Proper handwashing requires proper tools

Apparently, that’s just a throw-a-way tag line, at the end of an abstract for a paper, but my observations say it’s the most important. Have paper towels, not bacterial blow dryers; have soap; and have vigorous running water, not a trickle-down (as effective in economics as in handwashing).

Each year millions of children are enrolled in center-based childcare. Childcare employees are tasked with handling over half the children’s weekly meals. Proper food handling practices are crucial in mitigating this high-risk population’s risk of foodborne illness. The purpose of this study was to identify childcare food handling employees’ (n = 278) perceived barriers and motivators to follow recommended food safety practices. Six important barriers and 14 key motivators to following recommended food safety practices were identified. Important barriers pertained to time restraints, workloads, and lack of understanding of the importance of following proper food safety practices. Key motivators were focused on children’s safety, available supplies, communication, and food safety training/information. Employee and facility characteristics were shown to influence perceived importance of barriers and motivators to following food safety practices. Childcare directors should review scheduling and job duties of employees as the majority of identified barriers focused on “work pace” and “time restraints.” Directors should also attempt to increase food safety communication through practical situational training, written food safety policies, and use of food safety signage to increase understanding of the importance of proper food safety practices. Ensuring proper supplies are available is necessary.

Childcare food handling employees’ perceived barriers and motivators to follow food safety practices

Early Childhood Education Journal, pp 1-9, 24 October 2017, Joel Reynolds, Lakshman Rajagopal

https://link.springer.com/article/10.1007/s10643-017-0885-3

NZ school’s removal of soap from children’s toilets labeled ‘appalling’

Whenever someone tells me of an outbreak at a school, day care, university residence, whatever, the first place I go, or someone more geographically-centered should go, is check out the bathrooms.

It’s easy to preach proper handwashing as a way to reduce the spread of infectious disease.

But proper handwashing requires access to proper tools.

So I check out the bathroom and usually find the tools, uh, missing.

Proper handwashing requires vigorous water flow (temperature doesn’t matter), a vigorous rub with soap, and drying with paper towel.

Garth Bray of TVNZ reports an Auckland primary school has dumped a policy that saw soap and hand towels removed from all children’s toilets.

The school felt the children were wasting those basic items, but failed to follow some of the most basic health advice with its policy.

“I think it’s appalling”, said Dr Michael Baker, who is the University of Otago Professor of Public Health.

“We’ve got good evidence in big trials showing that having handwashing can actually reduce risk of gut infections by about 30 per cent and respiratory infections by about 20 per cent so I think all of our schools need to be part of this,” Dr Baker told Fair Go.

Fair Go was contacted by four parents of children at the school who objected to the school withdrawing soap but had been told by teachers this was the policy.

Some had simply accepted this and started sending their children to school with little bottles of liquid hand soap to use.

However, one took her concerns to the principal and to a school board member.

Fair Go has seen written messages between the board member and the parent which say: “There are no legal requirements from the Ministry of Health and the students were wasting the soap and hand towels so they were taken out but every class has hand sanitiser that they encourage their kids to use regularly.”

That’ll work until the kids start drinking the stuff.

Fair Go spoke with the principal, who disclosed that classrooms were sometimes locked at lunchtimes, meaning children had no access to anything but water for washing before meals and after using toilets.

The principal told Fair Go that the same week our programme had made contact, the school board had decided to reverse the policy and will now stock toilets with soap and hand towels again.

On that basis, Fair Go has decided for now not to name the school publicly as it takes steps to make good its commitment to provide hygienic hand washing facilities for children.

“New Zealand’s got an appalling record of having very high rates of a lot of major childhood diseases – respiratory infections, skin infections and gut infections and these are exactly the things that hand washing can protect our children against,” Dr Baker said.

Fair Go’s advice is for parents to take a look at their own school’s facilities and reassure themselves their children have the essentials on hand at school.

I do.

And the school knows I check.

Food Safety Talk 137: Grandma makes the best pickles

Don and Ben talk High Sierra and bricking a MacBook Air, Gord Downie of the Tragically Hip, State Fair judging, pH test strips, mail order food safety and cold brewed canned coffee. They also do some listener feedback on food safe issues related to brewing beer.

