Preventing food-borne illness in food service establishments: Broadening the framework for intervention and research on safe food handling behaviors

What motivates food workers to adhere with WHO guidelines to combat the COVID-19? A social cognitive theory perspective

Background

COVID-19 has become a public health emergency and pandemic of global concern, and the hundreds of millions of foodborne illnesses that occur each year also wreak havoc on human lives, society and the economy. Promoting workers in food service establishments to adhere to the hygiene practices in the WHO guidelines is a two-birds-one-stone strategy in preventing the spread of COVID-19 and limiting the occurrence of foodborne illness. The aim of this study was to determine the drivers that motivate workers to adhere to hygiene practices based on social cognitive theory.

Methods

The cross-sectional survey targeting food workers using face-to-face interviews was conducted from July to September 2022. Stratified random sampling and convenience sampling were employed to locate survey sites and respondents, respectively. The survey uses a credible questionnaire evaluated by multiple reliability and validity measures. Binary logistic regression was employed to identify significant determinants of adherence to WHO-initiated hygiene practices.

Results

A total of 900 workers were interviewed and 609 valid questionnaires were received. The study showed that the average correct rate of knowledge about hygiene practices was only 51.09%, that perceived non-adherence to hygiene practices was most likely to result in lower customer satisfaction and the spread of COVID-19, and that only about 11.7% of the workers always adhered to hygiene practices. Three of the cognitive dimensions in the personal factors, self-efficacy, risk perception, and knowledge, had significant positive effects on adherence practices. Among the demographic variables, there were significant differences in adherence practices differing by income level and place of residence.

Conclusion

It was found that workers' knowledge of the WHO-initiated hygiene practices is insufficient and that the frequency of adherence to hygiene practices is poor and require improvement. The significant drivers and effects of demographic variables provide evidence-based guidance to identify priority intervention information and populations to improve worker hygiene practices.

Food Safety Knowledge among Professional Food Handlers in Slovenia: The Results of a Nation-Wide Survey

The authors present and discuss the results of a nation-wide survey on food safety knowledge among professional food handlers in Slovenia. The data were collected via a telephone survey using a well-established questionnaire adapted to the Slovenian context. Altogether, 601 respondents from hotels, restaurants, catering, and confectionery units completed the questionnaire. To assess food safety knowledge among food handlers in both general and specific domains, three indexes (a General Knowledge Index, a Personal Knowledge Index, and a Temperature Knowledge Index) were created. Among them, the Temperature Knowledge Index revealed the largest gaps in knowledge. An insufficient transfer of food safety knowledge from managers and chefs to assistant chefs and kitchen assistants in establishments where more persons handle food was evident, while a course titled "Hygiene Minimum" of standardised training from the past still significantly contributes to food safety knowledge. The results suggest a need for improvement in the current system of food safety training courses for professional food handlers in Slovenia. The human factor in the food supply chain still has a significant role in ensuring food safety culture, and therefore must become a more important part of the food safety management system.

The Evolutionary Game Analysis of Low Carbon Production Behaviour of Farmers, Government and Consumers in Food Safety Source Governance

Whether the quality of agricultural products is safe or not is related to issues of food safety and low carbon production in agriculture. Based on evolutionary game theory, this paper establishes a game model among government, farmers and consumers and analyzes the dynamic evolutionary process and evolutionary stable strategies of the major stakeholders. The results show that: (i) government subsidy coefficient, farmers' penalty coefficient for not producing, consumer trust coefficient and willingness to pay carbon labelled agricultural products premium are positively related to farmers' adoption of low-carbon production behaviour, and fraud penalty coefficient and farmers' cost of adopting low-carbon production technology are negatively related; (ii) farmers' sensitivity to government regulation policies is: fraud penalty coefficient = farmers' cost of adopting low-carbon production technology > government subsidy The sensitivity of farmers to government regulation policies is: fraud penalty coefficient = cost of low-carbon production technology > government subsidy > penalty coefficient for non-production, and the sensitivity of farmers to direct market stimulation is: consumer trust coefficient > coefficient of willingness to pay premium for carbon labelled agricultural products, and the additional benefit coefficient has no significant effect on farmers' decision-making; (iii) In the early stage, the source control of food safety mainly depends on the government's policy intervention. In the later stage, the establishment of carbon label agricultural products market incentive mechanism can achieve long-term stable and effective source control of food safety.

