Lesson One 1 Focus on Listeria Have a Safe Pregnancy: Sponsored by research teams at Colorado State University Extension and Ohio State University Extension Lesson One GOALS: •Participants know they have a high chance of getting food poisoning during pregnancy and that they can protect themselves through safe food choices and proper preparation and handling of food. •Participants choose foods and follow practices that help them avoid Listeria during pregnancy. •Participants keep their refrigerators cold and clean. Key Messages: At the end of the lesson, participants will know: • Women are at higher risk of getting food poisoning during pregnancy because of hormone changes. • Some germs a mother may get from food can cross the placenta and harm the unborn child. • Pregnant women and their unborn babies are highly susceptible to getting sick from Listeria. • Listeria and other types of food poisoning can be controlled by following safe food selection, preparation, handling and storage practices. • What to look for on labels to reduce the risk of getting Listeria from foods. • How to keep the refrigerator clean and at a safe temperature. Through lesson activities, participants will: Read food labels to make sure cheese is made with pasteurized milk. Identify better choices for risky foods. Learn to use a refrigerator thermometer. Learn to clean (and clean out) the refrigerator often. 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Rosario: Thatʼs believe that one good ing to anyone They it from happen word, too. word . . . is to prevent spread the terrible tragedy on me to help count can Cristina: You 8 co Queso Fres How eating y. unborn bab harmed her HO 1.2 Maribel’s Story (Fotonovela from FDA’s Educator’s guide on Preventing Listeriosis in Pregnant Hispanic Women in the U.S.) y Pregnancy ng for a Health Safe Food Handli HO 1.3 Food Safety for Baby and Me Instead of.. Choose and at h teams by researc on and Sponsored ity Extensi State Univers Colorado Extension University Ohio State by and Your Ba Protect From Listeriosis Yourself my at high risk women are harmful Pregnant sick from Listeria, Listeria for getting in many foods. listeriosis. bacteria found a disease called age, can lead to cause miscarri sickness, Listeriosis can delivery, serious If you premature baby. a newborn or death of to know what t, you need are pregnan eat. to foods are safe I have I know If How will listeriosis? 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Later on, ns, or lose your of packages or headache, convulsio become walls and shelves Americans of 5 dying inside 2,500 the water and ■ Clean Every year, , with 1 out tor with hot your refrigera rinse. sick from listeriosis then liquid soap, from the illness. -eat food I d or ready-to it in the I do If I think store ■ Use precooke you can. Don't What shouldsis? as soon as too long. or have listerio clinic refrigerat nurse, or health after you touch or Call your doctor,of the signs. If you have your hands turkey, ■ Wash any meat, chicken, treat you. if you have doctor can hot dogs, raw juices. your , their listeriosis seafood or ® pâté, refrigerated counter, Do not eat from a meat in the meat spreads seafood found or smoked section of the store. refrigeration, refrigerated don’t need salmon, Foods that tuna and canned like canned eat. Refrigerate after are okay to ■ opening. (unpasteurized) drink raw that have ■ Do not not eat foods milk and do milk in them. unpasteurized made in the eat salads chicken ■ Do not as ham salad, or seafood store such tuna salad, salad, egg salad, salad. such as often with For more Wash hands eat soft cheesefresco, Brie, clean 1 Clean: tion ■ Do not queso water. Use informa warm Wash blanco, and forks. soap safety: Feta, queso cheeses, blue-veined knives, and and about food dishes, spoons,with hot soapy water Camembert Panela unless it is ed countertops right away. cheeses, and ent with pasteuriz U.S. Departm clean up spills labeled as made the label says, fish, and ure sure MILK." of Agricult Keep raw meat, will milk. Make PASTEURIZED and 2 Separate: from other food that Food SafetyService "MADE WITH poultry away Inspection not be cooked. minimum ov food to a safe a food www.fsis.usda.g 3 Cook: Cook ture. Check with Pork Hotline 160 ºF; and Poultry nationwide) internal tempera Ground beef USDA Meat e (toll-free thermometer. 165 ºF. 1-800-256-7072 1-888-MPHotlin 4-6854 • TTY: 160 °F; Poultry within 1-888-67 or te or freeze .gov/ 4 Chill: Refrigera te or freeze within http://www.fsis.usda °F). Ask Karen: and employer. y provider (above 90 2 hours—refrigera opportunit weather cooked hot equal USDA is an 2004 1 hour in meat, fish, poultry, or September 2006 Don’t leave Revised April out. food sitting ia–Fight BAC! Fight Bacter Optional Handout: Protect your Baby and Yourself from Listeriosis (USDA-FSIS) Teaching the Lesson Note: Plan to arrive 15–30 minutes before class starts to set up the room, prepare for the participant activities and set up the PowerPoint slides and/or flip chart. Create a welcoming, comfortable learning environment for participants. Amount of time needed for: Welcome ......................................................................................................... 