Salmonella and Food

Salmonella and Food

You may know that Salmonella can contaminate poultry and eggs, but it also sneaks its way into many other foods. Learn what you can do to make your food safer to eat.

Salmonella is a bacteria that commonly causes foodborne illness, sometimes called “food poisoning.” CDC estimates Salmonella causes 1 million foodborne illnesses every year in the United States. During the past few years, outbreaks of Salmonella illness have been linked to contaminated cucumbers, chicken, eggs, pistachios, raw tuna, sprouts, and many other foods.

Five Facts That May Surprise You

Don’t let Salmonella make you or your loved ones sick. Learn these five facts – and tips for lowering your chance of getting a Salmonella infection.

Do I have a Salmonella infection?

Contact your doctor or healthcare provider if you have:
Diarrhea and a fever over 101.5°F.
Diarrhea for more than 3 days that is not improving.
Bloody stools.
Prolonged vomiting that prevents you from keeping liquids down.
Signs of dehydration, such as:
Making very little urine.
Dry mouth and throat.
Dizziness when standing up.

You can get a Salmonella infection from a variety of foods. Salmonella can be found in many foods including beef, poultry, eggs, fruits, pork, sprouts, vegetables, and even processed foods, such as nuts, frozen pot pies, chicken nuggets, and stuffed chicken entrees. When you eat food that is contaminated with Salmonella, it can make you sick. Contaminated foods usually look and smell normal, which is why it is important to know how to prevent Salmonella infection.

Salmonella illness is more common in the summer. Warmer weather and unrefrigerated foods create ideal conditions for Salmonella to grow. Be sure to refrigerate or freeze perishables (foods likely to spoil or go bad quickly), prepared foods, and leftovers within 2 hours. Chill them within 1 hour if the temperature is 90°F or hotter.

Salmonella illness can be serious and is more dangerous for certain people. Symptoms of infection usually appear 6–48 hours after eating a contaminated food but can take much longer. These symptoms include diarrhea, fever, and stomach cramps. In most cases, the illness lasts 4–7 days without antibiotic treatment. Some people may have severe diarrhea and need to be hospitalized. Anyone can get a Salmonella infection, but some groups are more likely to develop a serious illness: older adults, children younger than 5, and people with immune systems weakened from medical conditions, such as diabetes, liver or kidney disease, and cancer or their treatment.

Salmonella causes far more illnesses than you might suspect. For every one case of Salmonella illness confirmed by laboratory tests, there are about 30 more cases of Salmonella illnesses that are not Most people who get food poisoning usually do not go to the doctor or submit a sample to a laboratory, so we never learn what germ made them sick.

To avoid Salmonella, you should not eat raw eggs or eggs that have runny whites or yolks. Salmonella can contaminate eggs, even perfectly normal-looking ones. But these eggs can make you sick, especially if they are raw or lightly cooked. Eggs are safe when you cook and handle them properly.   Check Your Steps

Remember to follow the Clean, Separate, Cook, and Chill guidelines to help keep you and your family safe from food poisoning. Be especially careful to follow the guidelines when preparing food for young children, pregnant women, people with weakened immune systems, and older adults.

Clean
Wash hands with warm, soapy water for 20 seconds before and after handling uncooked eggs, or raw meat, poultry, and seafood and their juices.

Wash utensils, cutting boards, dishes, and countertops with hot, soapy water after preparing each food item and before you go on to prepare the next item.

Don’t wash raw poultry, meat, and eggs before cooking. Germs can spread to other foods, utensils, and surfaces.

Sanitize food contact surfaces with a freshly made solution of one tablespoon of unscented, liquid chlorine bleach in one gallon of water.

Separate
Keep raw meat, poultry, seafood, and eggs separate from other foods in your grocery cart and in your refrigerator.

Keep eggs in the original carton and store them in the main part of the refrigerator, not in the door.

Keep raw meat, poultry, and seafood separate from ready-to-eat foods, such as salads and deli meat.

