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By the time the patient is hospitalized, there is usually an acceleration of symptoms and complications. These can be neurological problems, worsening gastrointestinal condition, kidney malfunction.
At this point one or several medical specialists will be brought in to consult.
They may include:
• Gastroenterologist (digestive system specialist)
• Nephrologist (kidney specialist)
• Infectious Disease physician
• Hematologist (blood specialist)
• Neurologist (brain and nervous system specialist)
• Cardiologist (heart specialist)
• Surgeon
Ideally if the patient is a child, pediatric sub-specialists will be brought in to evaluate the patient and confirm a diagnosis and treatment plan. (pediatric gastroenterologist, pediatric nephrologist, pediatric neurologist, pediatric surgeon, etc.).
If there is any suspicion of Hemolytic Uremic Syndrome (HUS) or any other foodborne illness that requires critical care, you are at a critical junction. The question becomes “Am I in the right place?”
Specifically you should ask if the hospital you are in has an Intensive Care Unit (ICU) if the patient is an adult. If the patient is a child, you should ask if the hospital has a Pediatric Intensive Care Unit (PICU). If not, ask the specialist(s) to make preparations for a transfer to a facility that can provide critical care.
Usually, the first specialist to suspect a severe illness will arrange for this transfer, but sometimes patients will have to ask that this be done in a more urgent manner. If there is delay, reach out to your pediatrician, family doctor, or personal contacts you may have in the medical field to intervene.
Patients have the right to be transferred to another hospital. The process of being accepted and admitted to another facility will be much smoother if your doctor(s) make the arrangements for you.
Transfer will be done by ambulance if distance allows, or by helicopter if needed.
It was 2:00 in the afternoon. I distinctly remember the time because my husband was at work, and my 6-year-old was in school and I said to myself, “I’ll just pop over to the ER real quick and be back home before anyone notices.”
An hour after I arrived, things were going according to plan. The ER doctor told me I would receive some fluids and be sent home. Then, at 4:30, that same doctor, along with a new doctor, arrived in my room with a whole battery of questions that seemed to be coming out of nowhere.
I was trying to make sense of what they asked as I answered:
+ “No, kidney disease doesn’t run in my family.”
+ “I have definitely not been out of the country.”
+ “No … I don’t think there is any history of blood disorders in my family either.”
The clock ticked on and for minutes at a time, doctors and nurses would pop in and out of my room, and ask questions while scratching their heads or looking like they were contemplating a riddle. It was odd, but I wasn’t panicking. In my mind, there was still no cause for concern.
At approximately 5:30, the hospital’s kidney doctor came into my room. Something about her immediately indicated a significant change. Something wasn’t right.
“Ms. Barnes,” she said, “you should call your husband now.” “Tell him to meet you in Columbia” (a nearby city with a bigger hospital) “because you are being taken by ambulance to the University Hospital’s ICU.” “Tell him your kidneys are failing, and we don’t feel we can help you here.”
By the time you have entered the medical system, certainly if you or your loved one is hospitalized, things may start happening very fast. It will be hard for you to keep up with developments if you do not start some method of taking notes.
One study found that 40-80% of medical information provided by healthcare professionals is forgotten almost immediately. For you to be a constructive member on the team of people caring for your loved one, you have to stay informed by accurately understanding the medical situation.
Some people dictate daily notes onto their smart phones, some start a journal, some write on the back of lab reports that are frequently printed out. Whichever method you use, there will also be quiet moments for you, your partner or friend to record any information or thoughts you consider important.
These will include:
• What the doctors tell you during their rounds
• Your questions and concerns
• Your observations of the patient’s condition
• Thoughts, advice shared by nurses
Note taking will help you reorient yourself when you become tired, distracted, or feeling overwhelmed. It will simplify the growing challenge of keeping other family members informed. Later, looking back, it's something you’ll be grateful that you did, and can even become a cathartic experience.
It worked best for us to take notes in a spiral notebook that we kept in the room. We tried to keep the important information in one place as best we could.
It would have been helpful if we had snapped a photo of the dry erase board in the room at each shift. It listed the assigned doctors, nurses, aides and the schedule for the day. A picture of those boards would have been useful when I was having trouble remembering a name.
It also would have been nice to have recordings of the daily rounds. Sometimes it was hard to catch everything.
You may also be inclined to keep up with the frequent lab results and findings of various tests that may be ordered, if only to keep abreast of the changing medical picture.
If not, rest assured that the patient’s entire medical record is accumulating and being preserved by the Medical Records department of the hospital.
By law, patients have access to their Personal Health Record, as do parents if the patient is a dependent minor. Upon discharge the medical record should be made available, and you should not leave the hospital without it.
It will include the lab work, test findings, surgical reports, imaging results, etc. The most important use of your complete medical record is that it can play a role in any follow-up care the patient may need in the future.
“My husband snatched up every lab result and folded it into four sections like a little book. This gave us four blank ‘pages’ to write our questions and notes upon, integrated into the lab report itself.
We kept all those little pamphlets; and they formed a pretty complete record of all the ups and downs, enough information to write a book.”
There are times in your life when you need help. This is one of them.
At some stage early on in a severe foodborne illness, you will realize that you need help. You may be dealing with medical complications that appear so quickly and you must accommodate very rapidly to a very stressful, unforeseen new reality.
It’s good to take stock of who can count on. If you have a spouse or a partner, they will be indispensable in handling the challenges that may lie ahead.
If you don’t have a partner to lean on, don’t go it alone. Identify that person who you can most rely on to be a steadying form of support for you. Bring them in physically, early on.
If you have other dependents at home, line up continuous childcare. Have a family member or friend move in to care for them. Or allow close friends to take children into their homes if you are facing a hospitalization of indefinite length of time. Start thinking about this and make preparations early on.
Do not underestimate how much people in your sphere will want to help your family.
If you have a family member, relative, or friend in the medical world, connect with them and let them know that you will depend on their expertise to help you interpret issues you don’t understand. They can be a tremendous resource of information and advice to you.
If the patient is a school-aged child, let the school know about your child’s absence and illness. This way the teacher can start a file of missed schoolwork and engage your child’s classmates to send supportive messages, cards, artwork.
Your hospital will have a social worker on staff. Ask to meet with them to inquire about support to help you manage. Most hospitals allow parents of critically ill patients to sleep in an on-site space designated for this purpose, or at a nearby location if they are affiliated with organizations such as Ronald McDonald House Charities Foundation.
“Because we were hospitalized far from home, I’d occasionally have to leave our son and my wife alone in the PICU to fly back and forth to our other children and my work a few days per week.
My sister in law, a retired nurse flew in to take my place for a few days. That was so helpful for my wife to have the support of her big sister, and helpful also to our son who was just recovering to the point that he could sit up again.
His aunt lifted his spirits, became a new and fresher advocate, and even found a way to roll him in a wheelchair, IV poles attached into the hospital courtyard to be out side for the first time in several weeks.”
“We were cautious about how much information we put on social media. I thought carefully how my private teenaged daughter might feel about it when she recovered.
I also considered that her siblings didn’t want to hear every detail of her illness, and I thought we’d be better off not putting it all 'out there’.
It was helpful to have one place to share information though, and the words of encouragement left by family and friends were comforting in a way I did not anticipate. Even now it’s moving to go back and look at how people reached out to us.”
Also, Child Life Specialists are available to help families of hospitalized children. They can provide resources, advice, emotional support throughout a hospitalization. As your child recovers they will become increasingly engaged in coordinating rehabilitation, psychological care, social activities, entertainment, etc.
Part of gathering your resources means also conserving your resources.
Understand that you now will focus all your energy and time on your loved one. This means that it is improbable for you to continue working, attending school, or continuing your normal routine.
An immediate action you can take to preserve your resources is to clearly outline your policy for hospital visitors, and how to share updates with your circle of family and friends. You can manage these communication demands in ways that conserve your time and attention.
Consider platforms like email chains, or a CaringBridge account on social media so that you can communicate efficiently with family and friends while limiting the number of independent calls and messages requesting updates.
Everyone around you means well, and is naturally impacted by what your loved one is going through. You also need their support, but find ways to get that support on your own terms so that you can focus on the patient.
When a patient requires critical care they will be moved to an Intensive Care Unit (ICU) if they are an adult. Children will be in a Pediatric Intensive Care Unit (PICU).
Intensive care medicine is a medical specialty that deals with critically ill patients. A physician in this specialty is called an Intensivist, and they will act as the team leader of the unit.
Patient care that had previously been managed by your family doctor or pediatrician, will be turned over to the Intensivist at this point. Some ICUs may refer to this doctor as the “critical care" or "attending" physician.
Intensive care units are also staffed by multidisciplinary teams composed of many different health professionals:
• doctors with specialty training in various organ systems,
• critical care nurses,
• physical therapists,
• respiratory therapists,
• laboratory specialists,
• pharmacists
The unit allows the patient to be constantly monitored for vital information such as their heart rate, blood pressure, breathing rate, body temperature, level of oxygen in the blood.
You will soon get very familiar with these numbers on the monitor, which also are displayed on a monitor at the Intensivist’s central desk.
Other diagnostic technologies can be brought to the patient’s bedside such as imaging equipment, echocardiogram, electrocardiograph, and ultrasound.
The patient will have intravenous (IV) lines to provide fluids, medication, and nutrition. Feeding tubes may be placed through the nose, or through a peripherally inserted central catheter (or PICC) line which delivers most of the body’s nutritional needs into Superior Vena Cava, bypassing the gastrointestinal tract.
Drains and catheters may be used to remove fluid and urine.
Life supporting technologies like ventilators, IV and feeding pumps, and dialysis equipment can be set up bedside.
All of this can be extremely intimidating.
Because there is no real preparation for how to react in this setting, you’ll probably feel like you’ve landed in an alien place. Also, by now you are exhausted by the worries, uncertainties, and frustrations you’ve endured to get here.
Hopefully, now that your loved one is being constantly monitored, you will feel some relief knowing they'll receive immediate intervention if the illness worsens.
Nurses will rotate on their shifts, and at many hospitals you will find that on average there is a continuity of the same nurses assigned to the patient over a period of time. They can be an extremely important source of comfort and information as their interaction with the patient is so focused and enduring.
Nurses will answer your questions and concerns or convey them to the Intensivist.
The Intensivist on duty will direct all the care. They will order the frequent lab work, other tests, and call in the various sub-specialists who will evaluate the patient from the perspective of their particular organ system. Together they will confer and act as a team.
You will have opportunities to meet with the group of specialists individually and collectively, and you will interact frequently with the intensivist.
“We had to deal with being in isolation, limiting visitors, suiting up with PPE every time we entered the cubicle, and were restricted from going anywhere else in the hospital for a time.
