Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 3. Factors contributing to outbreaks and description of outbreak categories

Functional Heuristics of Disease Transmission from Physical Deformities in Food Preferences

Ostensibly serving to restrict contact with disease vectors, humans exhibit aversion toward cues heuristically inferred as pathogenic. This restriction could lead perceivers to downregulate their interest in food consumption, even if such cues may not connote actual disease threats. This proclivity to avoid disease led us to consider how heuristic disease cues inform interest in foods. Participants evaluated a hypothetical food preparer that varied in the presence of heuristic cues to disease transmission (i.e., physical deformities versus healthy control). Individuals with low levels of perceived infectability were more discerning of the social target as a function of disease cues, whereas heightened levels of this trait fostered an overall aversion to targets regardless of health status. Results provide continued evidence for how pathogen avoidance motives compete with other somatic motives.

Food Safety Behaviours among Food Handlers in Different Food Service Establishments in Montenegro

Foodborne diseases in food facilities are a major public health problem, due mostly to the limited surveillance and educational level of food-handling workers. This study was conducted in 220 food service locations in Montenegro. Participants’ behaviour was assessed by a survey using the specifically designed structured questionnaire, administered before and after the training. To determine the effect of the training on the performance of food handlers, a microbiological analysis of food contact surfaces and food handlers’ hands was also performed. The behaviour of food handlers, viewed as a whole, is unacceptable. There was a statistically significant difference (<0.05) among participants who completed catering school compared with those who did not, regarding hand washing. The type of facility in which participants worked (restaurant, bakery, or pastry shop) revealed statistically significant differences (<0.05) in relation to hand washing, that is, restaurant employees had better habits than those from bakeries and pastry shops. Before the training, participants showed acceptable behaviour regarding hand hygiene, but it was much better after the training. Results of microbiological analyses of food contact surfaces and food handlers’ hands indicated better results after the education, especially with regard to hand swabs. The results of this study indicate the importance of education to improve food handling practices among food handlers, which might also decrease the possibilities for contamination of food.

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.

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.

Characteristics Associated With Consistent Handwashing and Satisfaction in the Workplace: A Pilot Survey of U.S. Workers

BACKGROUND

This study seeks to determine what handwashing facilities are available to workers, predominantly in the manufacturing and service industries, to find out if their workplace has the appropriate resources to conduct proper handwashing and how that affects handwashing satisfaction.

METHODS

This cross-sectional study surveyed U.S. adult workers (N = 241) on their workplace handwashing equipment and facilities. The associations between demographic characteristics, consistent handwashing, and handwashing satisfaction were evaluated using Fisher's exact test.

FINDINGS

Eighty-eight percent of respondents reported consistent handwashing. Pulling a handle to exit the restroom was negatively associated with handwashing satisfaction (p = .004) and having difficulty with an automatic faucet or dispenser was negatively marginally significant in its association with handwashing consistency (p = .10).

CONCLUSION/APPLICATIONS TO PRACTICE

Greater understanding of the available equipment in workplace restroom facilities and how to improve selection and use of that equipment may improve workers' handwashing experiences.

Risk factors for food poisoning among self-catering university students

Limited research has investigated self-catering university students' food hygiene practices that may increase their vulnerability to food poisoning. This study assessed the practice-related risk factors for food poisoning among 600 self-catering university students. A validated questionnaire was self-administered to collect data about their food hygiene practices in the previous 12 months. Factors associated with the prevalence of food poisoning were determined using logistic regression methods. Analyses showed significant associations of the use of wooden chopping boards and the consumption of unwashed fruits, with the prevalence of food poisoning (p < 0.05). However, the strongest association was for thawing of meat at room temperature (odds ratio for thawing at room temperature versus inside refrigerator, 6.07, 95% CI 3.98-9.25). Findings highlight the need for risk-based food hygiene training to inculcate safe food handling practices among self-catering university students.

Norovirus transmission mitigation strategies during simulated produce harvest and packing

In the agricultural setting, core global food safety elements, such as hand hygiene and worker furlough, should reduce the risk of norovirus contamination on fresh produce. However, the effect of these practices has not been characterized. Using a quantitative microbial risk model, we evaluated the individual and combined effect of farm-based hand hygiene and worker furlough practices on the maximum risk of norovirus infection from three produce commodities (open leaf lettuce, vine tomatoes, and raspberries). Specifically, we tested two scenarios where a harvester's and packer's norovirus infection status was: 1) assumed positive; or 2) assigned based on community norovirus prevalence estimates. In the first scenario with a norovirus-positive harvester and packer, none of the individual interventions modeled reduced produce contamination to below the norovirus infectious dose. However, combined interventions, particularly high handwashing compliance (100%) and efficacy (6 log10 virus removal achieved using soap and water for 30 s), reduced produce contamination to <1-82 residual virus. Translating produce contamination to maximum consumer infection risk, 100% handwashing with a 5 log10 virus removal was necessary to achieve an infection risk below the threshold of 0.032 infections per consumption event. When community-based norovirus prevalence estimates were applied to the harvester and packer, the single interventions of 100% handwashing with 3 log10 virus removal (average 0.02 infection risk per consumption event) or furlough of the packer (average 0.03 infection risk per consumption event) reduced maximum infection risk to below the 0.032 threshold for all commodities. Bundled interventions (worker furlough, 100% glove compliance, and 100% handwashing with 1-log10 virus reduction) resulted in a maximum risk of 0.02 per consumption event across all commodities. These results advance the evidence-base for global produce safety standards as effective norovirus contamination and risk mitigation strategies.