Use separate cutting boards and plates for produce and for raw meat, poultry, seafood, and eggs.

Never place cooked food on a plate that previously held raw meat, poultry, seafood, or eggs.

Cook
Use a food thermometer to ensure that foods are cooked to a safe internal temperature:
145°F for beef, veal, lamb, and fish (let the meat rest for 3 minutes before carving or eating)
145°F for pork and ham (let the meat rest for 3 minutes before carving or eating)
160°F for ground beef, ground pork, ground veal, and ground lamb
160°F for egg dishes
165°F for poultry (chicken, turkey, duck), including ground chicken and ground turkey
165°F for casseroles
Microwave food to 165°F or above.

Chill
Keep your refrigerator at 40°F or colder.
Refrigerate or freeze perishables, prepared foods, and leftovers within 2 hours (or 1 hour if the temperature is 90°F or hotter).

National Stuffing Day: Triple-Herb Pumpernickel and Sourdough Stuffing Food Safety

Fillers

Almost anything can serve as a stuffing. Many popular Anglo-American stuffings contain bread or cereals, usually with vegetables, herbs and spices, and eggs. Middle Eastern vegetable stuffings may be based on seasoned rice, on minced meat, or a combination. Other stuffings may contain only vegetables and herbs. Some types of stuffing include sausage meat, while vegetarian stuffings sometimes contain tofu. Roast pork is often accompanied by sage and onion stuffing in England; roast poultry in a Christmas dinner may be stuffed with sweet chestnuts. Oysters are used in one traditional stuffing for Thanksgiving. These may also be combined with mashed potatoes for heavy stuffing. Fruits and dried fruits can be added to stuffing, including apples, apricots, dried prunes, and raisins. In England, a stuffing is sometimes made of minced pork shoulder seasoned with various ingredients, such as sage, onion, bread, chestnuts, dried apricots, dried cranberries, etc. The stuffing mixture may be cooked separately and served as a side dish. This may still be called stuffing, or it may be called dressing.

Food Safety

The United States Department of Agriculture (USDA) states that cooking animals with a body cavity filled with stuffing can present potential food safety issues. These can occur because when the meat reaches a safe temperature, the stuffing inside can still harbor bacteria (and if the meat is cooked until the stuffing reaches a safe temperature, the meat may be overcooked). For turkeys, the USDA recommends cooking stuffing/dressing separately from the bird and not buying pre-stuffed birds. (Stuffing is never recommended for turkeys to be fried, grilled, microwaved, or smoked). The turkey's temperature must reach a safe minimum internal temperature of 165 °F. Check the temperature in the thigh, the innermost part of the wing, and the thickest part of the breast.

Resources
1. Triple-Herb Pumpernickel and Sourdough Stuffing
2. Stuffing, From Wikipedia, the free encyclopedia
3. Thanksgiving Stuffing Recipes, EatingWell

World Children's Day - Resources from Around the World

The future of tomorrow is the children of today.

A review of organizations dedicated to improving the quality of Children's lives. Presented through songs, news reports, mission statements, and children.

UNICEF, World Children's Day
WHO (World Health Organization)

Academy of Nutrition and Dietetics, Kids Eat Right 
We Day

Raffi Foundation for Child Honouring

A safe and clean environment for every child

 152 million children are trapped in child labor. Most of them are in agriculture. #Childlabour is depriving millions of girls and boys of their childhoods. Every child has the right to a childhood. #StopChildLabour @FAO

Love Is All | Playing For Change

By resolution 836(IX) of 14 December 1954, the General Assembly recommended that all countries institute a Universal Children's Day, to be observed as a day of worldwide fraternity and understanding between children. It suggested that the Day was to be observed also as a day of activity devoted to promoting the ideals and objectives of the Charter and the welfare of the children of the world. The Assembly suggested to governments that the Day be observed on the date and in the way that each considers appropriate. The date, 20 November, marks the day the Assembly adopted the Declaration of the Rights of the Child in 1959 and the Convention on the Rights of the Child in 1989.

