Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 1. Description of the problem, methods, and agents involved

Evaluation of Food Safety Knowledge and Attitudes Among Adults in the United Arab Emirates

Background Food is handled by many individuals in large food setups, therefore increasing the chance of contamination that leads to foodborne diseases (FBDs). This study was purposed to evaluate adults' understanding of food safety, FBDs, and hygiene practices across various demographic groups in the United Arab Emirates (UAE) and to explore the link between their knowledge of food safety and their corresponding attitudes. Methods A cross-sectional study was conducted with 402 adults using a validated, self-administered questionnaire available in both printed and online formats. The study was carried out at Gulf Medical University and Thumbay hospitals and clinics over six months, beginning in December 2022 to June 2023. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The chi-squared test was employed to examine the association between variables, and significant associations were further analyzed through logistic regression. Results Out of the 402 participants, the population was predominantly female 275 (67.9%), and from Southeast Asia 222 (55.4%), with students comprising the largest occupational group 186 (47%). Only 106 (26.36%) had received food safety training, and a mere 187 (46.51%) demonstrated adequate knowledge. Awareness levels varied, with the highest for raw food safety (64.02%) and the lowest for canned foods (40.79%). Demographic analysis revealed significant associations: males exhibited more inadequate knowledge 79 (62.2%) than females 136 (49.4%), and students showed higher inadequacy 104 (55.9%) compared to healthcare workers 31 (35.6%). Positive attitudes towards food safety were prevalent 226 (56.2%), and positive attitudes were found in women 157 (57.1%), individuals above 30 years of age 110 (50.5%), individuals working in healthcare 140 (62%), and married individuals 117 (60.9%). With a strong correlation (p<0.001), women were 1.68 times more likely to possess adequate knowledge than men (95% CI: 1.09, 2.59), and healthcare workers were 2.33 times more likely than students (95% CI: 1.37, 3.95). Conclusion The study reveals a low level of knowledge about food safety among adults in the UAE. Therefore, emphasis should be placed on increasing awareness of these concepts to reduce the burden of FBDs on the healthcare system.

Searching for Strep A in the clinical environment during a human challenge trial: a sub-study protocol

Streptococcus pyogenes (also known as group A Streptococcus , Strep A) is an obligate human pathogen with significant global morbidity and mortality. Transmission is believed to occur primarily between individuals via respiratory droplets, but knowledge about other potential sources of transmission via aerosols or the environment is limited. Such knowledge is required to design optimal interventions to control transmission, particularly in endemic settings. We aim to detail an experimental methodology to assess the transmission potential of Strep A in a clinical environment. We will examine potential sources of transmission in up to 20 participants recruited to the Controlled human infection for penicillin against Streptococcus pyogenes (CHIPS) Trial. Three approaches to understanding transmission will be used: the use of selective agar settle plates to capture possible droplet or airborne spread of Strep A; measurement of the possible distance of Strep A droplet spread during conversation; and environmental swabbing of personal and common high-touch items to detect the presence of Strep A on hard and soft surfaces. All methods are designed to allow for an assessment of transmission potential by symptomatic, asymptomatic and non-cases. Ethical approval has been obtained through Bellberry Human Research Ethics Committee (approval 2021-03-295). Trial registration number: ACTRN12621000751875. Any results elicited from these experiments will be of benefit to the scientific literature in improving our knowledge of opportunities to prevent Strep A transmission as a direct component of the primordial prevention of rheumatic fever. Findings will be reported at local, national and international conferences and in peer-reviewed journals.

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.

Carriage of Antibiotic Resistant Bacteria and Associated Factors Among Food Handlers in Tamale Metropolis, Ghana: Implications for Food Safety

Background

Bacteria pathogens constitute a significant proportion of diarrhoea-causing food contaminants. Transmission of antibiotic resistant foodborne pathogens to humans is a major threat to food safety, especially in developing countries where quality hygiene and sanitation facilities are lacking. Factors related to antibiotic use, sanitation and hand hygiene have been associated with the spread of infectious diseases as well as antibiotic resistant bacteria. Proper food handling ensures that food is not contaminated with potential pathogenic bacteria. This study assessed the carriage of antibiotic resistant bacteria and associated factors.

Methods

A cross-sectional study was conducted among food handlers who sell ready to eat food in the Tamale metropolis of the Northern Region of Ghana. Food vending stations with huge customer base were randomly selected and the food handlers recruited using written informed consent. Structured questionnaires were used to collect participants sociodemographic details and information on sanitation, hand hygiene practice and antibiotic use. Sterile cotton swabs soaked in phosphate buffered saline was used to swab the palms of participating food handlers for bacteria isolation. All identified bacteria were tested for susceptibility to 12 antibiotics.

Results

In all, 406 food handlers participated in this study, the mean (SD) age was 26.5 (2.64) years. Bacteria isolated were predominantly Staphylococci 60 (14.8%) and Escherichia coli 54 (13.3%). All the isolates were resistant to at least one antibiotic tested. The isolates showed high resistance to broad-spectrum antibiotics such as ampicillin (40.0%-75.0%), tetracycline (40.0%-80.0%), amoxiclav (20.0%-80.0%) and chloramphenicol (7.7%-50.0%). Logistic regression model revealed that the carriage of antibiotic resistant bacteria by food handlers was significantly associated with age, educational level, years on the job, training in food preparation, hygiene practice, water source, type of toilet facility used and antibiotic use.