Cross-Contamination on Atypical Surfaces and Venues in Food Service Environments

ABSTRACT

Cross-contamination of raw food to other surfaces, hands, and foods is a serious issue in food service. With individuals eating more meals away from home, contracting a foodborne illness from a food service establishment is an increasing concern. However, most studies have concentrated on hands or food contact surfaces and neglected atypical and unusual surfaces (surfaces that are not typically identified as a source of cross-contamination) and venues. This review was conducted to identify atypically cross-contaminated surfaces and atypical venues where cross-contamination could occur that have not been examined thoroughly in the literature. Most surfaces that could be at risk for cross-contamination are frequently touched, are rarely cleaned and sanitized, and can support the persistence and/or growth of foodborne pathogens. These surfaces include menus, spice and condiment containers, aprons and coveralls, mobile devices and tablets, and money. Venues that are explored, such as temporary events, mobile vendors, and markets, are usually limited in space or infrastructure, have low compliance with proper hand washing, and provide the opportunity for raw and ready-to-eat foods to come into contact with one another. These factors create an environment in which cross-contamination can occur and potentially impact food safety. A more comprehensive cleaning and sanitizing regime encompassing these surfaces and venues could help mitigate cross-contamination. This review highlights key surfaces and venues that have the potential to be cross-contaminated and have been underestimated or not fully investigated. These knowledge gaps indicate where further work is needed to fully understand the role of these surfaces and venues in cross-contamination and how it can be prevented.

HIGHLIGHTS

Hand Washing Observations in Fast-Food and Full-Service Restaurants: Results from the 2014 U.S. Food and Drug Administration Retail Food Risk Factors Study

ABSTRACT

Properly executed hand washing by food service employees can greatly minimize the risk of transmitting foodborne pathogens to food and food contact surfaces in restaurants. However, food service employee hand washing is often not done correctly or does not occur as often as it should. The purpose of this study was to assess the relative impact of (i) the convenience and accessibility of hand washing facilities; (ii) the maintenance of hand washing supplies, (iii) multiunit status, (iv) having a certified food protection manager, and (v) having a food safety management system for compliance with proper hand washing. Results revealed marked differences in hand washing behaviors between fast-food and full-service restaurants; 45% of 425 fast-food restaurants and 57% of 396 full-service restaurants were out of compliance for washing hands correctly, and 57% of fast-food restaurants and 78% of full-service restaurants were out of compliance for employee hands being washed when required. Logistic regression results indicated the benefits of accessibility and maintenance of the hand washing sink and of a food safety management system for increasing the likelihood of employees washing hands when they are supposed to and washing them correctly when they do.

HIGHLIGHTS

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

What changed between 2008-2020 about Employees' perception of hygiene in the catering industry in Ankara (Turkey)?

Food safety is a public health concern because foodborne diseases have been increasing in recent years due to several factors such as urbanization, globalization and changes in consumer habits. Many countries in the world, including Turkey have upgraded their laws about food and personnel hygiene in the catering industry and undertaken changes to the organizational structure of their regulatory institutions to protect consumers' health. In this study, it was aimed to evaluate the perceptions of food processors on food safety and to determine whether there has been a change in this matter over the last 12 years. The data has been collected by conducting face to face interviews and having 500 employees from the sector fill in a questionnaire constructed for this purpose. The responses to the questionnaire have been measured by assigning 'hygiene perception points' to each respondent according to their replies. These hygiene perception points have been analysed in terms of gender, age, educational level and work experience of the employees involved. The results have revealed that employees between the ages of 26-34, women, university graduates have a higher level of perception of hygiene than other age groups, men, those with lower education levels, respectively. Hygiene perception points were found to be higher compared to the results obtained 12 years ago. The positive changes observed in the hygiene perception points are thought to result from the differences in the legislation of the years in which both studies were conducted. It is thought that the obligatory of providing hygiene and food safety training to individuals working in the catering sector with law changes leads to positive changes in the employees. Legally compulsory training activities can overcome many sanitation and safety problems that result from misinformed or uninformed employees.