Episode 137 can be found here and on iTunes.

Show notes so you can follow along at home:

Food Safety Talk 135: This is a podcast

Don and Ben are on the road, talking to some of the best folks in the food safety world at the NEHA Region 4 conference/FDA Central Region retail food protection seminar in Minneapolis. This recording was an experiment, the first Food Safety Talk recorded in front of a live, non-studio audience. Topics included raw milk, hepatitis A, listener feedback on liquid nitrogen, our favorite Bond movies and least favorite pathogens.

Episode 135 can be found here and on iTunes.

 

Show notes so you can follow along at home:

Microbiological failure? UK school forces teachers to shake hands with pupils to help kids feel respected

Trevor Noah of The Daily Show rarely shakes hands with guests or correspondants.

He’s big into the fist-bump.

Maybe Schaffner can design a study to figure out which is microbiologically safer.

It’d be another pop-culture hit.

Maybe someone has done it.

Whatever, the  handshaking policy introduced by a new principal has led to panic among staff and parents.

Some teachers at Tunbridge Wells Grammar School for Boys, southeast of London, are now arming themselves with hand sanitiser amid fears that shaking hands up to 150 times a day may cause them to pick up germs.

Principal Amanda Simpson is standing by her decision, which sees teachers shaking hands with every member of their class before each lesson.

One parent told local news website Kent Live that she was worried about the consequences of the mandatory handshaking.

“It will be interesting to see what happens if there’s an outbreak of Norovirus,” she said.

“I assume it was introduced because the new head wanted to introduce some element of respect – but I wouldn’t think that sort of thing would make any difference.”

Ms Simpson believes that starting every lesson “with a handshake and a smile” makes children feel welcome and appreciated.

She confirmed that hand sanitiser was available throughout the school for anyone worried about the spread of germs.

Shigella in Kansas: Proper handwashing requires proper tools

There was this one time, when I was in Kansas, and there was an outbreak of something at the local high school.

Stalker alert: I went to the boys’ bathroom.

No paper towel. No soap.

Proper handwashing requires access to proper tools.

The Shawnee County Health Department and KDHE are checking several shigellosis cases in children.

USD 501 confirms it centers on Highland Park Central Elementary, saying the district sent information to those parents.

Shigellosis is a gastro intestinal illness caused by a bacteria.

It is treatable and most people quickly recover from symptoms including diarrhea, fever, nausea, vomiting, and stomach cramps.

Shigella is found in the feces of an infected person. It’s spread by close contact, and by eating and drinking contaminated food or water.

To stop the spread, always wash your hands thoroughly with soap and water before eating. Do not share food, drinks, spoons and or straws.

No paper towel. No soap.

Proper handwashing requires access to proper tools.

Those are the kinds of questions that get full professors fired.

Lots of Texas is under water; flooding is devastating

Today is our first full day of Fall, when it comes to scheduling, with both kids back in school.

I’m at home, just finished recording a podcast and have CNN on in the background. I’m watching the Hurricane Harvey coverage, in awe of the devastation of inches and inches of rain.

Last Fall, some of our close by communities in North Carolina experienced flooding following Hurricane Matthew.

I had never seen anything like it.

A couple of months later I traveled to the Greenville, North Carolina area with a few other extension folks and we shot a few videos about returning to a home after a flood. Stuff like cleaning dishes, pots and pans in Part 1; other kitchen items, including appliances, flatware and plastic, in Part 2; food for people and pets in Part 3; and refrigerators in Part 4. Amongst others.

We also have a few factsheets on disaster recovery here (including what to do with foods in refrigerators and freezers after the power has been out for a while)

Thoughts are with the people of Texas.

Just wash ’em: WaPo covers soap porn

Handwashing is making a pop culture splash this week with the New Yorker piece and today’s Washington Post article on the types of soap that serial hand washers (like a chef and recipe tester) prefer.

