Comparisons of microbiological evaluations of selected kitchen areas with visual inspections for preventing potential risk of foodborne outbreaks in food service operations

Microbiological Profiles of Disposable Gloves Used for Handling Ready-to-Eat Foods

Hand hygiene is critical in the food service industry. Bacteria can easily be transferred between different surfaces to food during food preparation. Common hygiene practices include hand washing and usage of disposable gloves. Food handlers are often susceptible to transferring pathogenic bacteria to food, thus proper hand hygiene can limit such transmission. While gloves serve as a barrier between bare hands and food, their misuse, including reuse or lack of change, can potentially result in cross-contamination, compromising on food safety. In Singapore, strict regulations and consumer perceptions have encouraged the use of gloves in food handling. This study assessed the microbiological profile of gloves used by food handlers across fifty randomly chosen food establishments, by swabbing samples from the inner and outer surfaces of gloves. Glove samples were also subjected to a watertight test to detect significant physical damage. The results revealed that gloves with damage exhibited significantly higher mean Standard Plate Counts (SPCs), suggesting the likelihood that damaged gloves promoted the transfer of bacteria. Damaged gloves used to handle certain types of food, like noodles and rice dishes, also had significantly higher mean SPC than those used for beverages and snacks. However, gloves without visible damage showed no significant difference in mean SPC across different food types. The study highlighted that proper glove use can help in preventing bacterial transfer and consequently, maintaining food safety. Regular glove changes, particularly when damaged, are imperative. The findings underscore the importance of proper glove use in conjunction with other hand hygiene practices to uphold food hygiene and safety standards.

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

The Presence of Norovirus and Adenovirus on Environmental Surfaces in Relation to the Hygienic Level in Food Service Operations Associated with a Suspected Gastroenteritis Outbreak

Norovirus (NoV) gastroenteritis outbreaks appear frequently in food service operations (FSOs), such as in restaurants and canteens. In this study the presence of NoV and adenovirus (AdV) genomes was investigated on the surfaces of premises, especially in kitchens, of 30 FSOs where foodborne gastroenteritis outbreaks were suspected. The objective was to establish a possible association between the presence of virus genomes on surfaces and a visual hygienic status of the FSOs. NoV genome was found in 11 and AdV genome in 8 out of 30 FSOs. In total, 291 swabs were taken, of which 8.9% contained NoV and 5.8% AdV genome. The presence of NoV genomes on the surfaces was not found to associate with lower hygiene level of the premises when based on visual inspection; most (7/9) of the FSOs with NoV contamination on surfaces and a completed evaluation form had a good hygiene level (the best category). Restaurants had a significantly lower proportion of NoV-positive swabs compared to other FSOs (canteens, cafeteria, schools etc.) taken together (p = 0.00014). The presence of a designated break room for the workers was found to be significantly more common in AdV-negative kitchens (p = 0.046). Our findings suggest that swabbing is necessary for revealing viral contamination of surfaces and emphasis of hygiene inspections should be on the food handling procedures, and the education of food workers on virus transmission.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 11. Use of antiseptics and sanitizers in community settings and issues of hand hygiene compliance in health care and food industries

Hand washing with soap is a practice that has long been recognized as a major barrier to the spread of disease in food production, preparation, and service and in health care settings, including hospitals, child care centers, and elder care facilities. Many of these settings present multiple opportunities for spread of pathogens within at-risk populations, and extra vigilance must be applied. Unfortunately, hand hygiene is not always carried out effectively, and both enteric and respiratory diseases are easily spread in these environments. Where water is limited or frequent hand hygiene is required on a daily basis, such as for many patients in hospitals and astronauts in space travel, instant sanitizers or sanitary wipes are thought to be an effective way of preventing contamination and spread of organisms among coworkers and others. Most concerns regarding compliance are associated with the health care field, but the food industry also must be considered. Specific reasons for not washing hands at appropriate times are laziness, time pressure, inadequate facilities and supplies, lack of accountability, and lack of involvement by companies, managers, and workers in supporting proper hand washing. To facilitate improvements in hand hygiene, measurement of compliant and noncompliant actions is necessary before implementing any procedural changes. Training alone is not sufficient for long-lasting improvement. Multiactivity strategies also must include modification of the organization culture to encourage safe hygienic practices, motivation of employees willing to use peer pressure on noncompliant coworkers, a reward and/or penalty system, and an operational design that facilitates regular hand hygiene.

