Shurley not: Food safety education of employees and the public

Food safety training is like psychotherapy: Sure, I understand the theory, the neural pathways, the addictive brain, but will that change my behavior (shurley not).

But there’s always hope – in place of well-designed studies that measure success, failure, and actual experiments with novel approaches. Most studies get tossed on the rhetorical pile of we-need-more-education crap.

Here’s the abstracts for two recent papers:

Effectiveness of food handler training and education interventions: A systematic review and analysis

Journal of Food Protection vol. 82 no. 10

Ian Young, Judy Greig, Barbara J. Wilhelm, and Lisa A. Waddell

https://doi.org/10.4315/0362-028X.JFP-19-108

https://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-19-108

Improper food handling among those working in retail and food service settings is a frequent contributor to foodborne illness outbreaks. Food safety training and education interventions are important strategies to improve the behaviors and behavioral precursors (e.g., knowledge and attitudes) of food handlers in these settings.

We conducted a comprehensive systematic review to identify, characterize, and synthesize global studies in this area to determine the overall effectiveness of these interventions. The review focused on experimental studies with an independent control group. Review methods included structured search strategy, relevance screening of identified abstracts, characterization of relevant articles, risk of bias assessment, data extraction, meta-analysis of intervention effectiveness for four outcome categories (attitudes, knowledge, behavior, and food premise inspection scores), and a quality of evidence assessment.

We identified 18 relevant randomized controlled trials (RCTs) and 29 nonrandomized trials. Among RCTs, 25 (64%) unique outcomes were rated as high risk of bias, primarily owing to concerns about outcome measurement methods, while 45 (98%) nonrandomized trial outcomes were rated as serious risk of bias, primarily because of concerns about confounding bias. High confidence was identified for the effect of training and education interventions to improve food handler knowledge outcomes in eight RCT studies (standardized mean difference = 0.92; 95% confidence interval: 0.03, 1.81; I2 = 86%). For all other outcomes, no significant effect was identified. In contrast, nonrandomized trials identified a statistically significant positive intervention effect for all outcome types, but confidence in these findings was very low due to possible confounding and other biases.

Results indicate that food safety training and education interventions are effective to improve food handler knowledge, but more evidence is needed on strategies to improve behavior change.

Gaps and common misconceptions in public’s food safety knowledge

British Columbia Institute of Technology

Kathy Kim, Helen Heacock

https://pdfs.semanticscholar.org/b78e/7eb080d0fe5a95f95e0b140ca183277c81cb.pdf

Background: Incidence rates of some foodborne illnesses (FBIs) in BC still remain on the rise despite numerous initiatives to prevent FBIs. This rise over the years has been attributed to gaps in the public’s food-safety knowledge and practices. In order to decrease incidence rates and prevent future FBIs, efforts should be made to identify common misconceptions in the public’s food safety knowledge. With a focus on the Metro Vancouver population, common misconceptions in food safety were found and their knowledge level towards the misconceptions was analyzed.

Methods: An in-person survey was conducted in three locations in Metro Vancouver. The survey asked for demographics information, perceived food safety knowledge and food safety misconceptions. ANOVA and Independent Sample T-test were administered to analyze results.

Results: No statistically significant difference in food safety knowledge was found between groups by gender, age, and geographic region. The majority of participants rated their food safety knowledge as moderate but they demonstrated a poor knowledge level in food safety.

Conclusion: The public’s knowledge level should be improved to prevent further rises of FBIs. Initiatives involving the provincial Foodsafe certification program, secondary school curriculums and health authority websites can be utilized to educate the public.

Australian Capital Territory food safety record improves after education model introduced

I’m not sure I buy it.

Not enough critical questions answered, coupled with numerical spin.

Jasper Lindell of The Canberra Times reports the number of improvement notices issued to ACT businesses for not complying with food safety requirements more than halved in the last financial year, with ACT Health confident there were fewer serious safety breaches.

Eighty-seven improvement notices were issued in 2018-19, down from 341 in 2017-18. More than 600 were issued in 2015-16, according to figures from ACT Health.

In 2017-18, 2443 inspections were carried out while 2552 inspections were completed in 2018-19.

