Behavioral risk factors associated with listeriosis in the home: a review of consumer food safety studies

Clinical Outcome and Factors with Dietary Behaviors in Pregnant Women with Listeria monocytogenes: A Hospital-Based Case-Control Study in Shanghai

Listeriosis is a globally rare foodborne disease that causes fetal-placental infection, leading to adverse pregnancy outcome, while limited research among pregnant women is available in China. This study was therefore aimed at analyzing the incidence, clinical manifestations, and clinical outcome of listeriosis among pregnant women and its associated dietary behavior risk factors in prevention. A hospital-based case-control study had been conducted from January 2017 to December 2021. Clinical data, laboratory information, and questionnaires including dietary behaviors and personal hygiene were collected within 2 days after case diagnosis. There were 48 pregnant women, including 12 cases and 36 controls, with an average age of 31.19 ± 3.75 years. The incidence of admission-based listeriosis among pregnant women was 1.6058 per 10,000. The 12 strains were divided into 3 serotypes: 1/2a(83.33%), 1/2b(8.33%), and 4b(8.33%). Among the cases, 5 cases (41.67%) resulted in abortion, 3 cases (25%) induced preterm labor, and 4 cases (33.33%) had full-term deliveries after treatment. There were 7 live births in the case group, among which 6 were admitted to the neonatal intensive care unit (NICU), while 1 case had a healthy fetal outcome. All patients in the control group gave birth to live fetuses. Epidemiological investigation revealed that pregnant women dining at restaurants three or more times per week might increase the risk of having Listeria infection. There were no significant differences in dietary consumed behaviors, hand hygiene, and refrigerator usage behaviors between case and control groups. The study suggested that dining at restaurants might be associated with Listeria infection among pregnant women. Therefore, it is essential to enhance education on listeriosis serious consequences and promote healthy dietary and hygiene habits among pregnant women.

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

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

A case study of food handler hand hygiene compliance in high-care and high-risk food manufacturing environments using covert-observation

Observation of behaviour is superior to cognitive data, which does not equate to behaviour. Covert-observation is seldom used in food manufacturing to assess behaviour. In this case study, closed-circuit-television footage (15 h) in a business were reviewed to assess hand hygiene compliance using an electronic-checklist. Hand hygiene attempts were observed prior to entering high-risk (cake/pie)(n= 47) and high-care (sandwich/salad)(n= 153) production areas. Business hand hygiene protocol required handwashing durations ≥ 20 s. Observed durations ranged 1-71 s, <96% of attempts were <20 s. Significantly longer durations were observed when food handlers were in the presence of others (12 s) than when alone (9 s). Although <99% utilised soap, only 56-69% wetted hands first. Failure to rub all parts of hands was commonplace (<87%) and 24-35% failed to apply sanitiser after drying. Consequently, >98% of observed attempts before entering production areas did not comply with the protocol. Observed non-compliant practices may have implications for food safety in manufacturing.

Food Safety Attitude and Associated Factors Among Mothers of Under 5 Children, Debarq Town: Community-Based Cross-Sectional Study, 2019

BACKGROUND

Food-borne diseases represent a widespread and growing public health problem, both in developed and developing countries. However, this problem has more impact on health and economy in developing countries than in developed countries but reliable data is not available.

METHODS

A cross-sectional study was done in 2019 at Debarq town, Amhara region, Northwest Ethiopia. A questionnaire prepared in English after adapted from previous studies then translated in to local language Amharic was used in order to collect the data. Data were checked manually for completeness, coded, and entered in to Epi Info version 7.1 and then exported in to SPSS version 26 statistical package for analyze. Descriptive statistics, percentage, frequency, standard deviation, and mean were analyzed. Likewise, bivariable and multivariable binary logistic regression analysis were done to know the relationship between the independent variables and attitude of food safety among mothers. The variables found having a P-value <.2 in the bivariable analysis were further analyzed in multivariable binary logistic regression. The variables with P-value <.05 were considered as significantly associated with food safety attitude of mothers.

RESULTS

About 423 mothers of under-5 children were involved in this study. The mean age of the participants was 39.844 ± 11.02. In this study, educational status (primary education (Adjusted Odds Ratio [AOR]: 2.66; 95% Confidence Interval [CI] [1.42-4.97]), secondary education (AOR: 2.66; 95% CI [3.35-14.05]), and diploma and above (AOR: 4.07; 95% CI [1.65-10.06])), higher income (AOR: 3.58; 95% CI [1.54-8.29]), good food safety knowledge (AOR: 3.08; 95% CI [1.51-6.242]) and good food hygiene practice (AOR: 3.97; 95% CI [2.33-6.75]) were factors associated with food safety attitude in the current study.