An owner of a restaurant group with six restaurants surely washes her hands countless times a day. Renee Erickson, a chef and cookbook author in Seattle, likes unscented soaps for a work environment. But for home, where one can have more fun, she says, “I have become a big fan of L:A Bruket’s cucumber and mint soap from Sweden”

We use whatever is on sale. Just wash ’em.

Shock and shame: Science behind getting people to wash their hands

Gimmie shelter from the ravages of time.

I’d largely forgotten about my lab’s handwashing phase, probably because I was leaving the safety (shurley not) of Kansas and heading to Australia.

But was reminded from this excerpt in The New Yorker from Nate Dern’s “Not Quite a Genius,” to be published by Simon & Schuster:

Employees must wash hands.

Employees must wash their own hands.

Employees must wash their own hands after they use the restroom.

Employees of this restaurant must wash their own hands after they use the restroom.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code, and, no, there is no practical way to regulate or enforce this rule.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code, and, no, there is no practical way to regulate or enforce this rule, but, yes, we still ask, and trust that you will comply.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code, and, no, there is no practical way to regulate or enforce this rule, but, yes, we still ask, and trust that you will comply, and, O.K., we apologize for the condescending tone of the posting of this rule, which seems to imply that without such a sign we would assume that our employees are disgusting children with no regard for their own hygiene.

Employees must wash hands. Greg has been fired.

Filion, K., KuKanich, K.S., Chapman, B., Hardigree, M.K., and Powell, D.A. 2011. Observation-based evaluation of hand hygiene practices and the effects of an intervention at a public hospital cafeteria. American Journal of Infection Control 39(6): 464-470.

Background

Hand hygiene is important before meals, especially in a hospital cafeteria where patrons may have had recent contact with infectious agents. Few interventions to improve hand hygiene have had measureable success. This study was designed to use a poster intervention to encourage hand hygiene among health care workers (HCWs) and hospital visitors (HVs) upon entry to a hospital cafeteria.

Methods

Over a 5-week period, a poster intervention with an accessible hand sanitizer unit was deployed to improve hand hygiene in a hospital cafeteria. The dependent variable observed was hand hygiene attempts. Study phases included a baseline, intervention, and follow-up phase, with each consisting of 3 randomized days of observation for 3 hours during lunch.

Results

During the 27 hours of observation, 5,551 participants were observed, and overall hand hygiene frequency was 4.79%. Hygiene attempts occurred more frequently by HCWs than HVs (P = .0008) and females than males (P = .0281). Hygiene attempts occurred more frequently after poster introduction than baseline (P = .0050), and this improvement was because of an increase in frequency of HV hand hygiene rather than HCW hand hygiene.

Conclusion

The poster intervention tool with easily accessible hand sanitizer can improve overall hand hygiene performance in a US hospital cafeteria.

Wilson, S.M., Jacob, C.J. and Powell, D.A. 2011. Behavior-change interventions to improve hand hygiene practice: A review. Critical Public Health 21: 119-127.

http://www.informaworld.com/smpp/content~content=a934338802~db=all~jumptype=rss

Despite the role of hand hygiene in preventing infectious disease, compliance remains low. Education and training are often cited as essential to developing and maintaining hand-hygiene compliance, but generally have not produced sustained improvements. Consequently, this literature review was conducted to identify alternative interventions for compelling change in hand-hygiene behavior. Of those, interventions employing social pressures have demonstrated varying influence on an individual’s behavior, while interventions that focus on organizational culture have demonstrated positive results. However, recent research indicates that handwashing is a ritualized behavior mainly performed for self-protection. Therefore, interventions that provoke emotive sensations (e.g., discomfort, disgust) or use social marketing may be the most effective.

Levine writes: Investigating shoppers’ perceptions of risk

Katrina Levine, extension associate and lead author of Consumer perceptions of the safety of ready-to-eat foods in retail food store settings writes,

While I was grocery shopping one day at my regular store, I noticed that one of the doors to the dairy refrigerator case was missing. There was no sign or notice to explain the gaping hole where the door should have been in front of the shredded cheese, nor was any attempt made to compensate for the absent door, such as by relocating the items in that section or putting up a temporary covering.