Effect of a manager training and certification program on food safety and hygiene in food service operations

Food safety is an important public health issue in the U.S. Eating at restaurants and other food service facilities increasingly has been associated with food borne disease outbreaks. Food safety training and certification of food mangers has been used as a method for reducing food safety violations at food service facilities. However, the literature is inconclusive about the effectiveness of such training programs for improving food safety and protecting consumer health. The purpose of this study was to examine the effect of food manger training on reducing food safety violations. We examined food inspection reports from the Toledo/Lucas County Health Department (Ohio) from March 2005 through February 2006 and compared food hygiene violations between food service facilities with certified and without certified food managers. We also examined the impact on food safety of a food service facility being part of a larger group of facilities.Restaurants with trained and certified food managers had significantly fewer critical food safety violations but more non-critical violations than restaurants without certified personnel. Institutional food service facilities had significantly fewer violations than restaurants, and the number of violations did not differ as a function of certification. Similarly, restaurants with many outlets had significantly fewer violations than restaurants with fewer outlets, and training was not associated with lower numbers of violations from restaurants with many outlets. The value of having certified personnel was only observed in independent restaurants and those with few branches. This information may be useful in indicating where food safety problems are most likely to occur. Furthermore, we recommend that those characteristics of institutional and chain restaurants that result in fewer violations should be identified in future research, and efforts made to apply this knowledge at the level of individual restaurants.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 6. Transmission and survival of pathogens in the food processing and preparation environment

This article, the sixth in a series reviewing the role of food workers in foodborne outbreaks, describes the source and means of pathogen transfer. The transmission and survival of enteric pathogens in the food processing and preparation environment through human and raw food sources is reviewed, with the main objective of providing information critical to the reduction of illness due to foodborne outbreaks. Pathogens in the food preparation area can originate from infected food workers, raw foods, or other environmental sources. These pathogens can then spread within food preparation or processing facilities through sometimes complex pathways and may infect one or more workers or the consumer of foods processed or prepared by these infected workers. The most frequent means of worker contamination is the fecal-oral route, and study results have indicated that toilet paper may not stop transmission of pathogens to hands. However, contact with raw foods of animal origin, worker aerosols (from sneezes), vomitus, and exposed hand lesions also have been associated with outbreaks. Transfer of pathogens has been documented through contaminated fabrics and carpets, rings, currency, skin surfaces, dust, and aerosols and though person-to-person transmission. Results of experiments on pathogen survival have indicated that transmission depends on the species, the inoculum delivery route, the contact surface type, the duration and temperature of exposure, and the relative humidity. Generally, viruses and encysted parasites are more resistant than enteric bacteria to adverse environmental conditions, but all pathogens can survive long enough for transfer from a contaminated worker to food, food contact surfaces, or fellow workers.

Efficacy of an extended theory of planned behaviour model for predicting caterers' hand hygiene practices

The main aim of this study was to determine the factors which influence caterers' hand hygiene practices using social cognitive theory. One hundred and fifteen food handlers from 29 catering businesses were observed carrying out 31,050 food preparation actions in their workplace. Caterers subsequently completed the Hand Hygiene Instrument (HHI), which ascertained attitudes towards hand hygiene using constructs from the Theory of Planned Behaviour (TPB) and the Health Belief Model. The TPB provided a useful framework for understanding caterers' implementation of hand hygiene practices, explaining 34% of the variance in hand hygiene malpractices (p < 0.05). Five components were identified as significant predictors of hand hygiene malpractices: attitudes, subjective norms, descriptive norms, perceived behavioural control and intention (p < 0.05). Thus, suggesting that hand hygiene practices cannot be improved solely through the provision of information to individuals. Effective interventions may need to focus on changing the organisational food safety culture.

Development of a microbial population within a hot-drinks vending machine and the microbial load of vended hot chocolate drink

In order to understand the development of the microbial population within a hot-drinks vending machine a new machine was placed in a staff area of a university campus vending only hot chocolate. The machine was cleaned weekly using a detergent based protocol. Samples from the mixing bowl, dispense area, and drink were taken over a 19-wk period and enumerated using plate count agar. Bacillus cereus was identified using biochemical methods. Vended drinks were sampled at 0, 3, 6, and 9 min after vending; the hot chocolate powder was also sampled. Over the 1st 8 wk, a significant increase in the microbial load of the machine components was observed. By the end of the study, levels within the vended drink had also increased significantly. Inactivation of the automatic flush over a subsequent 5-wk period led to a statistically but not operationally significant increase in the microbial load of the dispense area and vended drink. The simple weekly clean had a significant impact on the microbial load of the machine components and the vended drink. This study demonstrated that a weekly, detergent-based cleaning protocol was sufficient to maintain the microbial population of the mixing bowl and dispense point in a quasi-steady state below 3.5 log CFU/cm2 ensuring that the microbial load of the vended drinks was maintained below 3.4 log CFU/mL. The microbial load of the drinks showed no significant changes over 9 min after vending, suggesting only spores are present in the final product.