And that was before Covid-19, which has greatly impacted how ICU’s are run during the pandemic.”
Every intensive care unit not only has its own hierarchy, but its own rules and protocols -- which may differ from one hospital to the next. Here are some general rules you can expect:
• You must buzz in at the door to be allowed in.
• You will have to wash your hands upon entry, and departure.
• There may be differing rules and standards concerning isolation of the patient.
• You can usually be in the unit anytime of day or night, with some restrictions like change-over hours or during urgent scenarios for other patients.
• Visitors may be restricted according to the limited space available, privacy considerations for other patients, conditions in the unit, etc.
• In such a transparent, condensed space, it is important to respect other patients and their families’ privacy.
• You will be considered an essential part of the team if you interact with all in a respectful, appreciative, available manner.
• The ICU team needs and wants you there to comfort and love the patient.
... and even fielded all the calls into
the unit from friends and family back home asking about our child’s status.
Without her protecting us from a daily swell of
people trying to express their concern, we would have been even more exhausted and overwhelmed.”
HUS is a serious illness.
Most patients recover fully, but some cases are complicated.
Between 5-15 % of individuals infected with Shiga Toxin producing E.Coli (STEC) go on to develop hemolytic uremic syndrome (HUS).
HUS is a blood disorder in which many small blood clots (thrombi) form suddenly throughout the body. Hemolytic means that red blood cells break down, and uremic means that kidney injury causes urea (a waste product) to accumulate in the blood.
The minute blood clots block small blood vessels throughout the body, particularly those in the brain, heart, and kidneys. These minute clots damage organs by depriving them of oxygen, and their fibrin strands shred red blood cells as they pass through partially blocked vessels.
The formation of these clots also mean that an abnormally high number of platelets are being used up, which leads to a sharp decrease in the number of platelets in the bloodstream.
Symptoms of HUS can include:
• Abdominal pain
• Lethargy
• High blood pressure
• Shortness of breath, low oxygen saturation
• Easy bruising or unexplained bruises
• Pale coloring, loss of color in cheeks/inside lower eyelids
• Unusual bleeding, such as from the nose and mouth
• Confusion, shaking, tremors, hallucinations, seizures
• Decreased urination or blood in the urine
• Swelling (edema) of the legs, feet or ankles, and less often in the face, hands, feet or entire body
Most patients recover well with supportive therapy and go on to regain full kidney function. However, some HUS patients develop complications that are related to where in the body clots may form, causing infarcts to specific organs.
Complications may include:
• Cardiac problems
• Diabetes from damage to the pancreas
• Stroke or seizures
• Coma
• Pneumonia
• Digestive tract problems
• Kidney failure: sudden (acute) or over time (chronic)
“The first nine days of my son’s hospitalization had been horrendous! His body slowly filled with fluids due to his kidneys not functioning. On day eight they placed chest tubes and day nine he was struggling to breath.
He had nothing left in him to fight this battle. A group doctors came in the room to tell us he had congestive heart failure and they would be placing him on a ventilator. The room started spinning and everything seemed to move in slow motion.
It was too much information. My mind could not process it.
I thought my son was going to die. I started having visions of him in a casket. My husband and I had to leave the room. They let us back in a few hours later. To our surprise, he was resting peacefully. His vitals all looked normal. He was in a medically induced coma, but it really looked like he was sleeping, something he had not done for almost nine days.
Instead of despair, we felt relieved. He was no longer suffering. He remained on the ventilator for five days. I felt emotionally numb, but thankful he was still alive.”
50-70% of HUS patients need dialysis.
30% will have some degree of lasting renal impairment.
Traditionally it was thought that no known treatment could stop the progress of the syndrome once it has started. That approach uses only supportive care of key body functions, aimed at preventing further complications.
Supportive care may include:
• Treatment of high blood pressure.
• Maintaining specific levels of fluids and electrolytes.
• Kidney dialysis, usually “peritoneal dialysis” through a peritoneal catheter in the abdominal wall.
• Red blood cell transfusions for patients that become profoundly anemic. Infusion of platelets can then add to the formation of more thrombi to block small vessels. Most physicians try to avoid platelet transfusion because of fear it will worsen the disease, and implement it only in cases where there is active bleeding.
“We were encouraged when our daughter’s nephrologist told us that most HUS patients’ kidneys ‘wake up’ as they pass through the acute phase of the disease.
It was hard to imagine that could be possible after suffering such a horrible injury, but the human body can be pretty amazing.”
“Hope and Horror. That’s what I felt as I watched the repeated plasma exchanges used to treat my 11 year old.
Four bags of precious human plasma lined up on the foot of the bed. How many donors went into each one? Transparent lines a little larger than a drinking straw attaching him to the machine.
Hope: Look at how the fresh frozen plasma goes into him, a rosy syrup unpacked from the blood bank’s styrofoam cooler. While it cycles his entire blood supply the plasmapheresis machinery reminds me of the sound of our ice cream maker makes ... churning away while we wait in anticipation.
Horror: The cloudy, angry purulent slush draining into the exit lines. Evil exposed, the toxins that set this nightmare in motion and the shredded blood cells that have gone on to damage organ after organ siphoned off in this thick orange sludge.”
Complicated HUS involves damage to other organs beyond the kidneys, such as the brain, heart, or pancreas. Because complicated HUS is so unpredictable, other treatments must be implemented as complications emerge.
These reactive treatments may include:
• Artificial ventilation (respirator) for patients with lung complications like pulmonary edema and effusions.
• Heart procedures to relieve cardiac complications such as pericarditis and myocardial ischemia.
• Surgeries to repair bowel necrosis (death of a section of tissue) and bowel perforation.
• Insulin therapy for hypoglycemia caused by pancreatitis.
• Total Parenteral Nutrition (TPN) administered through a catheter in a large vein of the upper chest for patients unable absorb nutrition through their intestines.
HUS is very closely related to another blood disorder called TTP. TTP is more common among adults. TTP stands for thrombotic thrombocytopenic purpura.
Although there is no specific test to diagnose HUS, doctors conduct a number of tests to make a diagnosis. Various tests are used to show the count of platelets and red blood cells, and to reveal kidney function.
Diagnosis is made when these three clinical features converge:
• thrombocytopenia (low platelet count)
• hemolytic anemia (destruction of red blood cells)
• acute renal (kidney) failure.
Rather than wait for further damage to occur, it may be wise to have these discussions early in the course of your loved one’s disease. It is important to communicate to the team leader, the Intensivist, emphasizing that you need and appreciate the clinical judgement of the doctors involved, that you understand these treatments are not for every patient, but that you want the team to weigh the risks and benefits for your family member. In cases where life threatening complications arise, it often comes down to appealing “What do we have to lose?”
If you encounter resistance, ask your Intensivist and sub-specialists to access their “Up To Date” medical portal (www.uptodate.com) for the latest literature on the treatment of HUS.
There are differences of thought in various medical centers, and some physicians may not be aware of current recommendations on therapies which are rapidly evolving at centers that manage numerous HUS cases. However, with the links below and your communication skills, you should be able to point out the accumulating evidence of the efficacy of these two treatments when making your appeal: Plasmapheresis and Soliris (Eculizumab).
Plasmapheresis, or plasma exchange, is a proactive therapy aimed at stopping HUS on the level of its basic mechanism: damage to organs caused by the underlying disorder within the blood.
It has shown to be an important therapy, especially in typical HUS patients (those cases with bloody diarrhea) who develop central nervous system involvement.
Plasma exchange removes potentially toxic substances from the circulation, and some hematologists believe it may provide the patients with a missing blood factor which made him or her more vulnerable to HUS.
Plasma exchange is the first treatment of choice in the closely related disease, TTP (Thrombotic Thrombocytopenic Purpura). Without plasma exchange, 90% of TTP patients die.
There is a great overlap between HUS and TTP. Both are thrombotic microangiopathies, both are categorized by injury to endothelial cells which line small blood vessels, both involve small clots of platelet-fibrin. Both illnesses can occur as sporadic cases, or in epidemic outbreaks, or in familial/genetic pattern.
The distinction between the two syndromes of HUS and TTP is increasingly viewed as controversial and arbitrary. Complicated HUS patients, (ones who suffer damage to other organs besides the kidneys) are often described as “HUS/TTP" cases.
Soliris, or generic name, Eculizumab is a monoclonal antibody. If used very early in children with typical HUS who develop neurological complications – as 20-50% of HUS patients do –Soliris may reduce serious long-term neurological disabilities. It is also considered in cases with other severe organ involvement such as cardiac dysfunction.
The monoclonal antibodies of Soliris are lab-produced proteins and have been helpful in fighting a wide variety of diseases, including cancer. Although it has been used to treat severe cases of Shiga toxin E. coli related HUS (STEC-HUS), it has not yet been approved by the US Food and Drug Administration (FDA) for this purpose.
There is no single definitive cure for Hemolytic Uremic Syndrome (HUS). Rather, its treatment involves managing and monitoring its symptoms while the body recovers. The medicines and procedures involved in this treatment can be quite extensive, as multiple organ systems may be involved.
Shiga toxin E. coli related HUS (STEC-HUS), sometimes called typical HUS, is caused by the Shiga toxin that is most commonly found in E. coli bacteria. Atypical HUS (aHUS) is a related disorder, and generally has a genetic component in origin and may become a chronic condition.
Soliris is a drug that has been approved by the FDA to treat aHUS. Some doctors believe Soliris can help STEC-HUS patients and use it “off-label” for severe cases of STEC-HUS, particularly if the patient’s central nervous system has been impacted.
Hospitals may be reluctant to approve the use of Soliris in STEC-HUS patients for several reasons: its efficacy has not yet been proven in a large multi center trial; there are side effects including the possibility that patients may be more likely to acquire a meningococcal infection; and the drug is very expensive and may not be covered by insurance.
The nature of complicated STEC-HUS makes it challenging to conduct a large-scale clinical trial of Soliris to prove its efficacy. STEC-HUS is relatively rare, and unfortunately, it is not uncommon for there to be a delay in its diagnosis. Cases are sporadic, acute, and spread out across the country and world. These circumstances make it challenging to recruit patients for a large, well-designed clinical trial.
There is some evidence that early use of Soliris is beneficial, and there have been some relatively small studies of the use of Soliris in STEC-HUS patients, but more research is needed. Soliris prescribing information includes the warning, “Life-threatening and fatal meningococcal infections have occurred in patients treated with Soliris. Meningococcal infection may become rapidly life-threatening or fatal if not recognized and treated early.”
Meningococcal vaccines are typically given in the pre-teen and teen years, so children may enter the hospital without having been vaccinated. A vaccine can be given in the hospital prior to administering Soliris, but its effectiveness will be limited since there will likely not be enough time for the body to develop immunity. This very serious potential side effect requires that the use of Soliris in a STEC-HUS patient be carefully considered.