In 2000, world leaders outlined Millennium Development Goals (MDGs) – from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education, all by the target date 2015. Though the Goals are for all humankind, they are primarily about children.

WHO 10 Facts On Nutrition

1. Malnutrition is a significant contributor to disease and early deaths for mothers and children. Undernutrition, including vitamin and mineral deficiencies, contributes to about one-third of all child deaths and impairs healthy development. At the same time, growing rates of overweight are linked to a rise in chronic diseases. The result is a double burden of malnutrition.

2. An indicator of chronic malnutrition is stunting. This is when children are too short for their age group. About 165 million children globally are stunted, resulting from not enough food, a vitamin-mineral poor diet, inadequate child care, and disease. As growth slows down, brain development lags, and stunted children learn poorly.

3. Wasting and bilateral edema are severe forms of malnutrition - resulting from acute food shortages and compounded by illness. About 1.5 million children die annually due to wasting. Rising food prices, food scarcity in conflict areas, and natural disasters diminish household access to appropriate and adequate food, all of which can lead to waste.

4. Essential vitamins and minerals in the diet are vital to boost immunity and healthy development. Vitamin A, zinc, iron, and iodine deficiencies are primary public health concerns. About 2 billion people are affected by inadequate iodine nutrition worldwide. More than one-third of preschool-age children globally are vitamin A deficient. Vitamin A deficiency is the leading cause of preventable blindness in children.

5. Maternal undernutrition leads to poor fetal development and a higher risk of pregnancy complications. Maternal and child undernutrition accounts for more than 10 percent of the global disease burden.

6. For healthier babies, WHO recommends exclusive breastfeeding for six months, introducing age-appropriate and safe complementary foods at six months, and continuing breastfeeding for up to two years or beyond. Worldwide, about 20% of deaths among children under five could be avoided if these feeding guidelines are followed. Appropriate feeding decreases rates of stunting and obesity and stimulates intellectual development in young children.

7. Nutritional problems in adolescents start during childhood and continue into adulthood. Anemia is a critical nutritional problem in adolescent girls. Preventing early pregnancies and assuring adequate intake of essential nutrients for developing girls can reduce maternal and child deaths later and stop cycles of malnutrition from one generation to the next. Globally, anemia affects 42% of pregnant women.

8. The rise in overweight and obesity worldwide is a significant public health challenge. People of all ages and backgrounds face this form of malnutrition. As a consequence, rates of diabetes, cardiovascular disease, and other diet-related conditions are escalating worldwide. These are very difficult to treat in places with limited resources and already overburdened health systems. About 43 million children under age five are overweight, according to 2011 figures. 

9. Nutrition information is required to identify the areas where assistance is most needed. WHO released international child growth standards that provide benchmarks to compare children's nutritional status within and across countries and regions. 

10. Public education is another way to improve nutritional health. Starting in China during the Beijing Olympics and continuing in other countries, WHO and the Member States will promote the "5 keys" to a healthy diet:

a. give your baby only breast milk for the first six months of life

b. eat a variety of foods

c. eat plenty of vegetables and fruits

d. eat moderate amounts of fat and oils

e. eat less salt and sugars

Resources

Kids Eat Right

In November 2010, the American Dietetic Association (ADA) and ADA Foundation officially launched their first joint initiative, Kids Eat Right. The two-tiered campaign aims to mobilize ADA members to participate in childhood obesity prevention efforts and to educate families, communities, and policymakers about the importance of quality nutrition.

Mission: The Kids Eat Right campaign was launched to support public education projects and programs that address the national health concern of obesity among our children. 

To learn more about the Kids Eat Right Campaign, visit:

Website. Kids Eat Right

Facebook.  Kids Eat Right

"Raffi" (Raffi Cavoukian), C.M., O.B.C. 

Founder and Chair 
Raffi Foundation for Child Honouring

"Imagine a new idea as vital as a democracy.
Now imagine helping it spread
quickly throughout the world!
Child Honouring is one such idea,
an idea whose time has come.