The targeted amount in both years was 2500 inspections.

The executive branch manager of the ACT Health Protection Service, Conrad Barr, said food businesses in the ACT demonstrated a high level of compliance with safety standards.

“We are focused on protecting the community with our food safety inspectors doing over 2500 inspections every year.

“We also aim to strike the right balance of regulation with our compliance activity, actively working with businesses to rectify any issues that are identified,” he said.

The decline in food safety breaches followed the introduction in 2017 of a model to educate businesses and their staff in food safety requirements, after five years of inspection pass rates falling well below the targets.

ACT Health has collaborated with the Canberra Business Chamber and Access Canberra to run information seminars for food businesses, community groups and event organisers.

Proactive inspections provided a chance for food businesses to discuss food safety issues directly with public health officers, while seminars and self-assessment options were made available to businesses, a spokeswoman for the directorate told the Sunday Canberra Times.

Common food safety issues found in ACT food businesses include a lack of handwashing facilities, poor temperature control and live pests.

Inspectors also identified inadequate cleaning and sanitation, no food-grade thermometer at the time of the inspection, or no nominated food safety supervisor.

Despite strong public support, the ACT government in 2015 ditched its proposal for a “scores on doors” system of restaurant safety ratings, which has been used in other parts of Australia and globally.

Farms, not classrooms, to inform produce producers about food safety

The educational methods used in a food safety/Good Agricultural Practices (GAP) educational program with small and limited resource produce farmers in Alabama to assist them with obtaining certification were examined in this case study.

The educational methods enlisted to facilitate food safety certification included group meetings, instructional material delivery, individual farm instruction, and expert instruction. In addition, there were four challenges to food safety certification identified—the needs for motivation, information, clarification, and resources—along with strategies to address the challenges.

The program was found to be limitedly successful, producing ten GAP-certified operations. It was concluded that further evaluation of the educational methods is needed.

An educational program on produce food safety/good agricultural practices for small and limited resource farmers: a case study

December 2018

Journal of Agriculture and Life Sciences vol. 5 no. 2

Barrett Vaughan

doi:10.30845/jals.v5n2p7

http://jalsnet.com/journals/Vol_5_No_2_December_2018/7.pdf

How can you have your pudding if you don’t eat your meat? Pink Floyd figured out educating don’t mean much in 1979

Compelling stories are what get people to pay attention.

The U.S Centers for Disease Control in 2011, when an outbreak of variant virus infections* in people was linked to exposure to pigs at agricultural fairs, public health officials quickly recognized the need to support states in using a One Health approach to respond effectively to novel influenza A and other zoonotic disease outbreaks in rural areas. The approach would need to involve organizations focused in animal and human health, as well as members of the communities most at risk. In the United States, there are around 7.2 million youth actively involved in 4-H and FFA combined1. CDC and USDA saw that working with these youth groups could be an effective way to reach rural Americans with important influenza and zoonoses prevention education to protect the 150 million people who visit agricultural fairs each year, as well as the animals shown and exhibited in these venues

To improve influenza education and communication efforts around youth in agriculture, several government and non-governmental organizations partnered to launch a pilot program called Influenza Education among Youth in Agriculture. The program has since taken off, reaching hundreds of thousands of youth and their families across rural America and has expanded to include other zoonotic diseases caused by infections such as E. coli and Salmonella. The program is a joint effort of federal government (CDC and USDA), the Council for State and Territorial Epidemiologists (CSTE), several state health departments, land-grant universities and the 4-H programs run out of them, and state departments of agriculture. These One Health partners work together to develop hands-on activities for youth, zoonotic disease curricula and lesson plans, educational workshops, biosecurity and handwashing posters, and also hold meetings to foster relationships, build networks, and achieve project goals to protect human and animal health.</em

Food safety culture jumped the shark years ago

This short document is based on the content of the GFSI full position paper “a culture of food safety”. It includes the key definitions and a short description of the dimensions and critical components of food safety culture developed in the full paper.