Finally, Soliris is a very expensive drug. Insurance companies can be reluctant to cover the cost of the drug given the lack of FDA approval for its use in STEC-HUS cases, the need for additional research, and the risks involved. For critically ill patients, some hospitals may be willing to cover the cost of the drug.
A signed consent form will be required from the patient or parent acknowledging the experimental nature of the treatment and the risks involved.
"All of the tests came back negative and on August 28, after nearly a month, I was finally discharged. They believed it was E. coli that caused the HUS.
I was released to outpatient dialysis twice a week, while still taking antibiotics and high blood pressure meds. I had to check my blood pressure daily and keep track of my urine output. I was also started on a drug called Soliris every other week to assist my kidneys.
At this point, I had blurry vision and could barely drive, and it was discovered that the blood vessels behind my eyes had started leaking. My life went on like this for almost another month. I returned to work the same week of my discharge. Luckily, I had great co-workers who showed their support by driving me to and from work.
On September 25, after nearly two weeks of not eating (due to the effects of the antibiotics), I celebrated by having pizza for my first meal. By the end of September, I was able to end dialysis and be off of all of my medications."
There are potential treatments on the horizon. Recent progress has recently been made by Australian microbiologists who have discovered the pathway for the production of Shiga toxins in STEC infections. This research may lead to potential target drugs that can suppress Shiga toxins during early stages of E.coli infection.
There are many tests that will be frequently done in intensive care. These yield volumes of information doctors need to make decisions.
Laboratory studies are used to diagnose and to track the patient’s condition. Testing will include a long list of components. Your doctors and nurses can help you to understand their meaning and impact on the patient’s changing condition. This may seem like an incomprehensible alphabet soup of new terms and measurements.
However, if you are interested in the language of this intimidating terrain, it may help you to understand some of the bearings that the doctors are tracking in order to lead the patient back to health.
Commonly called "labs", blood laboratory testing will track:
Platelet Count: Platelets (thrombocytes) are blood cells that help your body form clots to stop bleeding. Thrombocytopenia is a condition in which you have a low blood platelet count. With HUS, platelets are consumed when tiny clots form throughout the body, blocking the small blood vessels and fragmenting the red blood cells. The bloody diarrhea of HUS also causes a sharp decrease in platelets.
A normal platelet count is 150,000 – 400,000*. In HUS patients, this number can drop to as low as 10,000, a level that can cause internal hemorrhage. Platelet count is a number that your doctors will monitor intensely during the critical stages.
Uric Acid Level can be elevated because of renal failure, dehydration, and cell breakdown. Normal values for uric acid range between 3.5 and 7.2 mg/dL*.
“There is so much large and small information coming at us every hour to show the rapidly changing condition of our child. Big things like portable machines rumbling in and out to make x-ray films of an enlarging heart silhouette, lungs fogging up.
Ever present little things like inch tall vital signs blinking over his head. Small vials of blood are sent downstairs to the lab which sends back reams of values measured on the most minute scale. Microliter, deciliter, milligram, million cells per microliter…
Tiny numerical clues of what’s happing now, and what can happen next on the grand scale of things.”
Hematocrit: The ratio of the volume of red blood cells to the total volume of blood. A lower than normal hematocrit can show an insufficient supply of healthy red blood cells (anemia). A normal range is For men 42-54%*; For women, 38-46%* ; For children, the normal range varies by age and sex.
WBC (white blood cell count): White blood cells (leukocytes) are the cells of the immune system that are involved in protecting the body's RBC, (red blood cell count). Red blood cells, (erythrocytes) are loaded with hundreds of millions of hemoglobin molecules to deliver oxygen to all the body’s tissues. The destruction of the red blood cells is the underlying disease mechanism of hemolytic uremic syndrome. The normal RBC range for men is 4.7 to 6.1 million cells per microliter* (mcL). The normal RBC range for women who aren’t pregnant is 4.2 to 5.4 million mcL*. The normal RBC range for children is 4.0 to 5.5 million mcL*.
FDP (Fibrin Degradation Products) or “fibrin split products” are substances left behind when clots dissolve. Normal results for FDP test are less than 10 mcg/mL* (micrograms per milliliter). FDP levels that are higher than normal may show a clotting disorder.
Fibrinogen, a blood protein made in the liver, plays a role in clotting. A normal range for fibrinogen is between 200 and 400 mg/dL*. A fibrinogen value of less than 50 mg/dL* may indicate a danger of bleeding after surgery. A fibrinogen value of more than 700 mg/dL* may indicate a danger of forming clots.
Hemoglobin, a protein in red blood cells. It carries oxygen from your lungs to the rest of the body. Abnormalities can be a sign of anemia. Normal ranges are For men, 13.5 to 17.5 grams per deciliter*; For women, 12.0 to 15.5 grams per deciliter*; For children the range varies with age and sex.
Creatinine, a waste product produced by muscles is normally removed from the body by the kidneys, which filter almost all of it from the blood and release it into the urine. The level of creatinine estimates how well kidneys are filtering the blood. Blood creatinine levels that reach 2.0* or more in babies and 5.0* or more in adults may indicate kidney impairment.
BUN (Blood Urea Nitrogen) reveals how much of this waste product is in blood. If levels are beyond the normal range, this could mean that kidneys or liver may not be working properly. Normal levels range between 7 to 20 mg/dL*.
GFR (Glomerular Filtration Rate), estimate how well the kidneys are filtering the blood. Doctors calculate GFR from the results of the blood creatinine test, age, race, body size, and gender. Normal GFR is 90* or higher.
Schistocytes are red blood cell fragments that underwent mechanical destruction. In HUS, healthy red blood cells are sheared (lysed, as in “hemolytic”) by the fibrin strands that form clots in small vessels. The fibrin strands slice and fragment red blood cells into abnormal shapes, thus reducing their lifespan.
Normal range may vary depending on the lab that performs the test.
Urine is analyzed for abnormal levels of protein and infection:
Protein in urine is referred to as proteinuria. Healthy people have very little protein in their urine. An excess of protein is a sign that kidneys are impaired .
Bilirubin is a product of red blood cell breakdown. Normally, bilirubin is carried in the blood and passes into the liver, where it's removed and becomes part of bile. Bilirubin in urine may indicate liver damage.
White blood cells (leukocytes) may be a sign of an infection when elevated.
Glucose is normally not present in urine. Its presence can indicate kidney dysfunction or diabetes.
Red blood cells (erythrocytes) can be misshapen, fragmented.
Casts — tube-shaped products made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat. The content of a cast can help tell your doctors when kidney function is abnormal.
Beyond these frequent blood and urine laboratory studies, doctors may want to evaluate the patient and guide treatment plans for any complications that might arise.
To do this, they would order Imaging Studies:
• Abdominal imaging with barium enema often shows “thumb-printing” of the large bowel due to the combination of edema and hemorrhage of the bowel wall.
• Renal ultrasound may be used at the onset of acute kidney failure, which occurs in 55-70% of cases of HUS.
• Chest x-ray (radiography) to let doctors evaluate any lung (pulmonary) congestion or edema.
• Echocardiogram (ECHO) and Electrocardiogram (ECG or EKG) to examine for cardiac problems.
• Abdominal ultrasound or CT scanning may be ordered if an intestinal obstruction or perforation is suspected.
• CEEG (Continuous electroencephalogram) monitoring can detect changes in the brain over time, thereby allowing early treatment of central nervous system problems.
• CT scan or MRI A CT scan (computerized tomography) or MRI (magnetic resonance imaging) of the head is indicated in patients with central nervous system (CNS) symptoms or acute changes in their mental status. Approximately one third of HUS patients have neurologic symptoms or signs.
There are ways you can get through such a long and exhausting experience.
When your loved one has a severe foodborne illness that develops into more serious complications, it can demand great resources on your part, often more than you feel you can possibly pull together.
Many parents and family members liken their experiences to a roller coaster ride because of the dizzying twists, tedious climbs, precipitous falls.
Some describe it as running a marathon because of the prolonged and grueling effort. Whichever analogy you experience, you’ll probably agree that HUS or any severe foodborne disease is:
Very prolonged,
Very unpredictable,
Very threatening,
Very demanding
So, how can you get through it, acting as the patient’s best advocate? Know these four characteristics going in, and know that you are not the first to work your way out of this terrifying place that your loved one has landed in.
It’s a prolonged journey. That means you’re going to have to pace yourself, use your resources wisely. Below is a list of suggested strategies that can help.
It’s an unpredictable landscape. Being informed, engaged with the experts who are reading the signs and plotting the course will be a big help as you try to keep up with your current position. Not counting on a direct and easy path is also something you can do emotionally to steel yourself for what lies ahead.
It’s a threatening place. Help the patient by being ever vigilant. Watch everything. Ask questions, bring details to the attention of the busy medical team. You know the patient better than anyone else. Trust your instincts and keep a laser sharp focus on the patient.
It’s a demanding place for all concerned. It’s demanding of the medical care givers, which you can think of as pathfinders. They are professionals with the expertise and judgement to lead the way. They are however imperfect, and the biggest threat to them working as a team is when one of them gets territorial.
For example, a child with a more severe case of HUS may have a cardiologist (heart), gastroenterologist (stomach, intestines, pancreas, gallbladder), nephrologist (kidneys), and neurologist (brain). Each only specializes in their "body part" and at times this can feel frustrating because the entire body is affected. Sometimes their ideas for best treatment are in conflict. Know that this can happen in the hyper-specialized world of modern medicine. Appeal to the Intensivist not to let that happen. In complicated disease involving multiple organ systems, they all have to work in a unified direction.
Having a severely ill child or other family member is extremely demanding on you and your family members. Look after yourself, and be mindful of your other dependents even if you cannot be with them now.
Demands are the highest on the patient as he or she struggles to stay alive and recover. Your role is to keep your child or loved one afloat emotionally and spiritually. No one else can do that.
“I didn’t know how aware my daughter was of what was happening when she was in the ICU, especially when she was unconscious, but we spoke to her like she was her old self.
We tried our best to be encouraging at her bedside. I asked one of the doctors if there was anything that would be beneficial for her brain function. He told us to treat her as if she were home with a bad flu, offering comfort and allowing time for rest.
That made good sense to us and helped me relax a bit and trust that her body was doing the work of healing.”
Parents, family members and survivors share their strategies for finding refuge and retreat in the midst of the maelstrom:
Tell the patient long stories of things you did together in happier times.
Focus on these wonderful parts of their past so you can channel positive energy to them.
Eat as wisely as you can in the hospital cafeteria. There are usually some healthy options to keep you properly nourished.
