Telling students to wash their hands isn’t enough: new research identifies barriers to handwashing compliance in a university residence

Food safety researcher and talk-show host Jon Stewart got it right back in 2002 when he said,

“If you think the 10 commandments being posted in a school is going to change behavior of children, then you think “Employees Must Wash Hands” is keeping the piss out of your happy meals. It’s not.”

Instead, getting college students to wash hands, halt disease, requires giving them proper tools and spreading the word in ways that get attention: the path to poor hand sanitation is paved with good intentions, according to researchers from Kansas State and North Carolina State Universities.

As college campuses prepare for an expected increase in H1N1 flu this fall, the researchers said students’ actions will speak louder than words.

"Many students say they routinely wash their hands," said Douglas Powell, an associate professor of food safety at Kansas State University. "But even in an outbreak situation, many students simply don’t."

In February 2006, Powell and two colleagues — Ben Chapman, an assistant professor at North Carolina State University, and research assistant Brae Surgeoner — observed hand sanitation behavior during an outbreak. What was thought to have been norovirus sickened nearly 340 students at the University of Guelph in Canada.

Hand sanitation stations and informational posters were stationed at the entrance to a residence hall cafeteria, where the potential for cross-contamination was high. The researchers observed that even during a high-profile outbreak, students followed recommended hand hygiene procedures just 17 percent of the time. In a self-reported survey after the outbreak had subsided, 83 of 100 students surveyed said they always followed proper hand hygiene but estimated that less than half of their peers did the same.

The results appear in the September issue of the Journal of Environmental Health.

Powell said that in addition to providing the basic tools for hand washing – vigorous running water, soap and paper towels — college students, especially those living in residence halls, need a variety of messages and media continually encouraging them to practice good hand hygiene.

"Telling people to wash their hands or posting signs that say, ‘Wash your hands’ isn’t enough," said Ben Chapman, an assistant professor at North Carolina State University. "Public health officials need to be creative with their communication methods and messages."

Most students surveyed perceived at least one barrier to following recommended hand hygiene procedures. More than 90 percent cited the lack of soap, paper towels or hand sanitizer. Additional perceived barriers were the notion that hand washing causes irritation and dryness, along with just being lazy and forgetful about hand washing. Fewer than 7 percent said a lack of knowledge of the recommended hand hygiene procedures was a barrier.

"Providing more facts is not going to get students to wash their hands," Powell said. "Compelling messages using a variety of media – text messages, Facebook and traditional posters with surprising images — may increase hand washing rates and ultimately lead to fewer sick people."

University students’ hand hygiene practice during a gastrointestinal outbreak in residence: What they say they do and what they actually do
Journal of Environmental Health Sept. issue 72(2): 24-28
Brae V. Surgeoner, MS, Benjamin J. Chapman, PhD, and Douglas A. Powell, PhD
Published research on outbreaks of gastrointestinal illness has focused primarily on the results of epidemiological and clinical data collected postoutbreak; little research has been done on actual preventative practices during an outbreak. In this study, the authors observed student compliance with hand hygiene recommendations at the height of a suspected norovirus outbreak in a university residence in Ontario, Canada. Data on observed practices was compared to post-outbreak self-report surveys administered to students to examine their beliefs and perceptions about hand hygiene. Observed compliance with prescribed hand hygiene recommendations occurred 17.4% of the time. Despite knowledge of hand hygiene protocols and low compliance, 83.0% of students indicated that they practiced correct hand hygiene during the outbreak. To proactively prepare for future outbreaks, a current and thorough crisis communications and management strategy, targeted at a university student audience and supplemented with proper hand washing tools, should be enacted by residence administration.

Ben Chapman profiled at NC State (this time with notes)

Chapman got his obligatory profile as new faculty in one of the North Carolina State University publications this week; this is the bites/barfblog version.

When Ben Chapman arrived at N.C. State University in January as the new food safety specialist in the Department of 4-H Youth Development and Family and Consumer Sciences, he hit the ground running. …

Since arriving in North Carolina, Chapman has converted from a former Toronto Maple Leafs hockey fan to a Carolina Hurricanes fan.

Carolina has a good hockey team and tickets are easy to get. Toronto sucks and tickets are impossible to get. Carolina has also won the Stanley Cup once in the past 42 years. Toronto has not.

He says that he spends much of his free time discussing the virtues of hockey with his wife and son (that’s Jack, below, left, at a Hurricanes game in about 4 years)..

Those who can, do. Others teach. Others talk. Others bore their families.

