus should be on;

- Personnel hygiene

- Accept goods

- Storage of food and chemicals

- Preparation

- Equipment and uses

- Cleaning and sanitation


Personnel hygiene: It should be ensured that the personnel should wash their hands especially when the duty or type of work changes, the use of gloves regularly and the use of cloths to wipe the hands or dirty foods should be avoided.

Acceptance of Goods: In this case raw and ready-to-eat foods should be kept separately at the time of delivery.

Storage of Food and Chemicals: Storage of raw meat and cooked or ready-to-eat foods in separate cabinets, if possible, storage of raw meat in the same cupboard under cooked or ready-to-eat foods, such as good wrapping (stretching) of foods, etc. should be kept at least 15 cm above, avoid storing in stacks, and certain persons should be allowed to enter the stores.
Chemicals should be stored in a separate and locked area, if possible, and separated from food, if possible.

Preparation: Frequent work benches and instrument equipment should be cleaned and disinfected. Apart from these, cutting boards should be cleaned between each use, gloves should be changed frequently, hands should be washed properly, food to be stored should be covered and eating should be avoided in working areas.

Equipment: There must be separate cutting boards for raw and cooked or ready-to-eat foods, if this is not possible, the use of different products should include documentation on how to use the same equipment. infrared thermometers should be used, it is recommended to clean high-risk areas before low-risk areas during cleaning. Especially if the same cleaning equipment will be used, employees should use each washbasin in accordance with the intended use to prevent contamination, plastic bags and foils should not be reused.

Cleaning and Disinfection: Buckets designed for cleaning and disinfection should be used, the concentration of sanitation solutions should be checked frequently and the sanitation solution should be changed frequently.

Cross-contamination Rules


- Foods that will be offered for direct consumption should not come together with raw products.

- Foods that will be offered for direct consumption and raw foods should be stored in separate places.

- Separate equipment should be used for direct consumption and raw foods.

- Wash your hands thoroughly if you are going to process food that is offered for direct consumption after touching raw foods or equipment used in raw foods.

- If possible, do not touch the foods that are to be consumed directly, or treat them with a disposable glove.

- Make sure that the equipment you use is clean and sound.

- Do not keep the garbage in the production and storage area for a long time.

- Protect against the entrance of insects, rodents and all kinds of pests in the production and storage area.


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Listeria Disease

Listeriosis is a serious infection caused by ingestion of food contaminated with Listeria monocytogenes bacteria and is a major public health problem in the United States. Every year 1600 people are infected and 260 of them die.
Infection

Listeria monocytogenes are often found in soil and water. Animals can carry the bacteria without getting sick, but food from meat and dairy products can be contaminated. Infection is transmitted to humans by ingesting contaminated food. Babies may be born with Listeriosis if their mothers have consumed contaminated food during pregnancy. Rarely, hospital-acquired transmission of neonates has been reported.

There are many microbes that are transmitted through food. Some of them, like Listeria, can be lethal.
symptoms

People with listeriosis usually have fever and muscle pains, and sometimes diarrhea or gastrointestinal symptoms. In almost every diagnosed patient, bacteria spread to the digestive tract. Symptoms vary according to the infected person:

Pregnant women: Typically, fever occurs, other nonspecific symptoms such as fatigue and pain may accompany. However, exposure to bacteria during pregnancy; abortion, stillbirth, preterm birth or newborn life-threatening infections.
People other than pregnant: In addition to fever and muscle pain; Headache, stiff neck, blurred consciousness, loss of balance and convulsions may occur.

Listeriosis can occur in different ways. Septicemia and meningitis are the most common clinical conditions in the elderly and immunocompromised individuals. People with immune system problems may develop acute febrile gastroenteritis or have no symptoms.

Some cases result in death even if treatment is initiated immediately. This is especially true for older people and risk groups with serious health problems.
Diagnosis and Treatment

Early diagnosis and treatment is very important. According to the patient's clinic, definitive diagnosis is made by the growth of bacteria in CSF (Cerebrospinal Fluid) or blood cultures. Effective antibiotics are used in the treatment. If no symptoms have appeared in a person who has consumed contaminated food, most experts believe that no testing or treatment is needed.
Risk for passengers

Listeriosis can be seen anywhere in the world. The disease is primarily related to the elderly (58%), pregnant women (approximately 1/7 of the cases (14%)), newborns and adults with weakened immune systems (such as cancer, liver and kidney failure, diabetes, alcoholism, AIDS, immunosuppressive treatment). effects. However, it may rarely affect people who are not in the risk group.
Protection

Listeria can survive for years in contaminated food products in food processing factories. Bacterium; uncooked meats and vegetables, non-pasteurized milk and dairy products, cream cheese, processed meats (ready to eat) and smoked fish.