Job Crafting and Burnout as Predictors of Food Safety Behaviors in the Foodservice Industry

This study aimed to investigate whether job crafting, burnout, and work engagement predict food safety behaviors in the foodservice industry. It was a cross-sectional study conducted in Cuiabá (Brazil) among foodservice workers. Four instruments were used among foodservice workers for the examination: (a) job demands and resources, (b) job satisfaction, (c) burnout, and (d) work engagement. Food safety practices were measured using a validated risk-based checklist. Partial least squares structural equation modeling was used to test the hypothesis model. In this study, 22 restaurants and 302 foodservice workers were examined. It was found that the “job demands-resources” model was valid for foodservice workers, i.e., burnout was strongly predicted by job demands (β = 0.550; p < 0.001); job resources were a positive predictor of work engagement (β = 0.258; p < 0.001); and burnout was a negative predictor of work engagement (β = −0.411; p < 0.001). Food safety violations were predicted by job crafting (β = −0.125; p = 0.029) and burnout (β = 0.143; p = 0.016). The results indicate that mitigating burnout and increasing job crafting can be important supporting strategies to improve food safety behaviors.

Initial Reports of Foodborne Illness Drive More Public Attention Than Do Food Recall Announcements

ABSTRACT

Recall announcements by the U.S. Food and Drug Administration (FDA) and Food Safety and Inspection Service (FSIS) are important communication tools. Nonetheless, previous studies revealed that the effects of recalls on consumer demand are small. Social media analytics can provide insights into public awareness of food safety-related incidents. This study included social listening data to analyze how the public, in social and online media spaces, responds to, interacts with, and references food safety recalls and/or initial announcements of foodborne illness outbreaks as reported by the Centers for Disease Control and Prevention (CDC). Analysis results suggest that mentions quantified in the social and online media searches moved closer in step with the CDC's initial reports of foodborne illness outbreaks than did FDA and FSIS recall announcements. Issuance of recalls may not be a popular source of food risk information in the social media space compared with reactions to the CDC's initial illness reports. This relative popularity reflects people more often sharing or posting about illness risk regardless of whether a recall occurs, suggesting that recall announcements by the FDA and FSIS may not induce changes in consumers' behavior, whereas initial illness reports by the CDC may. Although recalls by the FDA and FSIS may not generate social media posts, their primary role is to take potentially unsafe food items off grocery shelves. Online media analytics provide policy makers with information to guide effective food risk communication; initial CDC reports drive immediate attention more than do FDA and FSIS recalls.

HIGHLIGHTS

An Integrative Review of Hygiene Practice Studies in the Food Service Sector

ABSTRACT

This article reviews the recent literature on studies relevant to hygiene practices of food service workers. A total of 32 articles were chosen for evaluation from a systematic search of the published literature from 2014 to 2019. For the assessment of hygiene practices, hand washing as a measurement item and observation as a method were most frequently used. Factors influencing hygiene practices were categorized as internal and external variables. Internal variables included knowledge; psychological factors, such as attitude, risk perception, self-efficacy, and optimistic bias; and food handlers' sociodemographic characteristics, such as work experience and exposure to hygiene training. External variables included characteristics of food premises, such as the size of the operation and number of people served, and organizational factors, such as training. Regarding the recent training literature, attempts to bring in new methodologies and new technologies were found, such as multimedia case studies, cognitive word association, behavior-focused training, wearable technology, and simulation games. Among the theories utilized, knowledge, attitude, and practices were applied most frequently to explain hygiene practices. In particular, this review highlights the important fact that internal and external factors that affect hygiene practices should be considered to maintain good hygiene practices.

HIGHLIGHTS

An assessment of the food safety knowledge and attitudes of food handlers in hospitals

BACKGROUND

The possession of inadequate food safety knowledge (FSK) by food handlers poses a serious threat to food safety in service establishments. The aim of this research was to investigate factors that influenced the FSK and food safety attitudes (FSA) of employees involved in the preparation and/or the serving of food from nine hospitals in the Capricorn District Municipality (CDM) in Limpopo Province, South Africa.