 - Raffi

He is known to millions as "Raffi,"" a beloved songwriter and performer, author, ecology advocate, and founder of the Centre for Child Honouring. Child Honouring is a vision for creating a humane and sustainable world by addressing the universal needs of children.

Raffi Foundation for Child Honouring and join "the compassion revolution."

Young People Marching

Turn This World Around

Raffi's tribute to humanity's hero sprang from Mandela's call to global leaders in 2000 to turn this world around for the children. In 2001, Raffi sang this for Nelson Mandela at Toronto's Ryerson University. The song expresses the essence of Raffi's Child Honouring philosophy, a children-first paradigm for societal change. A child-friendly world enriches all of us and offers the best chance to create sustainable cultures. All children want to live in peace and to follow their dreams.

World Food Programme

As the most significant humanitarian provider of school meals worldwide, the World Food Programme ( WFP), along with governments and partners, supports education, reduces malnutrition, and promotes development, especially during crises and emergencies.

Nearly all countries worldwide have a school meals program, and about 368 million children from kindergarten to secondary school receive daily food. Governments recognize school meals as an essential tool for developing and growing children, communities, and society.

WFP provides school meals to more than 20 million children every year. But many more children do not benefit from school meals, and in countries with the highest poverty rates where school meals would make a big difference, the reach of school meal programs is far smaller. 

Schools are critical in WFP's efforts to create a world where educational and nutritional opportunities reach the hungry poor. It's where we lay the foundation for future generations to grow and thrive.

November 18, National Vichyssoise Day

Vichyssoise is a thick soup made of puréed leeks, onions, potatoes, cream, and a soup stock (usually chicken). It is traditionally served cold but can be eaten hot.

Serves: 5

Ingredients
1 teaspoon canola oil
3 cups diced leek (about 3 large)
3 cups diced peeled baking potato (about 1 1/4 pounds)
1 (16-ounce) can fat-free, low-sodium vegetable (or chicken) broth
2/3 cup half-and-half
1/8 teaspoon black pepper
1 tablespoon minced fresh chives

Directions
1. Heat the canola oil in a large sauce-pan over medium-low heat. 

2. Add the diced leek; cover and cook for 10 minutes or until soft. 

3. Stir in the diced potato and broth, and bring to a boil. 

4. Cover the potato mixture, reduce heat, and simmer for 15 minutes or until the potato is tender. 

5. Place the potato mixture in a blender or food processor, and process until smooth. 

6. Place the potato mixture in a large bowl, and cool to room temperature.
7. Stir in the half-and-half and black pepper.
8. Cover and chill. Sprinkle soup with minced chives.

Nutrition Information

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Ensure accurate and cost-effective nutritional analysis for your recipes utilizing an extensive research database and 35 years of experience. A great service for the Recipe Bloggers, Media, Cookbook Publishers, Writers, Chefs, and Recipe Websites. Your readers will enjoy and benefit from the Nutrition information.

For more information, visit Dietitians-Online Nutritional Analysis Services

contact:
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recipenews@gmail.com

954-294-6300

November 16, National Fast Food Day

A look at the Fast Food Industry

Many fast food items are high in Fat, Cholesterol, Saturated Fat, and Sodium and are Risk Factors associated with Heart Disease. However, informed customers can make healthier choices at fast-food restaurants. Below is the nutrition information of some Fast Food Hamburgers. Calories range from 140 for a White Castle Slyder to 1061 calories for a Burger King Cheeseburger, Double Whopper.

Healthy Options are the New Fast Food Trend

The Fast Food Burger
Burger Love Handles is a song written
by Don MacLeod about
his personal battle with being overweight.
The song focuses on fast foods as one
of his difficulties in losing weight.

Ways to Use Less Stuff

The purpose of  "Use Less Stuff" is to raise awareness of the garbage produced in America between Thanksgiving and New Year's Day. The estimated extra waste amounts to 25 million tons of garbage.

