Age-dependent resistance factors in the pathogenesis of foodborne infectious disease

FoodNet survey of food use and practices in long-term care facilities

Foodborne illness is an important problem among the elderly. One risk factor for foodborne illness and diarrhea-associated mortality among the elderly is residence in a long-term care facility (LTCF); thus, these facilities must implement measures to ensure safe food. To assess safe food practices, knowledge, and policies, we used a mailed, self-administered questionnaire to survey food service directors at LTCFs that were certified to receive Medicare or Medicaid at eight Foodborne Diseases Active Surveillance Network (FoodNet) sites. Surveys were distributed to 1,630 LTCFs; 55% (865 of 1,568) of eligible facilities returned a completed questionnaire. Only three LTCFs completely followed national recommendations for prevention of Listeria monocytogenes contamination. Nine percent of LTCFs reported serving soft cheeses made from unpasteurized milk. Most LTCFs reported routinely serving ready-to-eat deli meats; however, few reported always heating deli meats until steaming hot before serving (only 19% of the LTCFs that served roast beef, 13% of those that served turkey, and 11% of those that served ham). Most LTCFs (92%) used pasteurized liquid egg products, but only 36% used pasteurized whole shell eggs. Regular whole shell eggs were used by 62% of facilities. Few LTCFs used irradiated ground beef (7%) or irradiated poultry products (6%). The results of this survey allowed us to identify several opportunities for prevention of foodborne illnesses in LTCFs. Some safety measures, such as the use of pasteurized and irradiated foods, were underutilized, and many facilities were not adhering to national recommendations on the avoidance of certain foods considered high risk for elderly persons. Enhanced educational efforts focusing on food safety practices and aimed at LTCFs are needed.

Food safety practices and readiness to implement HACCP programs in assisted-living facilities in Iowa

OBJECTIVE

To evaluate current food-handling practices and employee food safety knowledge and attitudes and to provide baseline data for implementing the Hazard Analysis and Critical Control Point (HACCP) program in assisted-living foodservices for elderly persons.

DESIGN

Food-handling practices were observed at each assisted-living facility using a structured observation form. A validated questionnaire was used to determine demographic information and employees' attitudes and knowledge about food safety.

SUBJECTS/SETTING

A convenience sample of 40 assisted-living facilities in Iowa was recruited from a list obtained from the Iowa Department of Elder Affairs.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics were used to summarize data. One-way analysis of variance was used to assess differences in attitudes and food safety knowledge among the managers, cooks, and other foodservice employees. Multiple linear regression determined the relationship between manager and facility demographics and the food safety practice score.

RESULTS

Proper food-handling practices were followed in many assisted-living facilities, but areas in need of improvement were identified. Some HACCP prerequisite programs were found to be inadequate, including a lack of written standard operating procedures, documentation of food safety practices, and training. Temperatures and chemical concentrations need to be checked routinely. Foodservice employees had a significant amount of food safety knowledge (14.6+/-3.0 out of 20 possible points), and employees with food safety certification scored higher than those with no certification (15.6+/-2.6 and 13.9+/-3.1, respectively; P </=.001).

CONCLUSIONS

Training programs, both basic food safety and the HACCP program, will support improvement of safe food-handling practices and implementation of prerequisite programs and the HACCP program. Developing prerequisite programs, including sanitation standard operating procedures, will aid assisted-living facilities in moving toward HACCP program implementation.

Microbiological evaluation of foodservice contact surfaces in Iowa assisted-living facilities

A study of 40 assisted-living facilities in Iowa was conducted to assess the microbiological quality of food-contact surfaces (work tables/counters, cooking equipment such as mixing bowls, and cutting boards) and a surface that could cross-contaminate food (refrigerator or freezer handles) to determine the effectiveness of cleaning and sanitation. Standards were set for foodservice for aerobic plate count, Enterobacteriaceae, and Staphylococcus aureus . Two facilities met standards for all five surfaces for each of the three tests. Fewer facilities met the standard for aerobic plate count than for the other two tests, and nearly three fourths of the facilities failed to meet the aerobic plate count for cutting boards. Critically, cross-contamination from these surfaces could result in contamination of food; thus, attention needs to be given to training and supervision to ensure proper hand washing and appropriate cleaning and sanitation procedures to reduce or eliminate cross-contamination.

Use of the Health Belief Model to examine older adults' food-handling behaviors

OBJECTIVE

To measure the association among Health Belief Model (HBM) variables and safe food-handling behaviors among older adults.

DESIGN

A mail survey using Dillman's Total Design Method.

SETTING

In October 1999, a survey was sent to volunteers from a preexisting cohort of noninstitutionalized older adults living throughout Nevada. Data collection continued through January 2000.

PARTICIPANTS

With a 56% response rate, the sample (n = 266) was composed mainly of women (73%) and individuals from urban counties (74%). The mean age was 68.09 years (SD = 8.27). Except for gender, sample characteristics were similar to those of the preexisting cohort.

VARIABLES MEASURED

Perceived threat of foodborne illness (ie, perceived severity and perceived susceptibility), cues to action (ie, media cues and educational cues), and safe food-handling behaviors (ie, sanitation and cross-contamination).

ANALYSIS

Rank order correlation coefficients were computed to measure the association among variables. Significance was set at P <.05.

RESULTS

Cues to action were positively related to perceived threat of foodborne illness and safe food-handling behaviors. Perceived severity of foodborne illness was positively related to one dimension of safe food-handling behaviors (ie, sanitation).

CONCLUSIONS AND IMPLICATIONS

The HBM is a useful framework for examining food-handling behaviors among older adults.