Listeria can be killed by pasteurization and cooking. However, contamination may occur in some processed meats such as hot dogs and delicatessens before packaging. Although pasteurized milk is used, as in Mexican cheeses, it can still be transmitted during the cheese making phase.

The risk of disease can be reduced by recommending safe preparation, consumption and storage of food. The recommended general rules for the prevention of listeriosis are similar to those used in the prevention of other foodborne diseases such as salmonellosis. In addition, there are special recommendations for people in the high-risk group for Listeriosis.

Advice for the prevention of foodborne diseases:

Wash your hands frequently with soap and water. If water and soap are not available, use alcohol-based hand disinfectants,
Avoid consumption of risky foods and beverages,
Drinking water should be either in safe sealed packages or boiled before drinking. The carbonated ones of closed waters are safer than the ones that are not carbonated. Do not use in your drinks unless the ice is prepared with closed water or if it is not known how to prepare it. Your food should be fresh and very well cooked.
Do not buy food or drink from street vendors. Many travelers become ill with food from street vendors.
Do not consume fruits and vegetables without washing or peeling. Especially salad material vegetables should be washed very well with clean water (BOIL, COOK, SOY OR FORGOT).

FDA recommendations on food washing and use:

Rinse thoroughly under running tap water before cutting, cooking and eating raw products such as fruits and vegetables. The product should be washed before peeling off.
Hard products such as melon, cucumber should be brushed with a clean brush.
Dry the products with a clean cloth or paper towel.
Separate prepared foods and cooked foods from vegetables, uncooked meat and poultry.
Keep your kitchen and environment clean and safe.
After preparing and using uncooked food, wash the cutting boards, benches, knives and hands.
Unlike many bacteria, Listeria monocytogenes continue to grow and multiply in some refrigerated foods. The refrigerator must be at zero or lower temperature.
Immediately clean the food spilled in your refrigerator with hot water and liquid soap and rinse.
Thoroughly cook food of animal origin (such as meat, milk).
Do not drink non-pasteurized or raw milk and do not eat foods made from these milk.
Take care to buy and consume safe foods.

Trip Return Recommendations

If you are feeling sick, especially if you have fever, muscle pain, weakness, diarrhea, nausea, vomiting, contact your doctor or health care provider immediately.
Be sure to tell your doctor about your trip.

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What is cross-contamination, how to prevent it?

Cross-contamination, also called cross-contamination , is the transmission of harmful viruses and bacteria to environments that are not bacterial. The most important cause of food poisoning is cross-contamination. Raw foods, especially spoiled foods, are heavily viruses and bacteria. Therefore, the causes of cross-contamination and the precautions to be taken to prevent this situation should be known.
How does cross-transmission occur?

The equipment used by individuals and the unhygienic nature of the work areas bring about cross contamination. Of course, the use of faulty equipment also contributes to this process. Foods that contain bacteria are the most prone to spoilage, but diseases such as Salmonella and Listeria appear with foods that contain bacteria.

In addition, raw foods made ready for consumption also occur with cross contamination. To give an example in this regard; The addition of salami, sausage or raw broth to cooked foods or the transmission of viruses occurs between the food. This can naturally cause health problems.

People are the most important factor in today's ways of cross-contamination . Bacteria, which can easily multiply in human body, are densely found in hands and face. In addition, these bacteria, which can also be transmitted by clothing, are transmitted to food and cause cross-contamination.

Kitchen utensils used with people are also important. It should be remembered that viruses and bacteria can easily find themselves in cracks in kitchen tools and equipment. Bacteria and viruses can easily multiply on boards which are mostly used for cutting salads or meat.

What are the Cross-Contamination Types?

The cross-contamination process occurs in 3 different ways:

From food to food,
By the hand of the staff,
with equipment.