Measuring transfer of human norovirus during sandwich production: Simulating the role of food, food handlers and the environment

Foodborne outbreaks associated with transmission of norovirus are increasingly becoming a public health concern. Foods can be contaminated with faecal material at the point of production or during food preparation, in both the home and in commercial premises. Transmission of norovirus occurs through the faecal-oral route, either via person-to-person contact or through faecal-contamination of food, water, or environmental surfaces. Understanding the role and pathways of norovirus transmission - either via food handlers' hands, contaminated foods or the environment - remains a key public health priority to reduce the burden of norovirus-associated gastroenteritis. However the proportion of norovirus that is typically transferred remains unknown. Understanding this is necessary to estimate the risk of infection and the burden of gastroenteritis caused by norovirus. In this paper we present a novel method of capture, concentration and molecular detection of norovirus from a wider range of complex food matrices than those demonstrated in existing published methods. We demonstrate that this method can be used as a tool to detect and quantify norovirus from naturally contaminated food, and for monitoring norovirus transfer between food handlers' gloved hands, food or the environment. We measure the effect of introducing contamination at different food production process stages, to the final food product, to determine whether this could cause infection and disease. Between 5.9 and 6.3 Log₁₀ cDNA copies/μl of norovirus GII were inoculated onto food handlers' gloved hands, food or the environment and 1.1-7.4% of norovirus contamination was recovered from all samples tested. When interpreted quantitatively, this percentage equates to levels predicted to be sufficient to cause infection and disease through consumption of the final food product, demonstrating a public health risk. Overall detection and quantification of norovirus from foods, food handlers' gloved hands and the environment, when suspected to be implicated in foodborne transmissions, is paramount for appropriate outbreak investigation.

Microbial levels on street foods and food preparation surfaces in Mangaung Metropolitan Municipality

Background

The street food sector has become an important component of the food distribution system in many cities in both developing and industrialised countries, particularly for midday meals. However, certain street food can pose a significant risk to consumers because of microbiological contamination.

Aim

The aim of this study was to determine the microbial levels of street foods and preparation surfaces in Mangaung Metropolitan Municipality.

Setting

The study selected study setting was vending sites close to taxi ranks where prepared meals were accessible to consumers.

Methods

The study was conducted in Mangaung Metropolitan Municipality during the winter season. Samples were collected through convenience sampling from the representative towns Thaba Nchu, Botshabelo and Bloemfontein. Using swabs, surface samples were collected and quantified from selective media. Eight beef samples were also collected; the microbial load on each sample was quantified and identified using a RapID kit.

Results

The surface swabs obtained in Botshabelo (1.1 × 10⁴ cfu/m² – 1.1 × 10⁶ cfu/m²) showed higher microbial counts as compared to those obtained in Bloemfontein (1.1 × 10⁴ cfu/m² – 1.1 × 10⁵ cfu/m²) and Thaba Nchu (1.1 × 10⁴ cfu/m² – 1.1 × 10⁵ cfu/m²). Higher microbial counts were observed on meat samples sampled in Thaba Nchu (50 cfu/g x 10⁵ cfu/g), Bloemfontein (48 cfu/g x 10⁴ cfu/g) and Botshabelo (33 cfu/g x 10⁵ cfu/g) when compared to international microbiological standards. After assessing the microbial levels, Staphylococcus aureus, Escherichia coli, Candida guilliermondii, Corynebacterium jeikeium, Psychrobacter phenylpyruvicus and Peptostreptococcus tetradius were identified.

Conclusion

This study confirmed contamination of surfaces and food served by vendors in Mangaung Metropolitan Municipality. The identified foodborne bacteria could pose a public health problem in each specific locality.

Validation of a Simple Two-Point Method To Assess Restaurant Compliance with Food Code Cooling Rates

ABSTRACT

Outbreaks from improperly cooled foods continue to occur despite clearly described Food Code cooling guidelines. It is difficult for regulators to enforce these guidelines because they are typically in an establishment for less than the 6 h needed to document proper cooling. Prior research proposed using a novel method to estimate cooling rates based on two time-temperature points, but this method has not yet been validated. Time-temperature profiles of 29 different foods were collected in 25 different restaurants during cooling. Cooling curves were divided into two categories: typical (21 foods) and atypical (eight foods) prior to further analysis. Analysis of the typical cooling curves used simple linear regression to calculate cooling rates. The atypical cooling profiles were studied using Monte Carlo simulations of the cooling rate. Almost all linearized typical cooling curves had high (>0.90) R2 values. Six foods with typical cooling profiles that did not pass Food Code cooling times were correctly identified by the two-point model as having slow cooling rates. Three foods that did not pass Food Code cooling times were identified by the two-point model as having marginal cooling rates. Ten of 12 foods identified by the two-point model as having acceptable cooling rates met Food Code cooling times. Most (six of eight) foods that were considered to have atypical cooling curves failed to meet the Food Code cooling times. The two-point model was also able to determine whether these foods would fail based on Food Code guidelines depending upon the simulation criteria used. Our data show that food depth has a strong influence on cooling rate. Containers with a food depth ≥7.6 cm (3 in.) were more likely to have cooling rates slower than the U.S. Food and Drug Administration Model Food Code cooling rate. This analysis shows that the two-point method can be a useful screening tool to identify potential cooling rate problems during a routine restaurant inspection visit.

