SACRAMENTO, Calif. - Last year's E. coli outbreaks - one traced to bagged spinach and two to lettuce - have left a nation in a salad spinner of confusion.
Americans have come to expect the food they eat won't make them sick.
But unlike most edible items in the grocery store that have been cooked, baked, broiled, fried, or pasteurized to destroy harmful bacteria, fresh produce has no such "kill point," no moment on the assembly line when pathogens meet their doom.
The very attribute that makes produce so attractive in color, taste and nutritional value - its freshness - also leaves it vulnerable to contamination.
The outbreaks together sickened 350 people - and killed three, including 2-year-old Kyle Allgood, an Idaho boy who died Sept. 20 at Primary Children's from hemolytic-uremic syndrome - nationwide. Their one-two-three punch in the fall and winter led to consumer fear and outrage and an unprecedented push by politicians and health leaders for more regulation of the leafy greens industry.
"It's fundamental. You should be able to believe the food you're eating is safe," said Elisa Odabashian, director of the West Coast office of Consumers Union, the nonprofit publisher of Consumer Reports.
Other produce, such as tomatoes, also can cause pathogen outbreaks. But spinach and lettuce, with all their wrinkles and crinkles where harmful bacteria such as E. coli can hide, are among the most vulnerable produce around. In the past decade, 20 cases of E. coli outbreaks have been traced to fresh leafy greens - many linked to California's Salinas Valley.
The most recent outbreaks marked a breaking point for consumers. Many stopped buying spinach. Others took to scrubbing fresh greens with vigor.
Yolo County, Calif., Health Officer, Dr. Bette Hinton, decided it was time to start growing her own.
"I tried," Hinton said, "but then the critters ate it."
The outbreaks also marked a last straw for politicians and public health officials.
Investigations, sweeping in scope, are under way for each of the three outbreaks. Findings on the spinach probe should be released in coming weeks.
"This was a large investigation for us. The stakes were very high," said Jack Guzewich, director of emergency coordination and response at the U.S. Food and Drug Administration's Center for Food Safety and Applied Nutrition.
Meanwhile, consumer advocates and elected leaders from coast to coast are calling for greater government oversight of the leafy greens industry. Unlike meat, dairy and other basic food items, fresh produce is a largely unregulated corner of the nation's food supply.
Odabashian of Consumers Union said she has never seen a food safety conundrum like it.
"You can't tell people to avoid it because these are some of the most nutritional foods around," she said. "In all my years, this has been the toughest one I've encountered because there is nothing specific you can tell consumers they can do to safeguard themselves."
Foodborne illnesses are an unfortunate but common part of daily living, according to Christine Bruhn, director of the Center for Consumer Research at the University of California, Davis. On average, one in four people get sick from them every year. The national Centers for Disease Control and Prevention estimates that foodborne diseases cause 76 million illnesses and 5,000 deaths annually in the United States.
Last week, 300 cases of salmonella poisoning in 39 states were linked to consumption of several types of Peter Pan peanut butter. Unsanitary or improper food handling in homes and restaurants make countless others sick every year.
"Most people think they have never experienced this because they don't recognize it," Bruhn said, noting that symptoms such as vomiting and diarrhea tend to be attributed to the flu instead.
The strain of bacteria that caused the three recent outbreaks from leafy greens - E. coli O157:H7 - is a nasty pathogen that can bring severe illness, kidney failure and death. Carried in the stomachs of cattle, it can spread through water sources, fertilizer and tracking by animals, people or equipment.
Over the years, many have been sickened by E. coli from eating undercooked meat. The cooking process will kill such harmful bacteria, but only if foods are heated sufficiently.
If the pathogens are lurking on fresh produce, washing may eliminate some but not all traces because the bacteria cling stubbornly to surfaces and crevices.
During the past decade, as more people altered their diets to include more fresh produce, and as the fresh produce industry responded with new and appealing products such as ready-to-eat salads in bags, E. coli outbreaks rose.
Outbreaks from leafy greens have been especially notable, said Larry Beuchat, a food microbiologist at the University of Georgia's Center for Food Safety. Part of the problem is that the produce is grown in different places, then mixed together at the plant.
"This presents greater opportunity for the spread of pathogens," Beuchat said. Awareness also has grown, with more sophisticated methods of identifying outbreaks likely contributing to the rising numbers.
Last year's spinach outbreak was traced to bagged spinach processed by Natural Selection Foods LLC of San Juan Bautista. Two lawsuits against the company were filed in Utah as a result.
Soon after, the company began new pathogen tests of spinach and other greens before and after processing, said Samantha Cabaluna, director of communication. The company had not done such testing in the past because it took three to five days to get results, cutting into products' shelf life.
Last fall, the company began using a different type of test that gives results in 12 to 16 hours, Cabaluna said. Since then, positive results for harmful bacteria have turned up several times in greens arriving from fields. Entire lots were destroyed.
"The level of rigor has increased," Cabaluna said. "Now everything is on a very rigorous schedule of testing."
Fresh Express, another major produce processor based in Salinas, takes a different approach.
For the past two years, the company has done random testing in the fields, seven to 10 days before harvest, said Jim Lugg, executive vice president of food safety, quality and research and development. The company uses tests that run several days, hence the earlier testing.
If positive or suspicious results occur, "we don't even touch that field," Lugg said.
Fresh Express also takes other precautions, such as refusing to buy greens from fields within a mile of feedlots.
Lugg said the company ramped up its testing and field standards because increasingly, lettuce was being cored and stripped of outer leaves in the fields. The practice makes waste management more efficient - the discarded produce is left on the ground to decompose - but makes the greens more vulnerable to contamination, Lugg said.
Even with increased vigilance, contaminated greens still could turn up on the grocery shelf, consumer experts warn.
Kathy Howton, a 55-year-old state worker who lives with her college-age daughter, said such unknowns prompted her to stop buying spinach. Yet, she still buys bagged salads.
"I know, it doesn't make sense," Howton said. "Sometimes it's just hard to know what's a real concern."
Food safety and health professionals said most people should not give up eating salads or spinach.
"Eating is not free of risk," said Joseph Frank, a professor of food microbiology at the University of Georgia's Department of Food, Science and Technology. "But the risk of getting sick from spinach is so small."
Older people and very young children are more vulnerable and may want to take more precautions, Bruhn said. "Next week, my 1 --year-old grandson is visiting," she said. "I think he's going to have cooked spinach."
Julie Cross, education coordinator at the Davis Food Co-op, said there are several safety steps consumers can take.
"Wash your hands. Wash your sink. Wash your produce, all of it," Cross said, noting some pathogens, such as salmonella on the outside of melons, can successfully be washed away.
For spinach and lettuce, she recommends rinsing it in a basin of cold water, and letting it stand to allow grit to drop to the bottom. Then use towels or a salad spinner to dry it.
Oh, and one more thing: Don't forget to wash the spinner.