Salt Lake County Health Department (SLCoHD) announced today that people who consumed any food item from the Edible Arrangements store at 5211 South State Street in Murray between March 21 and April 13 may have been exposed to hepatitis A. This possible exposure affects only this Edible Arrangements location; health officials estimate that this store sold about 600 arrangements during this time.

Customers who consumed Edible Arrangements items from the Murray store between the dates listed should call 385-468-INFO (4636) for further instructions. The phone line will be staffed from 8:00 a.m. to 5:00 p.m. today through at least Friday, April 20. Health department staff will screen callers for their exposure risk and, if they are eligible, provide them with options for receiving an injection to prevent hepatitis A. To be effective, the injection must be given within 14 days of the possible exposure, so people who ate items from this location between April 4 and April 13 are eligible to receive the injection.

It is too late for people who ate items from this location between March 21 and April 3 to receive the injection, so those individuals should watch for symptoms of hepatitis A and see their health care provider if they’re concerned. Symptoms of hepatitis A include low fever, fatigue, loss of appetite, nausea, vomiting, and yellow skin and eyes.

Customers who are fully vaccinated (two doses) against hepatitis A are protected and do not need to contact the health department or receive vaccine. In July 2002, Utah began requiring hepatitis A vaccination for children entering kindergarten, so many people who began kindergarten during or after the 2002–2003 school year are likely vaccinated against hepatitis A; check your personal immunization record to be sure.

This possible hepatitis A exposure occurred when an employee infected with hepatitis A worked while ill. SLCoHD believes this case is linked to the ongoing outbreak Utah has been experiencing since summer 2017. To date, Salt Lake County has reported 153 hepatitis A cases related to that outbreak. We do not currently have any hepatitis A cases linked to this possible exposure at Edible Arrangements; because the incubation period for hepatitis A is two to seven weeks, we will not know for several weeks if anyone was infected from this possible exposure.

The Utah Department of Agriculture and Food, which permits and regulates this Edible Arrangements location, closed the store yesterday afternoon and will supervise its sanitation before reopening. Under Salt Lake County’s food service regulation, SLCoHD will also require all store employees to be vaccinated against hepatitis A before they return to work.

“Food service establishments should consider vaccinating their employees against hepatitis A,” said Dr. Dagmar Vitek, SLCoHD medical director. “It’s also important that food handlers be conscientious with hygiene, hand washing and not working when ill—and that managers be vigilant in enforcing those important requirements that help protect public health.”

Hepatitis A vaccine is covered by many insurance plans and is available at local pharmacies, health care providers and SLCoHD immunization clinics. People not affected by this possible exposure but who would like to receive the vaccine may call 385-468-SHOT (7468) to make an appointment at a health department immunization clinic.

The Toledo-Lucas County Health Department has confirmed a case of hepatitis A in a food handler at Dave & Buster’s restaurant on Monroe Street, the department said Thursday.

Any restaurant patrons who consumed food or drink there between March 1 and March 29 are encouraged to monitor potential symptoms and contact their health care provider to be assessed for vaccination or treatment.

Hepatitis A is a liver disease that can be spread by ingesting food or water contaminated by feces or through sexual contact. Symptoms such as fatigue, poor appetite, stomach pain, nausea or vomiting, dark urine, and jaundice can appear two to six weeks after exposure.

The employee is not currently working and is receiving medical care, according to the health department. The restaurant, located at 5001 Monroe St., is working with health officials to avoid additional exposure.

Southeast Michigan is experiencing a hepatitis A outbreak that began in August, 2016. As of April 11, 804 cases and 25 deaths have been confirmed in the region, according to the Michigan Department of Health & Human Services. Seventeen of those cases are from Monroe County.


Due to an ongoing outbreak of Hepatitis A, the Department for Public Health (DPH) within the Cabinet for Health and Family Services (CHFS), is recommending vaccination for everyone residing in Jefferson, Bullitt, Hardin, Greenup, Carter and Boyd counties.