HIGHLIGHTS

The microbial safety of fish and fish products: Recent advances in understanding its significance, contamination sources, and control strategies

Microorganisms play a crucial and unique role in fish and fish product safety. The presence of human pathogens and the formation of histamine caused by spoilage bacteria make the control of both pathogenic and spoilage microorganisms critical for fish product safety. To provide a comprehensive and updated overview of the involvement of microorganisms in fish and fish product safety, this paper reviewed outbreak and recall surveillance data obtained from government agencies from 1998 to 2018 and identified major safety concerns associated with both domestic and imported fish products. The review also summarized all available literature about the prevalence of major and emerging microbial safety concerns, including Salmonella spp., Listeria monocytogenes, and Aeromonas hydrophila, in different fish and fish products and the survival of these pathogens under different storage conditions. The prevalence of antibiotic-resistant bacteria (ARB) and antibiotic-resistant genes (ARGs), two emerging food safety concerns, is also reviewed. Pathogenic and spoilage microorganisms as well as ARB and ARGs can be introduced into fish and fish products in both preharvest and postharvest stages. Many novel intervention strategies have been proposed and tested for the control of different microorganisms on fish and fish products. One key question that needs to be considered when developing and implementing novel control measures is how to ensure that the measures are cost and environment friendly as well as sustainable. Over the years, regulations have been established to provide guidance documents for good farming and processing practices. To be more prepared for the globalization of the food chain, harmonization of regulations is still needed.

Assessment of food safety knowledge, attitudes and practices of fish farmers and restaurants food handlers in Bangladesh

The study was conducted to assess the present status of knowledge, attitudes and practices (KAP) concerning the food safety and hygiene issues among fish farmers and food handlers in Noakhali, Bangladesh. Data were collected from 100 respondents (50 fish farmers and 50 food handlers) through face to face interviews. All the respondents agreed that training on hygiene practices was necessary and they were interested to attend training in their spare time. Food handlers (88%) agreed that raw foods must be kept separate from prepared foods and 68% of them believed that improper preservation of foods is harmful to health. About 52% of farmers used a face mask when spreading insecticides, fertilizers, and chemicals. Food handlers were wearing protective clothing (32%) and masks (12%) when touching and distributing unwrapped foods, however no handlers used a cap. A significant strong correlation coefficient (rs) was found between knowledge with attitudes, knowledge with practices and attitudes with practices of 0.73-0.99 among the three domains for fish farmers and food handlers. The correlation among the three levels was satisfactory, however, some food safety concepts and practices regarding hygiene were still insufficient. Therefore, an effective and appropriate training program on food safety and hygiene should be launched in a holistic approach for all fish farmers and food handlers to increase awareness and ensure safe food for consumers with a view to reducing the possibility of disease outbreak.

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.

Molecular Serotyping and Antibiotic Resistance Patterns of Escherichia coli Isolated in Hospital Catering Service in Morocco

Escherichia coli is related to foodborne disease and outbreaks worldwide. It mainly affects persons at high risk as newborns, infants, and individuals with impaired immune system in hospitals. Multidrug-resistant E. coli is currently spreading both in community and hospital settings. Our study aims to evaluate the presence of E. coli and the incidence of its antibiotic resistance in samples obtained from various cooked and raw foods (N = 300), food contact surfaces (N = 238), and food handlers (N = 40) in Moroccan hospital catering service. E. coli was identified using API 20E, and the antibiotic resistance patterns were obtained using the agar disk diffusion methods. However, PCR method was used for O157 and H7 typing. The samples analysis showed that 14.33%, 24.16%, and 45% of food, surfaces, and food handlers harbored E. coli, respectively, with the highest rates obtained in raw meats (34.88%) and salads (34.88%). Molecular amplification shows that 14 E. coli isolates carried the flagellar antigen H7, while there are no isolates showing amplification for O157. The high rate of resistance was noted against ampicillin (100%), amoxicillin-clavulanate acid (100%), nalidixic acid (61.62%), and cefotaxime (59.49%), and isolates obtained from food handler's hands showed the highest rates of resistance. None of the isolates are extended-spectrum beta-lactamases producing, while 27.7% of the isolates were metallo-beta-lactams producing. This first study conducted on Moroccan hospital catering services may draw the authorities' attention to the necessity of setting up a surveillance system to monitor the food preparation process and the safety of prepared food in healthcare settings.