Through education and collaboration with many individuals and organizations worldwide, Just-Use-Less aims to share the message of common sense, timeless wisdom, and gratitude for what we have been given. Just Use Less.

Ways to Use Less Stuff During the Holidays and Any Time

Plan meals using portion control to minimize waste. Recommendations: Food/Drink Portion Per Person Turkey  3 ounces, without bone Stuffing  1/4 cup Sweet Potato Casserole  1/3 - 1/2 cup Green Beans  1/2 cup Cranberry relish  2 to 3 Tablespoons Pumpkin Pie  1/8 - 1/10 of a 9" pie

After a party, put leftovers in plastic containers or bags and send them home with guests, or donate to food banks.

Bring your own camera instead of using disposable cameras.

Cancel mail-order catalogs you no longer use.

Bring your own shopping bags.

Consolidate your purchases into one bag rather than getting a new bag at each store.

Plan your shopping in advance. Save money on fuel by making fewer trips to the stores. Avoid last-minute shopping when you won’t have time to make careful gift choices.

Consider giving gift certificates or making a donation to a favorite charity in your friend/family's name.

Give homemade food or something you’ve made yourself from reused items.

Shop for gifts at antique stores, estate sales, or flea markets since one person’s trash is another’s treasure.

When buying electronics, remember to buy rechargeable batteries to go with them.

Send e-greetings to family, friends, and business associates who are online. Did you know about 2.65 billion Christmas cards are sold annually in the US?

Get a tree that can be planted or mulched afterward, or buy an artificial one.

Compost your food waste. Fruits and vegetables and their peels, pits, and seeds are perfect for composting, a great natural fertilizer.

Resources

Keep America Beautiful believes each of us holds an obligation to preserve and protect our environment. Through our everyday choices and actions, we collectively have a huge impact on our world. Keep America Beautiful follows a practical approach that unites citizens, businesses, and government to find solutions for preventing litter, reducing waste, and beautifying communities.

November 15, America Recycles Day and Clean Out Your Refrigerator Day

November 15, America Recycles Day and  

Clean Out Your Refrigerator Day

America Recycles Day is dedicated to the promotion of recycling programs in the United States. Since 1997, communities across the country have come together on November 15th to celebrate America Recycles Day.

Keep America Beautiful believes each of us holds an obligation to preserve and protect our environment. Through our everyday choices and actions, we collectively have a huge impact on our world. Keep America Beautiful follows a practical approach that unites citizens, businesses, and government to find solutions for preventing litter, reducing waste, and beautifying communities.

America Recycles Day.
The four “R”s: Refuse, Reuse, Recycle, Reduce.
Get involved to help reach Zero Waste.   https://kab.org/recycling/

Reduce, Reuse, Recycle

According to the U.S. EPA (US Environmental Protection Agency), recycling:
*Conserves natural resources to help sustain the environment.
*Reduces the need for landfilling and incineration.
*Saves energy and prevents pollution.

Recycle Guys in the Supermarket

How You Can Help

1. Each community has different standards for what can be recycled and how to do it. Visit Keep America Beautiful and enter your zip code for your local information and resources.

2. Plastic. Look for the recycling symbol on plastic packaging or containers. #1 and #2 plastics should be accepted by almost every recycler.

3. Cans. Aluminum and steel cans are always welcomed by recyclers, and most metals can be recycled infinitely with no loss of quality.

4. Recycling and Traveling. Keep two trash bags in your vehicle - one bag for garbage, and one for recyclables. Pre-sorting makes it easier to transfer your recyclables to the proper container once you’ve reached your destination.

5. Recycle your wireless phone. Millions of out-of-service phones are waiting to be reused or recycled. Find a local charity with a phone recycling program, or visit http://www.kab.org/  to download a postage-paid mailing label and return your unused phones.

6. Paper. In addition to newspaper recycling, most communities will accept corrugated cardboard, and some will even accept junk mail, catalogs and phone books.