CONCLUSION

Significant proportion of participants in the study area had poor food safety attitude. Educational status, income, food safety knowledge, and food safety practice were significantly associated with food safety attitude among mothers. Food hygiene practice, knowledge, and level of education should be increased in order to improve food safety attitudes among mothers who were responsible in food processing at household level.

Counteracting Bacterial Motility: A Promising Strategy to Narrow Listeria monocytogenes Biofilm in Food Processing Industry

Listeria monocytogenes (L. monocytogenes) is often associated with processed food as it can form biofilms that represent a source of contamination at all stages of the manufacturing chain. The control and prevention of biofilms in food-processing plants are of utmost importance. This study explores the efficacy of prospect molecules for counteracting bacterial mechanisms leading to biofilm formation. The compounds included the phytomolecule tomatidine, zinc chloride (ZnCl₂), ethylenediaminetetraacetic acid (EDTA), and a more complexed mixture of bacterial compounds from coagulase-negative staphylococci (CNS exoproducts). Significant inhibition of L. monocytogenes biofilm formation was evidenced using a microfluidic system and confocal microscopic analyses (p < 0.001). Active molecules were effective at an early stage of biofilm development (≥50% of inhibition) but failed to disperse mature biofilms of L. monocytogenes. According to our findings, prevention of surface attachment was associated with a disruption of bacterial motility. Indeed, agar cell motility assays demonstrated the effectiveness of these molecules. Overall, results highlighted the critical role of motility in biofilm formation and allow to consider flagellum-mediated motility as a promising molecular target in control strategies against L. monocytogenes in food processing environments.

Biological, Chemical, and Nutritional Food Risks and Food Safety Issues From Italian Online Information Sources: Web Monitoring, Content Analysis, and Data Visualization

Background

With rapid evolution of the internet and web 2.0 apps, online sources have become one of the main channels for most people to seek food risk information. Thus, it would be compelling to analyze the coverage of online information sources related to biological, chemical, and nutritional food risks, and related safety issues, to understand the type of content that online readers are exposed to, possibly influencing their perceptions.

Objective

The aim of this study was to identify the types of online sources that are predominantly covering this theme, and the topics that have received the most attention in terms of coverage and engagement on social media.

Methods

We performed an analysis of big data related to food risks by combining web monitoring techniques, content analysis, and data visualization of a large amount of unstructured text. Using a dictionary-based approach, a web monitoring app was instructed to automatically collect web content referring to the food risk and safety field. Data were retrieved from March 2017 to February 2018. The validated corpus (N=12,163) was subject to automatic and manual content analysis. Results were combined with descriptive statistics extracted from Web-Live and processed with Qlik Sense.

Results

Nutritional risks and news about outbreaks, controls, and alerts were the most widely covered topics. Thematic sources devoted major attention to nutritional topics, whereas national sources covered food risks, especially during food emergencies. Regarding engagement on social media, readers’ interest was higher for nutritional topics and animal welfare. Although traditional sources still publish a great amount of content related to food risks and safety, new mediators have emerged as alternative sources for food risk information.

Conclusions

This mixed methodological approach was demonstrated to be a useful means for obtaining an accurate characterization of the online discourse on food risks, and can provide insight into how the monitored sources contribute to the process of risk communication.

Changes in Consumers' Food Purchase and Transport Behaviors over a Decade (2010 to 2019) Following Health and Convenience Food Trends

Although consumers’ food purchase/transport have been reported as causes of food safety risks, there is a lack of empirical data that are feasible to identify persistent and emerging risky behaviors of consumers. This longitudinal trend study consists of individual consumer surveys in 2010 (n = 609) and 2019 (n = 605) to analyze changes in risky behaviors linked to food purchase/transport over a decade. Overall, the results identified purchase/transport time and purchase order as the emerging and unchanged risk factors, respectively. Consumers’ preferences into channels for purchase (large discount stores rather than small/traditional markets) and transport (using cars or delivery) implied the convenience as the noticeable trend. Whereas, unexpected increases in purchase/transport time highlighted the underestimated risks in long-term exposure of foods under inadequate temperature. Food should not be exposed to danger zones > 1–2 h, but consumers might be unaware of the risk especially for preferred channels (e.g., 77 and 36 min. are required for purchase and transport from large discount stores, respectively). In the case of unchanged risky behavior, more than half of consumers in both surveys did not follow proper purchasing orders. Our findings highlight the necessity for novel countermeasures and the improvement of current consumer guidelines against emerging and unchanged risky behaviors, respectively.