METHOD

Up to 210 individuals (18-65 years) who were employed in these hospitals, and who were involved in the preparation and serving of food to patients were purposefully selected. Data collection was by means of an interview using a questionnaire design for this study. The FSK and FSA scores of hospital food handlers were obtained by adding the correct response to FSK or FSA questions.

RESULTS

Only 29% of the hospital food handlers have attended a food safety-training course. Many food handlers were not knowledgeable on the correct temperature for handling foods, and on the correct minimum internal cooking temperature for poultry, seafood and egg. Only the minority of food handlers knew that Salmonella is the main foodborne bacteria pathogen mostly associated with poultry products (47.1%) and that food borne bacteria will grow quickly in food at a temperature of 37 °C (38.1%). Hospital food handlers with higher academic qualifications do not possess more FSK than those with lower academic qualifications. 51% of the hospital food handlers possessed a Satisfactory FSK while 10% possessed a Good FSK and 39% possessed an Inadequate FSK.

CONCLUSION

More than 60% of the hospital food handlers possesses either Good FSK or Satisfactory FSK. Higher levels of education, experience in food handling and job position did not lead to better FSK outcome. All the hospital food handlers possess at least a Satisfactory FSA. There was a weak positive but significant correlation between the FSK and FSA of hospital food handlers. It is recommended all employees involved in food handlers be subjected to food safety training programmes on a regular basis irrespective of their academic, employment and training details.

A systematic review and meta-regression of single group, pre-post studies evaluating food safety education and training interventions for food handlers

BACKGROUND

Food handlers working in retail and food service establishments are a frequent source of foodborne disease outbreaks. Numerous studies have investigated different education and training approaches to improve their safe food handling knowledge, attitudes, and practices. Frequently, these studies use a single group, pre-post design, measuring changes before and after an intervention without a separate control group.

OBJECTIVES

We conducted a systematic review of these studies to identify their key characteristics and to evaluate possible predictors of between study heterogeneity in their estimates of intervention effect.

METHODS

the review steps included a comprehensive search; relevance screening; article characterization; risk-of-bias assessment; data extraction; and meta-regression on five outcome categories: attitudes and beliefs, knowledge, behaviours, food premise inspection scores, and aerobic plate counts.

RESULTS

Among 85 relevant studies identified, the most commonly investigated intervention type was in-person, group-based training courses (81%). Interventions primarily targeted food handlers in educational institutions and restaurants (32% and 31%, respectively). The most frequently measured outcome was food handler knowledge (66%). Studies mostly (89%) covered multiple food safety content areas, primarily targeting personal hygiene (88%) and avoiding cross-contamination (87%). All studies were rated as 'critical' risk of bias given the lack of an independent control group. Significant intervention effects were found for all outcome categories, but substantial heterogeneity was also identified. Studies that informed their intervention from formative research reported larger effect sizes for attitude and belief outcomes, those that based their intervention on a theory of behaviour change reported larger effect sizes for behaviour outcomes, and those published in grey literature sources reported larger effect sizes for behaviour and knowledge outcomes.

IMPLICATIONS

The results of this review have identified food safety training and education research gaps and future opportunities.

Food Safety Performance in Food Manufacturing Facilities: The Influence of Management Practices on Food Handler Commitment

The purpose of the study was to investigate the influence of management practices on food handler commitment and, ultimately, food safety performance in food manufacturing facilities. Two focus groups, one with six food handlers and the other with six food safety professionals, were used to develop a conceptual model that measured the effect of management practices on food handler commitment and organizational performance. The fitness of the structural model was measured via a survey with 945 respondents from 189 food manufacturing facilities and official food inspectors in the Emirate of Dubai, United Arab Emirates. The study found that training, communication, employee involvement, and organizational management support positively and significantly influenced employee commitment, and employee commitment positively and significantly influenced facilities' food safety performance. These results indicate food handler commitment is a critical factor in the relationship between all of the studied management practices and facilities' food safety performance. The study may have implications for food safety inspectors, enforcement officers, training agencies, and food manufacturing managements to consider human aspects in their work.

