Successful hazard analysis critical control point implementation in the United Kingdom: understanding the barriers through the use of a behavioral adherence model

Exploring Key Barriers of HACCP Certification Adoption in the Meat Industry: A Decision-Making Trial and Evaluation Laboratory Approach

Food safety management represents an important concern in contemporary society. The Hazard Analysis Critical Control Point (HACCP) system is a crucial tool for meat producers, preventing and controlling major food safety concerns in the process. This research investigates key barriers to HACCP implementation in the meat industry, employing the Decision-Making Trial and Evaluation Laboratory (DEMATEL) model to identify and categorize these obstacles. Using the insights of 18 experts, a cause-and-effect relationship diagram is generated through which twelve barriers are categorized in terms of their cause and effect and then analyzed. Threshold value is calculated as 0.299. The findings reveal poor management as the primary impediment, followed by challenges in training, knowledge, and dedication. Categorizing the barriers into four groups emphasizes the critical role of effective management and human resources. The study contributes valuable insights to food safety management literature, serving as a practical resource for industry practitioners. Despite limitations in relying on expert opinions and the industry-specific focus, the research lays a foundation for informed decision-making, stressing the importance of effective management in successful HACCP implementation. Future research directions include diversifying geographical representation, exploring practical solutions, and integrating emerging technologies for a better understanding of HACCP adoption challenges.

Study design and baseline characteristics of a combined educational and environmental intervention trial to lower sodium intake in Swiss employees

BACKGROUND

Blood pressure is a primary cardiovascular disease risk factor. Population-wide governmental strategies aim to reduce lifestyle and dietary risk factors for hypertension, one of which is an unbalanced diet with high sodium and low potassium intakes. Nutrition interventions in the workplace are considered a promising approach in encouraging health-promoting behaviors. We developed and conducted the health promoting sodium reduction trial "Healthful & Tasty: Sure!" in worksites in the German-speaking part of Switzerland from May 2015 to Nov 2016, for which we present the study protocol and baseline characteristics.

METHODS

Healthful & Tasty, a cluster nonrandomized single-arm trial with calibration arm, aimed to demonstrate the effectiveness of a combined educational and environmental intervention in the workplace in reducing employees' average daily sodium/salt intake by 15%. To this end, health and food literacy of employees and guideline compliance among the catering facility team needed to be improved. The primary outcome measure was sodium/salt intake estimated from sodium excretion in a 24-h urine sample. Secondary outcome measures included changes in the overall qualitative diet composition, blood pressure, anthropometric indices, and health and food literacy. Of eight organizations with catering facilities, seven organizations took part in the nutrition education and catering salt reduction interventions, and one organization participated as a control. Overall, 145 consenting employees were included in the staggered, one-year four-phase trial, of which 132 participated in the intervention group. In addition to catering surveys and food sampling, the trial included five follow-up health assessments including questionnaires, blood pressure measurements, anthropometrics, and sodium, potassium, and iodine intake measurements obtained from 24-h and spot urine samples, and a food record checklist. Exploratory and hypothesis generating baseline statistical analysis included 141 participants with adequate 24-h urine samples.

DISCUSSION

Despite practice-driven limitations to the study design and small cluster and participant numbers, this trial has methodological strength and will provide important insights into the effectiveness of a combined educational and environmental intervention to reduce salt intake among female and male Swiss employees.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00006790 . Registered 23 September 2014.

Obtaining compliance with occupational health and safety regulations: a multilevel study using self-determination theory

It was hypothesized that occupational health and safety (OHS) inspectors who prefer to use autonomy supportive tactics to resolve workplace conflicts (e.g. providing rationale, choices) would be more effective in resolving industry non-compliance with OHS regulations, compared to inspectors who prefer to use coercive tactics (e.g. deadlines, pressure). Preferences for resolving work conflicts were collected from 39 Canadian OHS inspectors and were linked to administrative records documenting 17,960 industry inspection episodes and 29,451 compliance orders issued by those inspectors from 2003-2006. Multilevel Poisson and negative binomial regression models examined associations between inspector autonomy-supportiveness and compliance outcomes, adjusting for covariates at the inspector level (e.g. job experience, number of inspection episodes) and at the worksite level (e.g. workplace safety record). Relative to coercive inspectors, autonomy-supportive inspectors issued fewer severe compliance orders and achieved compliance after fewer worksite visits. Use of autonomy-supportive approaches may reduce exposure to preventable injuries at non-compliant worksites.

Factors influencing workers to follow food safety management systems in meat plants in Ontario, Canada

Small and medium sized food businesses have been slow to adopt food safety management systems (FSMSs) such as good manufacturing practices and Hazard Analysis Critical Control Point (HACCP). This study identifies factors influencing workers in their implementation of food safety practices in small and medium meat processing establishments in Ontario, Canada. A qualitative approach was used to explore in-plant factors that influence the implementation of FSMSs. Thirteen in-depth interviews in five meat plants and two focus group interviews were conducted. These generated 219 pages of verbatim transcripts which were analysed using NVivo 7 software. Main themes identified in the data related to production systems, organisational characteristics and employee characteristics. A socio-psychological model based on the theory of planned behaviour is proposed to describe how these themes and underlying sub-themes relate to FSMS implementation. Addressing the various factors that influence production workers is expected to enhance FSMS implementation and increase food safety.