Conclusion

Street food handlers could be potential sources of food-borne transmission of antibiotic resistant bacteria.

Evaluation of bacteriological profile of meat contact surfaces, handling practices of raw meat and its associated factors in butcher shops of Arba Minch town, southern Ethiopia-A facility based cross sectional study

Background

Meat is subjected to contamination from a range of sources throughout animal slaughter and its sale. The demand for meat products in Ethiopia has been increased dramatically; especially the consumption of fresh chilled meat becomes a status of symbol.

Objectives

This study aimed to evaluate the bacteriological profile of meat contact surfaces, raw meat handling practices, and its associated factors in butcher shops located in Arba Minch town, southern Ethiopia.

Methods and Materials

A facility-based cross-sectional study was carried out among meat handlers in butcher shops in Arba Minch town from November to December 2020. A pre-tested and semi-structured interviewer-administered questionnaire was used to collect the data on workers meat handling practices and the sterile swab was used to collect samples from selected meat contact surfaces for bacteriological analysis. Statistical Package for Social Sciences (SPSS) version 21 was used for data analysis. Binary logistic regression analysis was utilized to assess the presence and degree of association between raw meat handling practice and independent variables. Adjusted odds ratio with a 95% confidence interval at P-value < 0.05 was considered statistically significant.

Result and Conclusion

This study revealed the knowledge and handling practice gap among meat handlers of butcher shops. Knowledge of food handling hygiene has shown significant association with handling practice [AOR = 4.5 (1.182,17.202)]. The median total viable count of bacterial loads from the swab samples of butchers’ hands, knives, and the tables was 5.60 ± 0.80, 5.60 ± 1.00, 5.70 ± 1.00 log10 Colony-forming unit (CFU)/cm2, respectively. Escherichia coli was the predominant isolate 34(68%) followed by Staphylococcus species 28(56%) and Salmonella species 19(38%). The median total bacterial load obtained from the samples exceeds the acceptable value of less than 5.0 log10 CFU/cm2 on fresh meat. This indicates the need for improvement in the meat handling and processing chain to safeguard the public health against the risks of foodborne bacterial infections.

Virulence Potential and Antibiotic Susceptibility of S. aureus Strains Isolated from Food Handlers

Staphylococcus spp. are common members of the normal human flora. However, some Staphylococcus species are recognised as human pathogens due to the production of several virulence factors and enterotoxins that are particularly worrisome in food poisoning. Since many of Staphylococcal food poisoning outbreaks are typically associated with cross-contamination, the detection of S. aureus on food handlers was performed. Hand swabs from 167 food handlers were analysed for the presence of S. aureus. More than 11% of the samples were positive for S. aureus. All S. aureus strains were isolated and analysed for the presence of virulence and enterotoxin genes, namely, sea, seb, sec, sed, seg, sei, tsst-1 and pvl. The same strains were phenotypically characterised in terms of antibiotic susceptibility using the disc diffusion method and antimicrobial agents from 12 different classes. A low prevalence of antibiotic-resistant strains was found, with 55.6% of the strains being sensitive to all of the antimicrobial agents tested. However, a high prevalence of resistance to macrolides was found, with 44.4% of the strains showing resistance to erythromycin. At least one of the virulence or toxin genes was detected in 61.1% of the strains, and seg was the most prevalent toxin gene, being detected in 44.4% of the strains.

Evaluation of the Impact of Compliance with Mitigation Strategies and Frequency of Restaurant Surface Cleaning and Sanitizing on Control of Norovirus Transmission from Ill Food Employees Using an Existing Quantitative Risk Assessment Model

ABSTRACT

Reduction of foodborne illness caused by norovirus (NoV) continues to be a focus for the food safety community. Using a previously published quantitative risk assessment model, we evaluated more than 60 scenarios examining the impact of implementation of and compliance with risk management strategies identified in the U.S. Food and Drug Administration Food Code for (a) surface cleaning and sanitizing, (b) hand hygiene, (c) exclusion, or (d) restriction of ill employees. Implementation of and compliance with hand hygiene and ill food employee exclusion strategies had the largest impact on the predicted number of highly contaminated food servings and associated consumer illnesses. In scenarios in which gloves were always worn and hand washing compliance was 90%, the model estimated reductions in the number of highly contaminated food servings and ill consumers to 39 and 43% of baseline estimates (i.e., typical practice), respectively. Reductions were smaller when gloves were never worn. Hand washing compliance after using the restroom strongly impacted predicted numbers of highly contaminated servings and consumer illnesses. Ten percent compliance with removing or excluding ill food employees was predicted to increase the number of highly contaminated food servings and ill consumers to 221 and 213% of baseline estimates, respectively. Ninety-four percent compliance with exclusion of ill food employees was predicted to decrease these numbers to 69 and 71% of baseline estimates, respectively. Surface cleaning in food establishments had a relatively small impact on these measures. Restriction of food employees (removed from contact with food and food contact equipment and utensils) was not effective for reducing NoV illness unless this restriction included additional provisions. The results from this study can help risk managers prioritize mitigation strategies and their implementation for controlling the transmission of NoV and subsequent consumer foodborne illness.

