Environmental Health|EHSB|EHSNET|Foodsafety

Beliefs About Sources of Gastrointestinal Illness Population Study
Objective: To increase understanding of the population’s experiences with and beliefs about gastrointestinal illness.

Study Results: A telephone survey of randomly selected U.S. residents revealed that: 22% of respondents believed their recent gastrointestinal illness resulted from a specific meal eaten outside the home; respondents who experienced mild symptoms were more likely to attribute their illness to a meal eaten outside the home; respondents tended to use some of the same reasons, such as symptom timing and illness of their meal companions, for attributing illness to a specific meal as epidemiologists do; only 8% of respondents reported their illness to a health department or suspected restaurant; and most respondents who attributed their illness to a specific outside meal said their illness symptoms began within a short time (5 hours) of eating that meal. These results suggest that education efforts should focus on the nature and timing of foodborne illness symptoms and the importance of reporting suspected foodborne illnesses.

Publications and Presentations

Ground Beef Handling Practices Study
Objective: To evaluate ground beef handling practices and the use of irradiated ground beef in restaurants.

Study Results: Interviews and observations in restaurants that handle raw ground beef revealed that risky ground beef handling practices were pervasive in restaurants. Sixty-four percent of restaurants reported they never took the temperature of fresh ground beef upon delivery, and 50% reported they never took the final cook temperature of hamburgers. Observations indicated that in 49% of restaurants, hands were not washed after handling raw ground beef, and in 60% of restaurants, hands were wiped on wiping cloths or aprons after handling raw ground beef. Only 1% of restaurants reported always or sometimes purchasing irradiated ground beef, and 29% reported that they had never heard of irradiated ground beef. These results indicate the need for food worker educational campaigns that focus on hand hygiene, avoiding cross-contamination, and verification of the final cook temperatures of ground beef.

Publications and Presentations

Egg-Handling Practices Study
Objective: To identify the prevalence of high-risk egg-handling practices and establishment policies in restaurants that serve breakfast all day.

Study Results: Interviews and observations conducted in restaurants that prepare eggs revealed that risk egg handling practices were common. Fifty-four percent of restaurants pooled raw shell eggs not intended for immediate service. These pooled eggs were held a median of 4 hours for scrambled eggs, 5.5 hours for omelets, and 6 hours for pancakes and French toast. Nearly 26% of restaurants reported storing eggs at room temperature. Employees reported sanitizing utensils used to prepare eggs less than once every 4 hours in 42% of restaurants. However, eggs were generally cooked to 72 to 83˚C, which is above the recommended final cook temperature of 63 to 68˚C.

Publications and Presentations

Environmental Health Specialists’ Inspection and Outbreak Investigation Practices Focus Group Study
Objective: To evaluate the knowledge, attitudes, and behaviors of environmental health specialists regarding inspections and outbreak investigations.

Study Results: Focus group results concerning inspections indicated that environmental health specialists thought that identifying and correcting critical violations of food safety regulations, educating restaurant workers and managers about these critical violations, and developing a good relationship with restaurant managers were common and important inspection activities. Specialists also identified inspection difficulties associated with the restaurant industry, the inspection structure, and environmental health management.

Results concerning outbreak investigations revealed substantial variability in the type of activities in which participants engaged during investigations, and the amount and nature of the collaboration between epidemiology and environmental health during investigations. Also, many participants indicated that they did not often identify contributing factors to outbreaks during investigations. Participants also identified several difficulties associated with outbreak investigations, including those associated with restaurant employees, restaurant customers, and environmental health organizations.

Publications and Presentations

Evaluation of Outbreak and Nonoutbreak Restaurants
Objective: To identify pathogens and contributing factors associated with restaurant-related foodborne illness outbreaks and food-safety differences between outbreak and nonoutbreak restaurants, through systematic environmental evaluations.

Study Results: For this study, systematic evaluations were conducted in restaurants in which foodborne illness outbreaks had occurred and in restaurants in which outbreaks had not occurred. Results indicated that Norovirus was the most common foodborne disease agent identified, accounting for 42% of all confirmed foodborne outbreaks during the study period. Handling of food by an infected person or carrier (65%) and bare-hand contact with food (35%) were the most commonly identified contributing factors. Outbreak and nonoutbreak restaurants were similar with respect to many characteristics, but did differ in the presence of a certified kitchen manager (CKM); 32% of outbreak restaurants had a CKM, but 71% of nonoutbreak restaurants had a CKM (OR= 0.2; 95% CI=0.1 to 0.5). CKMs were associated with the absence of bare-hand contact with foods as a contributing factor, fewer norovirus outbreaks, and the absence of outbreaks associated with Clostridium perfringens. Food safety certification of kitchen managers appears to be an important outbreak prevention measure.

Publications and Presentations

Food Workers’ Food Preparation Practices Focus Group Study
Objective: To evaluate behavioral factors, barriers, and motivations that influence safe food-handling practices in food-service establishments.

Study Results: In focus groups on food workers’ food safety practices, some food workers reported unsafe food preparation practices, such as inappropriate glove use and not checking the temperatures of cooked, reheated, and cooled foods. Most workers, however, reported safe practices (e.g., washing their hands after preparing raw meat). Workers identified a number of factors that impacted their ability to prepare food safely, including time pressure; structural environments, equipment, and resources; management and coworker emphasis on food safety; worker characteristics; negative consequences for those who do not prepare food safely; food safety education and training; restaurant procedures; and glove and sanitizer use. Results suggest that food safety programs need to address the full range of factors that impact food preparation behaviors.