Effectiveness of Food Handler Training and Education Interventions: A Systematic Review and Meta-Analysis

Improper food handling among those working in retail and food service settings is a frequent contributor to foodborne illness outbreaks. Food safety training and education interventions are important strategies to improve the behaviors and behavioral precursors (e.g., knowledge and attitudes) of food handlers in these settings. We conducted a comprehensive systematic review to identify, characterize, and synthesize global studies in this area to determine the overall effectiveness of these interventions. The review focused on experimental studies with an independent control group. Review methods included structured search strategy, relevance screening of identified abstracts, characterization of relevant articles, risk of bias assessment, data extraction, meta-analysis of intervention effectiveness for four outcome categories (attitudes, knowledge, behavior, and food premise inspection scores), and a quality of evidence assessment. We identified 18 relevant randomized controlled trials (RCTs) and 29 nonrandomized trials. Among RCTs, 25 (64%) unique outcomes were rated as high risk of bias, primarily owing to concerns about outcome measurement methods, while 45 (98%) nonrandomized trial outcomes were rated as serious risk of bias, primarily because of concerns about confounding bias. High confidence was identified for the effect of training and education interventions to improve food handler knowledge outcomes in eight RCT studies (standardized mean difference = 0.92; 95% confidence interval: 0.03, 1.81; I² = 86%). For all other outcomes, no significant effect was identified. In contrast, nonrandomized trials identified a statistically significant positive intervention effect for all outcome types, but confidence in these findings was very low due to possible confounding and other biases. Results indicate that food safety training and education interventions are effective to improve food handler knowledge, but more evidence is needed on strategies to improve behavior change.

Psychosocial and organizational determinants of safe food handling at retail and food service establishments: a systematic review and meta-analysis

Various psychosocial and organizational factors have been investigated as determinants of food handlers' food safety behaviours. A systematic review and meta-analysis of studies in this area was conducted to identify and synthesize the key behavioural determinants. Standard systematic review steps were followed: comprehensive search strategy; relevance screening; article characterization; risk of bias assessment; data extraction; and random-effects meta-analysis. Sixty-two relevant studies were identified, and knowledge was the most commonly investigated behavioural determinant (n = 51). Increased knowledge was consistently associated with safe food handing behaviours across both correlation (r = 0.30; 95% confidence interval [CI]: 0.12, 0.46; n = 24 studies; I² = 98%) and odds ratio (OR) measures (adjusted OR = 1.85; 95% CI: 1.27, 2.70; n = 3; I² = 0%). Seven other behavioural determinant categories were also consistently associated with various food safety behaviour outcomes. In contrast, no association was found between food handler experience and behaviour. The findings can inform the development of targeted training initiatives for food handlers.

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.

Knowledge, Attitude, and Practice toward Food Poisoning among Food Handlers and Dietetic Students in a Public University in Malaysia

Background:

Food poisoning (FP) commonly occurs because of consuming contaminated food, which can be fatal. Many people are not aware of the dangers of FP. Thus, the purpose of this study is to analyze the knowledge, attitude, and practice (KAP) of FP among dietetic students (DS) and food handlers (FH) in a public university in Malaysia.

Materials and Methods:

A cross-sectional study was designed, and a self-administered questionnaire was distributed to 106 respondents. The survey comprised four sections including sociodemographic, knowledge, attitude, and practice.

Results:

Total percentage scores for KAP for FH were 86.06%, 32.40%, and 19.91%, respectively, whereas the KAP scores for DS were 89.36%, 34.26%, and 19.94%, respectively. This study revealed that the respondents had good knowledge but poor attitude and practice toward FP. Total mean percentage of KAP scores for DS was higher than FH. Besides, no significant difference was observed in KAP toward FP across different genders, age, education, and income levels among FH. However, for DS, significant difference (p = 0.008) was observed in knowledge toward FP between genders. Significant association (p = 0.048) was also reported in practice toward FP with age among DS. This study also found a significant association between knowledge and attitude (p = 0.032) and knowledge and practice (p = 0.017) toward FP among FH.

Conclusion:

Nevertheless, among DS, no significant association was observed between knowledge, attitude and practice toward FP. The findings may help them to plan effective methods to promote better understanding about FP and improving their knowledge and awareness.