HIGHLIGHTS

Prevalence of intestinal parasites and associated factors among food handlers in food establishments in the Lideta subcity of Addis Ababa, Ethiopia: an institution-based, cross-sectional study

OBJECTIVE

This study was conducted to assess the prevalence of intestinal parasites and the associated factors among food handlers in the Lideta subcity of Addis Ababa, Ethiopia.

DESIGN

An institution-based, cross-sectional study design was used. Stool samples were collected from food handlers and examined using direct wet mount and formalin-ether concentration techniques. Personal and establishment-related information was collected using a pretested questionnaire, with a structured observation. Multivariable binary logistic regression was used to identify factors associated with the prevalence of intestinal parasites on the basis of adjusted OR (AOR) and 95% CI and p values <0.05.

SETTING

Food establishments in the Lideta subcity of Addis Ababa, Ethiopia.

PARTICIPANTS

411 food handlers participated in the study.

OUTCOME MEASURES

The primary outcome was the prevalence of intestinal parasites, defined as the presence of one or more intestinal parasitic species in stool samples.

RESULTS

One or more intestinal parasites were detected in 171 (41.6%; 95% CI 36.6% to 46.4%) stool samples. The most common intestinal parasites were Entamoeba histolytica/dispar (12.7%), Giardia duodenalis (11.2%) and Ascaris lumbricoides (8.3%). The presence of intestinal parasites among food handlers was associated with low monthly income (AOR: 2.83, 95% CI 1.50 to 8.84), untrimmed fingernails (AOR: 4.36, 95% CI 1.98 to 11.90), no food safety training (AOR: 2.51, 95% CI 1.20 to 5.58), low level of education (AOR: 3.13, 95% CI 1.34 to 7.44), poor handwashing practice (AOR: 2.16, 95% CI 1.03 to 4.22) and lack of medical check-up (AOR: 2.31, 95% CI 1.18 to 6.95).

CONCLUSION

The prevalence of intestinal parasites among food handlers in food establishments in the Lideta subcity of Addis Ababa was high. The presence of intestinal parasites was linked to socioeconomic conditions, poor hand hygiene conditions and absence of food safety training. It is crucially important to promote handwashing practices and provide food hygiene and safety training in these settings.

Microbial contamination of hands with or without the use of bidet toilets (electric toilet seats with water spray) after defecation

Bidet toilets (electric toilet seats with water spray) are increasing in popularity worldwide. However, the extent of reduction of microbial contamination of the hands with the use of bidet toilets after defecation is unclear. Microbe contamination of the hands with and without the use of bidet toilets after defecation was examined in 32 nursing students. Double gloves were worn on the dominant hand and four layers of toilet paper were used to wipe the buttocks after defecation, and microbe contamination of the second glove (outer glove) of the double gloves was examined. The volunteers were free to select the flow volume, wash time of the bidet, and the type of bidet. Without the use of a bidet toilet, the average value ± standard deviation of the number of microbes attached to the gloves was 39,499.3 ± 77,768.3 colony forming units (cfu)/glove; however, it was 4,146.9 ± 11,427.7 cfu/glove when the bidet toilet was used. The number of microbes adhering to gloves was significantly reduced when a bidet toilet was used (p < 0.00001, Wilcoxon signed-rank test).

Prevalence, Antimicrobial Resistance, and Molecular Characteristics of Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus from Retail Ice Cream in Shaanxi Province, China

Staphylococcus aureus (S. aureus) is one of the major opportunistic foodborne pathogens as well as a source of human and animal infections. As surveillance of S. aureus and methicillin-resistant Staphylococcus aureus (MRSA) is limited in ice cream, a total of 240 ice cream samples were collected from three cities in Shaanxi province, China, and screened for S. aureus. All isolates were characterized by antimicrobial susceptibility testing, staphylococcal protein A typing, multilocus sequence typing, enterobacterial repetitive intergenic consensus typing, virulence, and resistance genes. S. aureus was recovered from 10 (4.2%) ice cream samples (13 isolates) with average count from 10 to 100 colony-forming units per gram in all cases. Resistance to amoxicillin/clavulanic acid, penicillin, and trimethoprim/sulfamethoxazole (each 100.0%) was most frequently observed, followed by ampicillin (76.9%), erythromycin (46.2%), ceftriaxone (30.8%), and cefoxitin (15.4%). A total of five types of antimicrobial resistance genes were detected, including β-lactam (blaZ and mecA), macrolide (ermB and ermC), tetracycline (tetK), aminoglycoside [aac(6')/aph(2') and aph(3')-III], and trimethoprim (dfrG). All of the strains harbored at least one staphylococcal enterotoxins gene. The commonly detected virulence genes were selw and hld (100.0%), followed by selx (92.3%); hla (84.6%); pvl (76.9%); seg, sem, and sen (each 38.5%); sei, seo, and hlb (each 30.8%); sea, seb, selu, and sely (each 23.1%); sed, sej, sek, sep, and seq (each 15.4%); and ser (7.7%). ST5-t002, ST7-t091, and ST5225-t4911 (each 15.4%) were the predominant clones, followed by ST5-t045/t105, ST6-t701/t15417, ST25-t078, ST188-t189, and ST398-t034 (each 7.7%). Among the 13 strains of S. aureus, 2 isolates were detected as MRSA (15.4%), and the molecular type belonged to ST5225-IVa-t4911. Using a 98.8% similarity cutoff, the 13 isolates were divided into 5 clusters (I-1 to I-5). These results demonstrated that the prevalence of S. aureus and MRSA was low in ice cream. However, these isolates exhibited a high level of potential pathogenicity, which represents a potential health hazard for consumers.