Good nutritional practice from producer to consumer

Today we manage food safety through good practices at different levels of food production, distribution, and consumption. The paper analyses current good practices, parameters involved in the food safety circle along the food supply chain, and consumer dilemmas. As a result of the current situation the new approach called "Good Nutritional Practice" (GNP) is proposed to balance the food safety systems. It is shown how important it is to integrate actual the food safety solutions within GNP, which includes consumers, and is based on a model that covers subsystems from other relevant good practices (nine good practices along the food supply chain). It has been shown that present maintenance of food safety in the food supply chain can be easily broken down, because of the different kinds of barriers or a simple misunderstanding among stakeholders including consumers.

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.

Utilization of prevention research: searching for evidence

OBJECTIVE

Understanding the process of translating prevention research into practice calls for systematic efforts to assess the state of the published literature on the utilization of prevention research in public health programs and policy. This review describes the search strategy, methods, results, and challenges in identifying and reviewing literature relevant to this objective.

METHODS

Systematic searches of topics related to prevention research in literature published in 1995-2002 revealed 86 empiric articles in 12 public health areas.

RESULTS

A lack of uniform terminology, variation in publication sources, and limited descriptions of the stages of research utilization (e.g., adoption and implementation) in the published literature posed major challenges to identifying articles that met study criteria. Most accepted articles assessed the adoption or implementation of prevention research; four examined long-term sustainability. There was approximately equal distribution of reported research set in either health services or public health settings. Few of the articles contained search terms reflecting all four concept areas (prevention, public health, research, and use) targeted by the literature search.

CONCLUSIONS

Refining terms used in prevention research and research utilization could address lack of shared and unique definitions. Expanded reporting of research utilization stages in reports of prevention research could lead to improved literature searches and contribute to more successful adoption, implementation, and further use of prevention research products.

Microbiological evaluation of sugarcane juice sold at street stands and juice handling conditions in São Carlos, São Paulo, Brazil

Fresh sugarcane juice is sold by street vendors without any heat treatment in São Carlos, São Paulo, Brazil. Twenty-four samples of point-of-sale juice were tested by standard methods to determine heterotrophic bacteria, total and thermo-tolerant coliform counts, Salmonella, and parasites in the juice. 25% of samples showed poor sanitary conditions, with thermo-tolerant coliform levels higher than allowed by Brazilian standards. Salmonella spp. and parasites were absent in all samples. Thermo-tolerant coliforms were detected on the hands of 37% of juice handlers, and heterotrophic bacterial counts reached 2.0 x 10³ cfu/per hand. Escherichia coli was detected in one hand sample, and no Salmonella spp. was detected. Screening questionnaires were used to interview the vendors, and 62% of interviewees were either unfamiliar with or failed to adopt adequate hygiene for food handling.

Elaboration of microbiological guidelines as an element of codes of hygienic practices for small and/or less developed businesses to verify compliance with hazard analysis critical control point

Effective assurance of microbiological food safety practices in small and/or less developed businesses is not yet resolved. Although a start has been made by drafting hygiene codes, feasible methods for verifying manufacturing processes that rely on strict and meaningful criteria to be applied to process points are still lacking. This investigation is a model study with various types of ready-to-eat foods aimed at verifying adequate processing for safety and subsequent meticulous hygienic handling and safe storage of foods in small and/or less developed businesses by the use of quantitative methods for selected indicator organisms, as standardized by the International Organization for Standardization. The manufacture of the foods that were used in this study invariably included (i) a heat processing step that ensured a level of lethality of nonsporing organisms at least equivalent to the reduction of such organisms attained in the pasteurization of milk and (ii) effective means of prevention of postprocess recontamination and recolorization. The results of this study indicate that simple microbiological criteria used for this purpose, including aerobic mesophilic colony (standard plate) counts, Enterobacteriaceae counts, and, in some instances, enumeration of yeast propagules, allow adequate verification of good practices throughout. This verification through monitoring of samples taken during processing in small and/or less developed businesses was found to be an attractive alternative to the conventional examination of end products.

Using qualitative psychology to investigate HACCP implementation barriers

Hazard Analysis Critical Control Point (HACCP) is a system of food safety management that in the last few decades has become an increasing part of national government and international strategy to reduce the prevalence of food borne disease. Yet despite wide dissemination and scientific support of its principles, successful HACCP implementation has been limited. There has been very little in-depth consideration of the reasons behind this, and qualitative psychological research examining the interplay of factors involved is almost non-existent. For this study therefore, four in-depth narrative interviews were carried out with small business owners attempting to implement HACCP. Non-prescriptive analysis of their interviews was carried out, and this revealed five key themes acting as 'barriers' to successful implementation. These were of HACCP as difficult, burdensome and unnecessary, and hindered by staff and external problems. The analysis showed furthermore the complexity of issues underpinning problems with HACCP implementation and the way in which they operate at knowledge, attitude and behavioural levels. From this, essential issues to be addressed in order for successful HACCP to be achieved are put forward.

