The restaurant business has turned into a dynamic and ever-growing industry. So, food safety must be a priority for these establishments, especially during the COVID-19 pandemic. The aim of this study was to determine the effect of training intervention on the health and food safety knowledge, attitude, and self-reported practice (KAP) of restaurant food handlers during the COVID-19 pandemic.
This quasi-experimental study was conducted on 159 restaurant food handlers in Tehran, Iran. The training intervention was developed based on the latest global guidelines. The KAP of the subjects was measured before and after the training. Fisher’s exact test, paired t test, and repeated measures ANOVA were used for statistical analysis. Data analysis was done using the IBM_SPSS software. The total knowledge scores of participants were low (17.6%), moderate (35.2%), and good (47.2%) before training, which were changed to 5% (low), 23.9% (moderate), and 71.1% (good) after training. The total pretraining attitude scores were 0.6, 77.4, 18.2, and 3.8% that were changed to 0% (strongly negative), 49.1% (negative), 33.3% (positive), and 17.6% (strongly positive), respectively. Also, the self-reported practice scores of the participants before training were 1.3, 56, and 42.7 that were changed to 0% (weak), 26.4% (acceptable), and 73.6% (desirable) after the intervention, respectively. Paired t test results showed a statistically significant increase in all scores. The interaction of training with age and education was statistically significant in increasing the knowledge and attitude scores of the participants by the repeated measures ANOVA.
Improving the KAP of food handlers by health and food safety training can improve the status of restaurants and minimize the outbreak of pandemic diseases, including COVID-19, which is an effective step in community health. Thus, it is an urgent need for policymakers to design an online system of continuous food safety training for food handlers.
A quasi-experimental study on the effect of health and food safety training intervention on restaurant food handlers during the COVID-19 pandemic, 25 April 2021
Food Science & Nutrition
Fatemeh Mohammadi-Nasrabadi, Yeganeh Salmani, and Fatemeh Esfarjani
European Cleaning reports that a US hospital study has revealed that while healthcare hand hygiene compliance soared early on in the pandemic, it fell back to pre-pandemic levels after just four months.
Woman washing her hands at the kitchen sink. There are vegetables out of focus in the background.
The University of Chicago Medical Centre used an automated hand hygiene monitoring system to track how often staff washed their hands or used sanitiser when entering and exiting a patient’s room between September 2019 and August 2020. Compliance trends were then analysed by researchers at the hospital.
In September 2019, baseline monthly hand hygiene compliance levelled out at 54.5 per cent across all units, peaking at 75.5 per cent. On March 29, 2020 – when anxiety about the pandemic was running high – hand hygiene compliance hit a daily peak of 92.8 per cent across all hospital units. And it hit 100 per cent across those units that were temporarily given over for the exclusive use of COVID-19 patients.
However just four months later in August 2020, monthly compliance levels had dropped back to 56 per cent, researchers found.
The results of the study, published in JAMA Internal Medicine, considered various factors that may have contributed to the March 2020 jump in compliance including staff members’ increased awareness of the importance of hand washing during the pandemic.
They defined residual risk as what remains even after a fully compliant food safety system has been implemented. Every product has a residual risk but severity varies because it depends on a variety of factors such as the perspective or consequences.
Researchers gave the example of the risk of Salmonella in chocolate bars assuming contamination of one Salmonella enterica cell per 10,000 of 25,000 bars of 25-grams, and that the company produces 100,000 bars a day. Testing is limited to five samples per day, each sampling unit is a whole bar, and probability of a false negative or false positive is zero.
“The probability of detecting Salmonella in each sampling unit equals 0.01 percent, and the probability of detecting it in the product in a given day is 0.05 percent. In other words, we expect a single positive every 5.5 years. On the basis of this result, it could seem reasonable to conclude that the risk of salmonellosis is insignificant.
“However, a single cell of Salmonella enterica has a probability of causing illness that has been estimated to be 1 case per 400. Therefore, if we consider that 10 bars of the 100,000 daily production contain a single Salmonella enterica cell, the expected number of yearly cases of salmonellosis is 9.125, a value that is certainly not insignificant. Although sampling will rarely show a positive, there is clearly a residual risk.”
Bill Leiss and I wrote a book on this topic, Mad Cows and Mother’s Milk, published in 1997, explicitly stating there is no such thing as zero risk: it’s about maximizing the benefits and minimizing the risks in food safety stuff.