A player himself since age 4, he has even started playing hockey here in North Carolina with a group in Wake Forest.

If he’s been playing since 4 he really should be better.

Chapman has focused on finding the best ways to communicate food safety risk to the people who need to know. He is interested in how social media like Facebook and rapid communication technologies like Twitter might improve public safety around the issue of food risk.

It also helps to stay current on all the social media for fantasy baseball/football/hockey/cycling tips.

Chapman had a sense that the bathroom posters proclaiming that “employees must wash hands before returning to work” might not produce the desired results.

It was probably the sense of smell, coming from his hands.

Chapman even spent a semester working as a dishwasher in a restaurant to get a better sense of what the work climate was like.

I didn’t pay him enough as a graduate student and he had to moonlight.

Chapman noted that during busy times, employees tended to forget safe food-handling practices. “When it’s busy in a food-service operation, it gets really crazy,” he said.

That’s when the Pink Floyd is cranked.

In his new position, Chapman continues his quest to find the best ways of reaching food-service workers and consumers.

Go to a restaurant? A supermarket? It’s not like searching for a Holy Grail.

“We have a responsibility to get that information out there,” Chapman said. “The kind of things we’re doing here would have been hard to do in Canada — moving food safety forward.”

That’s what she said.

One way that Chapman has been moving food safety forward is helping agents develop training programs on home food preservation. Once a hallmark of extension programming through tomato clubs for girls, canning and other home food preservation techniques had largely fallen out of favor with consumers in recent years.

Ben Chapman: Defender of the can.

Whole cantaloupes recalled because of possible Salmonella risk

L&M Companies, Inc. of Raleigh, NC is recalling one lot of whole cantaloupes because it has the potential to be contaminated with Salmonella. No illnesses have been reported to date, and we are working with the FDA to inform consumers of this recall.

The whole cantaloupes were sold between May 10-15, 2009 in Walmart Supercenter Stores in North Carolina and South Carolina, and in the Walmart Supercenter Store located at 315 Furr Street in South Hill, Virginia. Consumers who have purchased whole cantaloupes from these Walmart stores during this time period should not consume them, and should destroy the product.

The recall comes after a cantaloupe at a small farm from which L&M Companies sources product tested positive for Salmonella. L&M Companies has ceased shipments from this farm, and the grower continues to investigate the cause of the problem.

A table of U.S. outbreaks related to the consumption of cantaloupe is available at:

With cantaloupe, the most important risk reduction strategy for consumers is to minimize the chances of contaminating the interior of the fruit.  This is done by preventing the rind from contaminating the inside of the cantaloupe, either by direct contact or by cross contamination.  There are different methods used for preparing a cantaloupe, but there is disagreement over which is the most effective technique.


“Reducing Salmonella on cantaloupes and honeydew melons using wash practices applicable to postharvest handling, foodservice, and consumer preparation”. Tracy L. Parnell, Linda J. Harris, Trevor V. Suslow.  University of California.  International Journal of Food Microbiology 99 (2005) 59-70.

“Effect of Sanitizer Treatments on Salmonella Stanley Attached to the Surface of Cantaloupe and Cell Transfer to Fresh-Cut Tissues during Cutting Practices”. Dike O. Ukuku and Gerald M. Sapers.  U.S. Department of Agriculture. Journal of Food Protection, Vol. 64, No. 9, 2001.

barfblog, bites, and food safety

Foodborne illness can be an unpleasant experience or something more serious. The World Health Organization estimates up to 2 billion people get sick from food and water each year – 30 per cent of all citizens in all countries.

Dr. Douglas Powell, associate professor of food safety at Kansas State University, leads a group of individuals passionately committed to reducing the incidence of foodborne illness, through research, teaching and information. The group strives daily to be the international leader in comprehensive and compelling food safety information that impacts individual lives – and reduces the number of sick people.

The electronic publications, and, are comprehensive, current and compelling sources of food safety news and analysis, and help foster a farm-to-fork culture that values microbiologically safe food.

•    The effectiveness of food safety messages and media in public discussions of food safety issues, such as the risks of listeria to pregnant women, legislation surrounding raw milk, public availability of restaurant inspection data, and the safety of fresh produce, are evaluated through qualitative and quantitative methods.

•    Observational research methodologies are used to quantify individual food safety behaviors from farm-to-fork, to enhance handwashing compliance, thermometer use, food packaging information and interventions that can reduce the number of people that get sick from the food and water they consume.

•    A graduate program in food safety risk analysis – including food safety, language, culture and policy — is being developed and will include distance-education.