From hazard analysis to risk control using rapid methods in microbiology: A practical approach for the food industry

The prevention of foodborne diseases is one of the main objectives of health authorities. To this effect, analytical techniques to detect and/or quantify the microbiological contamination of foods prior to their release onto the market are required. Management and control of foodborne pathogens have generally been based on conventional detection methodologies, which are not only time-consuming and labor-intensive but also involve high consumable materials costs. However, this management perspective has changed over time given that the food industry requires efficient analytical methods that obtain rapid results. This review covers the historical context of traditional methods and their passage in time through to the latest developments in rapid methods and their implementation in the food sector. Improvements and limitations in the detection of the most relevant pathogens are discussed from a perspective applicable to the current situation in the food industry. Considering efforts that are being done and recent developments, rapid and accurate methods already used in the food industry will be also affordable and portable and offer connectivity in near future, which improves decision-making and safety throughout the food chain.

Simulating transmission of ESKAPE pathogens plus C. difficile in relevant clinical scenarios

BACKGROUND

The prevalence of healthcare-acquired infections (HAI) and rising levels of antimicrobial resistance places significant economic and public health burdens on modern healthcare systems. A group of highly drug resistant pathogens known as the ESKAPE pathogens, along with C. difficile, are the leading causes of HAIs. Interactions between patients, healthcare workers, and environmental conditions impact disease transmission. Studying pathogen transfer under varying contact scenarios in a controlled manner is critical for understanding transmission and disinfectant strategies. In lieu of human subject research, this method has the potential to contribute to modeling the routes of pathogen transmission in healthcare settings.

METHODS

To overcome these challenges, we have developed a method that utilizes a synthetic skin surrogate to model both direct (skin-to-skin) and indirect (skin-to fomite-to skin) pathogen transfer between infected patients and healthy healthcare workers. This surrogate material includes a background microbiome community simulating typical human skin flora to more accurately mimic the effects of natural flora during transmission events.

RESULTS

We demonstrate the ability to modulate individual bacterial concentrations within this microbial community to mimic bacterial concentrations previously reported on the hands of human subjects. We also explore the effect of various decontamination approaches on pathogen transfer between human subjects, such as the use of handwashing or surface disinfectants. Using this method, we identify a potential outlier, S. aureus, that may persist and retain viability in specific transfer conditions better than the overall microbial community during decontamination events.

CONCLUSIONS

Our work describes the development of an in vitro method that uses a synthetic skin surrogate with a defined background microbiota to simulate skin-to-skin and skin-to fomite-to skin contact scenarios. These results illustrate the value of simulating a holistic microbial community for transfer studies by elucidating differences in different pathogen transmission rates and resistance to common decontamination practices. We believe this method will contribute to improvements in pathogen transmission modeling in healthcare settings and increase our ability to assess the risk associated with HAIs, although additional research is required to establish the degree of correlation of pathogen transmission by skin or synthetic alternatives.

Work Conditions, Social Incorporations, and Foodborne Diseases Risk: Reflections About the (Non)Compliance of Food Safety Practices

The number of foodborne diseases has increased in all continents, and efforts must be made to control this urgent and expressive public health problem. This article aims to present and discuss situations related to the compliance and noncompliance of food safety practices (FSPs) in light of Bourdieu's social theory. This qualitative study was conducted in commercial restaurants in two cities in São Paulo, Brazil. Participant observation was used in the restaurants, and notes referring to the kitchen workers and their bosses' work processes were registered in field journals. Thematic type content analysis was used to determine the meaning cores of field journals. It was found that aspects inherent to convenience and haste at work, deficient infrastructure, lack of employees, negative boss examples, exposure to noise, and body pain experienced by workers can contribute to noncompliance of FSPs and consolidate in the habitus and practical sense some dispositions that can increase the risk of foodborne diseases. This study highlights the necessity of creating environments that address food safety, which means being able to perform a service properly.

Food Safety Knowledge, Attitudes, and Practices of Brazilian Food Truck Food Handlers

This study aimed to (i) compare the food safety knowledge, attitudes, and self-reported practices (KAP) and observed food safety practices of food truck (FT) food handlers, (ii) evaluate the microbiological quality of food and water samples collected from these vehicles, and (iii) establish a score classification for the KAP instrument according to the food contamination probability assessment. This study was conducted in three stages with 40 food truck food handlers conveniently sampled in the Federal District, Brazil, through structured interviews, application of an observational checklist for the assessment of handlers’ practices and the collection of food and water samples for determination of microbiological quality. FTs that are likely to exhibit food contamination and are at a high risk of foodborne diseases if at least one of the following situations occur: (1) if a food handler scores ≤6 in the knowledge section; (2) if a food handler scores ≤5 in the attitudes section; or (3) if a food handler scores ≤6 in the self-reported practices section. On the other hand, FTs in which handlers score higher than the cutoff points in all the sections are unlikely to exhibit food contamination and are at a low risk of foodborne diseases. The findings of this study are the first step to understand food handlers’ point of view and the initial diagnosis to guide educational strategies in the FT sector.