7. Electronics. Never throw old computers, monitors, TV’s, printers, or other electronics in the landfill. Instead, donate them to a local charity for reuse, or find out about your local e-cycling programs.

8. Reduce the amount of trash you throw away and reuse products before you throw them out or recycle them. This creates the least impact on the planet and our resources.

Clean Out Your Refrigerator Day
Before food goes bad consider preparing meals in advance and freezing for later use. The food will last longer - Less Waste

Pressure Ulcer Awareness - Pressure Injury Prevention Points and Nutrition Intervention

The National Pressure Ulcer Advisory Panel (NPUAP) serves as the authoritative voice for improved patient outcomes in pressure injury prevention and treatment through public policy, education, and research. The objective of STOP logo 2017 World Wide Pressure Injury Prevention Day is to increase national awareness for pressure injury prevention and to educate the public on this topic. NPUAP has developed an extensive media materials package appropriate for all healthcare settings and organizations.

It is important to identify individuals who are prone to pressure injuries. I have a son with cerebral palsy. He is in a wheelchair and lacks movement without assistance. He receives a body check twice a day, but even with my constant supervision, an ulcer can creep up quickly. My son's feet had become swollen and hot. The doctor placed him on antibiotics, but his left foot continued to get worse. A few days later, I took a photo of my son's wound and showed it to the doctor. The doctor immediately contacted a wound care nurse and his ankle was diagnosed as a stage II pressure ulcer. The wound healed eventually. It took about 6 weeks. Be your family and/or friend's advocate.

Skin Care

1. Inspect all of the skin upon admission as soon as possible (but within 8 hours).
2.  Inspect the skin at least daily for signs of pressure injury, especially nonblanchable erythema.
3. Assess pressure points, such as the sacrum, coccyx, buttocks, heels, ischium, trochanters, elbows, and beneath medical devices.

4.  When inspecting darkly pigmented skin, look for changes in skin tone, skin temperature, and tissue consistency compared to adjacent skin. Moistening the skin assists in identifying changes in color.

5. Cleanse the skin promptly after episodes of incontinence.

6. Use skin cleansers that are pH balanced for the skin. 
7. Use skin moisturizers daily on dry skin.

8.  Avoid positioning an individual on an area of erythema or pressure injury.

Nutrition
1.  Consider hospitalized individuals to be at risk for undernutrition and malnutrition from their illness or being NPO for diagnostic testing.

2.  Use a valid and reliable screening tool to determine the risk of malnutrition, such as the Mini Nutritional Assessment.

3.  Refer all individuals at risk for pressure injury from malnutrition to a registered dietitian/nutritionist. 

4. Assist the individual at mealtimes to increase oral intake. 

5.  Encourage all individuals at risk for pressure injury to consume adequate fluids and a balanced diet.

6.  Assess weight changes over time.

7.  Assess the adequacy of oral, enteral and parenteral intake.

8. Provide nutritional supplements between meals and with oral medications, unless contraindicated.

Repositioning and Mobilization
1. Turn and reposition all individuals at risk for pressure injury, unless contraindicated due to medical conditions or medical treatments. 

2.  Choose a frequency for turning based on the support surface in use, the tolerance of skin for pressure and the individual’s preferences.

3.  Consider lengthening the turning schedule during the night to allow for uninterrupted sleep.

4.  Turn the individual into a 30-degree side-lying position, and use your hand to determine if the sacrum is off the bed

5.  Avoid positioning the individual on body areas with pressure injury.

6. Ensure that the heels are free from the bed.

7.  Consider the level of immobility, exposure to shear, skin moisture, perfusion, body size, and weight of the individual when choosing a support surface.

8. Continue to reposition an individual when placed on any support surface.

9.  Use a breathable incontinence pad when using microclimate management surfaces.

10.  Use a pressure-redistributing chair cushion for individuals sitting in chairs or wheelchairs.

11. Reposition weak or immobile individuals in chairs hourly.

12.  If the individual cannot be moved or is positioned with the head of the bed elevated over 30°, place a polyurethane foam dressing on the sacrum.