Especially in a study conducted on enterprises, it was stated that the causes of cross contamination occur due to the following factors. These factors are;

Failure to clean workbenches,
Use of refrigerator
Cutting different food types on the same cutting board,
Personnel do not pay attention to hand cleaning before handling food,
Open packages left on the looms are listed as.

Of course it is possible to avoid cross-contamination. In this process, storage of chemical products and foods should be considered. In addition, the hygiene of the personnel and the foodstuffs in the establishments should be kept in a healthy way. In addition, the preparation stage of foods should also be observed to prevent cross-contamination.

How to Prevent Cross-Contamination?

A number of measures are necessary to prevent cross-contamination. These measures;

Foods to be consumed should be kept in a different environment than raw foods.
Foods to be consumed and raw foods should not be brought together in any way.
Production and storage areas in enterprises should be hygienic.
Waste collected in the production and storage areas of the enterprises should be collected hourly or daily.
The equipment used must remain clean at all times.
Different equipment should be used in the preparation of raw foods and other foods.

In general, ways of preventing cross-contamination are such. In addition, some information about celiac disease, which is widely researched today and associated with the risk of cross contamination, should be obtained. Because the risk of cross-contamination in gluten is quite high.
Cross-Contamination and Gluten Relationship

What is Gluten?

Individuals with hypersensitivity to gluten protein are defined as celiac disease. In other words, gluten-containing foods should not be consumed by celiac patients for a lifetime. Therefore, it is essential that celiac patients take some importance against the risk of cross contamination. Furthermore, the cross-contamination and gluten relationship is a matter of utmost importance in the preparation and delivery of foods.

There is a diet program specially prepared for celiac patients. During the preparation of the foods in this program, attention should be paid to bakery products. Since the workshops cannot consume any floury products, gluten-free and gluten-free flours need to be stored in different areas.

In fact, there is always a risk of cross-contamination for celiac patients. No food should be taken from outside during this process. For example, soups and soups are prepared with oily flours which are intended to be consumed from the outside. For celiac patients, this may lead to many different health problems. For these reasons, it should be noted whether gluten information is available on the food to be purchased from outside.

How should celiac patients be fed?

Food preparation process is also important for celiacs. The food of such patients should be prepared with different kitchen equipment. Both wooden and iron spoons cannot prevent the risk of gluten contamination. Therefore, the kitchen equipment of patients on a gluten-free diet should be stored in a different part of their living space.

The risk of cross-contamination in foods is most likely to be celiac disease. For celiac patients, let food come into contact, even in the same environment. In particular, flour is a volatile substance and is the most risky food category for those who have to live gluten-free.


1AXX
MedPride Powder-Free Nitrile Exam Gloves, Medium, Box/100

Ziploc Slider Storage Bags, Quart, 42 Count per pack, Pack of 3

Honey storage at home: basic rules

This product has medicinal properties because it is known to everyone about the benefit of honey. It is used in various diseases as an additional treatment. With the continuous use of honey, there is an increase in immunity, restoration of strength and improvement of the general condition of the body. However, when the content of the product is in an unsuitable environment, some useful properties may be lost. In addition, the taste may deteriorate. Honey storage at home requires following certain rules, which are the main points we will try to emphasize in this article.

Product Storage Tanks

honey storage

Honey storage at home means that the product will not lose its properties:

Anti-inflammatory.
Bacteria.
Game Envelope.
Restore and others.

It is recommended to have a natural product in these containers:

Parquet casks.
Tin, aluminum or stainless steel kitchenware.
Ceramic products with glaze coating.
Glass containers.

Honey is not recommended to be placed in containers made of copper, lead, zinc, iron and cannot be stored from oak products.

Room for honey

keep refrigerated honey

Storage of honey in house conditions, preparation of a special room for these purposes. It is better to take these moments into account:

The room should be kept at a constant temperature (0–10 ° C) at a humidity of not more than 70%.
The absence of foreign odors is impossible. In particular, you cannot keep it near fuels, lubricants and other chemicals.
The room should be well ventilated and at the same time the direct rays of the sun should not fall on honey. Therefore, it is better to use opaque packaging.

Because this product is highly hygroscopic, it can rapidly absorb moisture from the environment and other substances. As a result, it is not recommended to store the honey in the refrigerator.