4 minutes Anchor (Food Safety) ....................................................................................... 3 minutes Add (Pregnancy and Foodborne Illness) . ......................................................... 6 minutes Add (Listeria) .................................................................................................... 5 minutes Apply (Maribel’s Story) . ................................................................................... 6 minutes Apply (Reading Cheese Labels) ....................................................................... 4 minutes Apply (Making Safe Choices) ........................................................................... 7 minutes Add and Apply (Chill, Use Quickly, Clean Refrigerator) . ................................... 6 minutes Review and Away ............................................................................................ 4 minutes Total 45 minutes HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 3 Lesson One Welcome ............................................................. 4 minutes Slide 1: Lesson 1 Welcome participants to the Healthy Baby, Healthy Me classes. Briefly introduce yourself. Tell participants who you are and what organization you work for. Ask participants to briefly introduce themselves (there will be time for more sharing later). Let them know you’re glad that they have come. Slide 1: Lesson 1 Explain that this is the first in a series of four lessons designed to help pregnant women make healthy and safe food choices during pregnancy. Anchor ................................................................ 3 minutes Food Safety during Pregnancy Working with a partner, have participants talk about if they have ever gotten sick from the food they ate or know someone who did. After one or two minutes, have one or two participants share their experiences. HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 4 Lesson One Add (Pregnancy and Foodborne Illness) ............. 6 minutes Slide 2: Pregnancy and Foodborne Illness Give each participant a copy of the handout, HO 1.1 Pregnancy and Foodborne Illness. Have them turn to the first page and follow along. • Explain that during pregnancy, changes in your hormones cause your immune system to become suppressed so the baby can develop. However, these changes make it harder for you to fight off infections. Slide 2: Pregnancy and foodborne illness • Because of this, you are at higher risk for getting some types of food poisoning. In these lessons we’ll be learning about 4 germs found in foods that pregnant women are most susceptible. Slide 3: What are the signs of food poisoning or foodborne illness? • Foodborne illness often is mistaken for the flu. You may get sick to your stomach, vomit, or have diarrhea. You may also have a headache, fever, muscle aches, or a stiff neck. • Eating an unsafe food will usually cause you to get sick in one to three days, but you may get sick as soon as 20 minutes after eating, or as long as six weeks later. Slide 3: What are the signs of food poisoning or foodborne illness? • You don’t want to take any chances when you are pregnant. Call your healthcare provider or clinic right away. You may need to visit the clinic to find out what is causing your illness and how it needs to be treated. HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 5 Lesson One • And, if you get sick after eating in a restaurant, also call your local health department, so the health department can check the restaurant food to see if that is where you ate the food that made you sick. Slide 4: Can a foodborne illness be harmful to my baby? • Usually food poisoning will make you sick, leaving you tired and dehydrated. It also depletes you and your baby of important nutrients. • Also, you may pass the germs in your body to your baby. This may happen even though your symptoms may be mild. Slide 4: Can a foodborne illness be harmful to my baby? • When germs pass through your body across the placenta to the unborn baby, the baby can develop an infection, possibly causing a miscarriage or stillbirth. The baby could be born with food poisoning. If that happens the baby may have serious health problems after birth, including eye problems or brain damage. Add (Listeria) ...................................................... 