Mancini speaks: Hands-on training to enhance the safe handling of food

Our own Rob Mancini will be speaking at the 12th Annual North American Summit on Food Safety taking place at the Old Mill in Toronto on Thursday, April 21st, 2016.

Rob_Mancini_001The importance of training food handlers is critical to effective food hygiene; however, there have been limited studies on the effectiveness of such training.

Food safety training courses are administered worldwide in attempts to reduce outbreaks in food service, retail and temporary food service establishments. However, food handlers often exhibit a poor understanding of microbial or chemical contamination of food and the measures necessary to correct them.

Studies suggest that the provision of a hands-on format of training would be more beneficial than traditional classroom-based programs. The delivery of such a program may assist in changing ones’ food safety behaviours and aid in the retention of knowledge that are necessary to reduce the incidence of foodborne illness.

“I hear and I forget. I see and I remember. I do and I understand.”

What works best? Food safety education interventions

Participants were placed in one of three interventions: positive deviance group (PD), standard reading material group (Standard) and story reading material group (Story). After the interventions, all participants reported significant self-reported knowledge gain. Participants in the diabetics group raised their mean score from 3.6 to 4.0 (p<0.05, t-test two tailed), with positive deviance intervention, and pregnant women raised from 3.6 to 3.8 (p<0.05, t-test two tailed). asked to list the three most useful things they learned from this program, most participants responded ‘washing hands’, ‘cooking temperature’, ‘2-hour rule of refrigerating’, ‘refrigerator temperature’. Many participants also listed ‘not thaw on the counter’, ‘using shallow  container for refrigerator storage’. Nearly 10% of pregnant women mentioned that they learned that pregnant women were at increased risk of foodborne illness, including Listeria.

Of those pregnant women, six responses were from the Story intervention, and two from the PD intervention. Only six participants from the diabetes group listed that they learned they personally were at increased risk for foodborne illness, three from Story, and three from PD. Some reported that they learned that some of their practices were not recommended, such as rinsing meat/poultry before cooking (from Diabetics group Standard intervention). Responses from PD intervention group were more specific and including more detail techniques than the other two interventions, like ‘wash cantaloupe before cutting’, ‘wash cuties (an orange)’, and ‘freezing does not kill bacteria’.

Across the interventions, the PD intervention tended to have the greatest increase of

participants’ self-efficacy, self-risk assessment, and knowledge gain. This preliminary study suggests that PD intervention is a promising food safety education module, especially for high-risk population.

Some study limitations merit comment. These study results were based on self-report survey data. Future research may benefit from observational research, which can validate the compliance of self-reported food safety behavior. Additionally, the relatively small sample size reduced the power of the analysis, and many of the comparison differences were not statistically significant. Future research needs to include a larger sample size and use a randomizing sampling process, in order to generalize findings to a larger population.

Future research efforts are needed to develop an effective food safety educational curriculum targeting people with diabetes, pregnant women and other immunocompromised patients, and delivered by health professional, like physicians, nurses and dieticians. This will facilitate health professionals’ ability to provide information about food safety to their patients and hereby help protect high-risk population from foodborne illness.

Yaohua Feng, Christine Bruhn, and David Marx. 2016. Evaluation of different food safety education interventions.

British Food Journal, Volume 118, Issue 4, February 2016,


Guidance on study design for drugs to reduce STEC in cattle

The U.S. Food and Drug Administration has published guidance on study design and criteria that the Center for Veterinary Medicine (CVM) thinks are the most appropriate for the evaluation of the effectiveness of new animal drugs that are intended to reduce pathogenic Shiga toxin-producing Escherichia coli (STEC) in cattle.

cow-faceSection II discusses general considerations regarding the development of protocols, study conduct, animal welfare, substantial evidence of effectiveness, experimental parameters, nutritional content of experimental diets, and the assessment of drug concentrations in experimental diets. Section III discusses the studies and analyses CVM recommends for sponsors to substantiate the effectiveness of pathogenic STEC reduction drugs.

The guidance is not a comprehensive source of information on conducting clinical effectiveness studies. Alternative study designs for providing substantial evidence of effectiveness may be acceptable. Sponsors should contact CVM to discuss their development plan prior to initiating any studies. Sponsors and clinical investigators should consult the Code of Federal Regulations (21 CFR Parts 511 and 514) for information on the proper shipment, use, and disposition of investigational new animal drugs, as well as submission of the results of clinical investigations. This guidance does not address the evaluation of human food safety with respect to microbial food safety and/or concerns related to antimicrobial resistance. CVM encourages sponsors to discuss any related concerns in their project plan with CVM as early as possible in the development process.

FDA’s guidance documents, including this guidance, do not establish legally enforceable responsibilities. Instead, guidances describe the Agency’s current thinking on a topic and should be viewed only as recommendations, unless specific regulatory or statutory requirements are cited. The use of the word should in Agency’s guidances means that something is suggested or recommended, but not required.

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. 

