Introduction
Food-borne illness or food poisoning is a sickness that occurs when harmful micro- organisms (bacteria, parasites, viruses) or chemical contaminants from foods or drinking water are ingested [1]. The US Centers for Disease Control and Prevention (CDC) estimates that each year, roughly 1 in 6 Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3000 die of foodborne diseases [2]. Certain groups, such as pregnant women and their fetuses, young children, older adults, people with weakened immune systems, and individuals with certain chronic ill- nesses, are at higher risk of food-borne illness than others [3, 4]. This group of vul- nerable individuals makes up approximately 20% of the American population [4].
Pregnant women are at higher risk of food-borne illness because of hormonal changes that compromise their immune system. During pregnancy, pathogenic microorganisms can cross the placenta, infecting the fetus, whose immune system has not developed enough for self-protection. These infestations can cause miscar- riage, premature delivery, hearing loss, intellectual disabilities, blindness, or serious sickness [5, 6]. Thus, safe food handling during pregnancy is critical for the health of the mother-to-be and her baby.
sanitation practices, are prevalent among consumers [11]. Most of the food safety risks can also be minimized with proper hand washing techniques, usage of ther- mometers to verify adequate cooking temperatures, preventing cross-contamination from utensils, equipment, and surfaces, and avoiding preparation of certain foods (e.g., sprouts) with a history of high food safety risk [12].
According to the guidelines given by the US Department of Health and Human Services, the following are basic principles of safe food handling for pregnant women [5].
Clean
Maintaining a clean environment in the kitchen including, but not limited to, clean cutting boards, counter tops, and utensils is essential to minimize microbial cross- contamination. After using the bathroom, changing diapers, or handling pets, as well as prior to eating food, hands should be thoroughly washed with soap and warm water. Hands should be lathered with soap at least for 20 s before rinsing with warm water [13].Warm water is effective in removing grease and grime by increas- ing the soap’s ability to penetrate dirt and oils found on the skin [14]. All utensils used for food preparation such as cutting boards, dishes, knives, and counter tops must be cleaned with hot soapy water [15]. Paper towels are recommended for cleaning kitchen surfaces, but if cloth towels are used, they should be washed thor- oughly in hot water. Fruits and vegetables should be washed under running tap water to remove dirt and contaminants. For fresh produce with hard and netted outer surfaces like cantaloupes and melons, scrubbing with a clean produce brush during washing is recommended. The surface of canned goods may also be a source of contamination. Microorganisms on the surface may contaminate the content after opening the can. Cleaning the lid of a canned food prior to opening may help in minimizing the risk of contamination [5].
Separate
Cross-contamination can occur specifically when handling raw meat, poultry, and seafood with other foods. A study carried out by Redmond et al. highlighted the route of microbial cross-contamination in a mock-up domestic kitchen. In their study, 29% of the food preparation sessions resulted in being positive for Campylobacter in prepared salads, cleaning materials, and food-contact surfaces [16]. The Campylobacter strains isolated from prepared chicken salad were identi- cal to the strains isolated from raw chicken pieces, indicating cross-contamination during food preparation and handling [16]. In a study to rank and identify food- handling and consumption behaviors associated with 13 major food-borne patho- gens, cross-contamination during food preparation was the major cause of food-borne illness associated with Campylobacter jejuni, Salmonella serotypes other than Enteritidis, and Yersinia enterocolitica [15]. To prevent cross- contamination, raw meat, seafood, and poultry should be separated from
ready-to- eat foods. The best practice is to keep these foods inside plastic bags dur- ing grocery shopping and in sealed containers/sealable plastic bags when storing in the refrigerator at home. The cutting boards and knives that were used for cutting raw meat, poultry, and seafood and those used for fruits and vegetables should be separate. Food preparation counter tops and cutting utensils should be washed prop- erly with hot water and detergent after preparing meat, poultry, and seafood [11].
Cross- contamination can also occur if cooked foods are served on plates that previ- ously held raw meat, poultry, or seafood, potentially leading to food-borne illnesses associated with Campylobacter jejuni, Salmonella serotypes other than Enteritidis, and Yersinia enterocolitica [5, 15].