5 minutes Slide 5: Listeria • In this lesson you will learn about Listeria (lĭ-stîr’ē-ă), a germ that may not make you that sick, but could still pass to your unborn baby. • This picture shows what the germ Listeria looks like. Slide 5: Listeria HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 6 Lesson One • It usually doesn’t cause a problem for healthy non-pregnant women, but can be very harmful for people with low immune systems like pregnant women, .unborn babies, the elderly, and very sick men and women. What is Listeria? Slide 6: What is Listeria? • Explain that Listeria is a germ found every where in the soil, in plants and decaying vegetation, in animals and in many foods. Healthy animals and people can carry Listeria in their bodies without becoming sick. The immune systems of pregnant women, their unborn, and the elderly, however, are susceptible to infection with Listeria. Most of these infections are caused by eating foods that are contaminated with Listeria. Slide 6: What is Listeria? • What makes Listeria different than other germs is that it can actually grow at refrigerator temperatures. It grows very slowly, but can still grow. Luckily, it’s easily killed by heating. Slides 7–8: Special Terms Explain that because Listeria can grow at refrigerator temperatures, we’ll be talking about some terms they may not have heard of: Pasteurized vs. unpasteurized food. • Slide 7: Pasteurized means heating or cooking foods to kill the germs that can cause food poisoning. The opposite of pasteurized is unpasteurized (or raw) which means the food may have germs that could make you sick. Slide 7: Pasteurized HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 7 Lesson One We’ll also be talking about Refrigerated, Ready-to-Eat Foods. • Slide 8: Ready-to-Eat Foods are foods (purchased or made at home) that do not need to be cooked or heated before they are eaten. If the ready-to-eat food has a lot of protein, it usually has to be refrigerated to keep it fresh and safe to eat, and thus is called a Refrigerated, Ready-to-Eat food. Slide 8: Refrigerated, Ready-toEat Which foods are likely to have Listeria? Slides 9–10: Where is Listeria Found? • Slide 9: Explain that Refrigerated, Ready-to Eat foods that are high in protein and have NOT been pasteurized or pre-cooked are especially likely to have Listeria. Examples include: o Unpasteurized (raw) milk o Soft cheeses made with unpasteurized milk like queso fresco, queso blanco, Brie or Camembert Slide 9: Where is Listeria found? o Raw fish and fish products like sushi, sashimi and cerviche o Lightly smoked fish products like lox o Raw oysters served on the half shell HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 8 Lesson One • Slide 10: Refrigerated, Ready-to-Eat foods that have previously been pasteurized or cooked, but are stored in the refrigerator for a long time and not reheated before serving can also have Listeria. Examples include: o Deli meats like turkey, ham and bologna Slide 10: Where is Listeria found? o Hot dogs served cold from the package o Seafood and other store bought salads o Pâtés and meat spreads How could Listeria affect you during pregnancy? Slide 11: Symptoms of Listeria • Explain that healthy children and adults may be able to eat many of these foods without getting sick. • However, during pregnancy, hormone changes reduce the mother’s ability to fight off infections, which means that Listeria may be able to infect the mother and cause illness. Slide 11: Symptoms of Listeria • If the mother is infected, there is a good chance the Listeria will pass through the placenta to the baby and cause the baby to also get sick. • The symptoms of infection with Listeria can be tricky to detect. This is because they may take a few days or even weeks to appear and can be mild. Sometimes the symptoms are so mild that you don’t even feel sick, but you can still pass the Listeria to your unborn baby. HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 9 Lesson One • If you experience any of these typical symptoms of Listeria, see your doctor or healthcare provider immediately: o Flu-like feeling; fever, chills o Muscle aches o Diarrhea, upset stomach o Stiff neck, headache o Seizures, loss of balance How could Listeria affect your baby? Slide 12: Risk to Baby • Explain that pregnant women are more resistant to getting an infection with Listeria early in pregnancy, but if a pregnant woman does become infected, she could miscarry her baby. • Pregnant women are more susceptible to getting Listeria in the last 6 months of their pregnancy. If a mother gets sick with Listeria late in her pregnancy and passes it to her baby, she could deliver a premature or stillborn baby. Her baby could also be born with brain, heart, kidney or eye problems. Slide 12: Risk to baby HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 10 Lesson One Apply (Maribel’s Story) ....................................... 6 minutes Slide 13: Maribel’s Story Hand out the fotonovela, HO 1.2: Maribel’s Story, to the participants. Read to the participants as they follow along or assign participants to be the different characters in the fotonovela and read aloud together. Talk about how they feel after reading the story. Ask which of the cheese products mentioned in Maribel’s Story (queso fresco, Panela, asadero, queso blanco) they know about (or have eaten). Have they had a craving for any of these foods since becoming pregnant? Slide 13: Maribel’s Story Apply (Reading cheese labels) ............................ 