This may therefore be a helpful aide-memoire. Crucially (who writes like this and expects attention from minimum-wage, front line staff? Where’s the Pink Floyd?), the full paper places emphasis on: 1. The essential role of leaders and managers throughout an organisation, from CEO to farm, field and shop floor supervisors, from local ‘Mom and Pop’ grocery stores to large franchise restaurant organisations. 2. Why regular communication, education, metrics, teamwork and personal accountability are vital to advancing a food safety culture. 3. How learned skills including adaptability and hazard awareness move important safe food practices beyond a theoretical conversation to live in “real time.

No cause IDed, but UK children told to get back to class after E. coli outbreak

There were 71 pupils absent at Carlogie Primary on Monday which was a fifth of the school roll of 346 with 46 being kept off as a precaution.

On Tuesday 57 were absent with 37 kept off as a precaution.

A spokesman for Angus Council said: “Members of the community are understandably concerned and have provided tremendous support in trying to minimise spread of infection and identify a possible source.

“The cases and contacts have now been identified and children should now be attending school or nursery unless they are symptomatic or have been formally excluded by the Health Protection Team.”

Part of Tayside Children’s Hospital at Ninewells in Dundee has been set aside for confirmed and suspected cases in the Angus E. coli O157 outbreak.

NHS Tayside confirmed the move as part of what health chiefs described as an “evolving situation” in which a young girl also remains seriously ill in a Glasgow hospital.

The Peter Pan playgroup at the centre of the Angus investigation remains closed.

Over 1200 sick: Campaign launched to fight Norovirus infection in Philippines

It’s gonna to more than edumacation to “effectively prevent and control the spread of the viral infection in Manila.

dude.wash.handsCity Health Officer Dr. Rodel Agbulos said his office has been saturating the different communities with varied information, education and communication (IEC) materials, through health centers and places of convergence in the different barangays.

Through the declaration, the CHO and other concerned offices and agencies and all health institutions in the city have been directed to institute, undertake and implement curative and proactive measures to effectively address and eradicate the outbreak.

CHO Epidemiology Division Chief Dr. Ivy Iturralde said the aggressive campaign will be focused on the practice of hand washing and proper hygiene.

Keep food out of animal education events

Next week I’m tagging along on a field trip with Jack’s first grade class. They’ve been studying the solar system and we’re headed to the planetarium to view the stars and learn about space missions.

No animal exhibits involved in this trip, but I’m sure those are in the future.

I plan on chaperoning any school trips the boys take to the farm, the fair or the petting zoo to help with the onsite risk management.070414.T.FF_.AGEDCENTER1

But, as today’s MMWR highlights, a lot of the disease risk stuff needs to be taken care of before with good planning and procedures.

Yeah, hand washing matters, but so does not letting kids bring lunch/snacks into a contaminated environment.

Or serving food directly in the barn to a 1,000 kids.

Or as Curran et al. say,  ‘These environments should be considered contaminated and should not be located in areas where food and beverages are served’
During April 20–June 1, 2015, 60 cases (25 confirmed and 35 probable) were identified (Figure). Eleven (18%) patients were hospitalized, and six (10%) developed hemolytic uremic syndrome. No deaths occurred. Forty primary cases were identified in 35 first-graders, three high school students, one parent, and one teacher who attended the event. Twenty secondary cases were identified in 14 siblings, four caretakers, and two cousins of attendees.

Food was served inside the barn to adolescents who set up and broke down the event on April 20 and April 24. During April 21–23 approximately 1,000 first-grade students attended the event, which included various activities related to farming. Crude attack rates were higher among those who assisted with setup on April 20 or breakdown on April 24 (three of 14 high school students; 21%) and among attendees on April 21 (22 of 254 students; 9%), than among attendees on April 22 (six of 377 students; 2%) and April 23 (seven of 436 students; 2%).

Animals, including cattle, had been exhibited in the barn during previous events. Before the dairy education event, tractors, scrapers, and leaf blowers were used to move manure to a bunker at the north end of the barn. Environmental samples collected in this area yielded E. coli O157:H7 PFGE patterns indistinguishable from the outbreak strains.