Many hospitals have a chapel of some sort. Go sit there quietly even if you do not pray. Think of it as a place to recharge your hope and deepest strength.
Touch, stroke, hold hands with, gently talk to, help bathe the patient. Let them feel and hear your presence, even when it seems they are far away.
Have your partner, a best friend, close family member be with you to support you and to rotate staying beside the patient.
Make a pact between the two of you that one will always keep optimistic if the other starts to lose faith.
Take turns sleeping in shifts so that neither of you becomes overly exhausted at the same time.
Offer to read books to the patient or let them listen to relaxing music. Do not be surprised or disappointed if they are uninterested or find these irritating.
Television will most likely also be especially overwhelming and annoying to them as they need peace and rest more than outside stimulation.
Find a place in the hospital that is quiet and deserted at night to sit and reflect when you take breaks from the intensive care unit.
You are living an ongoing traumatic experience
and there is no shame
in seeking help.
Do something. Feed your soul.
Music, writing, handwork ...
Read to them notes and cards from their friends, classmates, and siblings.
Post artwork and cards on wall space within their sightline, clearing this with the nursing staff so that these do not obstruct access to any of the instruments or machinery.
You may be overwhelmed with anxiety, finding it hard to sleep. It is very difficult to turn your brain off the day's worries, especially if it was a challenging medical day.
Some find it necessary to get a prescription for sleeping pills or anti-anxiety medication.
Other families in intensive care may overlap with yours, and you can share supporting words with one another. But guard your heart. Be careful that you do not become overly involved in their tragic stories.
You have to shield yourself emotionally and save all your energies for your own battle.
Eliminate as many distractions as possible (undesired visitors, responsibilities of day to day care for other children, constant demands of keeping everyone in your circle informed).
Make sure your other children are with people who can look after their daily needs as you may not be able to see them for extended periods of time.
It will be very reassuring to you, them, and the patient to talk daily if possible.
Get outside every day. Some hospitals have green spaces.
If not, find a safe route to walk in the day, through the parking lot or surrounding area. Your body needs movement to counteract all the sitting you are doing.
Some people find it helpful in such an alien place to create a new ritual to give some small bit of structure to their day and night.
This may be something as arbitrary as taking the elevator to each floor and walking in a circle through each public access area.
Keep a diary. People who’ve gone through what you are now enduring unilaterally agree that this is enormously beneficial in ways you may not even realize until years into the future.
You will not be an effective advocate for your loved one if you do not get sleep.
The need for good sleep lays a strong foundation for your continued emotional and physical health for the long haul of this illness.
As time goes on and the patient becomes more aware of his or her surroundings, be aware of the likelihood of developing a severe state of confusion, ICU Delirium or ICU Psychosis.
This condition is very common, occurring in 2 out of 3 patients hospitalized for any length of time in intensive care. Of those patients on a ventilator, 7 out of 10 suffer delirium.
People with delirium cannot think clearly, have trouble paying attention, have difficulty understanding what us going on around them, and may see or hear things that are not there.
These patients do not know that they are disoriented and away from a normal mental baseline. Their skewed sense of reality feels very real to them. Trying to reorient them to actual reality, to time and place is a good approach if this is done in a non-confrontational, calm way. Try to find something that you can both have in common with your perception. Ask your doctors and nurses to show you techniques they use when interacting with such patients to gently help them become reoriented, soothed, and reassured about their recovery.
Sleep is a key part of healing, and as your loved one improves, there are approaches that help them get periods of uninterrupted sleep in the invasive environment of the ICU.
Delirium usually clears up in a few days or a week. As your loved one continues recovering physically and mentally, be vigilant for Post Traumatic Stress Disorder (PTSD) and Depression, both of which can be triggered by exposure to a traumatic and disturbing experience.
“Subjected to constant pain, and the added indignities of enemas and other procedures, not being able to speak or move, I was trapped in my body. Emotions began to overwhelm me and depression predictably settled in.
The thought of death was becoming a welcomed relief. I clearly remember communicating to my husband that I could not go on. I remember him crying and begging me to promise that I would not give up but rather do my best to hang on. Once I promised him that I would try, my emotions were up and down and the feeling of being a prisoner in my own body proved overwhelming.
While losing track of time I became painfully aware of every second passing by. During the day I would often have a friend or family member read to me. During the evening hours when visitors would leave, I found those times of isolation extremely frightening.
My sons bought and set up a laser star projector in my ICU room. At night my ceiling would come alive with stars, constellations, shooting stars, and clouds. Bringing the beauty of the universe into my room helped get my mind off the machines keeping me alive in a fragile state.”
“When my daughter was coping with ICU delirium, she went a very long time without sleep. I was hoping she could get some medicine that would help her sleep, but the doctors advised that the medicine could make the problem worse.
As a mom, it was hard keeping her awake during the day, when I knew she needed sleep so badly, but it was the only way to get her back on a schedule that would help her recover.”
“Once I finally got off the ventilator, but still weeks before I was able to eat again, I thought my pulse oximeter was a chocolate bar.
When I sucked on it it tasted like candy.”
How you get along with the medical team
can have a large impact on the patient.
Many people are able to go through life without being in a prolonged, unpredictable, dangerous, and demanding medical situation. Most enter this intimidating world of critical care without any medical background. They have no preparation for the circumstances they find themselves in with a critically ill child or family member.
Don’t underestimate your own abilities, your unique relationship with the patient, or your role in becoming an essential member of the team working towards the best outcome for the patient.
To be a constructive team member, you may need to learn how the other members of the team interact, what their roles are, how their decision making and information sharing proceeds. You will learn about protocols, and what their expectations of you are.
You can be certain that everyone shares the best of intentions. Their first priority is to the patient. So on the most basic level you are intensely united with the medical team in the mutual mission to save your loved one.
Numerous studies support that when family members actively engage and communicate, there are better patient outcomes and a lower risk of medical errors. Don't be afraid to be assertive if you feel something is wrong, or that maybe the doctors or nurses have missed some detail that you sense is important. Different doctors and nurses rotate on and off shift. You do not. You are your child's or loved ones greatest advocate.
“Terry was the first nurse we met once we were transferred to the PICU. On the first day she helped me clean our son from the nearly constant bloody diarrhea. As he became more and more disoriented, Terry reassured us both that once he was taken down to surgery to implant a dialysis catheter in his abdomen, his condition would improve.
She was there for the entire first week, but when the weekend came and we knew she’d be off shift, my husband found her in the unit dressed in street clothes. She wiped a tear from her eyes and explained that she just needed to be sure our son had made it through the night.”
There are four points of reference that are considered important if your goal is to be as useful as possible to the patient’s care:
1. Your Attitude
With such a chaotic, stressful situation, and with the inevitable ups and downs of critical illness, it’s hard to have, much less to maintain, a good attitude. But a good attitude toward the caregivers will be an important factor to maximizing positive interaction with the medical team.
Again, know that they are doing everything they can to support the patient. Treat everyone with respect. From the Intensivist, the attending physician, to each sub-specialist physician, every nurse, technician, therapist, cleaning person you come into contact with….each deserves your thankfulness and respect.
This is not to say that there will never be a conflict that arises. But when it does, you can assert your perspective in a strong, yet appropriate way that will more likely be considered.
2. Your Presence
A family member who is seen as helpfully available is more likely to be embraced as an important team member. Most intensive care units will allow your presence around the clock with a few exceptions.
There may be times you will be asked to leave, such as when another patient is having a medical emergency, if the doctors have to perform an invasive procedure on your loved one, or during shift changeovers.
Sometimes the staff may kindly suggest you go home or sleep in the hospital’s parent room if they feel you need rest. They understand that you cannot be effective if you are exhausted.
3. Your Communication
Find a point person to communicate with. Often times this will be a primary nurse, consistently assigned to your loved one, who can gather all the information and keep the family updated.
This makes it easier for the family and intensive care team to agree on one or several staff nurses to communicate primarily with the family. This helps the staff by more efficiently managing their time to focus on care for all the patients in the unit, and adds a personal touch for the family.
If an informational conduit does not develop on it’s own, feel free to ask the Intensivist, or attending physician, the unit’s head nurse, or your bedside nurse upon whom can you most frequently rely to keep you informed on the patient and the daily plan. Ideally, this point person will interpret the changing lab numbers, vital signs, and testing results, framing all the multiple bits of information into the context of the whole patient.
Be aware that nurses, intensivists, attending physicians, and sub-specialists rotate on and off their varying schedules. Therefore, you have to be flexible and prepared to have other informational point people when your primary team members are not in the ICU for a day or week at a time.
4. Your Participation
Try to be present when doctors conduct their rounds. Rounds are the times when doctors develop and communicate the daily plan for the patient’s care. Usually rounds are in the morning, but sometimes they may be in the early evening as well. Doctors may round individually or as a group of sub-specialists.
Some hospitals have “family centered rounds” that allow family members to be present and involved. These practices differ from hospital to hospital and are in flux within each intensive care unit; but if you are present during doctors’ rounds you can learn much and perhaps participate.
Another very important way you can participate is to be another set of eyes on the patient. Remain vigilant on the details of care. You will soon become familiar with tasks, routine, the monitoring of vital signs, the functioning of infusion equipment, mechanical ventilation, the critical importance of sterile technique.
If something strikes you as odd, ask the nurse. Be especially watchful of sterile technique when IV’s, catheters, feeding tubes, surgical wound sites, etc. are being changed or adjusted.
Our dear friend and mentor who steered our boy’s care from afar reminded my husband everyday: “He’s gotten through all these life threatening complications and setbacks. Don’t lose him now on a stupid technicality like an infection.”
You’ve reached a great landmark when your loved one can leave intensive care.
When your medical team feels the patient no longer needs critical care, they will line up discharge from the PICU or ICU.
This is of course cause for great relief.
Yet many family members experience this as a stressful, vulnerable time. They worry that the patient will no longer be continuously monitored for vital signs or receive the immediate intervention if they take another bad turn. They are uneasy about a new nursing team, new routines, a lower nurse:patient ratio on the hospital in-patient ward. The patient still needs focused, ongoing care and families worry that new care givers will be less able to provide it.
Family members also worry about medical errors now more than ever. They fear a breakdown in communication about medications and the patient care plan during hand-off. They are concerned about possible delays and the timing of transfer, and they have a right to be. Data shows that transfers that occur during the night time or on weekends when staff is reduced are more likely to lead to readmission to intensive care.
All that being said, the patient will not be transferred out of intensive care until the doctors feel they are truly out of danger and ready to begin the recovery process.
In all likelihood you will not lose personal contact with your PICU/ICU team. The same sub-specialists will continue to check on the patient daily and direct their care through the Intensivist, even though they’ve been moved to an inpatient ward.