To date, 214 cases have been reported in the Jefferson County/Louisville area. Bullitt, Hardin, Greenup, Carter and Boyd counties have each reported 5 or more cases for a total 311 cases associated with the outbreak. One death has been reported.

“Hepatitis A is a vaccine-preventable illness. DPH recommends all children, ages 1 year through 18, receive the Hepatitis A vaccine as well as adults who want to protect themselves from an acute hepatitis A infection,” said Dr. Jeffrey Howard, acting DPH commissioner.  “In these counties with local transmission of the hepatitis A virus, we recommend everyone be vaccinated per guidelines to help stop this outbreak.”

For adults, the hepatitis A vaccine is typically given in two doses — an initial vaccination followed by another shot six months later. DPH recommends that all people in outbreak counties consult with their primary care doctor or insurance carrier regarding an in-network provider for administration of the hepatitis A vaccine. The Center for Disease and Control (CDC) recommends vaccination for people who wish to be protected against hepatitis A infection. For insured people, the hepatitis A vaccine should not require any out-of-pocket costs as long as policies are compliant with the federal Affordable Care Act.

Since 2006, the CDC has recommended children receive the hepatitis A vaccine series.  Effective July 1, 2018, all Kentucky students in kindergarten through 12th grade must receive two doses of the Hepatitis A vaccine to attend school or receive a provisional certificate of immunization (unless their parents claim an exemption).

Signs and symptoms of Hepatitis A include jaundice (yellowing of the skin or eyes), dark-colored urine, fatigue, abdominal pain, loss of appetite, nausea, diarrhea and fever. The virus is found in the stool of people infected with Hepatitis A and typically spread from person to person contact. The disease often is transmitted when people do not wash their hands properly or do not have access to proper sanitation.  DPH recommends individuals wash their hands often and particularly after using the restroom or before consuming food. Hand sanitizer should be used only when soap and water is unavailable.

While the current hepatitis A outbreak is occurring primarily within specific at-risk populations, including people who use illicit drugs (both injection and non-injection) and the homeless, through person-to-person transmission.  Approximately, 30 percent of cases do not report any risk factors.  Therefore, it is recommended that children and adults in counties with local transmission of the virus as part of this outbreak receive the hepatitis A vaccine.

Hepatitis A vaccine is widely available at local pharmacies and health care providers. For additional information on the hepatitis A vaccination, please visit

The Ashland-Boyd County Health Department reported on Tuesday that customers of both Waffle House restaurant locations in Boyd County were potentially exposed to the highly contagious virus by an infected foodservice worker.

“The single employee worked at each location during the infectious period,” according to the public health alert. “The window of possible exposure was Feb. 12-28.

The Waffle House restaurant owner and employees have cooperated fully with the local and state health officials to identify all employee contacts, according to the county alert. Waffle House employees are receiving post-exposure vaccinations.

Anyone who consumed foods or beverages at either of the Waffle House locations during the possible exposure period is urged to monitor themselves for signs of infection in the coming weeks. It can take up to 50 days after exposure for symptoms to develop, according to the U.S. Centers for Disease Control and Prevention.

Some of the Waffle House customers still have time to receive post-exposure vaccinations. The after-the-fact injections must be giving within 14 days of exposure or they are not effective. The last date for the post-exposure vaccine is March 13, according to the county health department.

Hepatitis A is a liver disease caused by a virus. Symptoms, when present, can include fatigue, low appetite, stomach pain, nausea, and the yellowing of the eyes or skin. Some adults and most young children do not develop symptoms while infected, but they can spread the virus. The virus can contaminate foods, beverages, surfaces, clothing, bed linens — often because of inadequate handwashing. Hepatitis A can also be spread by close personal contact with an infected person, including sexual contact and sharing needles.

In Kentucky, 148 cases have been confirmed through laboratory testing since Jan. 1, 2017. The state health department officially declared the outbreak on Nov. 28, 2017. Multiple Kentucky counties have reported confirmed outbreak cases, but Louisville in Jefferson County has the vast majority at 124 as of Tuesday. Of the state’s confirmed cases, 107 of the people have had such severe symptoms that they required hospitalization. The person who died was a Jefferson County resident.

