Military Hygiene and Hygiene in Emergency Situations - K.O. Pashka 2005

Fundamentals of organizing and conducting sanitary surveillance and medical control over the nutrition of military personnel and the civilian population in field conditions
Procedure for investigating food poisoning incidents in a military unit

Every case of food poisoning in a military unit should be treated as an emergency; therefore, all measures aimed at its localization, remediation of consequences, and investigation of causes must be prompt and effective.

An investigation of a food poisoning incident is conducted by specialists from Sanitary and epidemiological institutions and Representatives of the military medical service. In all cases, the HEAD of the food service is required to participate in the investigation.

The physician (feldsher) who provided emergency care to the victims and identified (or suspected) food poisoning is obliged to:

- immediately report the incident to the unit commander and senior medical officer;

- withdraw any leftovers of the suspicious food from consumption and prohibit its distribution;

- collect from each victim up to 100 ml of vomitus, 200 ml of gastric lavage fluid, up to 50 ml of feces, and up to 100 ml of urine;

- take Blood samples from the sick personnel (as clinically indicated) for hemoculture and botulinum toxin testing;

- send the samples of seized food, collected excretions, blood, and lavage fluids to a sanitary and epidemiological institution for analysis.

During the food poisoning investigation, the representative of the sanitary and epidemiological institution should:

- interview the medical personnel who provided first aid to the victims in order to determine the timing and circumstances of the outbreak's onset, the number of patients, and their clinical symptoms;

- draw up an investigation plan based on the information received;

- interview the personnel to fully identify all sick individuals and determine which dish could have caused the outbreak;

- additionally collect and send to the sanitary and epidemiological laboratory anything that may be relevant to the outbreak—leftovers of prepared food, suspicious food products, swabs from kitchen utensils and dishware, etc.

All samples must be labeled with numbers and an inscription detailing their contents (feces, vomitus, lavage fluids, etc.), securely packaged to prevent spilling, leaking, or contamination during transport, and typically sealed or stamped with sealing wax. The samples are sent to the SES (Sanitary and Epidemiological Station) laboratory along with accompanying documents listing the sample names, date and place of collection, date of onset of illness among personnel, Diagnosis or indications for testing, purpose of the analysis, as well as the position, military rank, surname, and initials of the person submitting the Materials. Clinical symptoms and the circumstances of the outbreak must also be indicated. During the warm season, samples should be delivered to the laboratory in a refrigerated state, while in winter they must be protected from freezing. Delivery time must not exceed 12 hours.

To determine the routes of infection or contamination with toxic substances of the food products that caused the poisoning, the sanitary condition of the kitchen and utility rooms is evaluated, and the compliance of products issued to the kitchen with the menu for the past two days is verified. The duration of culinary Processing of raw products and semi-finished meat and fish products at all stages of food preparation is established, as well as the storage time of prepared food in the kitchen from the moment of completion until the end of distribution. At the same time, food establishment personnel are examined to identify any bacterial carriers, or those suffering from pustular and gastrointestinal diseases. Following the inspection of the kitchen and dining hall, an assessment is made of the sanitary condition of the food warehouse from which products are supplied to the kitchen, and compliance with storage and issuance conditions for perishable goods is checked. The availability of appropriate veterinary and sanitary certificates and food quality certificates is verified.

Those investigating the food poisoning, in cooperation with the unit command, carry out a series of operational measures aimed at eliminating the outbreak and preventing recurrence in the future:

- prohibit The Use of food products suspected of causing or actually causing the poisoning;

- immediately suspend from work at food facilities any individuals who could be the source of foodborne toxic infection;

- organize and supervise the disinfection of all kitchen premises, equipment, and utensils, as well as sanitary facilities and living quarters where the sick resided (to prevent potential contact transmission of the disease);

- submit materials to hold accountable, through disciplinary or criminal action, the persons at fault for causing the food poisoning.

Upon completion of the food poisoning investigation, an official report is drawn up reflecting precise information on the time and place of the outbreak, the number of victims and fatalities, the Clinical presentation of the disease with a description of primary symptoms, subsequent progression, and diagnosis, as well as the laboratory test results of samples collected at food facilities. Additionally, data that can serve as an objective basis for establishing the cause of the food poisoning, sanitary violations committed, and the degree of guilt of the persons responsible for the outbreak must be indicated.