Although it might not be possible to completely disinfect barns and areas where animals have been kept, standard procedures for cleaning, disinfection, and facility design should be adopted to minimize the risk for exposure to pathogens (1). These environments should be considered contaminated and should not be located in areas where food and beverages are served. Hands should always be washed with soap and clean running water, and dried with clean towels immediately upon exiting areas containing animals or where animals have been kept previously, after removing soiled clothing or shoes, and before eating or drinking. Event organizers can refer to published recommendations for preventing disease associated with animals in public settings.

Here’s a set of guidelines we came up with for folks to use when choosing whether to take a trip to these animal events.

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petting2-791x1024-791x1024

 

Good food safety interventions are evidence-based and evaluated

Food safety and public health folks are pretty good at writing proposals, getting funds to do research, and, because of a funder’s requirement, sometimes add on an outreach throwaway activity to make something in the name of education.

Usually it is a brochure, or posters, or a website where the outputs are shared.

And they often suck.

I’m becoming more cynical as I get older and increasingly frustrated with how slow things progress. At one of my first IAFP meetings a decade ago I sat through a 3-hour session on cleaning and sanitation in processing environments and each speaker ended their talk with the same type of message – things would be better if we could just educate the staff, ritely stating it like it would be simple to in a 1-hr training session.

And no one mentioned evaluation.

There’s about 10,000 papers in the adult education, behavioral science and preventive health world that set the stage on how to actually make communication and education interventions that might work. The literature has some common tenants: know thy audience; have an objective; base your message on some sort of evidence; ground the approach in accepted theory and evaluate.

Unfortunately food safety professionals who are good at microbiology don’t usually consult it.

Young and colleagues from Canada recently published a paper in Foodborne Pathogens and Disease which provides an output of summarized packages of systematic reviews into one-and three page formats (abstract below).

The application of systematic reviews is increasing in the agri-food public health sector to investigate the efficacy of policy-relevant interventions. In order to enhance the uptake and utility of these reviews for decision-making, there is a need to develop summary formats that are written in plain language and incorporate supporting contextual information. The objectives of this study were (1) to develop a guideline for summarizing systematic reviews in one- and three-page formats, and (2) to apply the guideline on two published systematic reviews that investigated the efficacy of vaccination and targeted feed and water additives to reduce Salmonella colonization in broiler chickens. Both summary formats highlight the key systematic review results and im- plications in plain language. Three-page summaries also incorporated four categories of contextual information (cost, availability, practicality, and other stakeholder considerations) to complement the systematic review findings. We collected contextual information through structured rapid reviews of the peer-reviewed and gray literature and by conducting interviews with 12 topic specialists. The overall utility of the literature searches and interviews depended on the specific intervention topic and contextual category. In general, interviews with topic specialists were the most useful and efficient method of gathering contextual information. Preliminary evaluation with five end-users indicated positive feedback on the summary formats. We estimate that one-page summaries could be developed by trained science-to-policy professionals in 3–5 days, while three-page summaries would require additional resources and time (e.g., 2–4 weeks). Therefore, one-page summaries are more suited for routine development, while three-page summaries could be developed for a more limited number of high-priority reviews. The summary guideline offers a structured and transparent approach to support the utilization of systematic reviews in decision-making in this sector. Future research is necessary to evaluate the utility of these summary formats for a variety of end-users in different contexts.

While there’s a whole lot of information on how these summaries were designed – and that eight end-users were asked to participate in the development, there’s no mention of behavioral or education theory, why message and design choices were made or what they hoped the end users would do with them. And no evaluation at all.

Here’s how we’ve evaluated our food safety infosheets for a different user group, food handlers:

Assessment of Food Safety Practices of Food Service Food Handlers: Testing a Communication Intervention
June 2010, Journal of Food Protection

