Domestic refrigerator temperatures in Spain: Assessment of its impact on the safety and shelf-life of cooked meat products

Which domestic refrigerator temperatures in Europe? - Focus on shelf-life studies regarding Listeria monocytogenes (Lm) in ready-to-eat (RTE) foods

Listeria monocytogenes (Lm) is a pathogenic bacteria able to grow at refrigerated temperatures, widely distributed in the environment. This bacteria is susceptible to contaminate various food products of which refrigerated ready-to-eat foods (RTEF) may pose a risk for public health. In Europe, food business operators (FBOs) shall ensure that foodstuffs comply with the relevant microbiological criteria set out in the Regulation (EC) N°2073/2005. Food safety criteria for Lm are defined in RTEF throughout their shelf-life. FBOs should implement studies to demonstrate that the concentration of Lm does not exceed 100 CFU/g at the end of the shelf-life, taking into account foreseeable conditions of distributions, storage and use, including the use by consumers. However, this last part of the cold chain for food products is the most difficult to capture and control. For this purpose, the European Union Reference Laboratory for Lm (EURL Lm) launched an inquiry to its National Reference Laboratory network and reviewed the scientific literature from 2002 to 2020. The outcomes were integrated in the technical guidance document of the EURL Lm to assess shelf-life of RTEF which resulted in the recommendation to use 10 °C as the reference temperature to simulate the reasonably foreseen storage conditions in domestic refrigerators.

Assessment of the exposure to cytotoxic Bacillus cereus group genotypes through HTST milk consumption

This study addresses the limited tools available for assessing food safety risks from cytotoxic Bacillus cereus group strains in contaminated food. We quantified the growth, in skim milk broth, of 17 cytotoxic B. cereus strains across 6 phylogenetic groups with various virulence gene profiles. The strains did not grow in HTST milk at 4 or 6°C. At 10°C, 15 strains exhibited growth; at 8°C, one strain grew; and all strains grew at temperatures ≥ 14°C. Using growth data from 16 strains, we developed linear secondary growth models and an exposure assessment model. This model, simulating a 5-stage HTST milk supply chain and up to 35 d of consumer storage with an initial contamination of 100 cfu/mL, estimated that 2.81 ± 0.66% and 4.13 ± 2.53% of milk containers would surpass 105 cfu/mL of B. cereus by d 21 and 35, respectively. A sensitivity analysis identified the initial physiological state of cells (Q0) as the most influential variable affecting predictions for specific isolates. What-if scenarios indicated that increases in mean and variability of consumer storage temperatures significantly affected the predicted B. cereus concentrations in milk. This model serves as an initial tool for risk-based food safety decision making regarding low-level B. cereus contamination.

Development of a quantitative microbiological spoilage risk assessment (QMSRA) model for cooked ham sliced at retail

A quantitative microbiological spoilage risk assessment model (QMSRA) for cooked ham sliced at retail was developed based on a stochastic growth model for lactic acid bacteria (LAB), which are considered as the specific spoilage organisms (SSO), and a "spoilage-response" relationship characterizing the variability in consumer's perception of spoilage. In a simulation involving 10,000 cooked ham purchases, the QMSRA model predicted a median of zero spoilage events for up to 4.5 days of storage. After storage times of 5 and 6 days, the model predicted 1,790 and 8,570 spoilage events, respectively. A sensitivity analysis showed that domestic storage temperature was the most significant factor affecting LAB concentration in cooked ham, followed by the LAB contamination level at slicing. A scenario analysis was performed testing better temperature control of consumer's refrigerators, better hygiene conditions during slicing and a combination of the two strategies. Among the tested scenarios, a 2 log reduction in the LAB contamination at slicing combined with a 2 °C decrease in domestic storage temperature resulted in zero risk of spoilage for up to 12 days of storage. The QMSRA model developed in the present study can be a useful tool for quality management decisions.

