A review of motivational models for improving hand hygiene among an increasingly diverse food service workforce

Methods and measures in food service food safety research: A review of the published literature

Purpose

Food handlers working in food service establishments need to perform appropriate and consistent food safety practices to ensure that the prepared food is safe for consumers to eat, as a failure to do so may lead to foodborne illness. It is important to have an in-depth understanding of food handler food safety behaviour in the food service sector to design targeted educational interventions and approaches to safeguard consumers. The purpose of this review is to provide insight to the existing body of research regarding food handler food safety in the food service sector, and to identify future research needs in terms of methods and measures.

Methods

This study is a review of published food safety research studies (n = 118) focusing on food handlers in the food service sector conducted between 2001 and 2021. Data were collated regarding the methods used and the measures assessed in published studies to identify the gaps in current knowledge related to food safety in food service.

Findings

The majority of studies were conducted in the United States (29%), Brazil (17%) and United Kingdom (7%). A large proportion were carried out in restaurants (70%). Less than a third of studies (28%) relied on a mixed method approach for data collection; and only 12% of studies assessed a combination of cognitive and behavioural measures. Observation was used in only 29% of studies. A lack of observational data detailing food safety practices such as handwashing, temperature control, separation and cleaning was determined.

Significance

Such findings indicate a greater need for mixed method approach in future food safety research. It is recommended that the understanding of food handler food safety performance is best obtained through a combined assessment of cognitive and behavioural measures with subsequent triangulation of findings to reduce bias and to obtain reliable results.

Factors associated with meat hygiene-practices among meat-handlers in Metropolitan City of Kathmandu, Nepal

Meat hygiene refers to all conditions and measures necessary to ensure safety and suitability of meat at all stages of the food chain. Inadequate hygiene practices allow consumers to be exposed to pathogens causing public health problems. Inadequate facilities and hygiene practices in meat shops results in meat contamination. The study aimed to identify factors associated with meat hygiene practices among meat handlers in the Metropolitan City of Kathmandu, Nepal. A cross-sectional study was designed with a semi-structured questionnaire and observation checklist that collected information about hygiene practices from 320 consenting meat-handlers by interviewer-administered technique. Data was entered in EpiData and analyzed using IBM SPSS version 21. Descriptive statistics of frequency distribution were used to report meat hygiene-practices and other independent variables, with multivariate logistic regression to establish predictors of meat hygiene-practices at 5% level of significance. The study revealed that less than half (44.4%) of the meat handlers had satisfactory meat hygiene practices. The adjusted regression analysis showed, strong evidence (p<0.01) of association of higher education level (AOR = 2.8, 95% CI = 1.7-4.5), other occupational involvement (AOR = 2.2, 95% CI = 1.9-2.4), and being officially registered (AOR = 2.8, 95% CI = 1.2-6.8) with meat hygiene practices. However, there was fair evidence (p<0.05) of association between shorter duration of meat being processed to sale (AOR = 0.57, P = 0.042) and meat hygiene practices. In this study, the satisfactory meat hygiene practices of meat handlers was low. The educational level, registration status of shops, involvement in other jobs, and awareness on meat hygiene were identified as key factors associated with meat hygiene practices. Thus, these factors need to be considered while developing programs to improve meat hygiene practices among the meat handlers. Meat handlers should be provided with training and orientation program for improving the meat hygiene practices.

Tactile disgust: Post-contact can be more disgusting than contact

Several studies have examined if disgust can be evoked by contacting an object-yet none have examined if reported disgust changes when the hand leaves the object. This is surprising given that post-contact tactile disgust is probably a driver of hand hygiene. We examined contact and post-contact tactile disgust and its sensory origins. Participants were asked to touch several objects, making sensory, disgust, and desire-to-handwash evaluations. These ratings were made at three stages-of-contact: object-contact (just touch), post-contact (just touch), and visual post-contact (touch, vision). Disgust was typically highest at post-contact (when the hand left the object). Stickiness and wetness were uniquely predictive of object-contact disgust. Only stickiness drove post-contact disgust, and only wetness visual post-contact disgust. Hand-washing desire was primarily driven by quantity of residue perceived on the hand. These findings suggest that tactile disgust is a multisensory and iterative process relating to object- and residue-adhesiveness.

Risk Management of Dairy Product Losses as a Tool to Improve the Environment and Food Rescue

“Food loss”, defined as food produced for human consumption, which for various reasons leaves the supply chain, can be assigned to a group of new risks. Irrational use of food constitutes a risk to the environment. Moreover, food losses represent a missed opportunity to improve global food security. The aim of this study was to develop a risk management model for dairy product losses using the example of ripening cheese. The necessary data to develop the model were derived from a survey that was conducted in five dairies located in Poland. Total losses for nine products amounted to 1.1% of the average annual production, which accounted for more than 5635 t per annum. The studies that were conducted allowed the identification of three management methods of food loss in dairies: reprocessing, hand over for feed, and disposal. The level of risk was defined as “high” with two suggested courses of action: prevention and tolerance. Risks must be prevented by eliminating any errors that may result in a product of inadequate quality. Another solution is to redistribute or sell products at a reduced price, which despite their reduced quality, are nevertheless suitable for consumption. To some extent, this risk must be tolerated.

Explaining the food safety behaviours of food handlers using theories of behaviour change: a systematic review

Theories of behaviour change can explain the factors affecting food handlers' use of food safety practices. A systematic review was conducted on this topic to identify which theories have been applied in this area and to determine which theories are the most consistent predictors of food handlers' behaviours. Standard systematic review procedures were followed: comprehensive search strategy; relevance screening of abstracts; article characterization; data extraction; risk-of-bias assessment; and descriptive analysis. Among 19 relevant studies, the most commonly investigated theories were the Theory of Planned Behaviour (n = 9 studies) and Health Belief Model (n = 5). All investigated theories were useful to explain food handlers' behavioural intentions and behaviours related to food safety across different settings, and could serve as useful frameworks for future research and practice. However, there was wide variability in the predictive ability of the theories and their specific constructs, indicating theories should be adapted to the local context of application.

Using Olfaction and Unpleasant Reminders to Reduce the Intention-behavior Gap in Hand Washing

Lack of hand washing is a leading cause of food borne illnesses. To successfully increase hand hygiene compliance, interventions must have continual engagement with employees. This study used a real-time prospective memory (PM) scenario to measure the effectiveness of a control and sensory reminders of disgust to influence hand washing behavior and performance. First, a model of hand washing performance was built by having six participants' hands contaminated with GermGlo (a florescent micro-particle) and then washed their hands using predetermined protocols while monitored by an electronic hand hygiene verification (HHV) system. Next, eighty Hispanic/Latino participants, in a between-group experimental design, performed a PM experiment while one of four reminders were present (hand washing poster, disgusting image, disgusting sound, and disgusting odor) as the HHV recorded their hand washing performance. Visual cues, typical of hand washing campaigns, were not as effective at increasing hand hygiene compliance as disgust-induced sensory cues. Furthermore, olfactory disgust showed a significantly higher probability that individuals would engage in hand washing behaviors than all other conditions. This study provides new insight into the effectiveness of different senses and emotion to reduce the intention-behavior gap associated with modifying behaviors, and broadens current PM research to a real-time application.