Efficacy Evaluation of Control Measures on the Reduction of Staphylococcus aureus in Salad and Bacillus cereus in Fried Rice Served at Restaurants

The objective of this study was to assess the effect of washing on Staphylococcus aureus reduction in salads and the effect of reheating on Bacillus cereus vegetative cells and spores reduction in fried rice at restaurants using the stochastic food safety objective (FSO) tool. The leaf vegetable was inoculated with S. aureus and washed with tap water, 100 ppm of NaClO, or 30 ppm of slightly acidic electrolyzed water (SAEW) for either 60 s or 5 min. The washing effect of 30 ppm SAEW was greater than that of 100 ppm NaClO. Based on the FSO concept, washing leaf vegetables with 30 ppm SAEW for 5 min was the most efficient control measure for S. aureus in salads. In addition, the salad should be consumed within 4 h at 25°C and 2 h at 35°C after 5 min of washing with 100 ppm NaClO or 30 ppm SAEW. The fried rice was first inoculated with B. cereus vegetative cells or spores and was then reheated in a frying pan at medium (internal temperature of fried rice: 69.2°C-78.8°C) or high heat (internal temperature of fried rice:103.8°C-121.4°C) or in a microwave oven (internal temperature of fried rice:86.3°C-90.6°C) for 3 or 4 min. Based on the FSO, reheating rice in a microwave oven was the most efficient control measure for B. cereus vegetative cells and spores in fried rice. The holding time for fried rice can be extended up to 6 h at 25°C, 3 h at 35°C, and 2 h at 45°C with reheating. Microbiological hazards in salads and fried rice can be controlled by washing with a sanitizer and reheating, respectively and then by controlling of holding temperature before being served at restaurants.

Assessing user acceptance towards automated and conventional sink use for hand decontamination using the technology acceptance model

Hand hygiene (HH) prevents harmful contaminants spreading in settings including domestic, health care and food handling. Strategies to improve HH range from behavioural techniques through to automated sinks that ensure hand surface cleaning. This study aimed to assess user experience and acceptance towards a new automated sink, compared to a normal sink. An adapted version of the technology acceptance model (TAM) assessed each mode of handwashing. A within-subjects design enabled N = 46 participants to evaluate both sinks. Perceived Ease of Use and Satisfaction of Use were significantly lower for the automated sink, compared to the conventional sink (p < 0.005). Across the remaining TAM factors, there was no significant difference. Participants suggested design features including jet strength, water temperature and device affordance may improve HH technology. We provide recommendations for future HH technology development to contribute a positive user experience, relevant to technology developers, ergonomists and those involved in HH across all sectors. Practitioner Summary: The need to facilitate timely, effective hand hygiene to prevent illness has led to a rise in automated handwashing systems across different contexts. User acceptance is a key factor in system uptake. This paper applies the technology acceptance model as a means to explore and optimise the design of such systems.

Food safety knowledge, attitude and self-reported practice of secondary school students in Beijing, China: A cross-sectional study

In China, food safety problems have occurred frequently in the past ten years, causing great concern for the public. Adolescents, with higher exposure to problematic food, represent a unique target for interventions aimed at risk reduction. To understand their food safety knowledge, attitude and practice, a cross-sectional survey using paper questionnaire was carried out among 4,220 students (median age of 14 years, 50.3% females) from nine secondary schools in 3 districts of Beijing. The findings showed that the majority of respondents (42.0%) had a high knowledge level. Significant association was found between food safety knowledge score (median = 11, IQR:9-13) and demographic characteristics of region, school type, residence type, habit of smoking and alcohol use, academic record and parents' education background. In terms of attitude and practice, only 17% of those surveyed regarded China's food safety situation as good, 53.6% regarded it as worrying; almost all students (96.5%) did pay attention to food safety; 95.3% of the students had worried about the safety of the food provided by the small restaurants and street peddlers, but in reality, as many as 69.4% often or occasionally bought food from peddlers around their campuses and nearly half continued the consumption of such food in spite of worrying about its safety problems. Overall, the food safety knowledge among Beijing secondary school students was relatively good. They did not show much confidence in the country's food safety situation, but many aware of the safety issues did not bother to change or take action. The study suggests that more systematic and targeted education on food safety is necessary for this age group.

A Systematic Review of the Use of Social Media for Food Safety Risk Communication

This article covers the current published literature related to the use of social media in food safety and infectious disease communication. The aim was to analyze literature recommendations and draw conclusions about how best to utilize social media for food safety risk communication going forward. A systematic literature review was conducted, and 24 articles were included for analysis. The inclusion criteria were (i) original peer-reviewed articles and (ii) primary focus on communication through social media about food safety and/or infectious diseases. Studies were coded for themes about social media applications, benefits, limitations, and best practices. Trust and personal beliefs were important drivers of social media use. The wide reach, immediacy, and information gathering capacities of social media were frequently cited benefits. Suggestions for social media best practices were inconsistent among studies, and study designs were highly variable. More evidence-based suggestions are needed to better establish guidelines for social media use in food safety and infectious disease risk communication. The information gleaned from this review can be used to create effective messages for shaping food safety behaviors.