Temperature status of domestic refrigerators and its effect on the risk of listeriosis from ready-to-eat (RTE) cooked meat products

Inadequate domestic refrigeration is frequently cited as a factor that contributes to foodborne poisoning and infection, and consumer behaviour in this regard can vary largely. This study provides insight into the temperature profiles of domestic refrigerators in the Netherlands and the impact on the number of listeriosis cases related to ready-to-eat (RTE) cooked meat products. A survey was conducted among Dutch consumers (n = 1020) to assess their knowledge and behaviour related to refrigerators. Out of these participants, 534 measured their refrigerator's temperature, revealing an average temperature of 5.7 °C (standard deviation (SD) of 2.2 °C) with a maximum of 17 °C. Elderly people (65 years and older) had refrigerators with temperatures that were on average 0.6 °C higher than those of younger people (35 years or younger). The 24-hour temperature profiles of an additional set of actively surveyed refrigerators (n = 50) showed that the temperature measured on the upper shelf was significantly higher (mean 7.7 °C, SD 2.7 °C) than the temperature measured on the bottom shelf (5.7 °C, SD 2.1 °C). Quantitative Microbiological Risk Assessment (QMRA) predicted that the primary factors contributing to the risk of listeriosis were the initial concentration and the time and temperature during household storage. Scenario analysis revealed that storing opened RTE cooked meat products at home for either <7 days or at temperatures <7 °C resulted in a significant reduction of over 80 % in predicted illness cases. Among all illness cases, the elderly represented nearly 90 %. When assessing the impact of the disease in terms of Years of Life Lost (YLL), the contribution of the elderly was 59 %. Targeted communication, particularly directed towards the elderly, on the importance of storing RTE cooked meat products at the recommended temperature on the bottom or middle shelf as well as consuming within two to three days after opening, holds the potential to significantly reduce the number of cases.

Development and deployment of a supply-chain digital tool to predict fluid-milk spoilage due to psychrotolerant sporeformers

Psychrotolerant sporeformers pose a challenge to maintaining fluid milk quality. Dynamic temperature changes along the supply chain can favor the germination and growth of these bacteria and lead to fluid milk spoilage. In this study, we aim to expand on our previous work on predicting milk spoilage due to psychrotolerant sporeformers. The key model innovations include (1) the ability to account for changing temperatures along the supply chain, and (2) a deployed user-friendly interface to allow easy access to the model. Using the frequencies and concentrations of 8 Bacillales subtypes specific to fluid milk collected in New York, the model simulated sporeformer growth in half-gallons of high-temperature, short-time (HTST) pasteurized fluid milk transported from processing facility to retail store and then to consumer. The Monte Carlo simulations predicted that 44.3% of half-gallons of milk were spoiled (defined as having a bacterial concentration >20,000 cfu/mL, a conservative estimate that represents the Pasteurized Milk Ordinance regulatory limit) after 21 d of refrigerated storage at consumer's home. Model validations showed that the model was the most accurate in predicting the mean sporeformer concentration at low temperatures (i.e., at 3°C and 4°C; compared with higher temperatures at 6°C and 10°C) within the first 21 d of consumer storage, with a root mean square error of 0.29 and 0.34 log10 cfu/mL, respectively. Global sensitivity analyses indicated that home storage temperature, facility-to-retail transportation temperature, and initial spore concentration were the 3 most influential factors for predicting milk spoilage on d 21 of shelf life. What-if scenarios indicated that microfiltration was predicted to be the most effective strategy to reduce spoilage. The implementation of this strategy (assumed to reduce initial spore concentration by 2.2 log10 cfu/mL) was predicted to reduce the percentage of spoiled milk by 17.0 percentage points on d 21 of storage and could delay the date by which 50% of half-gallons of milk were spoiled, from d 25 to 35. Overall, the model is readily deployed as a digital tool for assessing fluid milk spoilage along the supply chain and evaluating the effectiveness of intervention strategies, including those that target storage temperatures at different supply chain stages.

Effects of chlorine and peroxyacetic acid wash treatments on growth kinetics of Salmonella in fresh-cut lettuce