Microbial Quality and Safety of Sushi Prepared with Gloved or Bare Hands: Food Handlers' Impact on Retail Food Hygiene and Safety

Food handlers play an important role in retail food hygiene and safety. This study was conducted to better understand the impact of food handlers on the microbiological quality and safety of sushi and ingredients handled by gloved and bare hands. At retail premises, food handlers were asked to prepare a batch of sushi with raw fish followed by a batch of sushi with cooked ingredients. Food (sushi and ready-to-eat ingredients), hand, and glove samples were collected for analysis of overall microorganisms (standard plate counts) and targeted foodborne bacteria: Staphylococcus aureus, Bacillus cereus, Escherichia coli, Salmonella, and Listeria monocytogenes. Results suggested that cross-contamination was more prevalent at premises where bare hands were used to prepare sushi. When bare hands were used, significantly higher standard plate counts were obtained from samples of cooked rice (2.3 to 4.9 log CFU/g) and sushi (2.8 to 6.9 log CFU/g) and the prevalence of S. aureus in samples was higher on food (21.7%, 28 of 129 samples) and hands (30%, 18 of 60 samples) ( P < 0.05). Glove changing in combination with hand washing minimized cross-contamination during sushi preparation as indicated by the lower prevalence of S. aureus (0%, 0 of 28 samples) and total targeted foodborne bacteria (3.6%, 1 of 28 samples) on the gloves of food handlers who changed gloves and washed their hands compared with those handlers who did not don new gloves. Repeated use of dishcloths could be a cause of cross-contamination, and the prevalence of total targeted foodborne bacteria was significantly higher on hands dried with dishcloths (64.7%, 11 of 17 samples) than on hands dried with paper towels (12.5%, 1 of 8 samples) ( P < 0.05). The prevalences of B. cereus, L. monocytogenes, and Salmonella in the 356 food samples were 5.1% (18 samples), 0.8% (3 samples), and 0%, respectively. Improvements to hand washing, hand drying, and glove changing practices are needed to lower the occurrence of cross-contamination during sushi preparation.

Dimensioning of the physical area and required number of food handlers for school food services

ABSTRACT Objective We aimed to establish equations for dimensioning of the physical area and determining the required number of food handlers in food services of schools and to compare them with reference equations. Methods It was visited 44 municipalities located in the states of São Paulo (n=36) and Rio de Janeiro (n=8) between 2013 and 2014. The physical area for school food services was evaluated using a measuring tape. For all food services, we calculated the Maximum Attendance Capacity, which is the sum of small and large meals served during the busiest shift. A validated checklist was used to evaluate food safety practices. Linear regression models were developed to establish the proposed equations. Results In total, we evaluated 205 school units. Based on the data, the following equations were established: Equation A: area of production=15.22+(maximum attendance capacity×0.02), which estimates the minimum area needed for a school food service; and Equation B: the number of food handlers=2.17+(maximum attendance capacity×0.002), to determine the minimum number of food handlers needed. These equations were established based on school food services that presented adequate food safety practices (i.e., low health risk). Conclusion It was established new equations for calculating the size of the physical area for school food services and the required number of food handlers. These new equations can be used as a starting point in management planning of a school food service.

Food safety performance and risk of food services from different natures and the role of nutritionist as food safety leader

Abstract The objective of this study was to evaluate the food safety performance of food services and its associated factors. The study involved 84 food businesses in the city of Santos as follows: street food kiosks and beach kiosks (street food), commercial restaurants, hospitals and school meal services (institutional food services). A food safety checklist with 81 items was applied. The overall percentage of adequacy was lower in street food kiosk (49.7%) and beach kiosk (62.0%) than in restaurants (69.7%), hospitals (83.9%) and schools (86%). Institutional and commercial restaurants showed higher scores of food safety performance than street food services, mainly regarding risker practices. The variables positively associated with food safety performance in commercial restaurants were: presence of a nutritionist as leader and adequate structure. These results show that street food services need, in a mediate way, the implementation of new strategies and regulations to improve food safety. A nutritionist acting as food safety leader may improve the food safety performance at commercial restaurants.

Microbiological Quality of Organic and Conventional Leafy Vegetables

The aim of this study was to assess the microbiological profile of leafy vegetables from organic and conventional farming (n=70). The microbiological parameters analyzed consisted of aerobic mesophilic bacteria, yeasts and molds, coliforms at 30 and 45°C, and Salmonella ssp. A biochemical identification of the Enterobacteriaceae species was carried out. Some Enterobacteriaceae species were identified in the produce from both farming systems and Hafnia alvei was the most widespread specie observed. Salmonella spp. was not detected in the samples analyzed. The microbial counts for indicator microorganisms were, in general, higher for conventional leaves when compared to those produced by organic farming.