4 minutes Slides 14–18: safe or not safe Reading cheese labels. For this activity pass out labels of cheese products made with raw (unpasteurized) and pasteurized milk or use the cheese product labels shown on the slides. Explain that we cannot see, taste or smell if a food has Listeria. However, we can make choices that will protect ourselves from getting the germ. Ask participants what we should be looking for when purchasing cheese to make sure they are safe? Have them decide which cheeses are safe and not safe to eat during pregnancy. Slides 14–18: Safe or not safe HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 11 Lesson One • Tell participants to look for the words “pasteurized milk” on the cheese label or in the list of ingredients. If they don’t find the words “Made with Pasteurized Milk” or “pasteurized milk” on the label, they should assume that the cheese has been made with unpasteurized milk. • Never buy cheese sold door-to-door or from a street vendor. Chances are they have been made with raw (unpasteurized) milk. • Besides soft Mexican-style cheeses, other cheeses sometimes made with unpasteurized milk include Brie, Camembert, feta, and blue-veined cheeses. Before you eat any of these types of cheese during pregnancy, check the label to be sure they’re made from pasteurized milk. • Any cheese made with pasteurized milk should be safe to eat during pregnancy. This includes cream cheese, cottage cheese, and hard cheeses like American, cheddar and Swiss. Apply (Making Safe Choices) .............................. 7 minutes Hand out HO 1.3 “Instead of… Choose” leaflet Food SaFety For BaBy & Me Explain that we’re now going to look at some other foods that are risky during pregnancy. Ask them to suggest safer choices they might make, along with other practices they might use to make the risky foods safer to eat. Food SaFety For BaBy & Me Did you know that during pregnancy you are MORE at risk for getting a foodborne illness? Did you know that during pregnancy you are MORE at risk for getting a foodborne illness? Foodborne illnesses come from foods that you eat. Symptoms can be mild or severe and may include: Foodborne illnesses come from foods that you eat. Symptoms can be mild or severe and may include: • Diarrhea • Headache • Diarrhea • Headache • Nauseaandvomiting • Fever • Nauseaandvomiting • Fever • Stomachcramps • Chills • Stomachcramps • Chills Foodborne illnesses can have harmful effects on you and your unborn baby. If you get sick from Listeria, Toxoplasma, Salmonella or Campylobacter, it can cause miscarriage, stillbirth or serious health problems for your newborn baby. Foodborne illnesses can have harmful effects on you and your unborn baby. If you get sick from Listeria, Toxoplasma, Salmonella or Campylobacter, it can cause miscarriage, stillbirth or serious health problems for your newborn baby. Amothermaynotfeelsick,butcan stillpasstheillnesstoherbaby. Amothermaynotfeelsick,butcan stillpasstheillnesstoherbaby. Ifyouthinkyoumighthavea foodborneillness,seeyourdoctor rightaway! Ifyouthinkyoumighthavea foodborneillness,seeyourdoctor rightaway! Sponsored by research teams at Colorado State University Extension and Ohio State University Extension Sponsored by research teams at Colorado State University Extension and Ohio State University Extension As you go through the “Instead of… Choose” foods, talk about what makes the “Choose” foods safer for them to eat. HO 1.3 “Instead of… Choose” Point out that heat (cooking or reheating to steaming hot) destroys any Listeria that may be present. HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 12 s, h s s e, Lesson One avOID RISky FOODS … LEaRn what tO chOOSE! t Slides 19–27: Instead of… Choose Insteadof: Choose: Cold hot dogs, deli meats and luncheon meats outof thepackage hot dogs, luncheon, and deli meats reheated to steaminghot Salads madeinthestore such as ham, chicken, egg, tuna or seafood salads Meat, egg and seafood salads thatyoumakeathome Refrigerated meat spreads and smoked or precooked fish and seafood fromameatcounter Meat and seafood sold in cansorpouchesormadein acookeddish Soft cheeses madefrom rawmilk, such as feta, Brie, camembert, blue-veined cheeses, queso fresco, queso blanco, and panela hard cheeses, processed cheeses, cream cheese, cottage cheese, mozzarella cheese, and soft cheeses labeledasmadewith pasteurizedmilk Raw (unpasteurized) milk and milk products Pasteurized milk and milk products Unpasteurized juice (May be labeled “fresh squeezed” or “chilled” Frozen concentrate, canned juices OR refrigerated juices labeledas pasteurized Raw sprouts Fresh vegetables (well cleaned) or cooked sprouts Raw or undercooked eggs Eggs that are cooked until both the white and yolk are firm Undercooked meat, poultry or seafood Fullycooked meat, poultry and seafood Authors: Patricia Kendall and Mary Schroeder, Colorado State University; Lyida Medeiros and Janet Buffer, The Ohio State University HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA This material was based on work was supported by the National Integrated Food Safety Initiative, 13 Lesson One Add and Apply (Chill, Use Quickly, Clean) .......... 