Fresh-cut produces are often consumed uncooked, thus proper sanitation is essential for preventing cross contamination. The reduction and subsequent growth of Salmonella enterica sv Thompson were studied in pre-cut iceberg lettuce washed with simulated wash water (SWW), sodium hypochlorite (SH, free chlorine 25 mg/L), and peroxyacetic acid (PAA, 80 mg/L) and stored for 9 days under modified atmosphere at 9, 13, and 18 °C. Differences in reduction between SH and PAA were non-existent. Overall, visual quality, dehydration, leaf edge and superficial browning and aroma during storage at 9 °C were similar among treatments, but negative effects increased with temperature. These results demonstrated that PAA can be used as an effective alternative to chlorine for the disinfection of Salmonella spp. in fresh-cut lettuce. The growth of Salmonella enterica sv Thompson was successfully described with the Baranyi and Roberts growth model in the studied storage temperature range, and after treatment with SWW, chlorine, and PAA. Subsequently, predictive secondary models were used to describe the relationship between growth rates and temperature based on the models' family described by Bělehrádek. Interestingly, the exposure to disinfectants biased growth kinetics of Salmonella during storage. Below 12 °C, growth rates in lettuce treated with disinfectant (0.010-0.011 log CFU/h at 9 °C) were lower than those in lettuce washed with water (0.016 log CFU/h at 9 °C); whereas at higher temperatures, the effect was the opposite. Thus, in this case, the growth rate values registered at 18 °C for lettuce treated with disinfectant were 0.048-0.054 log CFU/h compared to a value of 0.038 log CFU/h for lettuce treated with only water. The data and models developed in this study will be crucial to describing the wash-related dynamics of Salmonella in a risk assessment framework applied to fresh-cut produce, providing more complete and accurate risk estimates.

Consumer attitudes and perceptions towards chilled ready-to-eat foods: a multi-national study

Understanding consumers' behavior and their handling of high-risk foods at home is essential for reducing the number of foodborne illnesses. This study shows the results of a cross-national analysis of consumers' perception from nine countries, and the identification of customers' clusters and its characteristics in order to understand customers' behavior, and to build safe chilled ready-to-eat (RTE) foods prevention strategies. The cluster analysis resulted in two clusters: (1) "Precautious consumers" characterized by the orientation towards pre-packed RTE foods, with consumers mainly coming from Bosnia and Herzegovina, India, Poland, Portugal, Spain, and Turkey. Their attitudes and self-reported practices may be categorized as less risky in terms of food-borne illnesses connected with the consumption of RTE foods; (2) "Unconcerned consumers" preferred cutting and slicing RTE foods freshly at the point of purchase, usually sold at the delicatessen department in a supermarket or at open markets. Those consumers mostly came from Croatia, Serbia and Slovenia and their attitudes and self-reported practices were riskier. These results allow a better understating of what characterizes consumers of RTE foods in different countries.

Survey of Domestic Refrigerator Storage Temperatures in Poland for Use as a QMRA Tool for Exposure Assessment

In the framework of Quantitative Microbiological Risk Assessment, the estimation of the ingested dose of a hazard by the consumer is of paramount importance. This may be calculated by means of predictive modeling of growth/inactivation of the pathogen studied. For products that spend the majority of their shelf life in the domestic refrigerator, storage temperature will significantly impact the microbial population dynamics. To describe the variability of domestic storage temperatures in Poland, a survey including 77 participants, was carried out in Lodz, Poland. Participants were provided with temperature data loggers, which measured their refrigerator temperature for 24 h in 5-min intervals. The temperature-time profiles were used to calculate the mean working temperature, standard deviation, minimum and maximum values, and the data were statistically analyzed to find the best fitting probability distribution using R programming language. Out of the tested refrigerators, 49.35% had a mean working temperature of over 5 °C and 3.9% exceeded 10 °C. Distribution fitting scenarios were tested for goodness of fit, and the final selected distribution was a truncated normal distribution. This study can prove useful in Monte Carlo simulation analysis for stochastic quantitative food risk assessment in Poland.

Deterministic Approach and Monte Carlo Simulation to Predict Listeria monocytogenes Time to Grow on Refrigerated Ham: A Study Supporting Risk-based Decisions for Consumers' Health

This study assessed the growth of Listeria monocytogenes in ready-to-eat (RTE) ham during storage under conditions simulating domestic practices with the intention to offer support in the elaboration of food safety policies that should better protect consumers against food poisoning at home. RTE ham, artificially contaminated at either medium (10²-10³ CFU/g) or high (10⁴-10⁵ CFU/g) concentration, was stored at both isothermal (4℃ in a refrigerator able to maintain a relatively constant temperature and 5℃ and 7℃ in a refrigerator with fluctuating temperature) and dynamic (5℃ and 7℃ with intermittent exposure to ambient temperature, e.g. 25℃) conditions. Under isothermal conditions, the increasing storage temperature determined a significantly increased (p < 0.05) capacity of L. monocytogenes to grow. The kinetic growth parameters were derived by fitting the Baranyi and Roberts model to the experimental data and, based on the maximum specific growth rates, it was estimated the temperature dependence of L. monocytogenes growth in RTE ham. At medium contamination level, sanitary risk time calculation revealed that, unlike storage at 5℃ and 7℃, storage at 4℃ of the RTE ham extends the time period during which the product is safe for consumption by ∼40 and 52%, respectively. However, the real temperature fluctuations included in the Monte Carlo simulations at low L. monocytogenes counts (1, 5 and 10 CFU/g) have shortened the safety margins. Stochastic models also proved to be useful tools for describing the pathogen's behavior when refrigeration of the RTE ham alternates with periods of ham being kept at room temperature, considered dynamic conditions of growth.