After first being a bit confused when trying to reach for a non-existent handle, these questions popped into my head:

• how can the food in this section be at a safe temperature, as well as the foods on either side of it? and,

• doesn’t this missing door affect the ability of the case to maintain its temperature?

I’m a food safety nerd. Most people just want to shop and get on with whatever they are doing, but I’m subconsciously always looking for food safety behaviors. The person standing behind me was probably more interested in which brand was the least expensive or which package looked the freshest, or just wanted me to get out the way so they could buy their cheese and leave.

Does the lack of a door on a normally enclosed refrigerator case pose a food safety risk for dairy the products in that case? Depends on whom you ask. The average consumer (interpret this as you choose) often doesn’t see the same food safety risks when shopping in grocery stores compared to food safety folks.

Our group from North Carolina State teamed up with John Luchansky and Anna Porto-Fett at the U.S. Department of Agriculture’s Agricultural Research Service to investigate this difference between consumers and food safety folks in food safety risk perception when shopping at grocery stores.  We conducted a national survey and several focus groups where, instead of just describing a situation, we showed pictures of a food safety situation someone could actually encounter while shopping. In addition to asking questions about whether each photo was safe or unsafe, we wanted to know about the actions, if any, people would take to do something about a situation they thought was unsafe. We prodded them further with questions about how their perceptions of safety would affect their shopping behaviors.

We found that consumers and food safety folks don’t always see the same food safety risks. There were some situations consumers perceived as risky but that weren’t actually risks, like seeing an insect on the floor. There were also some risks that food safety folks saw but consumers missed, like food not properly stored within the refrigerated area.

I was explaining our study to a friend the other day, and she flat out told me, “I look for food quality when I’m shopping – is it fresh, is there mold or signs of damage, does it look ok?” This is exactly what we found. Consumers are looking for those quality aspects, but aren’t always seeing the warning signs that the safety of the food could be at risk. The viruses, bacteria, and other things that cause foodborne illness such as Listeria monocytogenes, might be present on foods in the grocery store at high levels by not storing soft cheeses at the proper temperature, allowing bacteria to grow more quickly.

Our research team will be taking this one step further to better understand the mind of the shopper and see things through their eyes. Everyday consumers will become our secret shoppers, and we plan to arm them with the information they need to be food safety detectives every time they shop. #citizenscience for the win.

Consumer perceptions of the safety of ready-to-eat foods in retail food store settings

Katrina Levine, Mary Yavelak, John B. Luchansky, Anna C. S. Porto-Fett, and Benjamin Chapman

Journal of Food Protection

August 2017, Vol. 80, No. 8, pp. 1364-1377

DOI: doi.org/10.4315/0362-028X.JFP-16-417

Abstract:

To better understand how consumers perceive food safety risks in retail food store settings, a survey was administered to 1,041 nationally representative participants who evaluated possible food safety risks depicted in selected photographs and self-reported their perceptions, attitudes, and behaviors. Participants were shown 12 photographs taken at retail stores portraying either commonly perceived or actual food safety contributing factors, such as cross-contamination, product and equipment temperatures, worker hygiene, and/or store sanitation practices. Participants were then asked to specifically identify what they saw, comment as to whether what they saw was safe or unsafe, and articulate what actions they would take in response to these situations. In addition to the survey, focus groups were employed to supplement survey findings with qualitative data. Survey respondents identified risk factors for six of nine actual contributing factor photographs >50% of the time: poor produce storage sanitation (86%, n = 899), cross-contamination during meat slicing (72%, n = 750), bare-hand contact of ready-to-eat food in the deli area (67%, n = 698), separation of raw and ready-to-eat food in the seafood case (63%, n = 660), cross-contamination from serving utensils in the deli case (62%, n = 644), and incorrect product storage temperature (51%, n = 528). On a scale of 1 to 5, where 1 was very unsafe and 5 was very safe, a significant difference was found between average risk perception scores for photographs of actual contributing factors (score of ca. 2.5) and scores for photographs of perceived contributing factors (score of ca. 2.0). Themes from the focus groups supported the results of the survey and provided additional insight into consumer food safety risk perceptions. The results of this study inform communication interventions for consumers and retail food safety professionals aimed at improving hazard identification.