Segmentation of Polish Households Taking into Account Food Waste

Currently, food waste is estimated at more than one-third of all food produced, and the primary responsibility for this phenomenon is attributed to households. Therefore, it seems reasonable to take action to limit food waste and to raise awareness about this link in the chain. To develop and implement educational programs addressed at consumers it is necessary to understand the factors determining food waste in households. Segmentation is a tool that can help effectively reach consumers who are to the greatest extent wasting food which identifies homogeneous clusters of consumers. The aim of this study was to perform segmentation to identify consumer groups with similar behaviors in relation to food, with particular emphasis on food wastage. We carried out segmentation on a representative sample of Polish people over 18 years of age and to identified three clusters of consumers. The three consumer segments diagnosed differed in sociodemographic terms, i.e., number of adults, number of children, subjective assessment of the financial situation, and percentage of spending on food. The segment exhibiting a high frequency of discarding food due to too large package size included single and double households.

Consumer Understanding of the Date of Minimum Durability of Food in Association with Quality Evaluation of Food Products After Expiration

Food labelled with a "best before" date has a long shelf life. This study aimed to examine the respondents' knowledge and understanding regarding the labelling on food products, as well as to assess the microbiological, physico-chemical and the sensory quality of selected durable food products on and after the date specified by the manufacturer. Two methods were used-a survey and laboratory tests. It was found that the majority of respondents have difficulty distinguishing and understanding the terms on the label and that a significant proportion of the respondents consume food products after the "best before" date. Laboratory tests of milk, pasta, mayonnaise and jam confirmed the microbiological safety of the products even six months after the "best before" date. Other features (texture, colour and sensory quality) slightly changed after one month for milk and mayonnaise (the colour had become more yellow) and after three months for pasta (its hardness had decreased) and jam (it had become browner). The possibilityof extending the "best before" dates of selected durable foods could be considered, which could allow such products to legally be handed over to public benefit organisations, thereby reducing food wastage.

Video observation of hand-hygiene compliance in a manufacturer of ready-to-eat pie and pastry products

Food-handler hand-hygiene can be a contributory factor for food-borne illness. Cognitive data (knowledge/attitudes/self-reported practices), while informative, are not indicative of behaviour, and are subject to biases. Consequently, observation of behaviour is superior to survey data. However, researcher presence in direct observation increases reactivity, whereas video observation gives comprehensive analysis over a longer period, furthermore, familiarity reduces reactivity. Although video observation has been used to assess food safety at retail/foodservice, this valuable method is under-utilized in food-manufacturing environments. For the study, footage (24 h) was reviewed to assess compliance in a food-manufacturing site with company protocol. Video observation of food-handlers entering production (n = 674) was assessed; upon 70 occasions no attempt to implement hand-hygiene was observed. Of attempted hand-hygiene practices (n = 604), only 2% implemented compliant practices. Although 78% of attempts utilized soap, only 42% included sanitizer. Duration ranged from 1 to 69 s (Median 17 s). The study provides hand-hygiene data in an area that observational data is seldom captured.

Factors affecting safe and healthy diet in older adults in Italy: results of a preliminary study performed in a community-dwelling sample

OBJECTIVE

To investigate, through a questionnaire, older adults' demographic and socio-economic characteristics, knowledge, attitudes and practices in terms of food safety and healthy diet; and to develop dietary and hygiene indices able to represent participants' nutritional and food safety behaviour, exploring their association with demographic and socio-economic factors.

DESIGN

One-year cross-sectional study.

SETTING

Gemelli Teaching Hospital (Rome, Italy).

PARTICIPANTS

People aged ≥65 years, Italian speaking, accessing the Centre of Ageing Medicine.

RESULTS

Mean age of the sample was 74 (sd 7·7) years. Subjective perception of a safe diet was high: 64·2 % of respondents believed they have a balanced diet. Interviewees got informed about proper nutrition mainly from television, magazines, newspapers, Internet (29·9 %) and from health professionals (34·8 %) such as dietitians, whereas 15·4 % from general practitioners. Regarding food safety, 33·8 % of participants reported to consume expired food, even more than once per month; between 80 and 90 % of participants reported to follow food safety practices during preparation and cooking, even though 49·3 % defrosted food at room temperature. Calculated dietary and hygiene indices showed that the elderly participants were far from having optimal nutritional and food safety behaviours.

CONCLUSIONS

These results suggest it is necessary to increase the awareness of older adults in the matter of healthy diet and food safety. Specific and targeted educational interventions for the elderly and their caregivers could improve the adoption of recommended food safety practices and safe nutritional behaviours among older adults.