Inside the black box of food safety: a qualitative study of 'non-compliance' among food businesses

Issue addressed This paper examines the meaning of food safety among food businesses deemed non-compliant and considers the need for an insider perspective to inform a more nuanced health promotion practice. Methods In-depth interviews were conducted with 29 food business operators who had recently been deemed 'non-compliant' through Council inspection. Results Paradoxically, these 'non-compliers' revealed a strong belief in the importance of food safety as well as a desire to comply with the regulations as communicated to them by Environmental Health Officers. Conclusions The evidence base of food safety is largely informed by the science of food hazards, yet there is a very important need to consider the practical daily application of food safety practices. This requires a more socially nuanced appreciation of food businesses beyond the simple dichotomy of compliant/ non-compliant. So what? Armed with a deeper understanding of the social context surrounding food safety practice, it is anticipated that a more balanced, collaborative mode of food safety health promotion could develop, which could add to the current model of regulation.

Preventing and controlling foodborne disease in commercial and institutional food service settings: a systematic review of published intervention studies

This study reviews the current literature on behavioral and environmental food safety interventions conducted in commercial and institutional food service settings. A systematic search of the published literature yielded 268 candidate articles, from which a set of 23 articles reporting intervention outcomes was retained for evaluation. A categorization of measured outcomes is reported; studies addressed multiple outcomes ranging from knowledge, attitudes, and behavior of personal hygiene and food safety to management practices and disease rates and outbreaks. This study also investigates the quality of reported research methods used to evaluate the effectiveness of the interventions, using a nine-point quality index adapted by the authors. The observed scores suggest that there are opportunities to improve the design and reporting of research in the field of foodborne disease prevention as it applies to food safety interventions that target the food service industry. The aim is to aid researchers in this area to design higher quality studies and to produce clearer and more useful reports of their research. In turn, this can help to create a more complete evidence base that can be used to continually improve interventions in this domain.

A follow-up study of hygiene in catering premises at large-scale events in the United Kingdom

AIMS

To investigate food hygiene practices at large events by assessing the microbiological quality of ready-to-eat food, drinking water, food preparation surfaces, cleaning cloths and wristbands worn by food handlers for event security purposes.

METHODS AND RESULTS

Over a 7-month period, 1662 samples were collected at 153 events and examined for microbiological contamination. Eight per cent of food samples were of an unsatisfactory quality. A further one per cent contained potentially hazardous levels of human pathogenic bacteria. 27% of water samples, 32% of swabs and 56% of cloths were also unsatisfactory. These results represented an improvement in hygiene compared to a previous study carried out 12 months previously. A fifth of food handler wristbands were contaminated with Enterobacteriaceae, Escherichia coli and/or coagulase-positive staphylococci, with those bands made from fabric being more frequently contaminated than those made from plastic or other materials.

CONCLUSIONS

This study provides evidence that the food hygiene at large-scale events may have improved. However, there is still a need for continued efforts to maintain an ongoing improvement in cleaning regimes and food hygiene management.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study was part of an ongoing focus on large events in the lead-up to the London 2012 Olympics. Lessons learnt here will be important in the planning of future large events.

Contributing factors in restaurant-associated foodborne disease outbreaks, FoodNet sites, 2006 and 2007