Before the transfer occurs, ask if the hospital has any printed material to help you to prepare for transfer. Some centers have printed material, and most hospitals will have patient care specialists to help answer your questions and may even be available to assisting the actual day of moving to the general ward.
Talk to the PICU nurse in the days leading up to the transfer about things that you should be attentive to during the transition. Is there a need for the caregiver to double-check medications during the transition, or at least review with new nurses on the ward?
Ask about what testing or procedures are planned in the coming days.
"I remained in intensive care for several more days and was even asked to talk with another patient who had just come in with HUS.
She got well faster than I did. Though she came into the hospital after I did, she left before me.
I was happy when I finally got to be moved to the main part of the ward I was in. I was in enteric isolation for another day and a half and then I got moved in with a roommate.
Even my roommate got to go home before me but she and I became friends in the short time we were together.
I was in Mayo for a total of 10 days when they decided that I was well enough to release me to go home."
During this time, the patient will become more aware of their surroundings and situation. Their memory and understanding of events may be impaired, especially if they were heavily sedated, spent time on a ventilator, in a coma, or had neurological symptoms.
Be gentle in relaying information about their condition to them, and follow their lead regarding how much they are ready to process. They may find it reassuring if a caring family member can matter-of-factly explain what happened, what machines are still assisting, and that they are getting good care. Don't be surprised if you have to repeat these things over the coming days.
How best to handle sharing information will depend on the patient's age, condition and preference. If their memory is foggy, what you say to them during this time could have a lasting impact on how they think about the event. While it may be hard, finding positive things to focus on can make a huge difference.
If you can share stories of loving friends and family that have reached out, caring and attentive hospital staff, and the patient's resilience and strength, it may make the discomfort easier to bear.
If the patient has a faith that could offer comfort, there may be readings, prayers or practices that can be done bedside.
Consider expressing your own gratitude about the recovery, the people that have helped, and the patient's bravery and good work.
Any complaints with hospital staff or issues around care may be best addressed out of earshot of the patient, especially if the patient is a child. You can ask that discussions with doctors take place in the hallway if your patient seems agitated by them.
“Once he was strong enough to walk, the child life specialist lined up interactions with other pre-teens on the ward.
Not only did this get him up and moving, strengthening his body by shuffling through the halls.
He was able to hang out in brief little visits with kids undergoing chemotherapy. This gave him a sense of purpose, supporting other kids fighting other battles.”
Once transfer is made and you get settled in on a pediatric or general ward, you and the patient may start to be aware of and actually enjoy a quieter, more private environment for those who have their own private room.
For others, you may now have to share a room with another patient and family and this comes with its own unique set of challenges.
Now that you're out of the PICU or ICU, patient care shifts from crisis management to rebuilding health.
Medical workers like physical therapists, child life specialists, nutritionists, pulmonary therapists, will play a more pronounced role than they did in the intensive care unit.
Patient care specialists are available to help monitor patients' physical and emotional well-being and report to medical staff.
Some may participate in rehabilitation and treatment program. They will focus on getting the patient physically and emotionally strong enough to leave the hospital. There will likely be opportunities through Child Life specialists to re-enter into social contact with other children on the ward (therapeutic play interactions for children, etc.)
Your patient may be able to receive more visitors now, though you may still want to limit them. Many hospitals have recreation, art and music activities available at this stage. In time, there may be opportunities to go on walks outside the unit, even outdoors.
If your patient is now allowed to wear their own clothes, it can help to feel more like themselves.
Just as open communication got you through the most critical stages of your loved one’s illness, staying informed and involved during this recovery stage will help the patient, you, and everyone around you.
Particular physical challenges during this time are fatigue and weakness, difficulty with resuming eating, being able to sleep. The average person loses about 2% of their muscle mass each day during intensive care. Many have to slowly learn how to sit up or walk again.
Because of severe gastrointestinal involvement during the critical stages, the patient may have gone days or many weeks without eating. It’s difficult to restart digestion, so feeding tubes and IV supplementation may need to be continued while on the ward.
Sleep cycles take a while to reestablish after all the medications, the insult of the multi-organ system disease, the harsh environment of intensive care. Despite all these challenges time on the ward can be a positive time for you and the patient.
Although there is still much hard work to be done, you’ll likely look back upon this phase as a bittersweet interlude.
You still can’t believe this happened. Your loved one has been grievously wounded. You’re still stuck in a hospital. But the patient is still getting support and care. Progress is being made. You are both alive. It’s a good time to let gratitude flow all over you.
Depending on the number and the degree of medical complications suffered, time in the in-patient ward can range from days to weeks or months. Your doctors and nurses will assess and keep you posted as the patient reaches key milestones along the way, getting ever closer to going home.
Jadé is Quality Manager for Kraft Heinz Coshocton’s Oscar Mayer plant, where she influences others by sharing knowledge gained throughout her years in the industry. Bringing a decade of hands-on experience in food safety and quality roles across the food industry, Jadé is committed to strengthening food safety culture by collaborating cross-functionally with her team to improve the attitudes and behaviors of front-line workers. She leads by example and is always ready to jump in and support her team so they can win together.
With a Master of Science in Food Safety from Michigan State University and a bachelor’s in chemistry and Black World Studies from Ohio Wesleyan, she has built a career grounded in strong technical knowledge and continuous learning. Her accomplishments include leading an applied research project measuring and improving food safety culture using a questionnaire shared with employees in 50+ restaurants across 6 states.
Jadé has contributed to the Food Safety Culture Toolkit through IAFP’s Food Safety Culture Professional Development Group, participating on panels to share her career journey, and mentoring young and upcoming professionals.
Wiggs has spent his career helping the food industry share the data needed to keep consumers safe, focused on making food safety technology practical and scalable. As Founder and CEO of Starfish, Wiggs and his team built the only neutral connectivity layer that lets traceability data flow across companies, enabling faster and more precise recalls globally.
In two years, Starfish has become the most connected traceability network in the world, linking thousands of companies through 85+ technology partners and 125 system integrations, and serves as the official traceability partner of IFMA, the Food Away from Home Association.
Previously, Wiggs led IBM Food Trust, the largest blockchain traceability network in the world, supporting live outbreak investigations and recalls globally and bringing lot level traceability to supply chains worldwide.
He serves the industry through board and volunteer roles: the Supply Chain of the Future steering committee (a partnership with IFPA), the Partnership for Food Traceability, and the Alliance to Stop Foodborne Illness. Wiggs works extensively with the FDA and industry to advance initiatives like FSMA 204.
Amy is an ORISE (Oak Ridge Institute for Science and Education) Postdoctoral Fellow with the Environmental Microbial & Food Safety Laboratory (EMFSL) at the USDA-ARS Beltsville (MD) Agricultural Research Center. Amy’s work focuses on investigating the growth and survival of foodborne pathogens in preharvest environmental matrices, such as irrigation water and amended soils. Additionally, Amy supports agricultural stakeholders through applied, on-farm research projects to improve food safety.
Before joining EMFSL, Amy completed her PhD in Microbiology at the University of Georgia (UGA) under the supervision of Dr. Nikki Shariat. Amy’s doctoral research integrated experimental methods with computational tools to study Salmonella population dynamics in food animals and the environment, with projects spanning next-generation sequencing, population genomics, predictive modeling, environmental surveillance, and development of diagnostic assays.
Amy is eager to continue her career in food safety, especially in developing a research program that connects microbial ecology, evolutionary biology, and bioinformatic analyses to study pathogen transmission, persistence, and resistance at the interface of animal and human health.
Angela is a member of FDA’s Human Foods Program Coordinated Outbreak Response Evaluation and Emergency Preparedness (CORE + EP). During her tenure at FDA, Angela has dedicated her career to implementing robust systems that safeguard consumers and enhance public health through the development and implementation of science-based policies, collaboration with internal and external stakeholders, and advancement of data-driven strategies to improve food safety outcomes.
Through her role in CORE Response, Angela leads and supports multidisciplinary efforts to detect, respond to, and prevent foodborne disease outbreaks providing epidemiologic traceback and analytical data expertise related to outbreaks in support of FDA’s response activities. Angela also serves as one of CORE’s traceability subject matter experts to help promote harmonized traceability standards and best practices.
She contributes to agency initiatives such as policy development and implementation, focused on enhancing supply chain transparency and traceability. Angela supports educational and outreach initiatives aimed at increasing awareness and preparedness among industry partners, government agencies, and the public for outbreak response and traceability.
Minji is a Research Professor at the Research Center for Marine Integrated Bionics Technology, Pukyong National University, Korea. She received her B.Sc. and M.Sc. from Pusan National University and her Ph.D. from the University of Massachusetts Amherst under the guidance of Dr. Matthew Moore. During her doctoral studies, she developed biosensing platforms for virus detection, including engineered biological nanopores capable of detecting target molecules at the single-molecule level.
Minji's research encompasses the detection, concentration, inactivation, and control of foodborne viruses and other microbial hazards. She has investigated emerging food safety technologies, including virus detection, antimicrobial sanitizers, and beneficial bacteria-based biofilm control. Through this multidisciplinary work, she aims to develop practical tools that improve the monitoring and prevention of foodborne illness, particularly in seafood and food-processing environments.
Minji was recently awarded the Sejong Science Fellowship from the National Research Foundation of Korea to develop a norovirus concentration technology that overcomes the detection limits of existing analytical methods. She is committed to advancing food safety through innovative detection systems and training the next generation of scientists.
Genevieve is a Principal Scientist of Microbiology for Global Food Safety at Mars Snacking. She leads the development and implementation of the segment’s microbiological strategy, leveraging foundational principles and advanced technologies to inform risk assessment, mitigation and continuous improvement across manufacturing and supplier operations worldwide.
The impact of her leadership is felt throughout the organization, where she leads capability building, including creating and delivering technical training programs for cross-functional teams. She also shares insights with external audiences at association and industry meetings. Genevieve currently serves as a member of the IFSH High-Throughput Sequencing Industry Advisory Committee.
Genevieve previously worked in the produce industry for SmartWash Solutions, leading projects that focused on understanding the presence of E. coli and Salmonella in the growing and harvesting environment.
She earned her Ph.D. in Food Science with minors in Microbiology and Epidemiology from Cornell University, under the advisement of Professors Martin Wiedmann and Renata Ivanek, where her graduate research focused on understanding Listeria dynamics in fresh produce operations, leveraging whole genome sequencing and in silico modeling.
Nalini is the Global Quality Culture Manager for Mars Petcare, where she leads global strategies to strengthen food safety culture, quality performance, advancing corrective action effectiveness, root cause analysis, and accountability across regions and functions. In the CAPA (Corrective and Preventive Actions) governance program, Nalini successfully transformed global CAPA performance, reducing overdue CAPAs from approximately 45% to less than 20% while improving on-time completion rates across the business.