My friend Tim Caufield, professor of law at the University of Alberta, the Research Director of its Health Law Institute, and current Canada Research Chair in Health Law and Policy, writes in an op-ed for the Globe and Mail that COVID public health policies have been with us for a year. So has uncertainty. We’ve all lived through twelve months of “huh”? And this has added to the public’s frustration, fatigue, and stress.
In the early weeks and months of the pandemic, there was uncertainty about masks and asymptomatic spread. There was uncertainty about if and when we’d get a vaccine. There was uncertainty about what type of public health policies worked best and were most needed. We have all had to tolerate a lot of ambiguity. And as the vaccines roll out, we are being asked to tolerate even more. (When will I get a vaccine? Which one will I get? And what about the variants?)
For public health communications to be effective, the public must have confidence in the message. And, unfortunately, for some, that confidence isn’t there. A recent study from the University of Calgary explored pandemic communication and found, not surprisingly, that “participants felt that public health messaging to date has been conflicting and at times unclear.”
This perception is understandable. An atmosphere of seemingly relentless uncertainty and confusion has been created by a combination of scientific realities, media practices, some less-than-ideal communication from policy makers, and the spread of misinformation and conspiracy theories.
The science surrounding COVID was – and, for some topics, continues to be – highly uncertain. While a growing body of evidence has emerged around the most contested issues (such as the value of masks and physical distancing strategies), early in the pandemic there wasn’t much that was unequivocal. The science evolved and, as you would hope with any evidence-informed approach, the resulting science advice and recommendations evolved too. But for some, shifting policies, even if appropriate, just added to a sense, rightly or not, of chaos.
In addition, the media has been reporting on the research as it unfolds, including referencing studies that have not yet been peer reviewed. Often the preliminary or uncertain nature of the relevant research is not reported in the media, thus creating a false impression about the actual state of the science – as exemplified by the “hydroxychloroquine works!” debacle (PS, it doesn’t). Perhaps worse, relatively fringe perspectives – such as those pushing the value of “natural herd immunity” – have been given a relatively high profile in both the conventional press and on social media. This can create a false balance (fringe idea vs. broad scientific consensus) that we know can be detrimental to both public discourse and health behaviours.
Despite the frustration that uncertainty can create, the public has a demonstrated preference for honesty about the limits of our knowledge. A recent study from Germany found that “a majority of respondents indicated a preference for open communication of scientific uncertainty in the context of the COVID-19 pandemic.” This finding agrees with other research that has found that when uncertainty is relevant to their lives, the public wants to know about it.
People may want to hear about uncertainty, but will communicating it do more harm than good? Will it just add to an already confused information environment? The data on this point are actually fairly mixed, but recent research exploring the impact of communicating scientific uncertainty found that it either increased perceptions of trust in science or had almost no impact. This is good news. As the authors of one of the studies notes, “this should allow academics and science communicators to be more transparent about the limits of human knowledge.” Other studies have found that being honest about uncertainties in media reports about research can actually boost the perceived credibility of journalists.
And over the long term, honesty about the uncertainties of the evidence used to inform policy seems essential to the maintenance of public trust. For example, being overly dogmatic about a policy or predictive model could hurt the credibility of decision makers if new evidence requires a revision of a past positions.
When possible, public health authorities (or anyone seeking to communicate science) should start with well-defined and well-supported takeaway messages (e.g., please get vaccinated with whatever vaccine is available to and recommended for you!).But then be honest about what is not known (e.g., while vaccines are our best defense, we aren’t sure how long immunity will last).
Depending on the medium used (a social media post, for example, may not be the best venue for a long discourse on methodological challenges), it may also be wise to explain the limits of the research approach (e.g., observational studies can’t prove causation). If there are areas of scientific disagreement, be honest about that too – but be specific about what is being disputed. Often there is broad agreement about the big stuff (e.g., vaccines work!), but academic debate about some details. Often those trying to sow doubt – like those in the anti-vaccine community – will try to weaponize and over-emphasize small academic disagreements. Don’t give them that room.
When communicating about uncertainty it is also important to highlight what is being done to reduce it, such as forthcoming research or new data analysis. This provides a road map forward and invites the public to follow the science as it unfolds. It is also a way to stress that uncertainty is a natural part of the scientific process.
For the public, try not to let the uncertainty kerfuffle distract you from the big picture. Remember that there are many clear knowns. Vaccines, physical distancing, hand washing, masks, and being responsible when symptoms emerge will get us through this pandemic.
Finally, it is also important to take a break from all the uncertainty noise. Studies have shown that the constant consumption of conflicting COVID news can (no surprise here) add to our stress. Put down the phone, back away from the screen, and take ten from “huh?”