The outbreak strain was first identified in California, but cases have been confirmed in several states, including Michigan, Utah, Oregon and Nevada. Nationwide more than 1,200 people have been confirmed in the outbreak, with the majority requiring hospitalization. More than 40 deaths have been confirmed.

According to the Arkansas Department of Health, officials are warning of a possible Hepatitis A exposure after a Taco Bell employee in Corning tested positive for the virus.

In a statement, officials asked that anyone who has eaten food at the restaurant between Jan. 24 and Feb. 7, 2018 and is having symptoms should call their doctor immediately.

Also, officials said they believe there is no known risk for anyone who ate at the restaurant after Feb. 7 at this time.

There are no specific treatments available once a person gets the virus, officials say.

However, the virus can be prevented by vaccination or through getting immune globulin medicine.

The medicine, officials say, includes antibodies from people who are immune to the virus and is effective if a person receives it within two weeks of exposure. If a person at the restaurant on Feb. 1, they would need to get medical help by Feb. 15.

The symptoms of Hepatitis A are fever, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark urine, joint pain, clay-colored bowel movements or jaundiced skin.

The virus, which can cause people to be sick within two to seven weeks of exposure, can also be transmitted to other people up to two weeks before and a week after the symptoms happen, officials say.

The Clay County Health Unit in Piggott will have immune globulin and Hepatitis A vaccine medicine available for people, upon request with an appointment or after Feb. 15.

People can call 870-598-3390 for more information on getting the medicine.

The FDA has investigated six complaints of illness and death in animals that have eaten the recalled products.

The FDA is alerting pet owners to a history of four recalls of and multiple complaints associated with Darwin’s Natural and ZooLogics pet foods, manufactured by Arrow Reliance Inc., dba Darwin’s Natural Pet Products, over the period from October 17, 2016 to February 10, 2018. In each instance, the company recalled these products after being alerted to positive findings of Salmonella and/or Listeria monocytogenes in samples of their raw pet food products.

In its most recent recall, on February 10, 2018, Arrow Reliance/Darwin’s Natural recalled ZooLogics Duck with Vegetable Meals for Dogs (Lot #41957) and ZooLogics Chicken with Vegetable Meals for Dogs (Lot #41567) because the products may be contaminated with Salmonella and therefore have the potential to cause salmonellosis in humans and animals. The company states that it only sells its products online through direct-to-consumer sales.

Arrow Reliance/Darwin’s Natural has notified its customers directly of the recalls but has so far not issued any public notification announcing this or any of the previous recalls.

This issue is of particular public health importance because Salmonella can make both people and animals sick.

As part of an ongoing investigation into complaints associated with products manufactured by Arrow Reliance/Darwin’s Natural of Tukwila, WA, the FDA has confirmed that new samples of Darwin’s Natural Pet Products raw pet foods have tested positive for Salmonella. These raw pet foods include ZooLogics Duck with Vegetable Meals for Dogs Lot #41957 and ZooLogics Chicken with Vegetable Meals for Dogs Lot #41567.

The latest recall was triggered by a complaint of an adult dog that had recurring diarrhea over a nine-month period. The dog tested positive for Salmonella from initial testing by the veterinarian and by follow-up testing by the FDA’s Veterinary Laboratory Investigation and Response Network (Vet-LIRN). The Darwin’s Natural raw pet food that the dog had been fed was also positive for Salmonella.

Arrow Reliance/Darwin’s Natural is aware of the dog’s illness and the positive results and initiated a recall on February 10, 2018 by directly notifying its customers via email. The firm has not issued a public recall notice.