A preliminary evaluation of the effect of glove use by food handlers in fast food restaurants

A study was conducted to determine whether the levels of selected microorganisms differed on foods handled by gloved and bare hands at fast food restaurants. Three hundred seventy-one plain flour tortillas were purchased from fast food restaurants and analyzed for Staphylococcus aureus, Escherichia coli, Klebsiella sp., coliform bacteria, and heterotrophic plate count bacteria. Approximately 46% of the samples were handled by workers wearing gloves compared with 52% of samples with bare hand contact. Coliform bacteria were found in 9.6% of samples handled by gloved workers and 4.4% of samples handled by bare hands, although this difference was not statistically significant. The distribution of heterotrophic plate count bacteria, a general measure of hygiene, was also higher in samples handled by gloved workers in one restaurant chain. The presence of E. coli, Klebsiella sp., and S. aureus was detected in one, two, and eight samples, respectively, and there were no significant differences between samples handled by gloved or bare hands. Neither direct contact of the tortilla with the food preparation surface nor gender of the worker affected the level of any organism tested. The observed tendency of food workers to wear the same pair of gloves for extended periods and complacency might account for the apparent failure of gloves to reduce or prevent bacterial contamination. The results further suggest that glove use might be counterproductive because workers might wash their hands less frequently when gloved.

Statistical distributions describing microbial quality of surfaces and foods in food service operations

Data on the microbial quality of food service kitchen surfaces and ready-to-eat foods were collected over a period of 10 years in Rutgers University dining halls. Surface bacterial counts, total aerobic plate counts, and total and fecal coliform counts were determined using standard methods. Analysis was performed on foods tested more than 50 times (primarily lunch meats and deli salads) and on surfaces tested more than 500 times (36 different surfaces types, including pastry brushes, cutting boards, and countertops). Histograms and statistical distributions were determined using Microsoft Excel and Palisades Bestfit, respectively. All data could be described by lognormal distributions, once data above and below the lower and upper limits of detection were considered separately. Histograms for surfaces counts contained one peak near 1 CFU/4 cm2. Surfaces with higher levels of contamination tended to be nonmetal, with the exception of buffalo chopper bowls, which commonly had high counts. Mean counts for foods ranged from 2 to 4 log CFU/g, with shrimp salad, roast beef, and bologna having higher means. Coleslaw, macaroni salad, and potato salad (all commercially processed products, not prepared in the dining halls) had lowest overall means. Coliforms were most commonly found in sealeg salad (present in 61% of samples) and least commonly found in coleslaw (present in only 7% of samples). Coliform counts (when present) were highest on average in shrimp salad and lowest in coleslaw. Average coliform counts for most products were typically between 1 and 2 log most probable number per gram. Fecal coliforms were not typically found in any deli salads or lunch meats.

A comparison of traditional and recently developed methods for monitoring surface hygiene within the food industry: an industry trial

A rapid, instrument-free, hygiene monitoring system, based on protein detection, was assessed as a means to evaluate the cleanliness of food contact surfaces within four different food processing environments. Its performance was compared to that of both ATP bioluminescence and a traditional agar-based microbiological method. Each surface was sampled using all three hygiene monitoring systems both before and after each of the production plants had carried out their normal cleaning procedures. In both cases, there was a significant difference (p < 0.05) between the number of surfaces that were passed or failed using each of the tests. In general the number of surfaces that were deemed acceptable for food production increased after cleaning but the level of agreement between test methods differed depending on the type of production facility sampled. Protein detection was most likely to fail surfaces within the baking facility, whereas ATP bioluminescence and traditional microbiology were most likely to fail surfaces within a frozen ready-meal and a cheese production unit respectively. The implications of these results are discussed in relation to plant trials of hygiene monitoring systems, the cleaning process itself, failures in disinfection, as well as the need for a combined methodological approach for monitoring cleanliness.

Effect of the licensing process on hygiene in retail butchers' premises in the West Midlands, United Kingdom

As the result of a change in legislation, all retail butchers in England were required to be licensed by 1 November 2000. A fully implemented hazard analysis critical control point plan was a condition of the license. This longitudinal study assessed the effect of licensing on hygiene in a group of retail butchers in the West Midlands, England. A hygiene audit and environmental sampling were used to determine if the licensing process improved hygiene in the study group. At the end of the study, 30% of the original group were no longer trading as they had been, having either altered the product they were selling or ceased to trade. The remaining butchers showed a significant improvement in the hygiene of their premises, both in the audit scores and in the environmental sampling. The mean audit score for the group had improved from an initial score of 47.54 to 54.95 (P < 0.02). The contamination with Enterobacteriaceae on equipment used for cooked meat had also improved, decreasing from mean contamination levels of 1.38 log CFU/cm2 before licensing to mean contamination levels of -0.11 log CFU/cm2 after licensing (P < 0.00001).