Leave the Greens to Prevent E. Coli

Luscious romaine lettuce, the base of a classic Caesar salad, is always a healthy food choice, right?

Usually, the answer is “yes.” However, since November, more than 60 cases of E. coli, and two deaths, have been documented in 13 states—including Illinois–and in Canada. While the Centers for Disease Control have not yet confirmed the culprit, romaine lettuce is the leading suspect.

“E. coli is a variety of bacteria naturally found in our bodies. Most strains won’t make you sick,” said Gina Carnduff, MPH, BSN, RN, Memorial Health System director of Infection Prevention. “However, it’s important to always take steps to avoid contracting harmful strains, not just when there’s an outbreak.”


Contaminated food is usually the cause in most E. coli cases. Traditional carriers include ground beef, fresh produce such as spinach and lettuce, contaminated water and unpasteurized milk.

  • Even though the CDC hasn’t yet identified romaine as the source, it’s best to err on the side of caution. “Rinsing doesn’t remove all the bacteria, and it doesn’t take much to make you sick. Organic produce can be affected, too,” Carnduff said.
  • Never fear, you don’t have to ditch your New Year’s resolution to eat more veggies. Instead, opt for greens cooked to at least 160 degrees. It’s difficult to gauge the temperature of cooked greens, but if they’re wilted, likely, you’ve killed all the bacteria.
  • Check meat with a thermometer to ensure it’s cooked thoroughly.
  • Scrub up since E. coli can also spread from person to person without proper handwashing. Wash hands for at least 15 seconds after using the bathroom, diapering babies and, in rural communities, handling livestock.
  • Just like the restaurant pros, store meat on the bottom shelf of the refrigerator. That way, it doesn’t drip on and contaminate produce.


If you’ve recently eaten romaine or any possible carrier of E. coli, symptoms usually appear within 24 to 48 hours. To be on the safe side, keep an eye out for 10 days, though.

Symptoms may include:

  • Severe diarrhea
  • Vomiting
  • Abdominal pain
  • Dehydration
  • In extreme cases, uremic syndrome which can lead to kidney failure

Symptoms lasting more than three days in a normally healthy adult warrants a call to your primary care physician.

“When in doubt, call your doctor,” Carnduff said. “Be especially vigilant for people who may have weakened immune systems, such as younger and older people or pregnant women.”

Gina Carnduff, MPH, BSN, RN, is Memorial Health System director of Infection Prevention. She monitors local and national health trends to protect patients, visitors and employees at the seven Memorial affiliates from the spread of infection.