Effect of Smartphone App's Intervention on Consumers' Knowledge, Attitude, Practice, and Perception of Food Poisoning Prevention When Dining Out at Selected Rural Areas in Terengganu

(1) Background: Lack of food safety awareness and preventive behaviour when dining out increases the risk of food poisoning. Furthermore, food poisoning cases among rural communities have been rising in recent years. However, the health-related mobile application is a promising tool in improving food poisoning prevention knowledge, attitude, practice, and perception (KAP2) among consumers. Therefore, the current study developed a novel smartphone app, MyWarung©, and determined its efficacy in increasing awareness, attitude, practice, and perception of food poisoning and its prevention when dining out, especially among rural consumers. (2) Methods: A quasi-experimental pre-and post-intervention study with a control and intervention group were performed on 100 consumers in Terengganu. (3) Results: The intervention's inter-group outcomes were analysed using the Mann-Whitney test, while the within-group effects were ascertained using the Wilcoxon sign rank test via the SPSS software. It was found that the control group had higher median scores in knowledge (30.0, IQR 7.0), attitude (46.0, IQR 5.0), and practice (34.0, IQR 3.0) than the intervention group before intervention. After the intervention programme, the intervention group showed significant improvement in food poisoning knowledge (p = 0.000), attitude (p = 0.001), and practice (p = 0.000). However, the intervention group's perceived barriers (p = 0.129) and susceptibility (p = 0.069) and the control group's perceived barriers (p = 0.422) did not show any significant improvement. (4) Conclusion: The findings indicated that the MyWarung© mobile app usage enhanced the food poisoning knowledge, preventive attitude, and practice among consumers when dining out.

Scientific Evidence Supports the Use of Alcohol-Based Hand Sanitizers as an Effective Alternative to Hand Washing in Retail Food and Food Service Settings When Heavy Soiling Is Not Present on Hands

ABSTRACT

Suboptimal food worker health and hygiene has been a common contributing factor in foodborne disease outbreaks for many years. Despite clear U.S. Food and Drug Administration (FDA) Model Food Code recommendations for hand washing and glove use, food worker compliance with hand washing recommendations has remained poor for >20 years. Food workers' compliance with recommended hand washing guidelines is adversely impacted by a number of barriers, including complaints of time pressure, inadequate number and/or location of hand washing sinks and hand washing supplies, lack of food knowledge and training regarding hand washing, the belief that wearing gloves obviates the need for hand washing, insufficient management commitment, and adverse skin effects caused by frequent hand washing. Although many of the issues related to poor hand washing practices in food service facilities are the same as those in health care settings, a new approach to health care hand hygiene was deemed necessary >15 years ago due to persistently low compliance rates among health care personnel. Evidence-based hand hygiene guidelines for health care settings were published by both the Centers for Disease Control and Prevention in 2002 and by the World Health Organization in 2009. Despite similar low hand washing compliance rates among retail food establishment workers, no changes in the Food Code guidelines for hand washing have been made since 2001. In direct contrast to health care settings, where frequent use of alcohol-based hand sanitizers (ABHSs) in lieu of hand washing has improved hand hygiene compliance rates and reduced infections, the Food Code continues to permit the use of ABHSs only after hands have been washed with soap and water. This article provides clear evidence to support modifying the FDA Model Food Code to allow the use of ABHSs as an acceptable alternative to hand washing in situations where heavy soiling is not present. Emphasis on the importance of hand washing when hands are heavily soiled and appropriate use of gloves is still indicated.

HIGHLIGHTS

Modernization of Control of Pathogenic Micro-Organisms in the Food-Chain Requires a Durable Role for Immunoaffinity-Based Detection Methodology-A Review

Food microbiology is deluged by a vastly growing plethora of analytical methods. This review endeavors to color the context into which methodology has to fit and underlines the importance of sampling and sample treatment. The context is that the highest risk of food contamination is through the animal and human fecal route with a majority of foodborne infections originating from sources in mass and domestic kitchens at the end of the food-chain. Containment requires easy-to-use, failsafe, single-use tests giving an overall risk score in situ. Conversely, progressive food-safety systems are relying increasingly on early assessment of batches and groups involving risk-based sampling, monitoring environment and herd/flock health status, and (historic) food-chain information. Accordingly, responsible field laboratories prefer specificity, multi-analyte, and high-throughput procedures. Under certain etiological and epidemiological circumstances, indirect antigen immunoaffinity assays outperform the diagnostic sensitivity and diagnostic specificity of e.g., nucleic acid sequence-based assays. The current bulk of testing involves therefore ante- and post-mortem probing of humoral response to several pathogens. In this review, the inclusion of immunoglobulins against additional invasive micro-organisms indicating the level of hygiene and ergo public health risks in tests is advocated. Immunomagnetic separation, immunochromatography, immunosensor, microsphere array, lab-on-a-chip/disc platforms increasingly in combination with nanotechnologies, are discussed. The heuristic development of portable and ambulant microfluidic devices is intriguing and promising. Tant pis, many new platforms seem unattainable as the industry standard. Comparability of results with those of reference methods hinders the implementation of new technologies. Whatever the scientific and technological excellence and incentives, the decision-maker determines this implementation after weighing mainly costs and business risks.