Domestic Kitchen Microbiological Contamination and Self-Reported Food Hygiene Practices of Older Adult Consumers

Because of increased susceptibility, older adults have an increased risk of foodborne infection, and data suggest elevated incidence; therefore, food hygiene is essential to reduce the risk. Research suggests older adults' inadequate knowledge and negative attitudes toward food hygiene may increase implementation of unsafe food practices. Data on microbiological contamination of domestic kitchens of older adults are lacking. Therefore, this study aimed to determine microbiological contamination of domestic kitchens of older adults. Food contact surfaces and equipment (n = 1,292) in domestic kitchens (n = 100) of older adults (≥60 years) were analyzed to isolate aerobic bacteria, Enterobacteriaceae, Staphylococcus aureus, and Listeria spp.; self-reported hygiene practices were also recorded. Highest contamination levels were determined on in-use cleaning equipment (dish brushes, dishcloths, sponges) with aerobic bacteria <9.3 log CFU per item, Enterobacteriaceae <8.8 log CFU per item, and S. aureus <7.0 log CFU per item. Reported usage length of dish brushes was significantly correlated (P < 0.05) with Enterobacteriaceae contamination. Significant correlations (P < 0.05) were determined between contamination and reported cleaning frequency of refrigerators. Contamination of hand towels in single-occupant households was significantly greater (P < 0.05) than in multioccupant households. The study facilitates novel comparison between reported hygiene practices with microbial contamination, suggesting older adults fail to implement adequate and regular hygiene practices that may increase the possibility of cross-contamination in the domestic kitchen and the associated risk of foodborne illness. Data from this study have determined a need for older adults to improve food hygiene practices in the domestic kitchen.

Food Safety Knowledge and Self-Reported Food-Handling Practices in Cancer Treatment

OBJECTIVES

To explore awareness of foodborne infection risk during chemotherapy treatment, to assess knowledge of risk-reducing food safety practices in patients with cancer and their family caregivers, and to determine self-reported food-handling practices.

SAMPLE & SETTING

A convenience sample of 121 patients receiving chemotherapy and 51 family caregivers of patients receiving chemotherapy in the United Kingdom recruited in the community and using online advertising.

METHODS & VARIABLES

Participants completed a self-report questionnaire to determine food safety knowledge and self-reported food-handling practices.

RESULTS

Although patients receiving chemotherapy and family caregivers reported awareness of food safety practices, self-reported practices indicated that potentially unsafe practices may be used in relation to temperature control, handwashing, safe cooking, and adherence to use-by dates. Such practices may increase the risk of foodborne illness to patients receiving chemotherapy treatment.

IMPLICATIONS FOR NURSING

Nursing research is required to explore the food safety training and awareness of healthcare providers. Highly focused and specifically targeted food safety interventions need to be developed and delivered to increase awareness and to implement food safety practices.

Knowledge, attitude and practices among parents regarding food poisoning: a cross-sectional study from Palestine

BACKGROUND

Food serves as a vehicle for many pathogenic and toxigenic agents that cause food-borne diseases. Knowledge, attitude, and practices are key factors in reducing the incidence of food-borne diseases in food service areas. The main objective of this study was to evaluate knowledge, attitude, and practices related to food poisoning among parents of children in Nablus, Palestine.

METHODS

A cross-sectional study was conducted in primary healthcare centers in Nablus district from May to July 2015. Data were collected using structured questionnaire interviews with parents to collect information on food safety knowledge, attitudes, and practices, alongside sociodemographic characteristics.

RESULTS

Four-hundred and twelve parents were interviewed, 92.7% were mothers. The median knowledge score was 12.0 with an interquartile range (IQR) of 11.0-14.0. The median attitude score was 11.0 with IQR of 10.0-13.0, while the median practice score was 18.0 with IQR of 16.0-19.0. Significant modest positive correlations were found between respondents' knowledge and attitude scores regarding food poisoning (r = 0.24, p < 0.001), knowledge and practice scores regarding food poisoning (r = 0.23, p < 0.001), and attitude and practice scores regarding food poisoning (r = 0.30, p < 0.001). Respondents with a higher education level and who live in a city were the only factors significantly associated with higher knowledge scores (p < 0.05). Attitude improved as educational level increased (p < 0.05) and income level increased (p < 0.05). Those of female gender and employed were statistically significantly associated with higher satisfactory hygienic practices in relation to the prevention of food poisoning (p < 0.05).

CONCLUSIONS

Knowledge, attitude, and practices regarding food poisoning prevention are associated with each other and are affected by a complex interplay between socio-economic variables. The study highlights the need for health education programmes and general awareness campaigns that intend not only to enhance knowledge but also promote parents to practice food safety measures strictly and further strengthen their awareness level.