Animal petting zoos and farm fairs provide the opportunity for children and adults to interact with animals, but contact with animals carries a risk of exposure to zoonotic pathogens and antimicrobial‐resistant bacteria.
The aim of this study was to assess the occurrence of Shiga toxin‐producing Escherichia coli (STEC), Salmonella, extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae and methicillin‐resistant Staphylococcus aureus (MRSA) in animal faeces from six animal petting zoos and one farm fair in Switzerland. Furthermore, hygiene facilities on the venues were evaluated.
Of 163 faecal samples, 75 contained stx1, stx2 or stx1/stx2 genes, indicating the presence of STEC. Samples included faeces from sika deer (100%), sheep (92%), goats (88%), mouflons (80%), camels (62%), llamas (50%), yaks (50%), pigs (29%) and donkeys (6%), whereas no stx genes were isolated from faeces of calves, guinea pigs, hens, ostriches, ponies, zebras or zebus. Salmonella enterica subsp. enterica serovar Stourbridge (S. Stourbridge) was detected in faecal samples from camels. A total of four ESBL‐producing E. coli strains were isolated from faeces of goats, camels and pigs. PCR and sequencing identified the presence of blaCTX‐M‐15 in three and blaCTX‐M‐65 in one E. coli. Antimicrobial resistance profiling using the disk diffusion method revealed two multidrug‐resistant (MDR) E. coli with resistance to ciprofloxacin, gentamicin and azithromycin, all of which are critically important drugs for human medicine. Multilocus sequence typing identified E. coli ST162, E. coli ST2179, extraintestinal high‐risk E. coli ST410 and E. coli ST4553, which belongs to the emerging extraintestinal clonal complex (CC) 648. No MRSA was detected.
On all animal petting venues, there were inadequacies with regard to access to hygiene information and handwashing hygiene facilities. This study provides data that underscore the importance of hygiene measures to minimize the risk of transmission of zoonotic pathogens and MDR, ESBL‐producing E. coli to visitors of animal petting venues.
Animal petting zoos as sources of shiga toxin-producing Escherichia coli, salmonella and extended-spectrum Beta-lactamase (EXBL)-producing Enterobacteriaceae
The American Veterinary Medical Association newsletter reports numbers of confirmed illnesses in humans resulting from common foodborne pathogens have risen or remained level for several years, putting the U.S. on track to miss 2020 reduction targets.
Better tests and more testing may help explain why the numbers have not fallen, but to reach its goals, the U.S. needs more work to reduce food contamination, according to authors of an article published this spring in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. Among the findings, the authors wrote that preliminary 2019 data show confirmed illness counts for Listeria, Salmonella, and Shigella have remained unchanged over several years, and confirmed illness counts for the other five pathogens tracked by the CDC’s Foodborne Diseases Active Surveillance Network increased.
“FoodNet surveillance data indicate that progress in controlling major foodborne pathogens in the United States has stalled,” the article states. “To better protect the public and achieve forthcoming Healthy People 2030 foodborne disease reduction goals, more widespread implementation of known prevention measures and new strategies that target particular pathogens and serotypes are needed.”
I saw the Hip at a bar in Waterloo, Ontario, Canada on this tour with my 6-month pregnant ex-wife.
My 28-year-old music therapist came over for her one hour session this morning which is the highlight of my week. I sing and play guitar like no one is watching. And I introduce her to 50-year-old songs, like those on Workingman’s Dead, which we played this morning in its entirety (Oh, and Chapman, she likes Jimmy Buffett, so suck it).
This paper forms part of an ongoing project studying various approaches to the management of hazards and risk in the food industry with implications for other areas of risk management where cooperation and collaboration between organisations are of a potential benefit. In this paper we give particular focus to the Food Standard Agency’s proposed Regulating Our Future that requires closer cooperation and collaboration between the public enforcement authorities and the industry organisations that police food hygiene and food safety management. The forming of a Primary Authority between Cornwall Council and Safe and Local Supplier Approval (SALSA) emerged as a potential means of contributing to this by improving trust between all parties involved, sharing of information, assessing risk, reducing inspection times and frequency of inspections from Primary Authority. Attention is given to the current relationship between the various organisations involved from the perspectives and viewpoints of Local Authority Enforcement Officers from Preston City Council, Cornwall Council and SALSA and other experienced food safety professionals. The research is qualitative and grounded, including a review of the extant literature and interviews with food safety and food standards professionals from the private and public enforcement sectors.