Modes of transmission and attack rates of group A Streptococcal infection: a protocol for a systematic review and meta-analysis

BACKGROUND

Group A Streptococcus (Strep A) is an important cause of mortality and morbidity globally. This bacterium is responsible for a range of different infections and post-infectious sequelae. Summarising the current knowledge of Strep A transmission to humans will address gaps in the evidence and inform prevention and control strategies. The objective of this study is to evaluate the modes of transmission and attack rates of group A streptococcal infection in human populations.

METHODS

This systematic review protocol was prepared according to the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols (PRISMA-P) 2015 Statement. Using a comprehensive search strategy to identify any transmission studies that have been published in English since 1980, full-text articles will be identified and considered for inclusion against predefined criteria. We will include all studies reporting on Strep A transmission, who have identified a mode of transmission, and who reported attack rates. Risk of bias will be appraised using an appropriate tool. Our results will be described narratively and where feasible and appropriate, a meta-analysis utilizing the random-effects model will be used to aggregate the incidence proportions (attack rates) for each mode of transmission. In addition, we will also evaluate the emm genotype variants of the M protein causing Strep A infection and the association with transmission routes and attack rates, if any, by setting, socioeconomic background and geographical regions.

DISCUSSION

We anticipate that this review will contribute to elucidating Strep A modes of transmission which in turn, will serve to inform evidence-based strategies including environmental health activities to reduce the transmission of Strep A in populations at risk of severe disease.

TRIAL REGISTRATION

Systematic review registration: PROSPERO ( CRD42019138472 ).

In the landscape of SARS-CoV-2 and fresh fruits and vegetables: The fake and hidden transmission risks

From the first notification reporting to the WHO a cluster of coronavirus in Wuhan City (China), over 114 million cases of SARS‐CoV‐2 have been confirmed, with more than 2,530,000 deaths, and over 400,000 new cases and 10,000 deaths daily. Numerous viruses are susceptible to contaminate crops during growth, harvesting, handling, marketing and minimally processing, and these steps share one common factor which is human. Different studies showed that viruses might persist on different crops for periods of 2 to 14 days under different conditions such as refrigeration, household and freezing. Little is known on SARS‐CoV‐2, but preliminary studies showed that this virus might survive 24 hr on cardboard and 72 hr on plastic, materials used in fruits and vegetables packaging. Based on preliminary data, there is no evidence of food or food packaging being associated with transmission of SARS‐CoV‐2. Certainly, to date there is no scientific evidence that SARS‐CoV‐2 might be transmitted by a contact with, or the ingestion of contaminated fresh or minimally processed fruits and vegetables. However, this risk even though being considered improbable, it cannot be “completely and definitely” discarded or ignored, particularly where the virus is spreading in the word. Some agencies indicated that in case some commodities and handlers are contaminated among the multiple people involved from the farm to the table, a cross‐contamination may occur, and the risk of the contamination of food, food contact materials, and packaging from infected but asymptomatic workers should not be discarded even though considered “Very Low = meaning very rare but cannot be excluded.”

Hand Hygiene Knowledge and Self-Reported Hand Washing Behaviors among Restaurant Kitchen Chefs in Jiangsu Province, China

Inadequate hand washing among chefs is a major contributor to outbreaks of foodborne illnesses originating in restaurants. Although many studies have evaluated hand hygiene knowledge (HHK) and self-reported hand washing behaviors (HWBs) in restaurant workers in different countries, little is known about HHK and HWBs in restaurant kitchen chefs, particularly in China. In this study, we interviewed 453 restaurant kitchen chefs in Jiangsu Province in China regarding their HHK and HWBs and used Chi-square tests (Fisher exact tests), pairwise comparisons, and linear regression models to analyze the responses and identify determinants of HHK and HWBs. Results reveal that less frequent hand washing after leaving work temporarily and after touching used cutlery were the main issues among restaurant kitchen chefs in Jiangsu Province. Kitchen hands had lower levels of HHK and engaged less frequently in good HWBs than the other type of chefs. Furthermore, working in a large restaurant and having worked in the restaurant industry for a longer amount of time were correlated with better HHK and HWBs. These findings suggest that close attention should be paid to the HWBs of chefs during food preparation, that kitchen hands are the key group of restaurant kitchen workers who need training in HHK, and that regulatory activities should focus on small-scale restaurants.

