Purpose: The purpose of this study was to review documented outbreaks of enteric illness associated with nosocomial salmonellosis to identify mode of transmission, morbidity and mortality patterns and recommendations for control and prevention.
Methods: Searches of electronic databases, public health publications, and federal, state and provincial public health websites were completed.
Results: Computer-aided searches of literature databases and systematic searches of government websites identified 52 relevant outbreak reports. The most commonly reported routes of transmission were food 31/52 (59.6%) and person-to-person 7/52 (13.5%), while 14/52 (26.9%) reported “other” or “unknown.” Actions taken during the outbreak to control transmission included improvements to infection control practices (41.8% of all actions); isolation or cohorting patients, improving hand hygiene practices and enhancing cleaning and disinfection in patient care areas, and; improvements in food handling (24.4%) through reviewing food preparation practices, enhanced cleaning and sanitation of the kitchen and control of food temperatures. Investigators made recommendations retrospectively in outbreak reports to provide direction to health centers in an attempt to prevent outbreaks in the future. These recommendations are not statistically supported because unlike intervention strategies in other sectors, it has not been possible to conduct trials to evaluate the effectiveness of one recommendation compared to another.
Significance: Although many recommendations were similar to control actions, centering on improving infection control practices important to prevent secondary transmission of salmonellosis, this study suggests that more emphasis should be placed on improving food handling practices, such as training food workers, monitoring food temperatures, and not using raw foods of animal origin, because almost 60% of the outbreaks were foodborne.