Storage highlights

honey storage rules

Honey in honeycombs can be preserved as long as desired. The fungus and mold are destroyed by substances found in the product itself and in the natural “container” composition. At the same time, the most favorable conditions that determine the honey storage rules are: temperature - about 5 ° C, humidity in the air - about 60%.

It is noted that honey can absorb moisture. The environment, even in closed containers with more than 70% air vapor in the air. If the value of this indicator is less than 30%, the product, by contrast, releases water particles.

It is forbidden to contain honey at a temperature above 15 ° С, because at the same time acid reactions begin to occur in the composition. And when heated to 40 ° C, vitamins and other substances are destroyed and the natural product loses its healing properties.

It is best to store the honey at home under optimal conditions. At the same time, the product does not lose its usefulness as it is a valuable product of the “natural masters” - bees.

56AXX
Ziploc Slider Storage Bags, Quart, 42 Count per pack, Pack of 3

Ziploc Storage Bags, quart, 80 Count (Pack of 1)

Some tips for storing honey in honeycombs

However, the beneficial properties of honey are known by everyone. Not every product sold in the store is natural. In addition, we generally obtain a specific substance having a modified composition in which sucrose, fructose and various preservatives are added to extend shelf life.

How to store honey in honeycombs
In order to obtain a real product, it must be purchased in its original form, since this will ensure that there is no pollution. In this article, honeycombs will be stored for as long as possible without preservatives to maintain their natural properties for storing them in honey.

As is known, the usual honey product is as follows: When stored in a clean container, it is desirable to have glassware that will prevent the occurrence of fermentation processes that degrade the quality of the product. However, if you are concerned about storing honey in honeycombs, the external conditions are slightly different. For example, the optimal capacity for such a natural material would be wood barrels made of linden, birch, cedar or beech. In principle, enamel or glassware is prohibited. The most important condition required by the honey storage in combs is that the compositions used are clean and protected from microorganisms, to prevent fermentation and the formation of foreign impurities in the product composition. Under no circumstances should it be possible to use containers of different alloys, for example lead and copper, as these metals may react with acids in honey, leading to the formation of harmful substances therein.

where to store honey in honeycombs
Asking how to hide honeySotah is also necessary to take into account the presence of light, because if you put the product in the light, it helps darken it. In principle, the temperature conditions are not critical when storing the combs, but if the temperature is excessively high (more than 22 degrees Celsius), the beneficial substances in the honey will disappear. Accordingly, the best place to store this product is a cellar or a cold cabinet in the apartment. A refrigerator is also suitable for maintaining the desired temperature.

Regardless of where it should be kept in mind.To prevent its crystallization fails, comb the honey and store it at what temperature. A product released from cells of natural origin is subject to the so-called saccharification, but this does not affect the composition and quality. If you want to avoid this phenomenon, collect regularly from the surface of the crystals on a weekly basis hence preserving the liquid part for a long time.
honey storage
Since the honeycombs offered for sale are in the form, it is allowed to cut large enough layers before storage, but it is preferable to keep each received part separate from the others to prevent it from sticking.

Before buying a remedial natural product, consider how honey is stored in honeycombs to maintain the healing properties as much as possible.



55AXX
Ziploc Storage Bags, quart, 80 Count (Pack of 1)

Ziploc Sandwich Bags, 280 ct

How to store refrigerator greens: a few simple ways

Each of us would probably like to consume something fresh, vitamins, especially during the spring beriberi and winter during this period. The greens are the best option here. Parsley, dill, onion, coriander, basil - and not all of the varieties offered in this market and supermarket. However, since it does not disappear, you need to know clearly how to store the greens correctly in the refrigerator, not to allow fading or drying. And from increased moisture, the product, by contrast, can be deoxidation or foul. To prevent this from happening, you can use some tips on how to store greens in the refrigerator - both public and more modern, technologically mature. And if some housewives in the kitchen have new models of refrigerators (where there is a special zero compartment where greens are not hard to hide), most people still use proven grandmother methods. Let's try to explain these methods and more in our article, which is not less interesting.
How to store refrigerator greens

Vacuum container

How to store greens in the refrigerator with a vacuum cup? Well, it should be purchased initially. And well-known companies that proved themselves in the market to choose better and more suitable dishes. This is because an uncertain manufacturer can use poor quality non-plastic products. In addition, many companies that are quite popular have already developed all the lines of such products - and do not need to invent any bikes. The containers are available in various sizes, shapes and colors. It's not the main thing here. And it is important that the plates respect the vacuum principle of action and are made of "food" material. Before the bookmark, the greens should be touched, washed with running water and dried. Yes and the final nuance: These accessories are quite expensive, but it is better to spend more than throwing spoiled products.
How to store greens in the refrigerator

Glass Jar

How are greens stored in the refrigerator with an ordinary glass jar? This is a proven method in people who first invented Soviet refrigerators, probably more invented.

