Understanding different types of bacteria and the ways they can be transmitted, plus a plan to keep your food safe, is key to enjoying your tailgate and keeping guests healthy, says Rachael Lee, M.D., assistant professor in the Division of Infectious Diseases at the University of Alabama at Birmingham.

“The top five causes of foodborne illness include norovirus, salmonella, clostridium perfringens, campylobacter and staphylococcus aureus,” Lee says. “Other pathogens such as clostridium botulinum, listeria and pathogenic E. coli cause fewer illnesses — but when they do, they can lead to hospitalization.”

Salmonella, shigella, campylobacter and pathogenic E. coli, which invade intestinal cells and can cause watery or bloody diarrhea, can come from fecal contamination of food. This includes raw meat, contaminated produce, and other contaminated water and food. In other cases, food can become contaminated by toxins from bacteria such as Staphylococcus and Clostridium, and when ingested, these toxins can cause abrupt nausea and vomiting with quick recovery —usually within one day.

Listeria is bacteria most commonly found in soil. It is carried in the intestinal tract of 5 percent to 10 percent of humans who are asymptomatic. Most foods will have certain bacteria; but not every food is contaminated with pathogenic bacteria, or bacteria that can make you sick. Pathogenic bacteria that multiply or create a toxin make one ill.

To lower your chances of food poisoning, follow these steps.

Understanding different types of bacteria, ways they can be transmitted and plans to keep your food safe is key to enjoying your tailgate and keeping guests healthy.

1. Wash your hands and food preparation items while cooking

Not washing your hands after using the restroom is a common cause of fecal-to-oral contamination, Lee cautions. Hand hygiene is the most effective way to prevent foodborne illnesses. People should wash their hands after using the restroom, before preparing food, after touching raw meat and before preparing anything uncooked.

2. Separate your food.

The Federal Food Safety Administration recommends using different plates, cutting boards and utensils for raw and cooked meats to prevent cross-contamination.

Poultry is a good example of meat that is contaminated when raw, Lee says. Sometimes, even if it is cooked thoroughly, people still get sick from eating it. This is because of cross-contamination.

“Did you properly wash the knife you used to cut into the raw turkey?” Lee asks. “If not, and you used it to cut the cooked turkey, the bacteria from the contaminated knife gets transferred to the cooked meat.”

Do not be fooled by the way meat and poultry look on the outside — they often brown faster than they cook on the inside, the FFSA warns. The only way to be sure food has reached a safe minimum internal temperature, which both prevents the growth of harmful bacteria and guards against overcooking, is to use a food thermometer.

The FFSA recommends cold perishable food items, such as raw hamburger patties, sausages and chicken, be kept in an insulated cooler packed with several inches of ice, frozen gel packs or ice containers. Pre-cooked perishable food items, including lunch meat, cooked meat, chicken, and pasta and potato salads, should be kept refrigerated too. Keep a thermometer in the cooler to ensure the temperature stays below 40 degrees.

Watch out for noncooked tailgate foods like mayonnaise and dessert icing, Lee says. Because they are not cooked, it can be hard to eradicate bacteria such as Staphylococcus if the items have already been contaminated. Even fruits and vegetables can contain pathogen bacteria; salmonella and pathogenic E. coli have been known to contaminate lettuce. The warmer the temperature, the more ideal it is for the bacteria to grow, so it is often best to keep everything chilled.

“Staph infections themselves don’t make us sick, but they produce toxins that do,” Lee says. “Be wary of popular tailgate foods like coleslaw and potato salad.”

5. Serve hot food safely.

If you bring hot take-out food to a tailgate, be sure to eat it within two hours of purchase, the FFSA recommends. That time frame shortens to one hour if the outdoor temperature is 90 degrees or more. Any perishable food that is not eaten within that period should be thrown away to prevent sickness from bacterial growth.

Don’t be fooled by the way meat and poultry look on the outside — they often brown faster than they cook on the inside.

Chilis, soups, stews and hot dips should be kept in an insulated container; if you cannot keep hot food warm during the drive to the tailgate, chill it before packing it in a cooler and reheat it on location to 165 degrees.

Starch-based foods such as pasta and potatoes can generate B. cereus, a spore-forming organism that creates an infectious toxin, after it sits and cools down. As the food cools to below 122 degrees, the spores germinate and start producing toxin, causing symptoms when ingested.