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

Evaluation of food safety knowledge, attitude, and self-reported practices of trained and newly recruited untrained workers of two baking industries in Dhaka, Bangladesh

In Bangladesh, with the mounting esteem of bakery products, food safety issues in bakery industries are a paramount concern nowadays. In this regard, this current study was performed to evaluate food safety knowledge, attitude, and self-reported practices of two groups (160 trained and 55 new untrained) of workers from two popular baking industries in Dhaka, Bangladesh. A self-administrated questionnaire was used to acquire the data during the study. On food safety knowledge, attitude, and self-reported practices, trained workers' scores (33.01 ± 0.09, 14.86 ± 0.03, 10.66 ± 0.25, respectively) were significantly higher than the scores (9.82 ± 0.23, 10.44 ± 0.26, 5.91 ± 0.33, respectively) of newly appointed untrained workers. The quality assurance department displayed better knowledge, attitude, and self-reported practices scores than the rest of the departments of the industries. However, compared to knowledge and attitude, the self-reported practice was not up to a satisfactory level. According to the study, training can be proved effective for improving knowledge and attitude but does not always translate those into self-reported practice and behaviors. The results also reinforce the importance of conducting training for untrained workers and suggest further behavior-based food safety training for all employees.

Food Safety Challenges and Barriers in Southern United States Farmers Markets

Purchasing fresh and local produce at farmers markets has seen an increasing trend over the past decade. However, with this rise in popularity food safety challenges need to be recognized and addressed. Farmers market managers play a significant role in ensuring that vendors implement food safety practices at the market. Thus, this study investigated the food safety perceptions of farmers markets managers and vendors in Texas and Arkansas. A total of 123 participants were surveyed, including 38 managers and 85 vendors. The survey included a series of questions to determine gaps in vendor and manager food safety knowledge as well as the barriers and factors that prevent the implementation of relevant food safety practices. The results indicate that a lack of facilities, equipment, and resources containing food safety guidelines specific to farmers markets were the major barriers to the implementation of food safety practices. In addition, only 36.7% of participants had formal food safety training (e.g., ServSafe) and approximately 50% of the market managers provided food safety materials to their vendors. Overall, these data suggest that the development of farmers market-specific training programs to enhance food safety behaviors and practices in farmers markets would be beneficial to stakeholders.

Observed Food Safety and Sanitation Behavior for Chinese Culinary Cooking

The purpose of this study is to develop a Chinese culinary food safety and sanitation behavior scale that can be used in industry auditing, inspection, and training, as well as in school education. This study first observed food safety and sanitation behaviors in the order of cleaning, cutting, and cooking procedures according to the standards of Chinese culinary cooking. According to the observation results, for the cleaning component, alcohol disinfection after cleaning utensils and hands, the utensil cleaning sequence, the placing of cutting boards, the cleanliness of articles and water tanks, and other cross-contamination actions, as well as the complete removal of gills and scales of fish in fish handling, received lower scores. In terms of cutting, cutting sequences for various ingredients, the three-stage egg knocking sequence, the cleaning actions after each action, and the action of cleaning the knife and cutting board again were not performed properly. In the cooking step, the cross-contamination of cutting raw and cooked food, the placing of finished products, plate decorations, and the cross-contamination of not wearing gloves when contacting cooked food and tasting the food were still major problems. Finally, the cleanliness of the working area still needs improvement in all processing.

Multistate Outbreaks of Foodborne Illness in the United States Associated With Fresh Produce From 2010 to 2017

In the United States, the consumption of fresh fruits and vegetables has increased during recent years as consumers seek to make healthier lifestyle choices. However, the number of outbreaks associated with fresh produce that involve cases in more than one state (multistate) has increased concomitantly. As the distance along the farm-to-fork continuum has lengthened over time, there are also more opportunities for fresh produce contamination with bacterial pathogens before it reaches the consumer. This review provides an overview of the three bacterial pathogens (i.e., pathogenic Escherichia coli, Listeria monocytogenes, and Salmonella enterica) associated with multistate fresh produce outbreaks that occurred between 2010 and 2017 in the U.S. Possible routes of fresh produce contamination, including pre- and post-harvest, are summarized and outcomes of selected outbreaks within this timeframe are highlighted. Eighty-five multistate outbreaks linked to fresh produce with a confirmed etiology occurred from 2010 to 2017. Cross-contamination within the distribution chain and poor agricultural practices, along with the production of sprouts and importation of fresh produce were frequently implicated contributors to these events. The evolution of the food supply chain in the U.S. necessitates an examination of multistate outbreaks to shed light on factors that increase the scale of these events.

Modelling of Risk Factors Associated with Foodborne Disease among School-Aged Children in Medan, Indonesia

BACKGROUND:

Foodborne disease (FBD) contributes several outbreaks worsening health quality of world population. Many risk factors associated with FBD are related to its processing, preparation, and storage as well as handling practice.

AIM:

The study aimed to evaluate several proposed risk factors of foodborne disease existed among school-aged children and food-handlers in the school environment.

MATERIAL AND METHODS:

The descriptive cross-sectional study enrolled 124 students consisting of 64 females and 60 males in two different public schools, 064024 and 066656, Medan, Indonesia, between April and August 2018. The bacterial and parasitological examination was carried out in Microbiology and Parasitology Department. Food-handlers were assessed their appropriateness using standardised questionnaire merit to the guidelines enacted by the Ministry of Health, Indonesia (Kepmenkes RI No.942 / Menkes / SK / VII / 2003 adapted from WHO guidelines) entitled food-handlers sanitation-hygiene requirement guidelines. Data analysis was conducted using logistic regression.

