Beware of Strangers Bearing Gifts: Foodborne Illness in Outpatient Clinic

BACKGROUND: Catered meals are common in hospitals, outpatient clinics, and physician offices. During a routine site visit of an outpatient clinic, Infection Control (IC) identified an outbreak of gastrointestinal (GI) illness among clinic employees. Personnel attributed their illness to a lunch catered from a local restaurant the previous day. METHODS: Cases were defined as personnel who ate catered food and developed two or more of the following symptoms: nausea, vomiting, diarrhea, abdominal cramps, headache, fever, or chills. A menu and list of employees present at the luncheon were obtained. Clinic personnel were interviewed for food and symptom histories. Stool specimens and temperatures were collected on symptomatic personnel. The local department of health (DOH) and the hospital epidemiologist were notified, along with the vendor who provided the lunch. RESULTS: Fourteen cases were identified among 21 clinic personnel (attack RATE=70%). The illness onset varied from 2 to 17 hours (median=12 hours) after lunch. Personnel reported the following symptoms: diarrhea (86%), abdominal cramps (66%), nausea (40%), chills (20%), and headache (20%). Personnel who ate pasta with cream sauce were more likely to become ill compared to those who did not (13/17 [76%] versus 1/3 [33%], P=0.14]. Stool cultures were obtained from six cases; all were negative for bacterial pathogens. Secondary illness developed in two family members of employees. Seven employees continued to have contact with patients while symptomatic and were reluctant to go home due to financial and staffing constraints. CONCLUSIONS: The attack rate and incubation period suggests this outbreak was directly related to a catered meal. IC and the DOH would not have been aware of this outbreak had the IC practitioner not arrived for a routine site visit. Clinic personnel were unaware that GI illness could be transmitted to others and continued to work while symptomatic. This investigation prompted education of the medical centerʹs clinical administrators regarding the importance of notifying IC regarding foodborne illnesses and prohibiting symptomatic personnel from working.