Since October 2016, Arrow Reliance/Darwin’s Natural has initiated four recalls and had six reported complaints (some referring to more than one animal) associated with their raw pet food products, including the death of one kitten from a severe systemic Salmonella infection. The Salmonella isolated from the kitten was analyzed using whole genome sequencing and found to be indistinguishable from the Salmonella isolated from a closed package from the same lot of Darwin’s Natural cat food that the kitten ate.

In addition to reports of illnesses associated with Salmonella contamination in the products, the FDA is aware of complaints of at least three animals who were reportedly injured by bone shards in the Darwin’s Natural raw pet food products.

Since 2016, Arrow Reliance/Darwin’s Natural has recalled the following raw pet food products:

The recalled lot codes and the manufacturing dates are printed directly on the flexible film packages.

Arrow Reliance/Darwin’s Natural initiated each recall of the product lots by notifying customers directly via email. The company states that the raw pet foods are only sold online through direct-to-consumer sales.

This contaminated raw pet food is of particular public health importance because of the potential hazard to both human and animal health. Pets can get sick from Salmonella but may also be carriers of the bacteria and can infect humans. Pets do not have to be apparently ill to be able to pass Salmonella onto their human companions.

The FDA has a zero-tolerance policy for Salmonella or other pathogenic bacteria in all pet food, meaning the agency will take action, as appropriate, against any pet food found to be contaminated with the harmful bacteria.

The Rhode Island Department of Health (RIDOH) is advising consumers that Stop & Shop in Warwick is issuing a consumer alert regarding deli sliced meat and cheese because of potential exposure to Listeria monocytogenes.

This alert pertains to deli sliced meat and cheese sold between January 18th and February 2rd. Customers who purchased deli sliced meat and cheese at this store during this period should discard these products and bring their receipts to Stop & Shop for full refunds.

The deli is temporarily closed while it is being professionally cleaned.

There have been no confirmed illnesses associated with this issue to date. Consumption of food contaminated with Listeria monocytogenes can cause listeriosis, an uncommon but potentially fatal disease. Healthy people rarely contract listeriosis. However, listeriosis can cause high fever, severe headache, neck stiffness and nausea. Listeriosis can also cause miscarriages and stillbirths, as well as serious and sometimes fatal infections in those with weakened immune systems, such as infants, the elderly and people with HIV infection or people undergoing chemotherapy.

The US Centers for Disease Control and Prevention (CDC) announced an E. coli O157:H7 outbreak that has sickened 17 people across 13 states. Although officials have not yet found the source of the outbreak, preliminary test show similarities to an ongoing outbreak in Canada linked to romaine lettuce that has sickened 41 with 1 death.

In a press release sent to journalists, the CDC stated, “this investigation is ongoing, and more information will be released as it becomes available.”

The information that they do have is that outbreak has an onset range from November 15 – December 8 and affects the states of California, Connecticut, Illinois, Indiana, Michigan, Nebraska, New Hampshire, New York, Ohio, Pennsylvania, Virginia, Vermont, and Washington.

The Public Health Agency of Canada (PHAC) issued its first announcement about an E coli outbreak linked to romaine lettuce on Dec 11. In a Dec 21 update, it said it is so far investigating 41 cases from five provinces: Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador. It urged the public to avoid eating romaine lettuce until more is known about the contamination.

A bit of history of Romaine and E. coli Outbreaks:

E. coli O157:H7 Outbreak Linked to Romaine Lettuce – Canada and California, April 2012

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetable, Leafy Greens, Lettuce, Romaine

An outbreak of E. coli O157 was linked to romaine lettuce grown and distributed by Amazing Coachella Inc., which is the parent company of Peter Rabbit Farms, both based in Coachella, California. Health officials in New Brunswick, Canada identified at…Read More »

Multistate Schnucks Salad Bars, College Campuses Romaine Lettuce 2011

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetable, Leafy Greens, Lettuce, Romaine

An outbreak of E. coli O157:H7 was first identified in the region around Saint Louis, Missouri. Cases were found in Saint Louis, Jefferson, Saint Charles, and Saint Clair counties and in the city of Saint Louis. The cases ranged in age from 1 to 94…Read More »

