Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Food Poisoning


Related Terms

  • FBD
  • Foodborne (Food-Borne) Infection
  • Foodborne Disease
  • Foodborne Illness

Differential Diagnosis

  • Acquired or congenital enzyme deficiency
  • Appendicitis
  • Endocrine disorders
  • Heavy metal poisoning
  • Inflammatory bowel disease
  • Intestinal malrotation
  • Malabsorption syndromes
  • Other acute abdominal disorders
  • Other bacterial infections
  • Other viral infections
  • Poliomyelitis

Specialists

  • Family Physician
  • Gastroenterologist
  • Infectious Disease Internist

Comorbid Conditions

  • Immune system disorders

Factors Influencing Duration

Factors influencing length of disability can include length and severity of condition, individual response to treatment, presence of complications, and underlying conditions.

Medical Codes

ICD-9-CM:
005.0 - Staphylococcal Food Poisoning, Staphylococcal Toxemia Specified as Due to Food
005.2 - Food Poisoning Due to Clostridium Perfringens; Enteritis Necroticans
005.3 - Food Poisoning Due to Other Clostridia
005.4 - Food Poisoning Due to Vibrio parahaemolyticus
005.81 - Food poisoning Due to Vibrio vulnificus
005.89 - Food Poisoning, Other Bacterial; Food poisoning Due to Bacillus cereus

Overview

Food poisoning (foodborne illness) is the general term used for any condition associated with ingestion of food or water that has been contaminated with microorganisms (bacteria, parasites, or viruses), microbial toxins, poisonous plants, or chemicals. Despite the popularity of this term, food poisoning is misleading because the illness is caused by a contaminant, not the food itself.

Bacteria are common causes of foodborne illness. Common culprits include Staphylococcus aureus, Bacillus cereus, Clostridium perfringens, Campylobacter jejuni, Yersinia enterocolitica, Escherichia coli, Vibrio parahaemolyticus, Shigella species, Salmonella species, Clostridium botulinum, and Listeria monocytogenes. Some bacteria cause illness directly. Others produce a poison (toxin) that causes illness. These toxins may be difficult to destroy even with thorough cooking. In the US, most cases of foodborne illness are attributed to C. jejuni. Many types of bacteria normally inhabit the intestines of farm animals and poultry. Improper slaughtering and / or butchering techniques can bring these bacteria into contact with the meat products. Improper cooking can then lead to illness.

Another common method of transmission occurs when meat or poultry is not properly handled in the kitchen. For instance, a cutting board and knife used to prepare uncooked meat can contaminate raw vegetables if the knife and cutting board are not thoroughly washed with hot soapy water prior to contact with the vegetables. While cooking the meat will eliminate risk of transmission from the meat, contaminated raw vegetables may still cause illness.

Many bacteria are normal inhabitants of the human body but when ingested can cause illness, e.g., E. coli (normally found in the human intestine), and S. aureus (commonly found in the nose and sometimes on the skin). Handling food without thoroughly washing hands after using the restroom, changing a baby's diaper, or blowing the nose can cause illness.

Raw sewage spilled into a body of water where fish or shellfish are harvested can cause foodborne illness particularly if the fish/shellfish is eaten raw or rare. Bacteria and parasites can also contaminate drinking water.

Viruses commonly responsible for causing food poisoning are the Norwalk virus (a common contaminant of shellfish), the hepatitis virus, and the rotavirus. Foodborne viruses are usually associated with undercooked or raw contaminated fish and shellfish, although other types of food can also transmit viral illness.

Parasites such as Giardia lamblia, Entamoeba histolytica, Cryptosporidium parvum or Trichinella spiralis may cause symptoms after an individual drinks contaminated water or eats undercooked pork.

Noninfective causes of foodborne illness include poisonous mushrooms and toadstools. Fresh fruit and vegetables can cause illness if they have accidentally been contaminated with high doses of insecticides, or if fertilized with manure and not thoroughly washed before eating. Food stored in an unsuitable container can cause chemical poisoning, e.g., food stored in a metal container (made partly of zinc) that has previously held poison or acidic fruit juice. If animals have eaten a poisonous product, this poison can be passed to individuals ingesting the animal product, e.g., shellfish that feed on poisonous plankton can cause illness when eaten.