Publications and Presentations

Food Workers’ Food Preparation Practices Population Study
Objective: To determine self-reported prevalence of food service workers’ safe and unsafe food preparation practices at the population level.

Study Results: In a telephone survey of randomly selected food service workers, respondents commonly reported risky food preparation practices. Respondents said that at work they did not always wear gloves while touching ready-to-eat (RTE) food (60%), did not always wash their hands or change their gloves between handling raw meat and RTE food (23% and 33%), did not use a thermometer to check food temperatures (53%), and had worked while sick with vomiting or diarrhea (5%). Workers responsible for food preparation reported washing their hands and wearing gloves when handling RTE food more often than workers not responsible for food preparation. Workers who cooked reported changing their gloves more often than workers who did not cook. Workers in chain restaurants more frequently reported using thermometers than workers in independently owned restaurants.

Publications and Presentations

Hand-Hygiene Study
Objective: To describe restaurant food workers' hand hygiene practices and identify factors associated with safe hand hygiene practices.

Study Results: Observations of workers preparing food at work indicated that workers engaged in approximately 8.6 activities per hour for which hand washing is recommended. However, workers made hand washing attempts in only 32% of these activities and washed their hands appropriately in only 27% of these activities. Attempted and appropriate hand washing rates were significantly higher in conjunction with food preparation than other activities (e.g., handling dirty equipment). Attempted and appropriate hand washing rates were significantly lower when gloves were worn than when gloves were not worn. Hand washing and glove use were more likely to occur when workers were not busy. Hand washing was more likely to occur in restaurants that provided food safety training, with more than one hand sink, and with a hand sink in the worker’s sight. Glove use was more likely to occur in chain restaurants and in restaurants with glove supplies in food preparation areas. These findings suggest that food worker hand washing practices need to be improved, glove use may reduce hand washing, and restaurants should consider reorganizing their work activities to reduce the need for hand washing. Findings also indicate that several factors are related to hand hygiene practices and support suggestions that food worker hand hygiene improvement requires multidimensional programs.

Publications and Presentations

Projects in Progress

Chicken-Handling Practices Study
Objective: To collect descriptive data on chicken handling and cooking practices in restaurants. Specifically, we will collect data on:

opportunities for cross contamination from raw chicken to the environment during storage, preparation, and cooking,
final temperatures of chicken immediately after cooking, and
opportunities for cross contamination from a contaminated environment to cooked chicken during preparation and cooking.

Environmental Surface Sampling Study
Objective: To determine whether outbreaks can be predicted on the basis of environmental samples collected in food-service establishments. This study is being conducted in Iowa.

Foodborne Illness Complaint System Project
Objective: To develop an “ideal” foodborne illness complaint capture form and evaluation questionnaire.

Foodborne Illness Outbreak Study
Objective: To identify contributing factors to foodborne illness outbreaks in food-service facilities and to describe the characteristics, policies and practices of those facilities. Food-service facilities include restaurants, delis, cafeterias, schools, nursing homes, etc.

Study results: Environmental assessments conducted as part of 154 foodborne illness outbreak investigations in food service establishments provided data on a number of establishment characteristics, policies and practices that may serve as potential antecedents to foodborne illness outbreaks. These data are summarized below as preliminary findings.

The majority (84%) of the foodservice establishments involved in the outbreaks were complex establishments, meaning a complex food handling process is utilized for one or more foods handled in the establishment. Additionally, 13% were cook serve establishments, and 3% were prep serve establishments.
Spanish was the primary language of 58% of food workers but only 41% of managers could speak Spanish.
Floor cleaning policies existed in 95% of establishments, but only 37% of these policies were written.
Fewer establishments had policies on cleaning of food contact surfaces (88%), cutting boards (89%), and food slicers (72%).
More managers (66%) received paid sick leave than workers (35%).
The majority (96%) of establishments had hand sinks available in employee restrooms and work areas (94%). However, hands-free operated sinks were rare (restrooms: 4%; work areas: 3%).

Publications and Presentations

Ill Food Worker Study
Objective: To describe restaurants’ existing ill food worker policies; practices associated with ill food workers, including symptoms that prompt food workers to call in sick and symptoms that prompt managers to send food workers home; and reasons why food workers work while ill.

Tomato-Handling Practices Study
Objective: To identify the types of tomatoes used in restaurants, describe tomato-handling practices, and to identify factors associated with safer tomato-handling practices.

Study Results: Interviews with managers and observations of tomato preparation indicated that tomato washing, cutting and holding were prevalent in restaurants, and that in the implementation of these practices, opportunities for cross contamination and proliferation of pathogens were common. These opportunities are summarized below as preliminary findings.

Washing practices

Tomato washing occurred in inappropriate sinks in 5% of observations.
Tomatoes were soaked during washing in 18% of observations; soaking of tomatoes is not recommended by the FDA.
When soaking occurred, the tomato-water temperature differential met FDA guidelines in only 7% of observations.

Many restaurants did not take cross contamination prevention precautions—in 50% of observations, a produce only cutting board was not used, and in 26% of restaurants, managers reported that gloves were not used during tomato preparation.
Tomatoes were above the maximum recommended temperature immediately after cutting in 89% of observations.

Cut tomatoes were held above the recommended maximum temperature in 53% of observations.

Publications and Presentations

Value of Inspections Study
Objective: To determine the relationship between restaurant inspections and foodborne illness outbreaks.

Environmental Health Specialists Network (EHS-Net)

Food Safety Projects

Completed Projects

Projects in Progress

Completed Projects

Projects in Progress