Women with food allergies must avoid foods that trigger their allergic reactions during pregnancy. Consumer awareness and safe handling practices (minimizing cross-contact) are the two most important strategies to prevent food safety risk asso- ciated with allergens [17]. Cooking doesn’t guarantee reduction or elimination of allergens from food [18]. Allergens are not easily removed from any utensils, kitchen surfaces, or hand surfaces that were once in contact with allergenic food materials. While cooking several different foods for the family, allergen-free meals should be cooked first. In addition, safe handling practices such as separating aller- genic and non-allergenic ingredients and/or products, washing kitchen utensils with soap/detergents, and using clean and closed containers at home help reduce the risk of allergen cross-contamination [17, 18].
Cook
Food must be cooked well enough to kill the potential food-borne pathogens that may be present. The use of a food thermometer is recommended to check if meat, poultry, eggs, or dishes containing eggs, and seafood have been cooked to their safe minimum internal temperatures. Eggs must be cooked until the yolk and white is firm. While cooking in a microwave oven, food should always be covered, stirred during cooking cycles, and should be rotated for even cooking. Sauces, soups, and gravy must be reheated to a boil while hot dogs, luncheon meat, and other deli meats must be reheated until the meat steams or is at 165 °F [5]. Thawing before cooking is important, espe- cially for cooking frozen whole chickens or ground meats, because the interior part of these meats may not reach optimum temperature to kill the associated pathogens [19].
The USDA-FDA recommended safe minimum internal temperatures for meat, poultry, fish, and egg dishes are listed in Table 1 [5].
Table 1 Safe minimum internal temperatures for meat, poultry, fish and egg dishes
Food commodity Required internal temperature
Beef, pork, veal, lamb, steaks, roasts and chops
145 °F with a 3-min rest time after removal from heat source
Fish 145 °F
Ground beef, pork, veal and lamb 160 °F
Egg dishes 160 °F
Whole, pieces and ground—Turkey, chicken, and duck
165 °F
Chill
Maintaining a constant refrigerator temperature of 40 °F or below will reduce the growth of microorganisms and minimize the risk of foodborne illness. The tempera- ture of the refrigerator and freezer should be checked using an appliance thermom- eter. Meat, poultry, eggs, seafood, and other perishables must be refrigerated or frozen within 2 h of cooking or purchasing, and the time should be decreased to 1 h if the outside temperature is 90 °F [5]. Perishable foods that are left for more than 2 h at room temperature should be discarded and not consumed [14]. Whenever in doubt, the food should be discarded to avoid potential risk. Large amounts of foods or leftovers must be divided and stored in shallow containers to facilitate rapid cool- ing. The leftovers must be kept on clean trays and cooled as quickly as possible, should be covered and stored in a refrigerator at 40–45 °F for a maximum of 3 days, or should be frozen if not being consumed soon [20]. Food should not be thawed at room temperature, such as on the counter top, because that practice facilitates the growth of microorganisms. The best practice is to thaw inside a refrigerator, or in cold water, or in a microwave oven. The latter two processes of thawing requires immediate cooking [5]. In a consumer focus group study, Jevsnik et al. observed a lack of consumer knowledge about the existence of insulated cooling bags that could be used for transporting frozen or refrigerated foods. Half of the focus group reported defrosting meat on working surfaces; only one-third washed knives and cutting boards with hot water and detergent for reuse, and 44% didn’t know the cor- rect temperature for storing perishable foods [11].
Safe Food Handling at Grocery Store/During Transportation
Safe food-handling practices during shopping will reduce the risk of food-borne illness. Food labels provide important information; shoppers should carefully read the labels to make sure products are not past their “sell by” date. Cross-contamination from the high-risk foods such as raw packaged meat, poultry, or seafood can be minimized by double bagging raw ingredients inside a plastic bag before putting them in the shopping cart. Keep fresh fruits and vegetables separate from raw meat, poultry, fish, and seafood. Unpasteurized products such as juices, milk, cheese, and dairy products may contain harmful microorganisms and should not be consumed during pregnancy. Unshelled eggs must be bought from the refrigerated section of the store. When shopping for fresh produce, items that are bruised, damaged, moldy, or that show signs of insect damage, should be avoided. Canned goods should be free from any dents, cracks, or bulging lids, and the lid must be cleaned before opening. Perishable foods exposed to warm temperatures may provide a favorable environment for the growth of microorganisms. Pre-cut fruits and vegetables should be selected from the refrigerated section. High-risk and perish- able foods should be added to the shopping cart just before the checkout, and must be refrigerated within 2 h of purchase. Using ice coolers to hold perishable foods during summer months maintains the quality and safety of the foods during transportation [5].