ServSafe certifies 5 million; no evidence it works

About 10 years ago, eldest daughter Madelynn got a job at a local supermarket.

I asked her if she got any food safety training.

“Yeah, we watched a video for 20 minutes, but we all forget that.”

If the daughter of a food safety nerd had such contempt for food safety training, I thought, maybe we should look at what works and what doesn’t.

We’ve reviewed various training packages over the years, and have a paper about a specific training approach coming out, but haven’t done the kind of observational research I’d like to. No one has.

But that doesn’t stop groups from trumpeting the glories of training.

The U.S. National Restaurant Association has offered the food safety training program, ServSafe, for almost 40 years and has now certified 5 million people.

I say some training is better than none, if only for introducing awareness that food safety is an issue. To coach a travel team in little girls’ ice hockey requires 32 or so hours of training; most people serve food with none.

But the more important question is what training or information works and what doesn’t. And collecting meaningful evidence to verify claims.

Does it suck or not? USDA’s version of protect your baby and yourself from listeriosis

The U.S. Department of Agriculture, eager to groove with the youtube generation but without the grossness that thrives online, released a video today highlighting the potential for certain foods to cause listeriosis in pregnant women.

I don’t know if it works so I asked Chapman. He said the video doesn’t spend enough time on deli meats, the food that risk assessments have shown was much riskier than others. He also said it’s not bad, but somewhat patronizing, but he’s also not a pregnant woman.

For which we are all grateful.

I asked a former pregnant woman, Amy, to look at the video. She said,

“The voices are crazy. I love the idea that she had her baby while they were filming.

“Why do they pick such a boring male narrator? Like I want to listen to him tell me about what not to eat.

“He sounds like he should be the voice of the Pork Bureau.”

These are anecdotal responses. I look forward to USDA releasing the results of their video evaluation research so taxpayers can be assured these attempts at video aren’t just wasting time and money.

Sarah Reasoner: Enhancing food safety distance education

Daughter Courtlynn is going to visit for American Thanksgiving in late November. Got her plane tickets last night. But even with the new flights from Dallas, getting to Manhattan (Kansas) just isn’t that easy.

That’s one of the reasons folks at Kansas State University went big into distance education. It’s just too much time spent on travel. My mother even figured out Skype last week so she could see granddaughter Sorenne.

But is there a better way to deliver food safety information by distance? And who better to answer that question than a food safety distance education person who wants to get an advanced degree?

Sarah Reasoner (right, with her hubby) had to watch and film me so much for distance education, I figured, maybe it’d be useful to actually figure out what works and what doesn’t for distance ed. So she’s been doing a part-time Masters degree while having more babies. And now she gets to tell her academic department, Diagnostic Medicine/Pathobiology at Kansas State University, all about it.

Sarah writes:

Distance education has experienced rapid growth in recent years in enrollment and technological advancements. These advancements have created a unique opportunity for instructors to implement emerging technologies into distance education courses and enhance student’s learning experiences. This presentation explores food safety distance education at Kansas State University, emerging web tools and how to affectively implement such tools into existing food safety distance education courses. Future research possibilities regarding the enhancement of distance education are also discussed.

Sarah talks at 8:30 Friday morning in Mosier 202. That’s in the vet college. In Manhattan (Kansas). Her slides are below. We’ll tape the talk, because how can you not tape a talk about distance education. And put it on the web. Students hate seeing themselves talk, and so do I, but it’s a useful learning tool. I’ve learned to dress better after seeing myself on video. Food Safety Distance Education.pptx

Save Lives: Clean Your Hands

Megan Hardigree, a research associate at Kansas State University working on hand hygiene, writes that this year, Cinco de Mayo wasn’t just a holiday to celebrate the Mexican army’s victory over the French in the Battle of Puebla (yesterday) or a song by the band, Cake. It was also a day to celebrate the launch of the World Health Organization’s (WHO) newest hand hygiene campaign: Save Lives: Clean Your Hands.

The aim of Save Lives: Clean Your Hands is to stop the spread of infection by increasing hand hygiene of healthcare workers. This is said to be the next step of the original, Clean Care is Safer Care, from 2005. The initiative persuades individuals to join the movement with gain-framed messages (they apparently encourage positive behavior) such as “Help stop hospital acquired infections in your country” and “Make patient safety your number one priority.”

To help support this initiative, WHO has accompanied the promotion with a variety of tools and resources to aid healthcare facilities in promoting and enforcing better hand hygiene. These tools include: tools for system change, tools for training and education, tools for evaluation and feedback, tools as reminders in the workplace, and tools for institutional safety climate. My personal favorite, mostly because of the fun diagram, is in the “tools as reminders in the workplace” which includes “My 5 Moments for Hand Hygiene:”

• before touching a patient;
• before clean/aseptic procedures;
• after body fluid exposure/risk;
• after touching a patient; and,
• after touching patient surroundings.

 “Be a part of a global movement to improve hand hygiene, “ says WHO.

Now to evaluate whether any of these messages actually compel people to wash their hands.