Cold chain relevance in the food safety of perishable products

The food cold chain is an effective tool that allows food markets to maintain food quality and reduce losses. Poor logistics may result in foodborne disease outbreaks and greenhouse gas emissions caused by organic matter decay. The ongoing pandemic of COVID-19 makes it necessary to study the chances of SARS-CoV-2 transmissions in food products. This study reviews cold chain logistics as a handy tool for avoiding food safety risks, including COVID-19. The cold chain of perishables and its proper management make it possible to maintain quality and safety at any stage of the food supply chain. The technology covers each link of the food chain to prevent microbial spoilage caused by temperature fluctuations and the contamination with SARS-CoV-2 associated with perishable foods. Given the lack of knowledge in this field in Latin America, the region needs new research to determine the impact of the cold chain on perishable foodstuffs. The perishable cold chain is only as strong as its weakest link, and the national and international markets require new traceability protocols to minimize the effect of COVID-19.

Low-Cost Nonreversible Electronic-Free Wireless pH Sensor for Spoilage Detection in Packaged Meat Products

Contamination of meat with pathogenic microorganisms can cause severe illnesses and food waste, which has significant negative impacts on both general health and the economy. In many cases, the expiration date is not a good indicator of meat freshness as there is a high risk of contamination during handling throughout the supply chain. Many biomarkers, including color, odor, pH, temperature, and volatile compounds, are used to determine spoilage. Among these, pH presents a simple and effective biomarker directly linked to the overgrowth of bacteria and degradation of the meat tissue. Low-cost methods for wireless pH monitoring are crucial in detecting spoilage on a large commercial scale. Existing technologies are often limited to short-range detection, with the use of batteries and different electronic components that increases both the manufacturing complexity and cost of the final device. To address these shortcomings, we have developed a cost-effective wireless pH sensor, which uses passive resonant frequency (RF) sensing, combined with a pH-responsive polymer that can be placed within packaged meat products and provide a remote assessment of the risk of microbial spoilage throughout the supply chain. The sensor tag consists of a sensing resonator coated with a pH-sensitive material and a passivated reference resonator operating in a differential frequency configuration. Upon exposure to elevated pH levels >6.8, the coating on the sensing resonator dissolves, which in turn results in a distinct change in the resonant frequency with respect to the reference resonator. Systematic theoretical and experimental results at different pH levels demonstrated that a 20% shift in resonant frequency demarcates the point for spoilage detection. As a proof of concept, the performance of the sensor in remotely detecting the risk of food spoilage was validated in packaged poultry over 10 days. The sensor fabrication process takes advantage of recent developments in the scalable manufacturing of flexible, low-cost devices, including selective laser etching of metalized plastic films and doctor-blade coating of stimuli-responsive polymer films. Furthermore, the biocompatibility of all the materials used in the sensor was confirmed with human intestinal cells (HCT-8 cells).

Analysis of microbiota structure in cooked ham as influenced by chemical composition and processing treatments: Identification of spoilage bacteria and elucidation on contamination route

Spoilage in cooked ham is one of the main challenges where microbial contamination can play a fundamental role. This study aimed to characterize pork-cooked ham's microbial community changes among different food production conditions (formulation and processing) using 16S rRNA sequencing and also to investigate the spoilage bacteria in order to elucidate their contamination route. Samples of three pork-cooked ham references with and without post-pasteurization treatment and in contact with the slicing-packaging conveyor belt and slicer and packager surfaces were performed by 16S rRNA gene sequencing. In order to clarify the contamination route, surfaces were sampled by conventional microbiological methods. Results showed that Leuconostoc spp. was the principal genera in spoiled cooked ham and had no relation neither to formulation nor contact with the slicing-packaging conveyor belt. The contamination route found for Leuconostoc spp. was associated with the storage and packaging zone. In addition, the calculated shelf-life decreased to 57.5% independently of the environment interaction minimization when ham casing permeability was changed and linked to contamination of spoilage bacteria during the slicing and packaging process. This research illustrates how the combined approach provides complementary results to implement suggestions in the facility to reduce the cross-contamination with spoilage bacteria. It also generates tools to comprehend and propose transference models understanding the environmental and intrinsic factors related to microbial transfer rate.