Older Adult Consumers' Attitudes and Perceptions of Risk, Control, and Responsibility for Food Safety in the Domestic Kitchen

Although vast amounts of consumer food safety knowledge and self-reported data exist, attitudinal data detailing perceptions of risk, control, and responsibility are lacking. Such data relating to vulnerable groups, including older adults, are particularly scarce. Perception determination is essential in consumer food safety research to facilitate a comprehensive understanding of the cognitive factors that may impact behavior. Previous research has indicated a relationship between food safety perceptions and behavior. Perceptual data can inform the development of targeted food safety educational interventions. This study was conducted to ascertain older adult consumers' cognitive perceptions regarding food safety. Older adults (≥60 years, n = 100) participated in a computer-assisted personal interview to determine perceived risk, control, and responsibility associated with food safety. Although the potential severity of foodborne illness may be understood, the association between foodborne illness and domestic food preparation may be underestimated. Significant differences were found between perceived personal risk, control, and responsibility and the risks, control, and responsibilities of others ( P > 0.001). Older adults perceived themselves to have lower levels of risk than other individuals have, suggesting perceptions of optimistic bias and personal invulnerability. Perceived greater levels of personal control and responsibility, compared with those of others, suggest perceptions associated with the illusion of control. Correlations were evaluated between personal perceptions of risk, control, and responsibility ( P < 0.05). Low levels of risk were correlated with high levels of control. Those respondents ≥80 years of age perceived higher levels of risk and lower levels of control and responsibility. Cumulatively, older adult consumers expressed perceptions of invulnerability, optimistic bias, and the illusion of control regarding food safety. Such perceptions may undermine attempts to provide education regarding food safety. Food safety messages for this audience must be tailored to overcome such perceptions.

Pregnancy-related listeriosis

About one in seven cases of listeriosis occurs in pregnant women, and, although listeriosis is rare, it is the third leading cause of death from food-borne infections. Pregnancy-related listeriosis increases the risk for fetal and neonatal mortality by approximately 21%. During pregnancy, infections are more likely to occur in the third trimester (66%) than the first trimester (3%). However, fetal and neonatal adverse effects are less common as gestational age increases or with older gestational age at birth. Pregnant women seem highly susceptible in some listeriosis outbreaks making up a large percentage of cases, whereas others contain very few. Whether this results from differences in strains of L. monocytogenes, exposures, or other factors remains to be determined. Food and Agriculture Organization of United Nations/World Health Organization (FAO/WHO) estimates the human lethal dose for 50% (LD₅₀ ) for fetal/neonatal loss is 1.9 × 10⁶ colony forming units (CFUs) L. monocytogenes. Animal models have been developed for pregnancy-related listeriosis showing similar susceptibility and clinical outcomes as in humans. Nonhuman primate and guinea pig animal models have similar (LD₅₀ ) values to the estimated human LD₅₀ . Additional animal studies are needed to understand the pathways leading to fetal and neonatal listeriosis in humans. More information is needed to understand dose response, to model risk for listeriosis at lower concentrations, and to determine why some pregnant women may be more susceptible than others. To better treat listeriosis during pregnancy, biomarkers for early diagnosis of listeriosis are also needed. Last, pregnant women need to be educated about avoiding high-risk foods, like Mexican-style cheese and ready-to-eat meats. Birth Defects Research 109:324-335, 2017.© 2017 Wiley Periodicals, Inc.

Behavioral Observation and Microbiological Analysis of Older Adult Consumers' Cross-Contamination Practices in a Model Domestic Kitchen

The incidence of foodborne illness is higher in older adults because of their increased susceptibility; therefore, food safety practices are important. However, inadequate knowledge and negative attitudes toward food safety have been reported, which may increase use of unsafe food handling practices. Data on the actual food safety behaviors of older adults are lacking. In this study, food safety practices of older adults were observed and linked to microbiological analysis of kitchen surfaces to identify suspected routes of contamination. Older adults (≥60 years, n = 100) prepared a set meal in a model domestic kitchen sanitized according to a validated protocol to ensure minimal and consistent microbiological loads. Food safety behaviors were observed using ceiling-mounted cameras and recorded using a predetermined behavioral checklist. Surface microbiological contamination also was determined after food preparation. Overall, older adults frequently implemented unsafe food handling practices; 90% failed to implement adequate hand decontamination immediately after handling raw chicken. For older adults who used a larger number of adequate hand decontamination attempts, microbiological contamination levels in the kitchen following the food preparation session were significantly lower ( P < 0.001). The novel utilization of behavioral observation in conjunction with microbiological analysis facilitated identification of potentially unsafe food handling practices as suspected routes of microbiological cross-contamination in a model domestic kitchen. Findings indicate the potential impact on domestic food safety of unsafe food handling practices used by older adult consumers. This innovative approach revealed that a large proportion of older adults implement behaviors resulting in microbiological cross-contamination that may increase the risk of foodborne illness in the home.