RESULTS:

The study obtained that there were no food-handlers performed basic principles rules producing high-risk environment and posing a threat to children. Suspected-FBD also found in 55 or 44.4% students, and it was significantly related to several risk factors such as nail hygiene, knowledge level, nail-trimming behaviour, and hand-washing behaviour among students. Data analysis revealed modeling risk factor, Y = 23.440 + 2.003 (Nail hygiene) + 1.294 (Knowledge level) + 5.025 (Nail trimming behavior) + 7.007 (Hand-washing behavior) from logistic regression equation.

CONCLUSION:

Poor hygiene and sanitation of food-handlers and children per se provide a supportive environment in producing FBDs.

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.

Prevalence of enteric non-typhoidal Salmonella in humans in the Middle East and North Africa: A systematic review and meta-analysis

To enhance efforts related to controlling foodborne pathogens in the Middle East and North Africa (MENA), information on epidemiology of non-typhoidal Salmonella enterica (hereafter termed "Salmonella") is limited. We quantified the overall regional and country-specific Salmonella prevalence in different human populations and identified the most common serotypes. Published literature of Salmonella prevalence was systematically reviewed and reported following the Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Pooled Salmonella prevalence measures were estimated using a random-effects model. We identified 46 research reports that reported 84 Salmonella prevalence measures in 15 out of 24 countries in MENA. There were 252,831 tested humans with 6,356 Salmonella-positive cases. The pooled Salmonella prevalence in MENA was estimated at 6.6% (95% confidence interval (CI): 5.4%-7.9%). The highest pooled Salmonella prevalence measures were in Morocco (17.9%, 95% CI: 5.7%-34.8%, 1997-2012), Tunisia (10.2%, 95% CI: 4.3%-18.0%, 1988-2009) and Sudan (9.2%, 95% CI: 6.5%-12.2%, 2006-2008), while the lowest were in Jordan (1.1%, 95% CI: 0.1%-3.0%, 1993-2010), Oman (1.2%, 95% CI: 1.2%-1.3%, 1998-2002) and Palestine (1.2%, 95% CI: 0.4%-2.1%, 1999-2011). In MENA, Salmonella pooled prevalence in gastrointestinal symptomatic, gastrointestinal asymptomatic and food handlers population groups was 13.0% (95% CI: 7.6%-19.6%), 11.4% (95% CI: 2.2%-25.7%) and 3.8% (95% CI: 1.0%-8.0%), respectively. Salmonella prevalence was 14.5% (95% CI: 8.7%-26.1%) in studies tested <100 subjects, whereas 4.6% (95% CI: 3.6%-5.8%) in studies tested ≥100 subjects. Salmonella Enteritidis (29.8%) and Typhimurium (23.6%) were the most common serotypes. Salmonella was a common foodborne pathogen in MENA countries, particularly in North African countries. Findings inform the scientific community, the public and the decision-makers with Salmonella prevalence and gaps in evidence in MENA to support control and prevention strategies and could leverage more research studies.

Effect of leadership style and organizational climate on employees' food safety and hygiene behaviors in the institutional food service of schools

This study took the employees working in the institutional food service of schools in northern Taiwan as subjects to explore the influences of leadership style and organizational climate on food safety and hygiene behaviors. In this study, 400 questionnaires were distributed and 324 valid questionnaires were collected, for a valid return rate of 81%. The results showed that leadership style and organizational climate positively correlate with employees' behaviors with respect to food safety and hygiene. Transactional and transformational leadership have a significantly positive effect on organizational climate. Organizational climate has a significantly positive impact on employees' food safety and hygiene behaviors. Transactional and transformational leadership have a significantly positive effect on employees' food safety and hygiene behaviors, but the difference between the two factors is not obvious. Organizational climate has a complete mediating effect on the process of transactional and transformational leadership affecting food safety and hygiene behaviors.

ELMO1 Regulates Autophagy Induction and Bacterial Clearance During Enteric Infection

Macrophages are specialized phagocytic cells involved in clearing invading pathogens. Previously we reported that engulfment and cell motility protein 1 (ELMO1) in macrophages mediates bacterial internalization and intestinal inflammation. Here we studied the role of ELMO1 in the fate of internalized targets. ELMO1 is present in the intracellular vesicles and enhances accumulation of the protein LC3B following engulfment of Salmonella or treatment with autophagy-inducing rapamycin. The protein ATG5 and the kinase ULK1 are involved in classical autophagy, while LC3-associated phagocytosis is ULK1 independent. ATG5 but not ULK1 cooperated with ELMO1 in LC3 accumulation after infection, suggesting the ELMO1 preferentially regulated LC3-associated phagocytosis. Because LC3-associated phagocytosis delivers cargo for degradation, the contribution of ELMO1 to the lysosome degradation pathways was evaluated by studying pH and cathepsin B activity. ELMO1-depleted macrophages showed a time-dependent increase in pH and a decrease in cathepsin B activity associated with bacterial survival. Together, ELMO1 regulates LC3B accumulation and antimicrobial responses involved in the clearance of enteric pathogens. This paper investigated how innate immune pathways involving ELMO1 work in a coordinated fashion to eliminate bacterial threats. ELMO1 is present in the phagosome and enhances bacterial clearance by differential regulation of lysosomal acidification and enzymatic activity.

