|
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.
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
Chicken-Handling Practices Study
Objective: To collect descriptive data on chicken handling and
cooking practices in restaurants. Specifically, we will collect
data on:
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.
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
Value of Inspections Study
Objective: To determine the relationship between restaurant
inspections and foodborne illness outbreaks.