Listeria monocytogenes contamination of ready-to-eat foods and the risk for human health in the EU

Food safety criteria for Listeria monocytogenes in ready-to-eat (RTE) foods have been applied from 2006 onwards (Commission Regulation (EC) 2073/2005). Still, human invasive listeriosis was reported to increase over the period 2009-2013 in the European Union and European Economic Area (EU/EEA). Time series analysis for the 2008-2015 period in the EU/EEA indicated an increasing trend of the monthly notified incidence rate of confirmed human invasive listeriosis of the over 75 age groups and female age group between 25 and 44 years old (probably related to pregnancies). A conceptual model was used to identify factors in the food chain as potential drivers for L. monocytogenes contamination of RTE foods and listeriosis. Factors were related to the host (i. population size of the elderly and/or susceptible people; ii. underlying condition rate), the food (iii. L. monocytogenes prevalence in RTE food at retail; iv. L. monocytogenes concentration in RTE food at retail; v. storage conditions after retail; vi. consumption), the national surveillance systems (vii. improved surveillance), and/or the bacterium (viii. virulence). Factors considered likely to be responsible for the increasing trend in cases are the increased population size of the elderly and susceptible population except for the 25-44 female age group. For the increased incidence rates and cases, the likely factor is the increased proportion of susceptible persons in the age groups over 45 years old for both genders. Quantitative modelling suggests that more than 90% of invasive listeriosis is caused by ingestion of RTE food containing > 2,000 colony forming units (CFU)/g, and that one-third of cases are due to growth in the consumer phase. Awareness should be increased among stakeholders, especially in relation to susceptible risk groups. Innovative methodologies including whole genome sequencing (WGS) for strain identification and monitoring of trends are recommended.

An assessment of food safety information provision for UK chemotherapy patients to reduce the risk of foodborne infection

OBJECTIVES

Given the increased risk of foodborne infection to cancer patients receiving chemotherapy treatment, and the risk of listeriosis reportedly five-times greater to this immunocompromised patient group, there is a need to ensure the implementation of domestic food safety practices among chemotherapy patients and their family caregivers. However, information regarding the adequacy of resources to inform and enable patients to implement domestic food safety practices to reduce the risk of foodborne infection is limited. Consequently, this study aimed to evaluate the provision of food safety information available to UK chemotherapy patients.

STUDY DESIGN

In-depth semi-structured interviews and content analysis of online patient information resources.

METHODS

Interviews with patients and family caregivers (n = 15) were conducted to explore food-related experiences during chemotherapy treatment. Online food-related information resources for chemotherapy patients (n = 45) were obtained from 35 of 154 National Health Service chemotherapy providers in England, Scotland, and Wales, the Department of Health (DoH) and three of 184 identified UK cancer charities. Identified food-related information resources were reviewed using a content-analysis approach to assess the inclusion of food safety information for chemotherapy patients.

RESULTS

In-depth interviews established that many patients indicated awareness of immunosuppression during treatment. Although patients reported practicing caution to reduce the risk of communicable diseases by avoiding crowded spaces/public transport, food safety was reported to be of minimal concern during treatment and the risk of foodborne infection was often underestimated. The review of online food-related patient information resources established that many resources failed to highlight the increased risk of foodborne infection and emphasize the importance of food safety for patients during chemotherapy treatment. Considerable information gaps exist, particularly in relation to listeriosis prevention practices. Cumulatively, information was inconsistent, insufficient, and varied between resources.

CONCLUSION

The study has identified the need for an effective, standardized food safety resource specifically targeting chemotherapy patients and family caregivers. Such intervention is essential to assist efforts in reducing the risks associated with foodborne infection among chemotherapy patients.

Barriers and Facilitators to Safe Food Handling among Consumers: A Systematic Review and Thematic Synthesis of Qualitative Research Studies

Foodborne illness has a substantial health and economic burden on society, and most cases are believed to be due to unsafe food handling practices at home. Several qualitative research studies have been conducted to investigate consumers' perspectives, opinions, and experiences with safe food handling at home, and these studies provide insights into the underlying barriers and facilitators affecting their safe food handling behaviours. We conducted a systematic review of previously published qualitative studies in this area to synthesize the main across-study themes and to develop recommendations for future consumer interventions and research. The review was conducted using the following steps: comprehensive search strategy; relevance screening of abstracts; relevance confirmation of articles; study quality assessment; thematic synthesis of the results; and quality-of-evidence assessment. A total of 39 relevant articles reporting on 37 unique qualitative studies were identified. Twenty-one barriers and 10 facilitators to safe food handling were identified, grouped across six descriptive themes: confidence and perceived risk; knowledge-behaviour gap; habits and heuristics; practical and lifestyle constraints; food preferences; and societal and social influences. Our overall confidence that each barrier and facilitator represents the phenomenon of interest was rated as high (n = 11), moderate (11), and low (9). Overarching analytical themes included: 1) safe food handling behaviours occur as part of a complex interaction of everyday consumer practices and habituation; 2) most consumers are not concerned about food safety and are generally not motivated to change their behaviours based on new knowledge about food safety risks; and 3) consumers are amenable to changing their safe food handling habits through relevant social pressures. Key implications and recommendations for research, policy and practice are discussed.