With more than a decade of experience spanning supplier quality assurance, auditing, compliance, and continuous improvement, she is recognized for driving sustainable change through capability building, governance, and cross-functional collaboration. She also established global Communities of Practice and engagement initiatives that promote proactive risk management and strengthen food safety and quality behaviors throughout the organization.
Prior to this role, Nalini held quality leadership positions at Mars and Amazon, leading supplier quality, audit, compliance, and operational excellence initiatives across complex supply chains and manufacturing networks..
Gretchen is the Senior Director of Food Safety at Food Safety Strategy, LLC where she serves food industry members and stakeholders by providing scientific support, educational opportunities, and guidance to navigate complex regulatory requirements and market demands for food safety and quality.
Gretchen is passionate about building food safety competency and capacity through effective training and mentoring opportunities. Her past professional roles include Director of Food Safety and Quality at the International Fresh Produce Association and Senior Extension Associate in the Department of Food Science at Cornell University where she continues to teach online food safety courses for produce growers.
She is an active member of the food safety community, contributing to efforts led by the International Association for Food Protection (IAFP). Previously, Gretchen served as chair of the Fruit and Vegetable Safety and Quality Professional Development Group and is a current member/reviewer for IAFP’s publication, Food Protection Trends.
Gretchen earned her M.S. in Interdisciplinary Studies in Food Science and Safety at Colorado State University and her B.S. in Food Science at The Pennsylvania State University.
Grishma is a Technical Service Analyst II in Technical Services and Regulatory Affairs at Elite Spice Inc.
Dr. Prabhukhot reviews and develops technical documentation for customer and business needs including reviewing supplier documentation; risk assessments; and supports GMP and food safety compliance through daily cross-functional collaboration.
Previously at Elite Spice, she led allergen validation design and execution, conducted process validations for novel sterilization technologies as part of opportunity analysis initiatives, conducted verification activities, and authored various regulatory documentation in response to FDA’s Appendix A draft guidance, helping position the company ahead of anticipated enforcement.
Grishma has a strong background in reviewing and evaluating third-party process validation studies. She earned her Ph.D. in Mechanical Engineering, with a concentration in food safety research, from the University of Maryland, Baltimore County. During her doctoral research at the USDA-ARS laboratory, she used bioreactor systems to investigate biofilm formation and evaluate mechanical and chemical strategies for biofilm removal from food-contact surfaces. Her research included E. coli O157, L. monocytogenes, and R. insidiosa.
Himabindu (Bindu) is a Senior Innovation Food Safety & Quality Advisor at Starbucks Coffee Company, where she leads food safety, quality, and risk management initiatives for innovative beverage, food, bakery, and frozen products across North America.
With more than 10 years of experience spanning industry and research, Bindu specializes in food safety systems, microbiological risk assessment, supplier quality management, process validation, and new product commercialization.
Holding graduate degrees from Tennessee State University and the University of Georgia, Bindu brings together a multidisciplinary academic foundation in agricultural, plant, and food sciences. As a food safety scientist and industry leader, she combines technical expertise with practical business applications, partnering with cross-functional teams, suppliers, and manufacturing facilities to successfully launch innovative products while ensuring the highest standards of consumer safety and product quality.
Beyond her corporate role, Bindu is an active contributor to the food science community as a journal reviewer, editorial contributor, invited industry speaker, and volunteer leader. She serves as a Board Member and National Co-Chair of the Starbucks Women's Impact Network and is committed to advancing professional development, mentorship, and food safety excellence across the industry.
Jannese is the Environmental Health Program Manager for the Jefferson County Department of Health in Alabama, where she leads the Food & Lodging Protection Division and oversees a team of approximately 35 environmental health professionals.
She directs a multi-million-dollar regulatory program responsible for retail food safety, lodging establishment oversight, and public health protection initiatives across Alabama's most populous county. Jannese played a pivotal leadership role in food safety operations for The World Games 2022, in Birmingham, coordinating food safety planning, inspections, permitting, industry education, and interagency collaboration for an international event hosting thousands of athletes and visitors.
She has led efforts to advance conformance with the FDA Voluntary National Retail Food Regulatory Program Standards, secured multiple federal grant awards to strengthen program capacity, and championed technology modernization initiatives that improved regulatory efficiency and data-driven decision-making.
Beginning her career as an Environmental Health Specialist, Ms. Covington has built extensive experience in regulatory compliance, food safety education, and program management. She holds a Master of Public Health from the University of Alabama at Birmingham.
Julia is a Ph.D. candidate in Food Science at the University of Massachusetts Amherst, working under the guidance of Dr. Matthew Moore and Prof. Amanda Kinchla.
Julia’s research advances food safety through applied studies addressing microbial and viral hazards in food systems. Her work evaluates critical process parameters in fermented foods to generate validation data that supports small and medium-scale processors in developing FSMA-compliant food safety plans. Additionally she investigates how norovirus may develop enhanced recalcitrance to commonly used disinfectants due to improper sanitation practices.
Julia earned her B.S. in Biochemistry & Molecular Biology with a minor in Food Science from UMass Amherst.
Beyond research, Julia has served as the International and Affiliate Representative for the IAFP Student Professional Development Group and currently serves as President of the UMass Phi Tau Sigma Chapter, where she promotes professional development and engagement among food science students. Her contributions have been recognized through the IAFP 2026 Student Travel Scholarship and the UMass STEM Leadership Fellowship.
Stephanie is a product and business leader who spent five years building and leading Trust20, a digital food safety training and compliance business serving more than 175,000 learners nationwide.
As General Manager, she led the business from an early idea through national growth, helping foodservice organizations better equip their teams with the knowledge and tools to keep people safe. Stephanie led the development and launch of accredited food handler, food manager, allergen, and alcohol safety training while expanding Trust20’s role beyond required education. She led webinars, developed practical resources, and created thought leadership to help operators understand emerging food safety challenges and build a culture that prioritizes food safety throughout their organizations.
Stephanie brought her human centered design background to food safety education, rethinking how training could better serve today’s workforce. Prioritizing experiences that were approachable, accessible, relevant, and actionable, Stephanie was designing for different learning styles, generations, backgrounds, and levels of industry experience. Her goal was to move beyond traditional compliance training and create learning experiences that people could understand, retain, and apply in their everyday work.
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Shawnil serves as FS and Compliance CAPA Manager at Sara Lee Frozen Bakery, where she leads complex customer complaint and CAPA investigations, strengthens root cause analysis, and uses digital tools to turn food safety data into preventive action.
As a food safety and quality leader, Shawnil has more than 15 years of experience advancing compliance, corrective action, and continuous improvement across food manufacturing and certification.
Previously, as Senior SQF Practitioner for The Cheesecake Factory Bakery, Shawnil directed multi-site food safety programs and developed systems that strengthened accountability, visibility, and cross-functional collaboration. In her career, she completed more than 400 certification audits across GMP, HACCP, FSMA, SQF, BRCGS, and Costco requirements.
She currently holds dual SQF credentials as a Certified SQF Auditor and Certified SQF Practitioner and was an early adopter of the SQF Practitioner certification program.
Shawnil founded SGP Food Safety Solutions, and holds an MBA and a bachelor’s degree in Biological Sciences and is completing a Master of Food Safety at Michigan State University.
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Shanice is a food safety leader and applied researcher with seven years of experience advancing pathogen reduction strategies in poultry. She holds Bachelor of Science and Master of Science degrees in Animal and Veterinary Sciences from Clemson University.
As the FSQA Applied Research Manager at Pilgrim’s Pride Corporation, Ms. McGuffin led research across live production and processing. She designed and executed research trials, conducted microbial risk assessments, and translated scientific findings into recommendations. Her work addressed Salmonella reduction, pre-harvest interventions, antimicrobial resistance, and emerging risks.
Shanice is passionate about advancing food safety through collaboration among industry, academia, and government. She managed a pilot project that contributed to USDA’s decision to exclude Salmonella vaccine subtypes from the Salmonella Performance Standard, removing a barrier to vaccine use in broilers.
She proposed a pre-harvest approach for Salmonella Enteritidis at the National Poultry Improvement Plan conference and has presented at the International Production and Processing Expo and the International Association for Food Protection. Through these efforts, Ms. McGuffin shares knowledge and advances food safety practices across the poultry industry.
Savana is Director of Food Safety and Scientific Affairs at the American Frozen Food Institute (AFFI), where she develops industry guidance, training programs, and collaborative initiatives that help frozen food manufacturers. As a food microbiologist, Savana is dedicated to translating complex science into practical solutions that protect public health by addressing emerging challenges including environmental monitoring, Listeria control, and enteric virus risk management. Most recently, she led an international food safety training program focused on enteric virus prevention in the frozen berry supply chain.
Prior to joining AFFI, Savana worked with Cooperative Extension to strengthen consumer and retail food safety education. Her accomplishments include developing training on the FDA Food Traceability Rule and delivering retail food safety curricula that were adopted and shared across multiple states.
Savana holds a Ph.D. in One Health Sciences (Texas Tech University) and an M.S. in Food Science (North Carolina State University). She is an active member of IAFP and CFP and helped revitalize the Carolinas Association for Food Protection, where she currently serves as President-Elect.
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Lakshmi Santoshi Muriki is the Food Safety & Quality Assurance Manager at Affiliated Foods, Inc., a wholesale grocery cooperative based in Amarillo, Texas. She oversees food safety compliance across more than 1,000 suppliers and serves as the primary regulatory liaison to the FDA, USDA, and Texas DSHS.
She holds an MS in Food Science & Nutrition from the University of Central Oklahoma and a BS in Food Science from Osmania University, and is certified in PCQI, SQF Level 3, FSSC 22000, ISO 22000, BRCGS, and HACCP, with FSPCA Lead Instructor Approved Candidate status.
Ms. Santoshi developed a risk-tiered supplier compliance model that reduced manual follow-up by 60%, accelerated supplier onboarding by 50%, and achieved 100% critical-document compliance. She has authored two forthcoming peer-reviewed articles in Food Protection Trends and contributes regularly to trade publications including Food Safety Magazine, Food Safety Tech, and FSMA Radar.
With more than a decade of FSQA experience spanning global manufacturing and U.S. wholesale grocery distribution, she is recognized as an emerging thought leader in predictive, data-driven food safety strategy.
Rashelly is the Food Safety Manager for the Virginia Department of Agriculture and Consumer Services Food Safety Program. She manages a statewide regulatory program that inspects and permits over 13,000 retail and manufactured food establishments throughout the Commonwealth.