•    Courses are currently taught in Food Safety Risk Analysis, and Food Safety Reporting.

•    Dr. Powell is the publisher and editor of bites and barfblog, rapid, reliable and relevant sources of food safety information. Dr. Ben Chapman of North Carolina State University is the assistant editor.

•    bites and barfblog are produced by a cross-cultural team of secondary, undergraduate and graduate students as well as professionals who create multilingual and multicultural food safety and security information, including weekly food safety information sheets, and multimedia resources.

•    Research, educational and journalistic opportunities are available for secondary, undergraduate and graduate students through and

For further information, please contact:

Dr. Douglas Powell
associate professor, food safety
dept. diagnostic medicine/pathobiology
Kansas State University
Manhattan, KS
cell: 785-317-0560
fax: 785-532-4039


Dr. Benjamin Chapman
Food Safety Specialist
Department of 4-H Youth Development and Family & Consumer Sciences
NC Cooperative Extension Service
North Carolina State University
Campus Box 7606 (512 Brickhaven Drive)
Raleigh, NC  27695-7606
919.515.8099 (office)
919.809.3205 (cell)

Domino’s Employees of the Month arrested: mug shot below

Unfunnyman Dane Cook and untalented Jessica Simpson have a better chance of finding future employment in pizza preparation – actually, a ridiculously certain chance — than the two below.

Police in Conover, North Carolina say two Domino’s Pizza workers and home video enthusiasts, 31-year-old Kristy Lynn Hammonds of Taylorsville and 32-year-old Michael Anthony Setzer of Conover (right, not exactly as shown) have each charged with distributing prohibited foods.

The pair (below, exactly as shown when booked) produced some employee training videos for Domino’s Pizza that are available at GoodAsYou, including one of Michael wiping his ass with a sponge and then using it to clean a pan, and another in which Kristy says, "Did you all see that? He just blew a booger on those sandwiches.”

Domino’s YouTube pizza ‘prank:’ arrest warrants issued

Arrest warrants have been issued for Kristy and Michael, the two former Domino’s employees who had their 15-minutes of Internet fame yesterday.

The videos are available at GoodAsYou, including one of Michael wiping his ass with a sponge and then using it to clean a pan, and another in which Kristy says, "Did you all see that? He just blew a booger on those sandwiches.”

The Charlotte Observer reports that Catawba County health inspection records show the Domino’s in Conover, on 10th Street N.W., has a very good sanitation rating — 96.5. In fact, its last four inspections have produced scores ranging from 95.5 to 97.5.

Domino’s officials and Catawba County health department inspectors took nothing to chance late Tuesday, sanitizing all equipment in the restaurant and throwing away all opened food items.

NewsChannel 36, the Observer’s news partner, said Kristy sent an email to Domino’s officials, saying it was a prank and that she and Michael never would prepare food that way — in contrast to what they said on the video.

Domino’s officials responded to the video Tuesday, sending out a news release that said, “We are appalled by the actions of these individuals and they do not represent the 125,000 hard-working men and women of Domino’s Pizza across the country and in 60 countries around the world.”

NC juveniles accused of urinating in ice machine

You can pee on the ice, but not in an ice machine.

Four juveniles are facing several charges after security cameras showed them urinating into a cafeteria ice machine at a Chapel Hill,North Carolina middle school.

The News & Observer of Raleigh reported Tuesday the boys range in age from 12 to 15, and are charged with breaking and entering, larceny and vandalism to a public building. Because they are under 16, their names are being withheld.

Police said the vandalism occurred Dec. 15 at Smith Middle School in Chapel Hill. School officials said the ice machine was used on the following three days.

But all the machine’s ice and containers were removed when school officials learned of the incident.

Public health officials instructed the school staff on how to clean and disinfect the surfaces and equipment before using them again.

Tips for buying fresh produce: Ask, hope, pray

Five people who got sick from salmonella this month ate at the same McDowell County restaurant, O’Dear’s Country Diner on U.S. 221 in Marion, North Carolina, but the cases do not appear linked to the ongoing Salmonella-in-tomatoes outbreak.

The restaurant was voluntarily closed Thursday, cleaned Saturday under the supervision of health department specialists, and plans to reopen Monday.

Marion restaurant owner Bob Gaddy said he had not heard about the salmonella problems. He and his brother, Mack, have run Harvest Drive-In for 35 years. Like O’Dear, Gaddy makes a point of buying tomatoes and produce from somewhere he thinks is safe, but said it’s tough to know.

"You ask. But you also hope and pray.”