Time-Temperature Profiling of United Kingdom Consumers' Domestic Refrigerators

Increased consumer demand for convenience and ready-to-eat food, along with changes to consumer food purchase and storage practices, have resulted in an increased reliance on refrigeration to maximize food safety. Previous research suggests that many domestic refrigerators operate at temperatures exceeding recommendations; however, the results of several studies were determined by means of one temperature data point, which, given temperature fluctuation, may not be a true indicator of actual continual operating temperatures. Data detailing actual operating temperatures and the effects of consumer practices on temperatures are limited. This study has collated the time-temperature profiles of domestic refrigerators in consumer kitchens (n = 43) over 6.5 days with concurrent self-reported refrigerator usage. Overall, the findings established a significant difference (P < 0.05) between one-off temperature (the recording of one temperature data point) and mean operating temperature. No refrigerator operated at ≤5.0°C for the entire duration of the study. Mean temperatures exceeding 5.0°C were recorded in the majority (91%) of refrigerators. No significant associations or differences were determined for temperature profiles and demographics, including household size, or refrigerator characteristics (age, type, loading, and location). A positive correlation (P < 0.05) between room temperature and refrigerator temperature was determined. Reported door opening frequency correlated with temperature fluctuation (P < 0.05). Thermometer usage was determined to be infrequent. Cumulatively, research findings have established that the majority of domestic refrigerators in consumer homes operate at potentially unsafe temperatures and that this is influenced by consumer usage. The findings from this study may be utilized to inform the development of shelf-life testing based on realistic domestic storage conditions. Furthermore, the data can inform the development of future educational interventions to increase safe domestic refrigeration practices.

Enterocin B3A-B3B produced by LAB collected from infant faeces: potential utilization in the food industry for Listeria monocytogenes biofilm management

Enterococcus faecalis B3A-B3B produces the bacteriocin B3A-B3B with activity against Listeria monocytogenes, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium perfringens, but apparently not against fungi or Gram-negative bacteria, except for Salmonella Newport. B3A-B3B enterocin has two different nucleotides but similar amino acid composition to the class IIb MR10A-MR10B enterocin. B3A-B3B consists of two peptides of predicted molecular mass of 5176.31 Da (B3A) and 5182.21 Da (B3B). Importantly, B3A-B3B impeded biofilm formation of the foodborne pathogen L. monocytogenes 162 grown on stainless steel. The antimicrobial treatment of stainless steel with nisin (1 or 16 mg ml^-1) decreased the cell numbers by about 2 log CFU ml^-1, thereby impeding the biofilm formation by L. monocytogenes 162 or its nisin-resistant derivative strain L. monocytogenes 162R. Furthermore, the combination of nisin and B3A-B3B enterocin reduced the MIC required to inhibit this pathogen grown in planktonic or biofilm cultures.

Older Adult Consumer Knowledge, Attitudes, and Self-Reported Storage Practices of Ready-to-Eat Food Products and Risks Associated with Listeriosis

Consumer implementation of recommended food safety practices, specifically relating to time and temperature control of ready-to-eat (RTE) food products associated with listeriosis are crucial. This is particularly the case for at-risk consumers such as older adults, given the increased listeriosis incidence reported internationally among adults aged ≥60 years. However, data detailing older adults' cognitive risk factors associated with listeriosis are lacking. Combining data about knowledge, self-reported practices, and attitudes can achieve a cumulative multilayered in-depth understanding of consumer food safety behavior and cognition. This study aims to ascertain older adults' cognition and behavior in relation to domestic food handling and storage practices that may increase the risks associated with L. monocytogenes. Older adults (≥60 years) (n = 100) participated in an interview and questionnaire to determine knowledge, self-reported practices, and attitudes toward recommended practices. Although the majority (79%) had positive attitudes toward refrigeration, 84% were unaware of recommended temperatures (5°C) and 65% self-reported "never" checking their refrigerator temperature. Although most (72%) knew that "use-by" dates indicate food safety and 62% reported "always" taking note, neutral attitudes were held, with 67% believing it was safe to eat food beyond use-by dates and 57% reporting doing so. Attitudes toward consuming foods within the recommended 2 days of opening were neutral, with 55% aware of recommendations and , 84% reporting that they consume RTE foods beyond recommendations. Although knowledgeable of some key practices, older adults self-reported potentially unsafe practices when storing RTE foods at home, which may increase risks associated with L. monocytogenes. This study has determined that older adults' food safety cognition may affect their behaviors; understanding consumer food safety cognition is essential for developing targeted food safety education.