Additionally, Ms. Bland manages the Food Safety Program’s Integrated Food Safety System initiatives such as the Manufactured Food Regulatory Program Standards Cooperative Agreement, Human Food Contract, and Domestic Mutual Reliance Partnership Agreement with the U.S. Food and Drug Administration (FDA).
She completed the International Food Protection Training Institute's Fellowship in Food Protection and presented her research project, Assessment of Inspector Confidence in Conducting Manufactured Food Inspections in Virginia, at the 2023 Association of Food and Drug Officials (AFDO) Annual Educational Conference in Norfolk, VA.
Ms. Bland is also the President for the Association of Food and Drug Officials of the Southern States (AFDOSS), an AFDO regional affiliate that supports the protection of public health through the collaboration and professional development of its membership that includes regulatory agencies, industry partners, and academic partners.
Rabia Farheen S is a Ph.D. candidate in Food Science at the University of Illinois Urbana-Champaign, where she is a Kathryn V. Burns Memorial Doctoral Fellow in Dr. Yi-Cheng Wang's lab. Her doctoral research develops light-based sanitization technologies that achieve 99.999% of microbial elimination in liquid foods, fresh produce, and microbial biofilms. She has since co-founded C-Safe Technologies to commercialize this sanitization platform, validating market need through more than 50 customer interviews via the Illinois I-Corps program.
Rabia earned her M.S. in Food Science from the University of Massachusetts Amherst, where her research on plant-based yogurt safety — testing pathogens including E. coli O157:H7 and Listeria monocytogenes — produced three first-author publications.
She is a Preventive Controls Qualified Individual (PCQI) and has held food safety and quality assurance scientist roles at Blount Fine Foods and International Flavors & Fragrances. A dedicated mentor and educator, she has trained more than 20 students in laboratory instrumentation and received a Top Teaching Assistant Award for her work with undergraduates.
Priscila is the Food Safety, Quality, and Regulatory Manager for Cargill's Prepared Foods facility in Round Rock, Texas. Since joining Cargill in 2015, Priscila has built a diverse career spanning prepared foods, case-ready meats, grinds, and egg products, serving in leadership roles across the United States and Mexico.
A graduate of Michigan State University with a degree in Food Science, she has spent more than a decade advancing food safety, developing high-performing teams, and driving continuous improvement across complex food manufacturing operations. She has led food safety and quality system improvements, regulatory initiatives, major business transitions, and export programs to Mexico, helping ensure compliance while supporting operational excellence. Her accomplishments include supporting the startup and integration of case-ready operations in Monterrey, Mexico, and leading the FSQR organization through the acquisition and transformation of the Round Rock facility.
She is also Lean Six Sigma Yellow Belt certified, bringing a continuous improvement mindset to operational and food safety challenges.
Passionate about creating opportunities for others, Priscila has served on Cargill's Protein Hispanic & Latino Council, supporting inclusion, professional development, and community engagement. Recognized with Cargill's 2025 Power of Protein Award, Priscila is inspiring the next generation of industry leaders through her collaborative leadership style, bilingual communication skills, and commitment to strengthening food safety culture.
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Maryella is Operations and Quality Coordinator at BCFoods Brazil, a multinational company specializing in the spice industry. From her first days as a food science student, Maryella understood that behind every flavor and ingredient is a world of scientists working to make food safe, enjoyable, and feasible to produce.
Through her experience as both an analyst and, today, a coordinator, she has developed a strong sense of ownership and problem-solving, grounded in the belief that quality is non-negotiable in the food industry.
After several years pursuing her master’s degree and working in food safety and quality, she remains passionate about translating food safety knowledge into practical insights that help people make better nutritional choices and support meaningful innovation across the food industry.
As the industry evolves, colorants are increasingly being replaced by natural extracts, vegan alternatives are gaining momentum, and innovative proteins such as mycoproteins are emerging. Maryella wants to be part of this transformation, helping ensure that food safety remains the foundation that allows technical innovation to move forward—because creating the food of the future should never mean compromising its safety.
Luyao is an Assistant Professor in the Departments of Food Science and Technology and Biological and Ecological Engineering at Oregon State University, where she leads an AI4Food research program focused on smarter food safety. Her work integrates artificial intelligence (AI), optical sensing, microbiology, and engineering to develop tools for pathogen detection, antimicrobial-resistance surveillance, sanitation verification, and processing hygiene.
Recent work includes AI-enabled rapid detection of live bacteria in complex food samples and low-cost assays for near-real-time assessment of sanitizer efficacy during produce washing. She also leads and collaborates on federally funded projects addressing microbial spoilage, pathogen persistence, and targeted sanitation.
Active in the food safety community, she has organized AI-focused symposia at meetings of the International Association for Food Protection and the American Chemical Society.
Luyao earned her Ph.D. and M.S. in Food Science from the University of British Columbia and a B.Eng. in Food Science and Engineering from Zhejiang University. She was a NSERC Postdoctoral Fellow at UC Davis and was affiliated with the AI Institute for Next Generation Food Systems.
Laura is an Epidemiologist with the National Antimicrobial Resistance Monitoring System (NARMS) team in the Enteric Diseases Epidemiology Branch at the U.S. Centers for Disease Control and Prevention (CDC). Through her work, she has advanced understanding of antimicrobial-resistant foodborne pathogens.
Laura holds a PhD in Epidemiology from the Australian National University, focusing her research on public health surveillance and outbreak investigation of Salmonella. At CDC, Laura has made substantial contributions to food safety through the characterization and investigation of antimicrobial-resistant foodborne enteric bacteria that cause significant illness in the United States. Her recent efforts have brought together genomic, epidemiologic, and regulatory data to shed light on a widespread food safety threat and guide prevention strategies.
Laura has led work informing national policy, publishing and communicating a landmark CDC analysis of Salmonella outbreaks associated with frozen not-ready-to-eat breaded, stuffed chicken products. Beyond her technical contributions, she is committed to strengthening food safety through mentorship and service.
Kelsey is a Senior Director of Operations Food Safety & Quality at TreeHouse Foods, where she leads enterprise food safety and quality initiatives across a multi-site manufacturing network.
With more than 10 years of experience in the food industry, she has built a reputation for strengthening food safety culture, developing high-performing teams and translating complex food safety requirements into practical solutions that improve compliance, reduce risk and drive sustainable business results. A recognized leader in food safety culture and continuous improvement, Kelsey is known for connecting frontline execution with strategic business objectives, helping teams at every level understand their role in protecting consumers and advancing food safety performance.
She developed TreeHouse Foods' Program Element Assessment framework, a food safety maturity model that helps manufacturing sites evaluate, prioritize and continuously improve their food safety systems. Through strong partnerships with operations, engineering, regulatory and plant teams, she has led initiatives that strengthened quality systems, improved compliance and supported sites through significant operational challenges.
Beyond her technical contributions, Kelsey is passionate about mentorship, leadership development and advancing food safety culture across the industry.
Ellen is Director of Retail Compliance and Food Protection for Hy-Vee, leading initiatives focused on protecting consumers, strengthening operational compliance, and developing practical solutions that support food safety at scale.
As a food safety and retail compliance leader with more than 14 years of experience advancing food safety practices across the retail industry, Ellen has championed collaboration between retailers, regulators, academia, and industry partners to address emerging food safety challenges and improve public health outcomes. Her work includes developing innovative food safety and compliance tools, strengthening allergen and labeling controls, supporting local food producers, and advocating for clear, effective regulations.
Ellen is actively engaged in the food safety community through the Conference for Food Protection and the Iowa Food Protection Task Force, where she contributes industry perspective and helps advance meaningful, science-based approaches to food safety.
Casey serves as the senior director of regulatory policy at the Meat Institute where she provides analysis and expertise on a variety of topics including food safety, processing, animal welfare, and cybersecurity.
Prior to joining the Meat Institute, Casey spent seven years in the food industry in food safety, quality assurance, and regulatory compliance roles. She has worked in FDA and USDA regulated facilities ranging from chocolate and ingredient manufacturing to portion cut steaks and market hog slaughter.
Casey Gallimore earned her Bachelor of Science in Biology from Truman State University, with minors in Chemistry and Justice Systems.
Ashlee-Rose is passionate about animal and human food safety, integrity, and improving their awareness, understanding, food safety culture, and One Health. Working with the Washington State Department of Agriculture’s Animal Feed Program as their Program Manager, her current priority is advancing alignment amongst state and federal partners for better, more proactive outcomes in public health, consumer protection, and orderly commerce.
She also serves as the Secretary-Treasurer and Finance Committee Chair for the Association of American Feed Control Officials (AAFCO), a Board Liaison for Association of Food & Drug Officials (AFDO), and Liaison for Animal Food Regulatory Program Standards (AFRPS).
Ashlee-Rose obtained a Bachelor of Science from SUNY: College of Environmental Science & Forestry at Syracuse (NY) University. She went on to gain valuable public and environmental health experience with: Washington State Department of Health, Clemson University, and South Carolina Department of Health & Environmental Control.
She has her Registered Sanitarian credential and is a graduate of the International Food Protection Training Institute (IFPTI) Fellowship in Food Protection where her research focused on refrigerated and frozen pet food.
Vishal is an R&D Food Scientist at McKee Foods Corporation, integrating food safety, quality, and regulatory compliance into the development and commercialization of baked goods and snacks. He brings over seven years of experience in food and dairy microbiology, pathogen mitigation, and product innovation.
He earned his doctorate in Food, Nutrition, and Packaging Sciences from Clemson University and his master’s in food science from Drexel University. His research explored cold plasma treatments for produce safety and evaluated black cumin, kefir, and bacteriophages as antibiotic alternatives in poultry, examining their effects on Clostridium perfringens infections and the gut microbiome. His scholarly contributions include peer-reviewed articles, book chapters, and presentations at national and international meetings.
Active in the food science community, Vishal serves in national and regional leadership roles within the Institute of Food Technologists (IFT) and Phi Tau Sigma, supporting professional education, student engagement, and collaboration between academia and industry.
Recognized for teaching, mentorship, and leadership, Vishal combines food safety expertise with product innovation and a commitment to developing future food science professionals.
Stephen is the Founder and Principal Consultant of Safe Food, LLC, with more than 14 years of experience advancing food safety through auditing, consulting, training, and industry leadership. Through Safe Food, Stephen supports food manufacturers, distributors, packaging operations, and animal feed manufacturers across North America in developing practical, sustainable food safety systems.
He holds a BS from Salem State University and maintains certifications across food safety and food science disciplines. Stephen has conducted hundreds of food safety audits and helped organizations implement programs aligned with GFSI standards, HACCP, and FSMA.
Stephen focuses on developing people as well as programs. He mentors food safety professionals, coaches’ management teams, and trains frontline employees to understand the “why” behind food safety requirements. Beyond audit readiness, he emphasizes food safety culture, risk management, and continuous improvement.