Abstract: Globally, foodborne illness affects an estimated 30% of individuals annually. Meals prepared outside of the home are a risk factor for acquiring foodborne illness and have been implicated in up to 70% of traced outbreaks. The Centers for Disease Control and Prevention has called on food safety communicators to design new methods and messages aimed at increasing food safety risk-reduction practices from farm to fork. Food safety infosheets, a novel communication tool designed to appeal to food handlers and compel behavior change, were evaluated. Food safety infosheets were provided weekly to food handlers in working foodservice operations for 7 weeks. It was hypothesized that through the posting of food safety infosheets in highly visible locations, such as kitchen work areas and hand washing stations, that safe food handling behaviors of foodservice staff could be positively influenced. Using video observation, food handlers (n ~ 47) in eight foodservice operations were observed for a total of 348 h (pre- and postintervention combined). After the food safety infosheets were introduced, food handlers demonstrated a significant increase (6.7%, P , 0.05, 95% confidence interval) in mean hand washing attempts, and a significant reduction in indirect cross-contamination events (19.6%, P , 0.05, 95% confidence interval). Results of the research demonstrate that posting food safety infosheets is an effective intervention tool that positively influences the food safety behaviors of food handlers. 

Rob Mancini: Food safety training is more than just another brick in the wall

Classroom-based food safety lectures remind me of the Pink Floyd video Another Brick in the Wall, where trainers gather the masses to pump out certified food handlers. It’s all about the money; it’s a business. The expectation in providing these courses is ultimately to reduce the incidence of foodborne illness. However, there is little evidence in the literature that the provision of knowledge actually changes food safety attitudes and behaviors. An effective food training course should not only provide food safety information, it should implement knowledge into practice for proper information retention, which is one of the points (point 5) I agree with in the article listed below.

pink.floyd.another.brickI have been out of school for a couple of years and heavily in debt but that is another story, and when I am attending a course with an exam component, I get flustered. Imagine someone who has been out of school for 20-30 years? Classroom-based courses present an overload of information in typically a one-day session. The participants are then obliged to memorize information presented and take an exam. The only thing these participants are concerned with is passing the exam so they don’t get fired from work. Effective food safety training is difficult and different people learn in different ways.

Participants should be informed on where to find the presented information, rather than memorize it. Memorizing doesn’t work and it definitely does not change behaviors; why not have an open-book exam? Ask the participants what they want and what would best suit their needs. I have done this.  The answer is always the same, reduce the number of hours and make the course hands-on focusing on the critical issues in food safety, i.e how to use a probe thermometer properly.

A group of corporate trainers and educators captured some of their thoughts and ideas on effective food safety training and identified 10 key training messages:

  1. “Do your homework” – Research the company and products that they produce and serve. Identify what food safety experiences the participants have so that you can deliver the most effective information and relate to what they do every day in their jobs.
  2. “Start off right” – Get people engaged and involve them in an activity as you begin your educational program. Have people introduce themselves and make them feel comfortable  speaking to the group.
  3. “Start low, and bring it up” – You are likely to have a very diverse group of participants with different educational levels and different sets of experiences. Be sure to introduce concepts at the “USA Today level” and then develop more comprehensive examples later to further describe the more complex concepts. You need to build a foundation of knowledge that everyone is comfortable in learning.
  4. “Get them involved” – Assemble participants into multi-disciplinary teams and involve them in real-world problem solving activities. Participants will learn much better when they use the skills and knowledge they have just learned.
  5. pink.floyd.another.brick.II“Make it real” – You need to relate the learning concepts to what they do in their jobs. Take a tour of the kitchen, study the flow of food, have them clean equipment or assemble a 3-compartment sink, have them show each other how they can calibrate a temperature measuring device, etc.
  6. “Open it up” – Questions are key to learning – encourage questions! Be sure to have an open training environment that allows time for people to ask questions. I often have a “question box” at the back of the training room for those participants who are apprehensive or afraid to ask questions.
  7. “Involve stakeholders” – John Marcello made a great point at the Food Safety Summit about the importance of bringing industry and regulatory together. Consider this an important relationship, and, think about how these important stakeholder groups can be brought together for food safety training.
  8. “Review it” – Be sure to have clear objectives for each learning lesson, and review these concepts at the end of the session. This will help them retain the most important information.
  9. “Make it fun – Celebrate” – Fun starts with a positive attitude of the trainer. Make the training session fun… and the participants will have fun also… and they will want to learn.
  10. “Evaluate and change” – A good trainer always makes time to ask the group how he/she did and how he/she can be better next time. Do an evaluation and respond to the comments from participants. Make suggested changes and be better the next time.