13.  Use heel offloading devices or polyurethane foam dressings on individuals at high-risk for heel ulcers

14,  Place thin foam or breathable dressings under medical devices.

Education
1. Teach the individual and family about risk for pressure injury

2.  Engage individual and family in risk reduction interventions

Staging Pressure Injury

A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other devices. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue.

Stage 1 Pressure Injury: Non-blanchable erythema of intact skin. Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. The presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.

Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis. Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel.  This stage should not be used to describe moisture associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive related skin injury (MARSI), or traumatic wounds (skin tears, burns, abrasions).

Stage 3 Pressure Injury: Full-thickness skin loss. Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds.  Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Stage 4 Pressure Injury: Full-thickness skin and tissue loss. Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

Unstageable Pressure Injury: Obscured full-thickness skin and tissue loss. Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.  If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar (i.e. dry, adherent, intact without erythema or fluctuance) on the heel or ischemic limb should not be softened or removed.

Deep Tissue Pressure Injury: Persistent non-blanchable deep red, maroon or purple discoloration. Intact or non-intact skin with a localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood-filled blister. Pain and temperature changes often precede skin color changes. Discoloration may appear differently in darkly pigmented skin.  This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface.  The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle, or other underlying structures are visible, this indicates a full-thickness pressure injury (Unstageable, Stage 3, or Stage 4).

References
1. The National Pressure Ulcer Advisory Panel - NPUAP - Resources

World Diabetes Day - The Family and Diabetes

World Diabetes Day was created in 1991 by the International Diabetes Federation and the World Health Organization. World Diabetes Day became an official United Nations Day in 2007. The campaign draws attention to the issues of importance to the diabetes world and keeps diabetes in the public spotlight. 

World Diabetes Day (WDD) is celebrated every year on November 14th. The World Diabetes Day campaign is led by the International Diabetes Federation (IDF) and its association members. It joins millions of people worldwide in diabetes advocacy and awareness.

The Family and Diabetes

To mark diabetes awareness month and World Diabetes Day on November 14, the International Diabetes Federation (IDF) is urging families to learn more about the warning signs of diabetes. New research from IDF has discovered that parents would struggle to spot this serious life-long disease in their own children. Despite the majority of people surveyed having a family member with diabetes, alarming four-in-five parents would have trouble recognizing the warning signs. One-in-three wouldn’t spot them at all.

The findings underline the need for education and awareness to help people spot the diabetes warning signs early.

The warning signs can include excessive thirst, frequent urination, a lack of energy, blurred vision, slow-healing wounds, and numbness in the feet and/or hands.

This November, IDF is urging people to test their diabetes knowledge and learn more. IDF has made an awareness assessment available online at http://discoverdiabetes.idf.org/

Meet Toby Smithson, RDN, LDN, CDE

Toby Smithson is a Registered Dietitian, a Certified Diabetes Educator, a national spokesperson for the American Dietetic Association, and holds a certification in adult weight management. Toby was diagnosed with Type 1 diabetes in October 1968 and has managed diabetes personally every single day since with no hint of complications. Toby founded DiabetesEveryDay to share her insights into successful diabetes self-management.

DiabetesEveryDay.com members enjoy 24/7 access to weekly menu selections, recipes (developed by dietitians for heart health and carbohydrate management), grocery lists, and a unique library of video clips featuring Toby Smithson. New content is added weekly, Toby draws upon her own extraordinary diabetes management success to make this overwhelming responsibility for self-care both understandable and practical. She explores not only the nuts and bolts…. medical issues, food, and physical activity…. but also everyday lifestyle, emotional challenges, stress, and life-changing motivation; the real keys to success. To learn more, visit DiabetesEveryDay.com

Blue Circle Dance

About 500 employees, families, and friends of Novo Nordisk from all around the world filmed themselves while dancing to 'Move your feet' by Junior Senior. The idea is to generate awareness for diabetes on World Diabetes Day on 14 November.