“The best weapon against getting sick from eating at a tailgate is doing due diligence,” Lee says. “If you’re doing the cooking, make sure your hands, cookware and utensils are clean and free from contamination. If you’re eating pre-prepared food, make sure it’s been kept at the right temperature.”

6. Keep an eye on your loved ones.

Most at risk are senior adults, babies and those who are immunosuppressed. Senior adults and babies are at a higher risk of dehydration, which can be harmful.

“Babies and senior adults who need assistance with daily living may not always know when they are thirsty and can’t necessarily tell their caretaker,” Lee explains. “They can’t always voice their symptoms, so it is important to make sure they stay hydrated.”

People with diabetes, cancer, lupus, rheumatoid arthritis, Crohn’s disease and other immunologic diseases are at risk of serious complications when it comes to foodborne illness. The bacteria could get into their bloodstream or settle in their bones, affecting their diseases further.

A particular strain of E. coli (O157:H7) and shigella can cause a rare complication called hemolytic uremic syndrome, which is when clots form in the very small vessels. They can block circulation to kidneys and brain and cause kidney failure and/or confusion. Lee recommends visiting your primary care provider immediately if you experience bloody diarrhea, or if you develop unexplained bruises or unusual bleeding or have decreased urination.

And if you do get sick, remember to hydrate.

“If you get sick from contaminated food, you might experience nausea, vomiting, watery or bloody diarrhea, and maybe fever. The good news is that your illness will last only a day or so if you stay hydrated,” Lee says. “For the most part, the toxins will work themselves out within 24 hours. You will just be sick and uncomfortable, but there are not any serious dangers unless you have a compromised immune system.”

Depending on the pathogen, foodborne illnesses are self-limiting, and one will recover within 24 to 72 hours. Once the body has dispensed the bacteria or toxin, the body will recover.

If you experience symptoms for more than three days, become dehydrated, dizzy, pass out or have a fever for more than 24 hours, you should see a physician.

“Hydration is more important than food, and the key to recovering from a foodborne illness,” Lee says.

But besides the health benefits of food, you also need to monitor the safety of what you eat. And that holds true as well when the food isn’t considered healthy. Here, Stop Foodborne Illness, a nonprofit organization dedicated to preventing illness and death from foodborne pathogens like salmonella and E. coli, answers questions and shares some smart tips on food safety:

Is organic food safer?

Many people eat organically produced, sustainably raised, and locally farmed foods because they believe it’s the healthier and more conscious choice. But just as with conventionally produced foods, organic food is raised out in the open, handled by people and naturally contains pathogens. For example, Stop Foodborne Illness points out that chicken, whether organically raised or not, naturally contains salmonella. Cooking it to an internal temperature of 165°F kills the salmonella and eliminates the risk.

According to a 2012 Stanford University analysis of various research studies, there was not a statistically significant difference in the amount of pathogen contamination between organic and conventionally produced food. When it comes to meat products, though, the study found that both organic and conventionally produced varieties are widely contaminated with harmful pathogens. They found, however, that organic meat products may offer some food safety benefit because antibiotics are not used in organic meat production so there is a lower risk the meat will contain antibiotic-resistant bacteria.

Are raw and vegan diets safer?

Basically, a raw food diet means eating mostly or completely raw and unprocessed foods. While there are nutritional benefits to eating a raw food-only diet, there are definite risks regarding foodborne illness. According to the Centers for Disease Control and Prevention (CDC), fruits and vegetables are commonly susceptible to contamination from salmonella and other pathogens. The risk is higher during  warm weather months and when these foods are not refrigerated. Salmonella-contaminated foods look and smell normal, so your senses won’t help you avoid them.

People on raw diets tend to be primarily vegan, which means they don’t consume meat products, eggs or dairy. But the record on food recalls involving uncooked fruits and vegetables—produced organically or not—shows they can be contaminated. People on a raw diet must consider the risks and benefits of this food lifestyle. In the last year alone there have been many cases of raw food recalls. You can find a list of these here.

Are dietary supplements safe?

It would seem that health-conscious people are more likely to use dietary supplements. Anyone considering using supplements, should do the research and decide for themselves if the benefits are worth the risk. Our main focus is the safety of dietary supplements.

The primary concerns here are: source (Who is making the supplements?) and production methods (How are they produced?).  There’s a lot of information for the average person to have to sift through, so anyone considering using dietary supplements might be wise to get the advice of their health care professionals—a physician or pharmacist. These are the people most familiar with supplements and can help you make the best choice. The FDA does not evaluate dietary supplements.