6 minutes Slides 28–32: Chill, use quickly, clean Explain that there are 3 more easy steps that they can follow to help prevent Listeria. These include: 1.chill: Keep your refrigerator between 35°F and 40°F (1.7°C and 4.4°C). • Explain that unlike most bacteria, Listeria can grow in the refrigerator. The colder the refrigerator, the more slowly it grows. Keeping your refrigerator between 35°F and 40°F (1.7°C and 4.4°C) will help keep Listeria from growing in your refrigerator, and won’t freeze your lettuce. The best way to make sure that the inside of your refrigerator is between 35°F and 40°F (1.7°C and 4.4°C) is to check it with a refrigerator thermometer. A refrigerator thermometer tells you the actual air temperature inside the refrigerator. • Slide 28: Slide 28: Chill Show participants what a refrigerator thermometer looks like. If available, give each participant a refrigerator thermometer. Slide 29: chill—Where to place the refrigerator thermometer. Or, show video on proper placement of thermometer. If a refrigerator is available, have participants decide where to place the thermometer in the refrigerator. Slide 29: Chill HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 14 Lesson One • If the thermometer sits on the shelf, try to place it in the middle of the refrigerator. If placing it on an inside wall of the refrigerator, be sure to place it in a spot where you can read it. • Once you place the thermometer in the refrigerator, wait 5 to 8 hours to allow the thermometer to adjust to the refrigerator’s air temperature. • Make sure your refrigerator thermometer reads between 35°F and 40°F (1.7°C and 4.4°C). If it reads 40°F (4.4°C) or higher, adjust the refrigerator temperature control dial to a colder setting. Check it again in 5 to 8 hours. 2.use quickly: Use Refrigerated, Ready-to-Eat foods as soon as possible. Slide 30: use quickly—Use Refrigerated, Ready-to-Eat foods as soon as possible. (You may also pass out real labels of refrigerated, ready-to-eat foods like lunch meats, hot dogs, milk products, cheese products, tuna salads, etc.) Have participants find the use by or sell by dates on the labels. • Explain the importance of checking the “sell by” or “use by” labels on refrigerated, ready-to-eat foods and not buying foods that are past the dates on the label. Once home, the longer products are stored in the refrigerator, the more chance Listeria has to grow. • Reinforce that during pregnancy they should avoid some refrigerated, ready-to-eat foods, like salads made in the store, e.g., ham salad, chicken salad, egg salad, seafood salad, or potato salad. Slide 30: Use quickly Slide 31: Slide 31: Use quickly HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 15 Lesson One • For unopened products like hot dogs, it’s best to freeze or use within 2 weeks of purchase. Once opened, use or freeze the food within 3 to 4 days, or throw away. • Leftovers can also have Listeria. Discuss the importance of putting leftovers in small meal-sized containers, labeling them with the contents and a use-by date, and putting in the refrigerator as soon as possible after the meal. Leftovers should be refrigerated within two hours of preparing and serving. Leftovers should be used within 3 to 4 days. If leftovers are best eaten hot, be sure to reheat them to steaming hot or 165°F (74°C). Slide 32: Slide 33: Making it Work: Have participants talk about what they can tell about the safety of the food from the labels, and how they would handle that food. Slide 32: Use quickly Slide 33: Use quickly 3.Clean the refrigerator often. Slide 34: Clean the refrigerator often. • Explain that it’s important to clean your refrigerator regularly, about every 2 to 3 months. Clean the inside walls and shelves with hot water and dish soap; then rinse with a clean wet cloth. Dry with a clean cloth or paper towel. Slide 34: Clean • If something spills in your refrigerator, wipe it up immediately with a clean cloth or paper towel. This is particularly important, so Listeria doesn’t have a place to grow and then spread to other foods. HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 16 Lesson One Making it Work: Working with a partner, have participants talk about how and how often they clean their refrigerator. After a couple of minutes, have them share any ideas they have to make refrigerator cleaning easier. Review and Away ............................................... 4 minutes Using the handout Pregnancy and Foodborne Illness or Protect Your Baby and Yourself From Listeriosis, review the main points of the lesson. Goal setting: Slide 35: Goals for the Week Ask participants to: • Check their package labels to be sure their soft cheeses are made with pasteurized milk. • Clean out their refrigerator, discarding all products that are past their “use by” date. Slide 35: Goals for the week Slide 36: Have participants write the date and time of the next lesson. Preview of next lesson: Tell participants that the next lesson is about Toxo and the importance of cleaning and sanitizing your kitchen surfaces. Slide 36: See you next time! Thank participants for coming and let them know that you look forward to seeing them at the next lesson. HAVE A SAFE PREGNANCY: FOCUS ON LISTERIA 17 This material was based on work was supported by the National Integrated Food Safety Initiative, U.S. Department of Agriculture Cooperative State Research, Education and Extension Service, project 2006-51110-03663 © Healthy Baby, Healthy Me, 2011, Ohio State University Extension and Colorado State University Extension