An estimated 48 million cases of foodborne illness occur each year in the United States, resulting in approximately 128,000 hospitalizations and 3,000 deaths. Over half of all foodborne disease outbreaks reported to the Centers for Disease Control and Prevention are associated with eating in restaurants or delicatessens. We reviewed data from restaurant-associated foodborne disease outbreaks to better understand the factors that contribute to these outbreaks. Data on restaurant-associated foodborne disease outbreaks reported by sites participating in the Foodborne Diseases Active Surveillance Network (FoodNet) were analyzed to characterize contributing factors reported in foodborne disease outbreaks and the levels of evidence used to identify these factors. Of 457 foodborne disease outbreaks reported in 2006 and 2007 by FoodNet sites, 300 (66%) were restaurant associated, and of these 295 (98%) had at least one reported contributing factor. One to nine (with a median of two) contributing factors were reported per outbreak. Of the 257 outbreaks with a single etiology reported, contributing factors associated with food worker health and hygiene were reported for 165 outbreaks (64%), factors associated with food preparation practices within the establishment were reported for 88 outbreaks (34%), and factors associated with contamination introduced before reaching the restaurant were reported for 56 outbreaks (22%). The pronounced role of food workers in propagating outbreaks makes it clear that more work is needed to address prevention at the local level. Food workers should be instructed not to prepare food while ill to prevent the risk of transmitting pathogens.

Restaurantes self-service: segurança e qualidade sanitária dos alimentos servidos

OBJETIVO: Esse trabalho teve por objetivo avaliar a temperatura e a qualidade sanitária de alimentos servidos nos balcões de distribuição em restaurantes self-service no município de Taubaté (SP), com vistas à discussão da segurança alimentar. MÉTODOS: Foram coletadas quatro amostras, sendo dois alimentos quentes e dois alimentos frios de 16 restaurantes; antes da coleta mediu-se a temperatura dos alimentos expostos nos balcões de distribuição. As amostras foram analisadas quanto aos seguintes parâmetros: contagem de bactérias aeróbias mesófilas, determinação de coliformes a 35ºC e a 45ºC, contagem de Staphylococcus coagulase positiva e detecção de Salmonella. RESULTADOS: Cinquenta e seis (87,5%) alimentos estavam em temperaturas inadequadas, alimentos frios expostos em temperaturas acima de 10ºC e alimentos quentes abaixo de 60ºC. Bactérias aeróbias mesófilas em contagem acima de 10(6) UFC/g foram detectadas em 11% das amostras e coliformes a 35ºC e coliformes a 45ºC foram detectadas em 76,6% e 43,7% das amostras, respectivamente. Dois alimentos, sendo um frio e um quente, provenientes de um mesmo restaurante, apresentaram contagem de Staphylococcus coagulase positivo acima de 10(4) UFC/g. Todas as amostras apresentaram ausência de Salmonella. CONCLUSÃO: A manutenção dos alimentos servidos, nos balcões de distribuição, em temperaturas abusivas e a presença de microrganismos indicadores de qualidade sanitária em número elevado comprometem a segurança e podem colocar em risco a saúde dos consumidores, em restaurantes self-service. Os instrumentos utilizados demonstraram-se como ferramentas importantes de avaliação da segurança das refeições servidas.

Factors influencing workers to follow food safety management systems in meat plants in Ontario, Canada

Small and medium sized food businesses have been slow to adopt food safety management systems (FSMSs) such as good manufacturing practices and Hazard Analysis Critical Control Point (HACCP). This study identifies factors influencing workers in their implementation of food safety practices in small and medium meat processing establishments in Ontario, Canada. A qualitative approach was used to explore in-plant factors that influence the implementation of FSMSs. Thirteen in-depth interviews in five meat plants and two focus group interviews were conducted. These generated 219 pages of verbatim transcripts which were analysed using NVivo 7 software. Main themes identified in the data related to production systems, organisational characteristics and employee characteristics. A socio-psychological model based on the theory of planned behaviour is proposed to describe how these themes and underlying sub-themes relate to FSMS implementation. Addressing the various factors that influence production workers is expected to enhance FSMS implementation and increase food safety.

Knowledge levels of food handlers in Portuguese school canteens and their self-reported behaviour towards food safety

Food safety levels in school food services are an important concern, given that any incident can affect a high number of students. The purpose of this research was to evaluate food handlers' knowledge and self-reported behaviour as regards the safe handling of food in school canteens. The study was conducted in 32 school canteens and included 124 participants. Food handlers displayed a reasonable level of knowledge, particularly regarding personal hygiene and cross-contamination, but fared worse in other areas. The level of knowledge displayed was influenced by age, motivation and training. A high correctness in handlers' self-reported behaviour towards food safety was observed, with a negative trend appearing when workload was increased. Our assessment of prevailing knowledge levels indicates that food professionals need to be made significantly more aware of the importance their actions can have on children's health.