Certain exotic foods are poisonous if improperly prepared or cooked and can lead to serious illness or death. These include the Japanese puffer fish or the tropical cassava.

The gastrointestinal (GI) tract is the most common target in food poisoning followed by the central nervous system and autonomic nervous system. Other organs that may be involved include liver (hepatitis), muscles (trichinosis), and kidneys (hemolytic uremic syndrome).

Because food in the US increasingly originates from other parts of the world (globalization) and is distributed by centralized networks (centralization), the number of foodborne illnesses caused by these organisms (pathogens) increases as well as the risk for nationwide outbreaks. When common exposures are recognized (e.g., among multiple individuals eating at the same picnic, restaurant, or other gathering), prompt notification of health authorities may be warranted.

Most outbreaks of foodborne illness are due to improper preparation (under-cooking meat, fish, or poultry); contaminating food with uncooked food; or improper storage (keeping food at room temperature for an extended period of time).

Incidence and Prevalence: Because food poisoning is commonly underdiagnosed or mistaken for viral gastroenteritis, the actual number of cases is unknown. Foodborne illness affects millions of individuals worldwide. Foodborne illness due to bacterial infection alone accounts for approximately 76 million illnesses, 300,000 hospitalizations, and 5,000 deaths in the US each year (Wethington; Sood).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The very young and the elderly are at an increased risk of serious disease or death from foodborne illnesses.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms vary according to the type of poisoning, how heavily the food was contaminated, and how much of the food was ingested. In general, symptoms usually include stomach (abdominal) pain, nausea, vomiting, and diarrhea. In some cases, diarrhea may be bloody. In severe cases, shock, circulatory collapse from dehydration, or paralysis may occur. Fever, rash or muscle pain may be present. There may be symptoms of meningitis such as severe headache and stiff neck. Individuals may report that others sharing the same food or foods also became ill. The history should include a food inventory for the preceding 48 to 72 hours.

Physical exam: The exam may be normal or reveal abdominal tenderness. General findings can apply to numerous illnesses (nonspecific). The individual may have signs of dehydration including blood pressure that changes with body position changes (orthostatic hypotension), dry mucous membranes, a sunken appearance of the eyes, and decreased skin tension (turgor). The rectal exam may be painful due to inflammation caused by constant diarrhea. The individual should be questioned regarding onset of symptoms and the timing of the suspected meal. In chemical poisoning, symptoms occur quickly, usually within 1 hour. Bacterial infection tends to occur within 1 to 12 hours, but can be delayed as long as 3 days for certain bacteria (e.g., salmonella). Toxins produce symptoms anywhere from 1 hour to 6 days after ingestion. Most viruses produce symptoms within 2 to 5 days after ingestion. Parasitic infections may not produce symptoms for 1 to 4 weeks following ingestion (incubation period).

Tests: Tests used may vary with the suspected causative agent and usually include microscopic examination or cultures of stools, vomit, or blood. Cultures may be done on remaining suspected food, food preparation area, or the food handlers. Blood tests to assess hydration and kidney function include serum electrolytes, blood urea nitrogen (BUN), and urine test (urinalysis). Other tests to identify the causative organism include gel diffusion, radioimmunoassay (RIA), enzyme-linked immunoassay (ELISA), latex agglutination, serotyping of suspected organism, gene probe for toxin, tissue culture assays, and immunoelectron microscopy. DNA "fingerprinting" (pulsed-field gel electrophoresis, PFGE) can be done to identify the specific strain of E. coli, salmonella, Shigella and Listeria causing an outbreak allowing better tracking of the source and possible infected individuals.

Source: Medical Disability Advisor



Treatment

Treatment depends on the causative agent. Most cases of food poisoning are self-limited and require only supportive care. Recovery is often complete within 24 hours from the onset of symptoms.