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The structure of the bacterial community in cooked ham had no relation to the formulation.

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Genus Leuconostoc dominated the spoilage in cooked ham.

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The methodology allows validating the contamination route for spoilage bacteria.

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Post-pasteurization treatment reduce microbiota diversity.

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The ham shelf lifetime decrease get related to cross-contamination during slicing.

Quantitative risk assessment of Listeria monocytogenes in ready-to-eat (RTE) cooked meat products sliced at retail stores in Greece

A quantitative microbial risk assessment (QMRA) model predicting the listeriosis risk related to the consumption of Ready- To- Eat (RTE) cooked meat products sliced at retail stores in Greece was developed. The probability of illness per serving assessed for 87 products available in the Greek market was found highly related to the nitrite concentration; products having a lower concentration showed a higher risk per serving. The predicted 95^th percentiles of the annual listeriosis cases totaled 33 of which 13 cases were <65 years old and 20 cases ≥65 years old. The highest number of cases was predicted for mortadella, smoked turkey, boiled turkey and parizer, which were the most frequently consumed product categories. Two scenarios for assessing potential interventions to reduce the risk were tested: setting a use-by date of 14 days (these products have no use-by date based on current European Union legislation) and improving the temperature control during domestic storage. The two scenarios resulted in a decrease of the 95^th and 99^th percentiles of the total annual cases by 97% and 88%, respectively.

Guidance on date marking and related food information: part 2 (food information)

A risk-based approach was used to develop guidance to be followed by food business operators (FBOs) when deciding on food information relating to storage conditions and/or time limits for consumption after opening a food package and thawing of frozen foods. After opening the package, contamination may occur, introducing new pathogens into the food and the intrinsic (e.g. pH and aw), extrinsic (e.g. temperature and gas atmosphere) and implicit (e.g. interactions with competing background microbiota) factors may change, affecting microbiological food safety. Setting a time limit for consumption after opening the package (secondary shelf-life) is complex in view of the many influencing factors and information gaps. A decision tree (DT) was developed to assist FBOs in deciding whether the time limit for consumption after opening, due to safety reasons, is potentially shorter than the initial 'best before' or 'use by' date of the product in its unopened package. For products where opening the package leads to a change of the type of pathogenic microorganisms present in the food and/or factors increasing their growth compared to the unopened product, a shorter time limit for consumption after opening would be appropriate. Freezing prevents the growth of pathogens, however, most pathogenic microorganisms may survive frozen storage, recover during thawing and then grow and/or produce toxins in the food, if conditions are favourable. Moreover, additional contamination may occur from hands, contact surfaces or contamination from other foods and utensils. Good practices for thawing should, from a food safety point of view, minimise growth of and contamination by pathogens between the food being thawed and other foods and/or contact surfaces, especially when removing the food from the package during thawing. Best practices for thawing foods are presented to support FBOs.

Thermolabile drug storage in an ambulatory setting

More thermolabile drugs are becoming available, and in most cases, these medications are dispensed to ambulatory patients. However, there is no regulation once medications are dispensed to patients and little is known with regard to what happens during transport and home storage. Previous studies suggest that these drugs are improperly stored. The present study was designed to determine the storage conditions of thermolabile drugs once they are dispensed to the patient in the Hospital Pharmacy Department. This is a prospective observational study to assess the temperature profile of 7 thermolabile drugs once they are dispensed to ambulatory patients at a tertiary care hospital. A data logger was added to the medication packaging. Temperature was considered inappropriate if one of the following circumstances were met: any temperature record less than or equal to 0 °C or over 25 °C; temperatures between 0-2 or 8-25 °C for a continuous period over 30 min. The time series of temperature measurements obtained from each data logger were analyzed as statistically independent variables. The data shown did not undergo any statistical treatment and must be considered directly related to thermal measurements. One hundred and fourteen patients were included and 107 patients were available for the analysis. On the whole, a mean of 50.6 days (SD 18.3) were measured and the mean temperature was 6.88 °C (SD 2.93). Three data loggers (2.8%) maintained all the measurements between 2 and 8 °C with less than 3 continuous data (< 30 min) out of this range but no data over 25 °C or below or equal to 0 °C. 28 (26.2%) data loggers had at least one measurement below zero, 1 data logger had a measurement greater than 25 °C and 75 (70.1%) were between 0 and 2 °C and/or between 8 and 25 °C for more than 30 min. In conclusion, once dispensed to patients, most thermolabile drugs are improperly stored. Future studies should focus on clinical consequences and possible solutions.