The green beams are free of teeth and possible spoiled elements. Cut the roots.
Pour cold water in a large and deep container and rinse the plants thoroughly.
We forgive your towel on the table or in any plane (you can make paper) and suck the greens from the liquid. We take some time to dry as much as possible.
For dry liters (if there is too much greenery in a three-liter box), place the jar with a plastic lid after placing the plant jar.
We put it at the bottom of the refrigerator where the temperature is always plus, but not high.

In this way green plants can continue two or three weeks fresh (this applies to species such as dill, celery, parsley). More tender types - for example lettuce or coriander - can live there a little shorter time: up to a week.
Polyethylene, food packaging

How to store refrigerator greens in the package? Simple than simple! It's also a well-proven way. This allows you to store greens on the refrigerator, pantry or even in the winter on a glass balcony. But it feels great even at the bottom of the refrigerator: it's been held for more than a week.

We rank among the purchased plants and clean the bruises. In any case not mine?
We put them in a pretty dense food plastic package.
We did this, the green bag was inflated with air from the inside like a ball. Then hold a round shape, firmly attached (it is convenient to make it with office scotch tape).
The spicy bundles in the bag are placed in the refrigerator with the plus indicators of the thermometer.

How to store fresh herbs in the refrigerator

Wet wrapping paper

How is the newspaper stored in the refrigerator greens? Proper paper towels or food packaging - no difference. Don't use newspapers - they have inks that can turn into products. The main quality of the selected material is that it is not filtered under the influence of moisture. My greens and sequential. It was then wrapped in paper and sprayed with water from a spray gun. The dressing laid the refrigerator in an open polyethylene bag. Thus, the greens can be stored for up to a week and possibly longer.
How to store greens in the refrigerator

Freezer and zero room

The most technological way to store fresh greens in the refrigerator. Plants need to be prepared to shape them by cleaning and washing them. Then - grind and place in a plastic container. Place in freezer (or zero compartment, specially designed for freezing fruit and greens). If you know how to properly store the greens in the fridge in such situations, you can use it to decorate dishes that you can use to make salads and other tasty and useful things, while serving on the table all year round!



54AXX
Ziploc Sandwich Bags, 280 ct

Amazon Brand - Solimo Sandwich Storage Bags, 300 Count

How to store cranberries at home: useful suggestions for housewives to note

A long time ago, cranberries were considered one of the vitamin stores. The berry is rich in ascorbic acid, so it is recommended for the prevention of colds. It is used in folk medicine and cooking. But not everyone knows how to keep cranberries for a long time. We'il talk about it.

How to store cranberries at home

Delicious mousse, salads, fruit drinks and even second dishes from fruits. And how useful vitamins stuffed with cranberry juice! They differ in their curative strength and taste. Doctors recommend eating fruits throughout the year.
How to store cranberries at home, so that it remains useful and delicious?

Yes, very simple. Remember: Sour longer and best kept acid. After picking, it does not need to be free of debris, the fruits remain under fresh moss for a long time. So, how do you keep cranberries at home in many ways? We're moving to the important part of the article.

Fruits leaves all winters, benefit and taste, use ordinary water. But only the immature fruits are stored. Cranberries are filled with boiled water in a bowl and stored in this form in winter time.

How to store cranberries for winter

Many granulated sugarand frozen. To begin, the fruits need to be sorted and removed. Also wash them dry and leave on towel. Dried fruits are passed through a mincer or mixed with sugar in a mixer (ratios 1: 1).