Just because your food looks done doesn’t mean it is done. Use a food thermometer.

What overall food safety practices can help avoid foodborne illness?

Always start by washing your hands with soap and water.

Clean your counter top, cutting boards, and utensils before cutting and chopping produce. Use clean, drinkable cold water to wash your produce. For fruit and vegetables with thick skin, scrub with a vegetable brush to remove dirt and microbes. Produce that needs a gentler touch (leafy greens, berries, broccoli, etc.) can be soaked for a few minutes in clean cold water and dried with a clean paper towel or salad spinner. Even produce to be peeled, like melon or avocado, needs to be washed. Once produce is cut or peeled, refrigerate as soon as possible.

Keep your food out of the danger zone (40°F – 140°F). Bacteria grow fastest in the range of 40° – 140°F, the “Danger Zone.” A refrigerator set at 40°F or below will protect most foods. Your fridge is one of the very best weapons you’ve got in the fight against foodborne illness. When bacteria get nutrients, moisture, and warmer temperatures, rapid growth occurs and can reach levels that may cause illness. Refrigeration slows bacterial growth.

Cook your food to safe internal temperatures. Just because your food looks done doesn’t mean it is done. The only way to know if your meat, poultry, and egg dishes are safely cooked is to use a food thermometer. The safe internal temperature (SIT) or ground meat and meat mixtures such meatloaf and hamburgers is 160°F; for chicken and poultry (including ground, like turkey burgers) it’s 165°F; for fresh, raw, whole cuts of red meat (beef, veal, chops, and lamb) as well as fish and shellfish, it’s 145°F. Not cooking your food to these safe internal temperatures means illness-causing bacteria may still be surviving inside.

Reheat your food thoroughly. When reheating leftovers, cook them thoroughly to a minimum SIT of 165°F and use a food thermometer to check every single time! Your food should be steaming hot all the way through. Cover leftovers when reheating on the stove or in the microwave, which helps retain moisture and ensures even cooking. For sauces, stews, soups, and gravies, bring them to a rolling boil. When reheating frozen leftovers, it’s best to first thaw them in the fridge.

Don’t let your leftovers linger. One common cause of foodborne illness is not cooling leftovers soon enough. After foods are cooked to safe internal temperatures, bacteria can reappear and reproduce. So, be sure to get those leftovers transferred into shallow containers (for quicker cooling) and into the fridge within two hours of being cooked. And remember that your leftovers in the fridge will last safely for four days max.

For more information on food safety issues, click here.

But the United States has had several large outbreaks of illness caused by contaminated fresh fruits and vegetables.

In 2018, the federal Food and Drug Administration (FDA) investigated an E. coli outbreak of romaine lettuc  that sickened more than 40 people in 12 states and sent 16 people to hospitals. Eventually, the agency traced the outbreak to six California counties and cautioned consumers that they should not eat any lettuce if they were not sure where it had been grown. As of this writing, the investigation was continuing.  Other outbreaks have been caused by spinach, cantaloupe, tomatoes and lettuce.

Contamination can occur even after the produce has been purchased.

Glenda Lewis, an FDA expert on foodborne illness, says fresh produce can become contaminated in a lot of ways. During the growing phase, produce may be contaminated by animals, harmful substances in the soil or water, and poor hygiene among workers. After produce is harvested, it passes through many hands, increasing the contamination risk. Contamination can even occur after the produce has been purchased, during food preparation, or through inadequate storage.

The FDA recommends these strategies for effectively cleaning fresh fruits and vegetables:

• Choose produce that isn’t bruised or damaged. If you do have a bruised or damaged product, cut away those areas before you prepare or eat it.
• Make sure that pre-cut items—such as bags of lettuce or watermelon slices—are either refrigerated or on ice both in the store and at home.
• Wash your hands for 20 seconds with warm water and soap before and after preparing fresh produce.
• Rinse produce before you peel it, so dirt and bacteria aren’t transferred from the knife onto the fruit or vegetable.
• Gently rub produce while holding under plain running water. You don’t need soap or a produce wash.
• Use a clean vegetable brush to scrub firm produce like melons and cucumbers.
• Dry produce with a clean cloth or paper towel to further reduce bacteria that may be present.
• Remove the outermost leaves of a head of lettuce or cabbage.
• Store perishable produce in the refrigerator at or below 40 degrees.

For more information from the federal government on food safety issues, click here.