Church Brothers LLC/ Cafe Rio Restaurant/ Chipotle Restaurant Romaine Lettuce 2009

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetable, Leafy Greens, Romaine Lettuce, Iceberg Lettuce

In September, 2009, a cluster of patients who had been infected with an indistinguishable strain of E. coli O157:H7 was identified. Initially case-patients were identified in Colorado, Utah, and New York State. Additional case-patients were identif…Read More » 

2009 Multistate outbreak of E. coli O157 linked to leaf lettuce

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetables, Leafy Greens, Romaine lettuce

In September 2009 public health officials in Colorado, Minnesota, North Carolina, Iowa, Connecticut, and Missouri identified a cluster of patients with an indistinguishable strain of E. coli O157. The cluster was assigned 0910MLEXH-1. Two Colorado …Read More »

M.T. Belllies Restaurant Ontario Romaine Lettuce 2008

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetable, Lettuce, Romaine

An outbreak of E.coli O157:H7 was associated with eating at M.T. Bellies Restaurant, Welland, Ontario, Canada. This was one of four, concurrent, restaurant-associated, outbreaks of E.coli O157:H7 that occurred in Ontario, Canada. Romaine lettuce wa…Read More »

Johnathan’s Family Restaurant Ontario Romaine Lettuce 2008

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetable, Lettuce, Romaine

Johnathan’s Family Restaurant in Burlington, Ontario, Canada, was implicated in an outbreak of E.coli O157:H7 involving romaine lettuce. This outbreak was one of four, concurrent, restaurant-associated outbreaks in Ontario, Canada. The E.coli O157:…Read More »

Little Red Rooster Restaurant Ontario Romaine Lettuce 2008

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetable, Lettuce, Romaine

The owners of Little Red Rooster Restaurant, in Niagara-on-the-Lake, Ontario, Canada, closed the restaurant in October after an outbreak of E.coli O157:H7 was discovered. This outbreak was one of four, concurrent, outbreaks of E.coli O157:H7 occurri…Read More »

Spokane Dance Camp Lettuce 2002

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetable, Leafy greens, Romaine lettuce

An outbreak of E.coli O157:H7 occurred among attendees of a dance camp held between July 11-14 on the campus of Eastern Washington University. The camp was for middle and high school girls. Attendees were from Washington, Montana, and Minnesota. S…Read More »

Multistate Retirement Facility and Private Home Romaine Lettuce 1999

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetable, Leafy greens, Romaine Lettuce Caesar Salad

When in November, 1999, seven residents of a Pennsylvania retirement facility were hospitalized with E. coli O157:H7 infection, an outbreak investigation began. The investigation associated eating romaine lettuce that had been prepared in one of the…Read More »

Multistate Restaurant or Private Home Romaine Lettuce 1999

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetable, Leafy Greens, Romaine Lettuce

An outbreak of E. coli O157:H7 was associated with eating romaine lettuce in restaurants and in private home settings.…Read More »

Romaine Lettuce 1995

  • Organism:
  • coli O157:H7
  • Vehicle:
  • Vegetable, Leafy Greens, Romaine Lettuce

An outbreak of E. coli O157:H7 occurred among people who ate romaine lettuce in Idaho. The lettuce possibly was contaminated by a food handler. No other details were available.…Read More »

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.

If you or a family member became ill with an E. coli infection or HUS after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark E. coli attorneys for a free case evaluation.

The Department of Health said a case of Hepatitis A has been identified from a food handler that worked while potentially contagious at a Huddle House in Dexter, Missouri.

Members of the public who ate at the Dexter, Missouri, Huddle House between November 21, 2017, and December 2, 2017, should watch for symptoms of Hepatitis A.

The restaurant, county health, and health and senior services are investigating and said they are taking the necessary control measures to decrease the spread of illness.

Health officials say to seek medical care if symptoms develop. Hepatitis A is a virus that infects the liver.