Poisoning due to a chemical or bacterial toxin may need to be washed out of the stomach (gastric lavage). The local poison control center can provide specific treatment information and antidotes for chemicals. If the individual has been vomiting for an extended period of time, however, drugs may be given to help stop vomiting (anti-emetics). Other medications include antibiotics for certain types of bacteria, antiviral agents, pain relievers (analgesics), or fever-reducing medication (antipyretics). Severe dehydration and shock may require hospitalization with intravenous replacement of fluid and electrolytes.

Infections inherently more serious than others may require hospitalization and include infections in the bloodstream (septicemia), the brain or spinal cord (meningitis), and toxins affecting the nervous system (toxin produced by C. botulinum). Respiratory failure or paralysis may require a ventilator for breathing assistance.

Public health officials may need to be contacted to report confirmed cases of food poisoning.

Source: Medical Disability Advisor



Prognosis

Foodborne illness is not life-threatening in the vast majority of cases. Most individuals will experience complete recovery even in the absence of medical treatment. Severe or complicated cases may, however, require hospital based treatment for recovery particularly severe dehydration, septicemia, meningitis, respiratory failure, or shock.

In rare cases, a foodborne illness can result in a life-threatening illness. For example, toxin produced by C. botulinum affects the nervous system causing muscle paralysis. Death can occur quickly if the toxin reaches the heart or the diaphragm.

Source: Medical Disability Advisor



Complications

Complications include cardiovascular collapse, irregular heartbeat (arrhythmias) due to electrolyte imbalance, hemolytic uremic syndrome, Guillain-Barré syndrome, reactive arthritis, severe dehydration, respiratory failure, neurological problems, abscess formation, infection in the blood (sepsis), and infection of other body organs (metastatic infection). Coma, paralysis, and shock can also complicate foodborne illness.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Accommodations and work restrictions are not generally required. However, heavy lifting, extensive walking, or strenuous physical activity may need to be modified until physical stamina returns. Work in especially hot, humid environments (high heat stress) may require special attention to accommodation.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has diagnosis of foodborne illness been confirmed? Has causative agent been identified? Have other possible causes of infection or poisoning been ruled out?
  • How timely was medical attention sought? Had complications (such as dehydration) already occurred?
  • Have underlying medical conditions that may impact recovery been identified or ruled out (i.e., disorders causing immunosuppression)?

Regarding treatment:

  • Was treatment appropriate for the underlying cause and symptoms present? Was antimicrobial (antibiotic, antiparasitic, etc.) medication warranted? Were symptoms of fever and / or dehydration addressed in the treatment plan?
  • Were symptoms serious enough to warrant hospitalization?

Regarding prognosis:

  • Based on the underlying cause, severity of symptoms, and general health of the individual, what was the expected outcome? Did adequate time elapse for complete recovery?
  • Did symptoms persist despite treatment? If so, did individual receive repeat or additional diagnostic testing to rule out the possibility of bacterial resistance, secondary infection, or associated complications? Were appropriate adjustments made in the current treatment to address any bacterial resistance or complications?
  • If slow recovery is due to poor general health or underlying medical conditions (such as disorders involving immunosuppression), what is being done to address these issues? Is individual receiving appropriate treatment?

Source: Medical Disability Advisor



References

Cited

Sood, Sunil K. "Food Poisoning." eMedicine. Eds. Rosemary Johann-Liang, et al. 14 Oct. 2004. Medscape. 25 Oct. 2004 <http://emedicine.com/ped/topic795.htm>.

Wethingoton, Holly, and Paul Bartlett. "The URsick2 Foodborne Disease Forum for Syndromic Surveillance." Emerging Infectious Diseases 10 3 (2004): Centers for Disease Control and Prevention. 31 Mar. 2004. U.S. Department of Health and Human Services. 25 Oct. 2004 <http://www.cdc.gov/ncidod/EID/vol10no3/03-0358.htm>.

Source: Medical Disability Advisor






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