In 2025, Stephen was recognized as Auditor of the Year by a global certification body for his commitment to auditing excellence and integrity. He also shares accessible food safety education through social media to help consumers better understand everyday food safety risks.
Stefan is the Manager of AFCO's Quality Action Team (QAT), AFCO’s premier team of field deployment experts for the Food and Beverage industry’s cleaning & sanitation applications, as well as microbial mitigation.
Stefan has worked with numerous companies directly solving microbial opportunities and helping optimize their food safety antimicrobial and sanitation program challenges.
In addition to his QAT responsibilities, Stefan acts as AFCO’s North American Subject Matter Expert for AFCO’s newest product offering, PRISM, the patented color changing soil detection thin coat chemical cleaner. He is excited to bring this chemistry system to the market to help sanitation teams perform enhanced training and optimize soil removal and sanitation efficiencies.
In previous roles, Stefan has been the FSQA manager of a Plant of the Year award recipient, a founding member of Fortrex’s FAST Group, and was part of the QA management team that developed an industry-leading multi-hurdle intervention program after the largest ground turkey recall on record.
In his free time, Stefan enjoys spending time outdoors, and raising his two daughters with his wife.
Shivam is a Manager, Food Safety at PepsiCo R&D, supporting beverage and foods innovation across India, Middle East and North Africa.
With more than eight years of experience in food safety, quality assurance, and research and development, Shivam specializes in science-based food safety assessments, designing sanitation protocols and validation of thermal processing technologies, including retort, frying, popping, aseptic, and hot-fill systems etc.
In his current role, he leads thermal and sanitation validation, food manufacturing processes risk assessments that enable innovation while ensuring consumer safety and operational excellence. He partners with cross-functional teams, manufacturing sites, and global food safety experts building capability in thermal processing, sanitation, and risk management through training, coaching, and collaborative problem-solving.
In his previous role, Shivam strengthened food safety and quality systems across dairy and nutrition operations through managing HACCP, FSSC 22000, sanitation, and risk-based programs. A strong advocate for innovation, he is also a co-inventor on a patent for a biopolymer-based electrospun oxygen indicator for dairy packaging.
Robert is a public health communication professional committed to disseminating scientific information in clear, understandable ways that meet the needs of a variety of audiences.
While working as a health communicator in Center for Disease Control and Prevention’s (CDC) Division of Foodborne, Waterborne, and Environmental Diseases, he has helped share important information about foodborne outbreaks (including recent outbreaks of infant botulism linked to powdered infant formula), concerning bacterial strains (including a number of persisting Salmonella strains with resistance to key antibiotics used to treat serious infections), and the latest scientific studies and surveillance reports on bacteria transmitted commonly through food.
For the past eight years, Robert has used the knowledge he gained from his studies at the University of Georgia – where he obtained a bachelor's degree in biology and psychology and a master's degree in public health – and the experience gained from working alongside CDC's dedicated staff and their partners to ensure that people throughout the country, healthcare providers, public health professionals, and industry leaders have the information they need to prevent foodborne illnesses.
Praveen is a Postdoctoral Research Associate at the University of Connecticut specializing in food safety microbiology, antimicrobial interventions, and poultry and produce safety. His research focuses on controlling foodborne pathogens, including Salmonella and Listeria, through probiotics, postbiotics, aerated water, and other practical intervention strategies.
His work has included poultry processing, table eggs, dairy processing environments, fresh produce, and biofilm control, with an emphasis on translating laboratory findings into scalable food safety applications.
Praveen has presented his research at national scientific meetings, including the International Association for Food Protection, where he received a Student Travel Scholarship and delivered a podium presentation on postbiotic and aerated-water strategies for reducing Salmonella biofilms.
He also has experience in proteomics, microbial challenge studies, and food safety validation. With training in veterinary medicine, microbiology, and food safety research, Praveen brings a multidisciplinary perspective to developing practical approaches that improve microbial safety across animal and food production systems.
Kendall serves as the Retail Food Safety Operations Manager for the Texas Department of State Health Services, where he oversees the team responsible for policy development, compliance enforcement, and stakeholder support for the Retail Food Program.
A dedicated leader in regulatory food safety, Kendall has spearheaded major rule projects tied to legislative initiatives and new program implementations. His extensive background includes serving as a state standardization and training officer, as well as collaborating with the Texas Rapid Response Team to coordinate outbreak and emergency responses.
An accomplished speaker and educator, Kendall regularly designs and delivers training sessions for regulatory, industry, and public stakeholders. Notably, he has presented on cottage food laws and building strong regulatory-industry relationships at the Association of Food and Drug Officials (AFDO) annual education conference.
Kendall is a Registered Sanitarian that holds a Bachelor of Science in Public Health from the University of Texas at Austin and a Master of Public Health in Epidemiology from UTHealth.
Jack is a food safety scientist at Vikan North America, where he serves as the company's food safety subject matter expert for customers industry wide. His path to Vikan began with his master's research at Purdue University on the prevalence and persistence of Listeria monocytogenes and Salmonella in retail produce environments, which led to a six-year run at Diversey Holdings.
During his final three years at Diversey, he completed his PhD at Purdue, examining L. monocytogenes persistence in retail deli environments—work that shaped a career-long conviction: Listeria control is fundamentally a mechanical action problem, not a chemistry problem.
He has published in the Journal of Food Protection, Food Control, and Comprehensive Reviews in Food Science and Food Safety, including a 2025 systematic review and meta-analysis on L. monocytogenes community associations and a 2026 open-access mini-review introducing the Secondary Colonizer Hypothesis.
Jack is a frequent conference presenter and familiar voice in the food safety regulatory and auditing community. He sees this recognition as validation that rigorous science belongs on the plant floor, not in the journal.
Dharamdeo is a food safety researcher and educator whose work focuses on understanding and controlling microbial hazards across food systems. He is currently a PhD candidate in Food Science at the University of Guelph, where his research investigates the survival, persistence, and recovery of Salmonella in low-moisture foods. By integrating predictive microbiology, whole-genome sequencing, bioinformatics, and phenotypic analysis, his work aims to strengthen microbial risk assessment and support the development of more effective food safety interventions.
His broader research experience includes developing data-driven tools and analytical workflows for food safety and public health applications, with an emphasis on translating complex biological data into practical evidence for decision-making. He also contributes to graduate education in genomic data analysis for food safety.
Beyond research, Dharamdeo is actively engaged in the Canadian food protection community and serves as a Board Director with both the Ontario Food Protection Association and the Canadian Institute of Food Science and Technology.
His work is driven by a commitment to advancing science-based approaches that strengthen food safety practices and protect public health.
Luke is a postdoctoral associate at Cornell University and co-founder of FLX Food Safety Intelligence Group. His work focuses on developing and deploying risk assessment tools, predictive models, and agentic AI to support food safety and quality decision-making, particularly in dairy and fresh produce. He has contributed to collaborative industry projects that generate data-driven insights for pre-harvest and post-harvest produce safety.
Beyond his research, Luke works to strengthen open science and workforce development in food safety. He established and maintains Food AI Nexus, a centralized public repository for food safety datasets; organizes IAFP student competitions on AI benchmarking to help train future multidisciplinary food safety scientists; and maintains the Salmonella Serovar Wiki, an open reference resource for the food safety community.
He earned his Ph.D. in Food Science from Cornell, with minors in epidemiology and data science. His work bridges food microbiology, data science, and AI to make food safety decision tools more accessible, rigorous, and practical.
Brandon started his food safety career working part time in a Prairie Farms Dairy facility quality lab in 2018 where he was responsible for day to day quality testing and assisting the Quality Manager. At the same time, he was attending the University of Missouri-Columbia for degrees in Food Science and Nutrition and Agribusiness Management.
After graduating in 2020, he started as a Manufactured Food Inspector with the State of Missouri where he worked with food manufacturers to ensure compliance and educate on food safety risk. He has taken on advanced inspection work including preventive controls for human food and acidified foods.
He has helped train multiple peers in basic and advanced inspection work. Brandon feels honored to work for the State and help ensure that we all have access to safe food.
Alex is a proven leader in Food Safety and Quality Assurance with more than 16 years of leadership experience across food manufacturing operations, quality assurance, regulatory compliance, and continuous improvement. Currently, Alex is a senior manager of supplier quality management at Nestlé USA. In this role he is responsible for partnering with companies across the food industry to ensure compliance and food safety within his organization’s supply chain.
Throughout his career, Alex has delivered measurable improvements in food safety performance with a focus on foreign body elimination, validated cleaning programs, reductions in consumer complaints, and the implementation of robust compliance programs. As a Quality Manager, he has led ISO 9001 and FSSC 22000 certification initiatives, built problem-solving capability, and achieved substantial reductions in foreign material defects.
His experience and expertise spans FDA and USDA regulations, FSMA, HACCP, and GFSI systems, with extensive experience leading regulatory responses, crisis management, food safety initiatives, and food safety culture development across global manufacturing operations.
Abigail is a food safety and quality leader with more than 13 years of experience advancing consumer protection and strengthening food safety systems across the food industry.
As an R&D Principal Scientist at PepsiCo, she provides global technical leadership in sanitation, hygienic design, contamination prevention, and food safety risk management across complex manufacturing and innovation environments.
Throughout her career, Abigail has been recognized for translating food safety science, regulatory requirements, and industry best practices into practical, scalable solutions that strengthen both operations and governance. Her expertise spans global food safety and sanitation standards, risk-based ingredient and process assessments, contamination prevention strategies, supplier and manufacturing risk management, and digital transformation initiatives that improve consistency, efficiency, and decision making.
Abigail is passionate about proactive prevention, embedding food safety into equipment, processes, and emerging technologies from the earliest stages of development. With a forward-looking perspective and a strong passion for elevating food safety culture, Abigail is helping shape a future where safer food isn't simply the goal—it's built into the way the industry operates.
Alexandra is the Food Safety Director – Southeast at Fresh Express, where she is responsible for the east coast agricultural operations food safety program, environmental monitoring, and provides corporate food safety and quality oversight for the Columbia, SC facility.
Prior to working at Fresh Express, Alexandra was the Food Safety Director of Agricultural Operations at McEntire Produce. She volunteers her time as a member of the Center for Produce Safety Technical Committee and as a steering committee member for the International Fresh Produce Association Food Safety Council.
Alexandra received her Ph.D. in Food Science with minors in microbiology and epidemiology from Cornell University under Martin Wiedmann and Renata Ivanek. During graduate school, she modeled pathogen die-off and presence in the pre-harvest produce environment and assisted companies in improving their Listeria environmental monitoring programs.