Guidance on date marking and related food information: part 1 (date marking)

A risk-based approach was developed to be followed by food business operators (FBO) when deciding on the type of date marking (i.e. 'best before' date or 'use by' date), setting of shelf-life (i.e. time) and the related information on the label to ensure food safety. The decision on the type of date marking needs to be taken on a product-by-product basis, considering the relevant hazards, product characteristics, processing and storage conditions. The hazard identification is food product-specific and should consider pathogenic microorganisms capable of growing in prepacked temperature-controlled foods under reasonably foreseeable conditions. The intrinsic (e.g. pH and aw), extrinsic (e.g. temperature and gas atmosphere) and implicit (e.g. interactions with competing background microbiota) factors of the food determine which pathogenic and spoilage microorganisms can grow in the food during storage until consumption. A decision tree was developed to assist FBOs in deciding the type of date marking for a certain food product. When setting the shelf-life, the FBO needs to consider reasonably foreseeable conditions of distribution, storage and use of the food. Key steps of a case-by-case procedure to determine and validate the shelf-life period are: (i) identification of the relevant pathogenic/spoilage microorganism and its initial level, (ii) characterisation of the factors of the food affecting the growth behaviour and (iii) assessment of the growth behaviour of the pathogenic/spoilage microorganism in the food product during storage until consumption. Due to the variability between food products and consumer habits, it was not appropriate to present indicative time limits for food donated or marketed past the 'best before' date. Recommendations were provided relating to training activities and support, using 'reasonably foreseeable conditions', collecting time-temperature data during distribution, retail and domestic storage of foods and developing Appropriate Levels of Protection and/or Food Safety Objectives for food-pathogen combinations.

Temperatures and storage conditions in domestic refrigerators - Slovenian scenario

Cold chain maintaining is least stable at its end, where domestic storage often represents one of the most critical links because of storage time and inappropriate temperatures, increasing the risk of food-borne outbreaks in domestic households. Considering the time-temperature profile of refrigerators as a food safety indicator, the purpose of this study is to gain insight into refrigeration temperatures in parallel with refrigerator and household characteristics that could potentially influence the refrigeration temperatures. During a 24 h period in 15-min intervals, internal temperature of the test product, refrigerator air and ambient air temperatures were measured with one penetration and two air probes coupled with a data logger. The internal temperature of the test product was measured with pre-prepared “Karlsruhe Test Material”, which had thermal properties similar to those of lean beef. Refrigerator and household characteristics were collected with a predefined observational sheet and short, structured questionnaire. In total, 50 households and their refrigerators were included. Gaps related to the cold storage and cross-contamination were observed. Temperature displays were present in 16% while control thermometers were not observed at all; 20% of the refrigerators enabled 24 h average internal temperature lower than 4 °C, 30% between 4 and 6 °C and 50% over 6 °C. Refrigerator age, type and load were observed but had no significant impact, which suggests thermostat setting as a key factor influencing refrigerator temperatures. Food distribution inside refrigerators was related to the refrigerator load with significant risk for cross-contamination in overpacked refrigerators. High temperatures combined with a non-systematic distribution of food in the refrigerator, expired dates of durability, and non-systematic cleaning strategies allow favourable preconditions for food infections occurring at the end of the food supply chain. Tailored acceleration of existing food safety messages could and should help consumers to minimise food safety risks, improve food quality, and reduce food wastage.

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Gaps related to the cold storage and cross-contamination were observed.

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One third of refrigerators provided recommended temperatures.

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Temperature displays present in 16% while control thermometers not observed at all.