Botulism: Control Measures Overview for Clinicians

Decontamination

Medical personnel caring for patients with suspected botulism should use standard precautions (hand washing, eye protection, gown).
Patients with suspected botulism do not need to be isolated, but those with flaccid paralysis from suspected meningitis require droplet precautions.
Despite its extreme potency, botulinum toxin is easily destroyed. Heating to an internal temperature of 85°C for at least 5 minutes will decontaminate affected food or drink.
All foods suspected of contamination should be promptly removed from potential consumers and submitted to public health authorities for testing.
Commercially canned food is treated to eliminate all spores. Most other foods can be assumed to contain spores. Control methods focus on the inhibition of growth and toxin production. The main factors limiting growth of C. botulinum in foods are:

Temperature
pH
Water activity
Redox potential
Food preservatives
Competing microorganisms.

Persons who do home canning should follow strict hygienic procedures to reduce contamination of foods. They should also be educated about the proper time, pressure, and temperature required to destroy spores, the need for adequately refrigerated storage of incompletely processed foods, and the effectiveness of boiling, with stirring, home-canned vegetables to destroy botulinum toxins.
Baking potatoes in aluminum foil does not kill spores and may actually facilitate germination and growth if the potato is held at ambient temperature.
Oils infused with garlic or herbs should be refrigerated.
Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated.
Because botulinum toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure safety.
A pressure cooker must be used to can vegetables at home because it can reach temperatures above boiling, which is necessary to kill botulism spores. Instructions on safe home canning can be obtained from county extension services or from the US Department of Agriculture.
Honey can contain spores of C. botulinum and has been a source of infection for infants. Children less than 12 months old should not be fed honey. Honey is safe for persons 1 year of age and older.
Wound botulism can be prevented by promptly seeking medical care for infected wounds and by not using injectable street drugs.
Commercial cans or home-canned products with dents or bulging lids should not be opened, and foods that have abnormal odors should not be eaten.

Infection-Control Professionals

Heightened awareness by infection-control professionals (ICPs) facilitates recognition of the release of a biologic agent. ICPs are involved with many aspects of hospital operations and with counterparts in other hospitals. As a result, ICPs may recognize changing patterns or clusters in a hospital or in a community that might otherwise go unrecognized.
ICPs should ensure that hospitals have current telephone numbers for reporting and notification to both internal (ICPs, epidemiologists, infectious diseases specialists, administrators, and public affairs officials) and external (state and local health departments, Federal Bureau of Investigation field office, and CDC Emergency Response office) contacts and that they are distributed to the appropriate personnel. ICPs should work with clinical microbiology laboratories, on- or off-site, that receive specimens for testing from their facility to ensure that cultures from suspicious cases are evaluated appropriately.

State Health Departments

State health departments should implement plans for educating and reminding health-care providers about how to recognize unusual illnesses that might indicate intentional release of a biologic agent.
See: Botulism: Suspected Intentional Release Overview for Clinicians