Giardia: an under-reported foodborne parasite

Foodborne zoonotic pathogens are a serious public health issue and result in significant global economic losses. Despite their importance to public health, epidemiological data on foodborne diseases including giardiasis caused by the enteric parasite, Giardia duodenalis, are lacking. This parasite is estimated to cause ∼28.2 million cases of diarrhoea each year due to contamination of food, but very few foodborne outbreaks have been documented due to the limitations of current detection as well as surveillance methods. The current method for the recovery of Giardia cysts from food matrices using immunomagnetic separation requires further standardisation and cost reduction before it can be widely used. It also should incorporate downstream molecular procedures for genotyping, and traceback and viability analyses. Foodborne giardiasis can be potentially controlled through improvements in national disease surveillance systems and the establishment of Hazard Analysis and Critical Control Point interventions across the food chain. Studies are needed to assess the true prevalence and public health impact of foodborne giardiasis.

Prevalence of antibiotic resistant Escherichia coli isolates from fecal samples of food handlers in Qatar

Background

It is well documented that food handlers harbor and shed enteric foodborne pathogens causing foodborne disease outbreaks. However, little known on enteric antibiotic resistant (AR) bacteria carriage in food handlers. The objective of this study was to establish a baseline prevalence of fecal AR E. coli among food handlers in Qatar.

Methods

Fecal samples were collected from 456 migrant food handlers of different nationalities arriving in Qatar on a work permit between January 2015 and December 2016. These samples (25 g each) were collected based on the availability and examination schedule at the Medical Commission facility from those consented to participate. Isolated E. coli bacteria were tested for antibiotic susceptibility against nine antibiotics using the E-test method and Double Disc Synergy Test (DDST) for extended-spectrum beta-lactamase (ESBL) production.

Results

From the 78 E. coli positive samples (17.1%, n = 456), 60% of the isolates were resistant to at least one antibiotic, whereas, 27% were multi-drug resistant (MDR). Seven isolates (9%, n = 78) were ESBL producers of which five were MDR. Individual AR E. coli frequencies to the nine antibiotics were not significantly (P > 0.05) different by nationality.

Conclusions

Based on our findings, we revealed that individual resistant E. coli and MDR resistant E. coli were common in fecal samples of food handlers in Qatar. This may indicate that food handlers can potentially contaminate foods with AR E. coli, a possible public health concern.

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.

Bacteria and poisonous plants were the primary causative hazards of foodborne disease outbreak: a seven-year survey from Guangxi, South China

Background

Foodborne diseases are a worldwide public health problem. However, data regarding epidemiological characteristics are still lacking in China. We aimed to analyze the characteristics of foodborne diseases outbreak from 2010 to 2016 in Guangxi, South China.

Methods

A foodborne disease outbreak is the occurrence of two or more cases of a similar foodborne disease resulting from the ingestion of a common food. All data are obtained from reports in the Public Health Emergency Report and Management Information System of the China Information System for Disease Control and Prevention, and also from special investigation reports from Guangxi province.

Results

A total of 138 foodborne diseases outbreak occurred in Guangxi in the past 7 years, leading to 3348 cases and 46 deaths. Foodborne disease outbreaks mainly occurred in the second and fourth quarters, and schools and private homes were the most common sites. Ingesting toxic food by mistake, improper cooking and cross contamination were the main routes of poisoning which caused 2169 (64.78%) cases and 37 (80.43%) deaths. Bacteria (62 outbreaks, 44.93%) and poisonous plants (46 outbreaks, 33.33%) were the main etiologies of foodborne diseases in our study. In particular, poisonous plants were the main cause of deaths involved in the foodborne disease outbreaks (26 outbreaks, 56.52%).

Conclusions

Bacteria and poisonous plants were the primary causative hazard of foodborne diseases. Some specific measures are needed for ongoing prevention and control against the occurrence of foodborne diseases.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5429-2) contains supplementary material, which is available to authorized users.

An Investigation of Factors that Influence Hygiene Practices at a Small Day Care Center

The aim of this study was to explore factors that influence hygiene practices at small day care centers. It examines the effect of food hygiene training on hygiene practices and investigates the correlations between the hygienic status of food handlers' hands and that of kitchen utensils. Furthermore, it determines the influences of demographic and facility-related factors on hygiene practices in small day care centers. A total of 56 food handlers at 49 day care centers in the Gyeongnam area of South Korea participated in hygiene training. The results of the study showed that after two training sessions, the ATP bioluminescence levels of knives ( P < 0.01), cutting boards ( P < 0.01), food handlers' hands ( P < 0.001), and UV disinfection cabinets ( P < 0.01) decreased. After training, the total scores on the inspection checklist were significantly improved ( P < 0.05). Strong associations between the microbial quality of hands and kitchen utensils were seen. Classification and regression tree analysis identified important factors that influence hygiene practices at small food service kitchens, such as status of registration with the government certification authority, length of food handlers' working experience and their age, and maximum number of people served. This study helps to broaden our knowledge of food hygiene issues in small day care centers.