Foodborne disease and food control in the Gulf States

Gulf States in the Middle East have had to change rapidly from subsidence herding, farming and fishing communities to modern states through the exploitation of revenue-generating petroleum products. Fresh water is an even more precious commodity than oil today as this is seen as a rapidly diminishing resource through over use of aquifers with scarce and unpredictable rainfall not replenishing the needs of these countries which increasing rely on reverse-osmosis (RO) desalination of seawater but at a cost in terms of energy. Recycling of waste water and sewage is carried out and used to water urban landscaping and some crops, but there are risks of the presence of pathogens. Much food today is imported to satisfy the requirements of expanding populations, especially foreign workers on temporary visas who make up more than half the residents in many of these Gulf States. Despite limited published data on Gulf States regarding enteric and foodborne diseases and their prevention and control, profiles emerge that can describe the current situation and some future directions. Gastrointestinal diseases, such as typhoid, cholera, and amebic dysentery can be brought into these countries through workers returning from endemic regions, and also through refugees from conflict-torn neighboring countries. However, some diseases are endemic like brucellosis and fatal illnesses from the newly identified Middle East Respiratory Corona Virus (MERS-CoV) associated with camels. In the 1990s, coalition troops stationed during the Gulf War brought in external suppliers and caterers, but using local products like chickens with troops occasionally suffering from infections. The hot climate, particularly in summer, can allow rapid growth of pathogens in foods, especially where refrigeration is not available as in home-prepared lunches by workers and during transportation of foods across traffic-congested cities. One of the biggest concerns for Saudi Arabia is the health oversight of millions during the annual Hajj, and despite much care over restriction of infected pilgrims and care of food, occasional outbreaks have been reported. Government agencies are particularly concerned about restaurant food and try and follow up on complaints of customers but rarely are agents identified; those that have include Salmonella, Bacillus cereus and Staphylococcus aureus. Implicated foods include ethnic products such as Turkish menu items and shawarma. Local culture may play a role in allowing growth of pathogens such as serving women after men at weddings. However, deaths that have been attributed to microbial sources may have been caused by illegal use of pesticides such as aluminum phosphide. Severe penalties have been applied to owners and staff implicated in outbreaks including fines, jail sentences and deportations, which are not typical of Western nations. However, some agencies have initiatives to help educate and train foreign workers in several languages. Foodborne disease surveillance systems are generally not adequate though some countries have initiated modernization of inspection approaches and laboratories. Consumer surveys show that residents have some knowledge of foodborne disease but this could be improved especially for women who do most of the shopping and food preparation in homes. Agencies are increasing directing campaigns for general food safety in their populations, and as long as resources are available, food control is likely to improve over time in Gulf States which is good news for visitors, expatriate workers and citizens alike.

Epidemiology of Classic and Novel Human Astrovirus: Gastroenteritis and Beyond

Since they were identified in 1975, human astroviruses have been considered one of the most important agents of viral acute gastroenteritis in children. However, highly divergent astroviruses infecting humans have been recently discovered and associated with extra-intestinal infections. The report of cases of fatal meningitis and encephalitis, especially in immunocompromised individuals, has broadened their disease spectrum. Although zoonotic transmission among animal and human astroviruses has not been clearly recognized, the genetic similarity between some human and animal viruses makes it likely to occur. This review provides an update on the epidemiology of both classic and novel human astroviruses, and a comprehensive view on confirmed or potential association between astrovirus and human disease.

Assessment of Food Safety Knowledge, Attitude, Self-Reported Practices, and Microbiological Hand Hygiene of Food Handlers

Institutional foodborne illness outbreaks continue to hit the headlines in the country, indicating the failure of food handlers to adhere to safe practices during food preparation. Thus, this study aimed to compare the knowledge, attitude, and self-reported practices (KAP) of food safety assessment and microbiological assessment of food handlers’ hands as an indicator of hygiene practices in food premises. This study involved 85 food handlers working in a university located in Kuala Lumpur, Malaysia. The food safety KAP among food handlers (n = 67) was assessed using a questionnaire; while the hand swabs (n = 85) were tested for the total aerobic count, coliforms, and Escherichia coli, Staphylococcus aureus, Salmonella, Vibrio cholerae and Vibrio parahaemolyticus. The food handlers had moderate levels of food safety knowledge (61.7%) with good attitude (51.9/60) and self-reported practices (53.2/60). It is noteworthy that the good self-reported practices were not reflected in the microbiological assessment of food handlers’ hands, in which 65% of the food handlers examined had a total aerobic count ≥20 CFU/cm² and Salmonella was detected on 48% of the food handlers’ hands. In conclusion, the suggestion of this study was that the food handlers had adequate food safety knowledge, but perceived knowledge failed to be translated into practices at work.