Approaches to the management and policing of food safety: The food standard agency’s regulating our future, 2019
International Journal of Management and Applied Research vol. 7 no. 2
Richard Bradford-Knox, Kevin Kane, Simon Neighbour
My friend Andrew Thomson writes in this piece for Hospital Health here in Australia:
COVID-19 has sharpened our focus on safety, with lockdown providing an opportunity to reflect on current approaches and where improvements to compliance policies and practices could be achieved.
Food safety management systems in Australia have largely not changed on the safety front. A one-size-fits-all approach to food safety management systems is widespread across the foodservice sector — a certain recipe for failure. All too familiar food safety problems persist at unacceptably high rates.
Leaders (at all levels) do not fully understand their food safety obligations — they are wanting a quick fix so they can tick the regulatory box.
Characteristically, a leader within an organisation will copy and paste another organisation’s food safety management system and make minimal changes; or they will download a template to assist them develop what they believe is a compliant system. This leader fills out a few text boxes here and there throughout the document, which is done in isolation of operational employee consultation and involvement. The newly created food safety management system completely lacks operational detail and bears no resemblance to site-specific operational and food law requirements.
Validating the system and developing robust verification mechanisms are poorly understood, and in many cases does not occur.
Production processes impacting on food safety are not fully understood by operational leaders and employees, or there is inconsistent understanding of the processes. If leaders and employees do not know how the food safety system works (or is supposed to work), how can they improve it?
There are significant shortcomings around resource allocation, including sub-par training — there is no genuine commitment to training, nor are there any accountability processes in place — this is just another example of ticking the box.
Food handling employees need to know:
what to do,
how to do it,
why it’s important, and
what corrective actions to take when required.
Corrective action is a critical food safety step that helps prevent a food safety incident from occurring.
The dated ‘compliance-based training’ and ‘mandatory online modules’ approach and refresher training has failed. New training and learning habits and practices will need to be created.
Implementation and meaningful review of food safety management systems rarely occur. An organisation must be able to demonstrate that it is complying with its food safety management system and conduct a regular review — a requirement of Australian food law.
A review is of critical importance as food production activities within the operation will change over time, such as when new equipment is purchased or changes are made to cooking methods.
The involvement of senior leadership is required in the review process, to provide an opportunity to examine business activity from a different perspective. Soft or inconsistent regulatory audits are simply not helpful and place the organisation and other stakeholders at risk, including the regulator. In many situations food safety management is not a priority and is not taken seriously, with a ‘she’ll be right’ approach, until there is a food safety incident or regulatory intervention. This can often lead to unwanted and negative (social) media attention.
Food safety colleague Dr Doug Powell explained that when there is an outbreak of foodborne illness many food operations will rely on a go-to soundbite, “Food safety is our top priority”.
For Dr Powell, a former professor of food safety for 17 years at the universities of Guelph and Kansas State, this sets up a mental incongruity: if food safety is your top priority, shouldn’t you show me?
The other common soundbite is, “We meet all government standards”.
With a changing regulatory landscape, advances in technology, and food products and ingredients travelling great distances, it is time for senior leadership and boards of directors to elevate the food safety conversation within their organisation.
Far too many foodservice operations are leaving brand protection to government inspectors or auditors — this is a bad idea.
Organisational leaders should commit themselves to achieving optimal industry standards in food safety management instead of aiming to meet minimum requirements. Leaders must be actively involved in celebrating team success and equally the reporting and development of risk-reduction strategies when a food safety issue arises. Leaders must hold every employee accountable for consistent adherence to recognised food law requirements and safety practices. Failing to respond to these matters leaves many organisations (and employees) vulnerable to a myriad of risks.
This is why I avoid potlucks (not that anyone would invite Dr. food safety).
I have no idea of the kitchen prep area, nor the personal hygiene of the providerer.
According to David Opinko of Lethbridge News Now, the Government of Alberta (that’s in Canada) has made it easier for individuals to start or continue operating businesses out of their home that sell food.
Health Minister Tyler Shandro says this will also help to increase the public’s access to locally grown or processed foods.
“This regulatory change maintains our standards for food safety, supports Alberta entrepreneurs, adds new jobs, and benefits the economy by giving Albertans new opportunities to buy locally produced foods. It also makes it easier than ever to turn your passion into a home business.”
Specifically, those who sell low-risk items, or ones that have a lower ability to create food-borne illnesses, will not require food-handling permits or be subject to inspections.