Symptoms develop between two and seven weeks after exposure and can include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored stools
  • Joint pain
  • Jaundice (yellow skin and eyes)

Residents or providers who are concerned about a potential exposure can call the Stoddard County Health Center at 573-568-4593.

Anyone who ate at the Jet’s Pizza at 15235 East Seven Mile Road from Nov. 30 through Monday (Dec. 11) should get a vaccine before Dec. 21, Detroit Health Department officials said.

Generally, the risk of transmission of Hepatitis A from an infected employee is low. Hepatitis A can potentially be prevented if given a vaccination within two weeks of having come in contact with the virus. Given the low, but potential risk, the Detroit Health Department is recommending vaccination for people who may have eaten at the establishment during the exposure period.

The Detroit Health Department is conducting a thorough investigation of the establishment to ensure appropriate food handling and cleaning protocols are being followed. The employee stopped working at the establishment after symptoms began, and the Detroit Health Department has notified the establishment that the infected employee cannot return to work until approved by their doctor. The establishment has been thoroughly cleaned and sanitized, and the Detroit Health Department does not believe there is further risk of Hepatitis A at this location at this time.

The Detroit Health Department recommends all food establishments work to get their food handlers vaccinated. To support this effort, the Detroit Health Department is launching a mobile vaccination clinic program to provide easy and convenient access for Detroit food establishments to vaccinate their employees. The first mobile clinic will be held at the University of Detroit Mercy on Tuesday, December 19, 2017 from 10 am to 4 pm. Employees should bring their ID and health insurance card, and employers will be responsible for payment at $40 per employee. The Department will set up more clinics throughout the City of Detroit, where clusters of restaurants are located.

Restaurants can also call the Detroit Health Department to arrange for vaccination. For more information on the upcoming mobile vaccination clinic, restaurants should call 313-876-0135.

Hepatitis A is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Symptoms can include fever, diarrhea, nausea, vomiting, abdominal, and sometimes yellow eyes or skin and dark urine. A person can get Hepatitis A when they eat, drink, or touch their mouth with food, liquid or objects (including their hands) that have come into contact with stool from an infected person. Anyone experiencing these symptoms should seek medical attention immediately.

The Detroit Health Department will be offering Hepatitis A vaccines to uninsured Detroit residents at both of its Immunization Clinics: Monday, Tuesday, Thursday and Friday, 8am to 5pm and Wednesday 9am to 6pm. The clinics are located at:

The Samaritan Center (5555 Conner Street Detroit, MI 48213) 313-410-8142
The Family Place (8726 Woodward Avenue Detroit, MI 48202) 313-410-7803

The Detroit Health Department recommends that non-Detroit residents contact their local Health Department if they are uninsured and consumed food and beverages at the Jet’s Pizza at 15235 East Seven Mile Road near Hayes in Detroit during the exposure period. Information for the local health departments:

Macomb County (586) 469-5372
Oakland County (800)-848-5533
Wayne County (734) 727-7100

Southeast Michigan has seen an increase in Hepatitis A cases since 2016. High risk individuals identified in association with this outbreak include persons who: share injection and non-injection street drugs (including pain killers); have sexual activities with someone who has Hepatitis A; have close contact, care for, or live with someone who has Hepatitis A; are homeless or have transient living situations; or are men who have sex with men. To address the outbreak, the Detroit Health Department has facilitated dozens of community outreach clinics, provided over 2,600 vaccinations to those who could have been exposed, and is proactively educating medical clinics, hospitals and food establishments about the importance of prevention through vaccination and proper sanitizing protocols.

“We are excited to announce that the Detroit Health Department will be in the community providing vaccines to food handlers. We will continue to work with our state partners, physicians, hospitals, food establishments, and community groups to educate the community and prevent the outbreak from spreading further,” said Dr. Joneigh Khaldun, Director and Health Officer of the Detroit Health Department.

The best way to prevent Hepatitis A is through vaccination. Other means of preventing the spread of infection is to thoroughly wash hands with soap and water: after using the bathroom, after diaper changes, and before handling food.