Routes of Transmission in the Food Chain

More than 250 different foodborne diseases have been described to date, annually affecting about one-third of the world's population. The incidence of foodborne diseases has been underreported and underestimated, and the asymptomatic presentation of some of the illnesses, worldwide heterogeneities in reporting, and the alternative transmission routes of certain pathogens are among the factors that contribute to this. Globalization, centralization of the food supply, transportation of food products progressively farther from their places of origin, and the multitude of steps where contamination may occur have made it increasingly challenging to investigate foodborne and waterborne outbreaks. Certain foodborne pathogens may be transmitted directly from animals to humans, while others are transmitted through vectors, such as insects, or through food handlers, contaminated food products or food-processing surfaces, or transfer from sponges, cloths, or utensils. Additionally, the airborne route may contribute to the transmission of certain foodborne pathogens. Complicating epidemiological investigations, multiple transmission routes have been described for some foodborne pathogens. Two types of transmission barriers, primary and secondary, have been described for foodborne pathogens, each of them providing opportunities for preventing and controlling outbreaks. Primary barriers, the most effective sites of prophylactic intervention, prevent pathogen entry into the environment, while secondary barriers prevent the multiplication and dissemination of pathogens that have already entered the environment. Understanding pathogen dynamics, monitoring transmission, and implementing preventive measures are complicated by the phenomenon of superspreading, which refers to the concept that, at the level of populations, a minority of hosts is responsible for the majority of transmission events.

Assessment of mothers’ knowledge and practice towards aflatoxin contamination in complementary foods in Ethiopia: from pre-harvest to household

This study assessed the knowledge and practices of the mothers in Ethiopia on issues related to aflatoxin in complementary foods (CFs) using structured questionnaires. The study involved 195 mothers from Amhara, Tigray, Oromia, and Southern Nations Nationalities and Peoples (SNNP) regions and addressed a range of issues used to prevent the risks of mould and aflatoxin contamination from farm-to-table. Of the 195 mothers who responded; 186 (95%) were ploughing their land before growing the next crop, 177 (91%) used the crop rotation schedule, 157 (81%) reported the practice of removing old seed heads and stalks used as an inoculum for aflatoxin contamination, 185 (95%) harvested the crops as soon as the crops were matured, 138 (70%) used a threshing method known as ‘trampling by hoofed animals’. After threshing, about 124 (64%) respondents had the knowledge and practice of drying cereals and legumes to decrease the moisture content, 134 (68%) used solar drying on a bare ground, 184 (94%) cleaned and disinfected the storage structures before storage. Almost all the respondents practiced the CFs processing steps properly and they used colour, type, odour, insect infestations, mouldiness and all these criteria to select the CFs ingredients. A total of 78 (40%) respondents had the practice of feeding mouldy cereals and legumes to animals, and 89 (46%) of the respondents erroneously believed that roasting can decontaminate the aflatoxin produced from mouldy cereals. As a general conclusion, the majority of the respondents are practicing good agricultural practices in the field, but they use poor storage and processing practices at homes which are susceptible to mould and aflatoxin contamination. Besides, they lack awareness about the toxic effects of aflatoxin on human health. Therefore, awareness creation about the health impacts of aflatoxin and methods of prevention need to be implemented in the study areas.

Efficacy of Instant Hand Sanitizers against Foodborne Pathogens Compared with Hand Washing with Soap and Water in Food Preparation Settings: A Systematic Review

Hands can be a vector for transmitting pathogenic microorganisms to foodstuffs and drinks, and to the mouths of susceptible hosts. Hand washing is the primary barrier to prevent transmission of enteric pathogens via cross-contamination from infected persons. Conventional hand washing involves the use of water, soap, and friction to remove dirt and microorganisms. The availability of hand sanitizing products for use when water and soap are unavailable has increased in recent years. The aim of this systematic review was to collate scientific information on the efficacy of hand sanitizers compared with washing hands with soap and water for the removal of foodborne pathogens from the hands of food handlers. An extensive literature search was carried out using three electronic databases: Web of Science, Scopus, and PubMed. Twenty-eight scientific publications were ultimately included in the review. Analysis of this literature revealed various limitations in the scientific information owing to the absence of a standardized protocol for evaluating the efficacy of hand products and variation in experimental conditions. However, despite conflicting results, scientific evidence seems to support the historical skepticism about the use of waterless hand sanitizers in food preparation settings. Water and soap appear to be more effective than waterless products for removal of soil and microorganisms from hands. Alcohol-based products achieve rapid and effective inactivation of various bacteria, but their efficacy is generally lower against nonenveloped viruses. The presence of food debris significantly affects the microbial inactivation rate of hand sanitizers.