If you get less sugar, then cranberries begin to wander and deteriorate. We transfer the fruit mass to a clean and dry jar, cover it with a lid and carry it to the ceiling or basement where it is not ribbed.
ice cream

How else to store cranberries? Can be frozen for winter. This is an excellent and acceptable option. Take the undamaged fruit, rinse thoroughly and put in a special container or plastic bag. Shake containers periodically, do not allow fruits to stick together. Jelly, fruit drinks and compotes are prepared from fresh frozen cranberries. Can be thinned with dried fruits.

How to store cranberries

In dried form

How do they store dried cranberries at home? Washed fruits lightly wrap, the skin itself enough to leave the skin. The uniform layer spread the product onto the baking sheet and dried in an oven at 60 ° C for 5 hours. A simple and effective method likes mistresses.
Wet case

Fill the fruits with water, add some honey, spices (cloves, cinnamon). We set up the yoke upstairs. You can eat cranberries in a month. Wet, even more delicious.

We recommend you to cook a delicious jam from cranberries. One kilogram of strawberries, one and a half cups of water and the same amount of sugar is taken. Cook syrup, add fruits and leave on low heat for 15 minutes. Meanwhile, for piquancy, put some walnut or apple slices. Ready jams are placed in glass containers and sealed.

Thus we explained how to store cranberries.Home conditions without the use of harmful impurities - all recipes are quite simple and affordable. Similarly, any fruit is stored. I agree: it is much better to eat fresh, cooked food, knowing that they will bring tremendous benefits to the body.



53AXX
Amazon Brand - Solimo Sandwich Storage Bags, 300 Count

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How is watermelon stored? Some practical tips

It's hard to find a person indifferent to this strawberry. Watermelons are loved by everyone. But a great pity that you cannot enjoy your pleasures throughout the year. Each fruit has its own season. Therefore, many people are trying to find a way to store watermelons for the winter. The simplest is protection and salting. There are many recipes to choose from. But at least until the beginning of winter you want to keep a fresh watermelon!
A few facts

Watermelon lowers body temperature, normalizes the pressure and strengthens the immune system. In addition, it extinguishes thirst perfectly on a hot day. Watermelon contains iron, magnesium and folic acid. It is useful for people suffering from anemia and atherosclerosis, helps to thin blood, removes bile and is the most powerful diuretic. A list of these beneficial properties can be supported by the removal of toxins from the liver and cleaning of the kidneys and gallbladder. Therefore, it is very important to know how to store the useful features of watermelon so that it can be used for as long as possible.
How to choose a watermelon

How to store watermelon in winter
The right choice is the most important thing. Therefore, before asking the question sakla hiding watermelons,, you should find out what the best fruits are for this. It is believed that watermelon fruits retain their nutritional properties for 3 months. Therefore, then the ordeal is better severed. We'il get them at the end of the season. But there are subtleties here too. Watermelon should not be ripe. It is better to take fruits in the first stage of maturity. At this point, the meats are still brown and the stalk is lightly dried. It is necessary to select a watermelon with a whitish coating on the bark. Optimal for storage. The sound of the fetus blowing should be further inspired. During the storage process of brown strawberries dospevayut, it becomes red and the right amount of nutrients are obtained. However, it should be borne in mind that very green watermelons will not mature sufficiently and cannot achieve the true taste.

storage

How to store watermelon for winter

And now consider hiding watermelons in the winter. Generally, separate rooms are provided for this purpose. They must pay attention to a special temperature regime and sufficient humidity. Only in these conditions is it possible to store the watermelon as much as possible. The temperature in the room should be about 3-4 degrees. The humidity of the air is 70-75%. Therefore, it creates the necessary conditions by learning how to store watermelons. Distance between shelves, with shelves in the room - 1 meter. It should also be retracted approximately 0.5 m from the wall. The condition of watermelons should be monitored during storage. If signs of deterioration occur, this sample should be subtracted from the total mass. We have to make sure strawberries don't touch each other. Thus, you can save the watermelons before New Year and even longer. By selecting the fruits correctly and providing all the conditions, you can feed yourself and your friends with the aroma and taste that looks very unusual in winter.
Easy way to hide

You can protect the watermelons in small quantities.nets or shopping bags. We hang them on the ceiling in a room with the necessary conditions. The main thing is that the fruits do not touch each other. They must be checked periodically for damage.



52AXX
Ziploc Sandwich Bags, XL, 3 Pack, 30 ct