Effects of Domestic Storage and Thawing Practices on Salmonella in Poultry-Based Meat Preparations

Among consumer food handling practices, time-temperature abuse has been reported as one of the most common contributory factors in salmonellosis outbreaks where the evidence is strong. The present study performed storage tests of burgers, sausages, and kebabs and investigated (i) the effect of refrigerator temperatures (4°C versus 8 or 12°C, which were the temperatures recorded in 33 and 3%, respectively, of domestic refrigerators in Italy), with or without prior temperature abuse (25°C for 2 h, simulating transport of meats from shop to home), and (ii) the impact of the thawing method (overnight in the refrigerator at 8°C versus on the kitchen countertop at 23°C) on the presence and numbers of Salmonella bacteria. Storage tests were carried out on naturally or artificially (Salmonella enterica serovar Typhimurium at ca. 10 CFU/g) contaminated products, while freezing-thawing tests were conducted only on artificially contaminated products (Salmonella Typhimurium at ca. 10, 100, and 1,000 CFU/g). The results from the artificially contaminated products showed significant (P < 0.05) growth of Salmonella Typhimurium at 12°C (i.e., from ca. 8 most probable number [MPN]/g to > 710 MPN/g) in kebabs after 7 and 10 days but more moderate growth in sausages (i.e., from ca. 14 MPN/g to a maximum of 96 MPN/g after 9 days of storage). Storage of naturally contaminated burgers or sausages (contamination at or below 1 MPN/g) at 4, 8, or 12°C and a short time of temperature abuse (2 h at 25°C) did not facilitate an increase in the presence and numbers of Salmonella bacteria. Thawing overnight in the refrigerator led to either a moderate reduction or no change of Salmonella Typhimurium numbers in burgers, sausages, and kebabs. Overall, this study showed that domestic storage and thawing practices can affect food safety and that time-temperature abuse can cause a substantial increase of Salmonella numbers in some types of poultry-based meat preparations, highlighting that efforts for the dissemination of consumer guidelines on the correct storage and handling of meats need to be continued.

Analysis of older adults' domestic kitchen storage practices in the United Kingdom: identification of risk factors associated with listeriosis

Increased listeriosis incidence among older adults (≥ 60 years) has been reported internationally, with many cases reported to be sporadic and associated with ready-to-eat (RTE) food products with extended refrigerated shelf life. Given that the home kitchen is recognized as a significant location where foodborne illnesses are acquired, it is important that consumers implement safe food practices to minimize risks. This is crucial for vulnerable consumers, such as older adults. Consumer food safety recommendations in the United Kingdom to reduce the risk of listeriosis at home include (i) following "use-by" dates on unopened prepacked RTE food products, (ii) consuming RTE food products within 2 days of opening, and (iii) ensuring the safe operating temperatures of domestic refrigerators (≤ 5 °C). This study utilized observation, self-reporting, and microbiological analysis to determine actual food storage practices to identify behavioral risk factors. A domestic kitchen survey was conducted in older adult (≥ 60 years) consumers' domestic kitchens (n = 100) in South Wales, United Kingdom. Forty-one percent of foods in home refrigerators were beyond the use-by date, of which 11% were unopened RTE food products commonly associated with listeriosis. Sixty-six percent of opened RTE foods had been or were intended to be stored beyond the recommended 2 days after opening. Older adults failed to ensure safe refrigeration temperatures, with 50% of central storage and 85% of door storage areas operating at temperatures >5 °C. Older refrigerators operated at significantly (P < 0.05) higher temperatures. Given that Listeria monocytogenes was isolated in 2% of kitchens, these findings suggest that storage malpractices may have a greater effect on the potential risk of listeriosis than its presence alone. The study has determined that many older adults fail to adhere to recommendations and subject RTE foods associated with L. monocytogenes to prolonged storage at unsafe temperatures which may render food unsafe for consumption.

Applications and Perceptions of Date Labeling of Food

Open dating of food products has been practiced for decades, and has been key to achieving stock rotation at retail and providing information to consumers. The open date provides a simple communication tool, which may be based on product quality and/or food safety as determined by the manufacturer or retailer. Date marking is generally open but it can be closed (code intended for managing product at retail, and for recall and traceability), and the terminology and applications vary widely around the world. The variation in date labeling terms and uses contributes to substantial misunderstanding by industry and consumers and leads to significant unnecessary food loss and waste, misapplication of limited resources, unnecessary financial burden for the consumer and the food industry, and may also lead to potential food safety risk in regards to perishable foods. A "use by" or similar date cannot be relied on to indicate or guarantee food safety because absolute temperature control of food products throughout the food supply chain cannot be assured. This paper provides an introduction to the issue of food product date labeling and addresses its history in the United States, different terms used and various practices, U.S. and international frameworks, quality compared with safety, adverse impacts of misconceptions about date labeling, and advantages of technological innovations. Collaboration to develop a simple workable solution to address the challenges faced by stakeholders would have tremendous benefit. Conclusions include a call to action to move toward uniformity in date labeling, thereby decreasing confusion among stakeholders and reducing food waste.