Validation of Guidelines for Investigating Foodborne Disease Outbreaks: The Experience of the Lazio Region, Italy

Information about risk ratios, exposures, and vehicles for foodborne diseases tends to be more reliable when it is obtained from outbreak surveillance than when it is obtained from disease notifications. In 1997, guidelines for methods of investigating foodborne disease outbreaks (FBDOs) were implemented in the Lazio region. To evaluate the impact of these guidelines, we analyzed information about 410 FBDOs from 1996 to 2000. Under these guidelines, the delay in the reporting of outbreaks decreased from 10 to 2 days. An analysis of 82 large FBDOs (in which &gt;30 people were exposed) showed increases in the calculation of attack rates with a cohort approach (up to 83%), correctly drawn epidemic curves (up to 79%), and the calculation of food-specific relative risk (up to 60%). On the other hand, the level of the determination of etiology remained low: tests were performed on patients in 57% of the cases considered, resulting in an agent identification rate of 38%; for 22 outbreaks, tests were performed on food, resulting in three positive identifications. Analysis of the contamination route with the use of hazard analysis critical control point criteria a posteriori was carried out for 15 outbreaks, and nine of these analyses were successful. The implementation of the 1997 guidelines was successful with regard to epidemiological and statistical methods but did not improve etiological diagnosis for FBDOs. These guidelines improved surveillance for outbreaks in which &gt;30 people were exposed in well-defined exposure situations; however, the guidelines did not significantly improve epidemiological investigations of small household outbreaks.

Foodborne enteric infections

Foodborne infections are estimated to affect one in four Americans each year. Most these (67%) are caused by the Norwalk-like viruses, but Campylobacter and nontyphoidal Salmonellae together account for about one fourth of cases of illness in which a pathogen can be detected. Less common bacterial infections, such as with Listeria monocytogenes and the Shiga toxin-producing Escherichia coli, cause fewer infections but are important because of their severe complications or high mortality rate, or both. This review describes the recent development of a national surveillance system for foodborne illness, newer methods for molecular characterization of organisms for epidemiologic studies, and individual etiologic agents in the order of frequency of occurrence. Methods for decreasing the disease burden are discussed, including education of health care professionals and the public, modification of food-handling behaviors, the use of food irradiation, and the application of probiotics to foods.

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).

Clinical pharmacology of antimicrobial use in humans and animals

Veterinary public health is a frontier in the fight against human disease, charged to control and eradicate zoonotic diseases that are naturally transmitted between vertebrate animals and man. Currently there is a need for clinical pharmacologists and all health care givers to limit the development of bacterial resistance in humans to contain the increased health care expenditures related to morbidity and mortality associated with the use of antimicrobials. The development of resistance predates the use of antibiotics and will always be a problem to the successful treatment of patients. Ongoing discussion debates the extent to which antibiotic use in animals contributes to the development of antibiotic resistance in humans. The veterinary use ofantibiotics as antimicrobial growth promoters is thought to influence the prevalence of resistance in animal bacteria and to be a risk factor for the emergence of antibiotic resistance in human pathogens. Transfer of antibiotic resistant bacteria from animals to humans may occur via contact, including occupational exposure and via the food chain. Resistance genes may transferfrom bacteria of animals to human pathogens in the intestinal flora of humans. Prevention of the development of resistance in humans necessitates good animal husbandry and hygienic measures to prevent cross contamination and a decrease in the use of antibiotics. Appropriate use of antibiotics for food animals will preserve the long-term efficacy of existing antibiotics, support animal health and welfare, and limit the risk of transfer of antibiotic resistance to humans. Investigators must also develop new antimicrobial agents. Poole (J Pharmacy Pharmacol 2001;53:283) recommends targeting the three predominate mechanisms of development of resistance by antimicrobials (i.e., antibiotic inactivation, target site modification, and altered uptake via restricted entry and/or enhanced efflux) to specifically complement the development of novel agents with novel bacterial targets. Bacterial resistance and its selection may be evaluated by comparing the relationship to antibiotic pharmacokinetic (PK) values obtained from serum concentrations and organism MICs (minimum inhibitory concentrations; concentration-dependent killing) to reveal culture and sensitivity tests in patients. Pharmacodynamic (PD) models may be developed to identify factors associated with the probability that bacterial resistance will develop. Thomas et al (Antimicrobial Agents Chemotherapy 1998;42:521) used this combined approach of PK/PD and MICs to examine data retrospectively. The role of clinical pharmacology is to work with PK/PD models such as these to determine the best use of antibiotics in humans to minimize the development of resistance. The role of any regulatory body responsible for the protection of the public health and food safety for consumers is to assess risk and to then communicate and manage the risk. Scientific uncertainty must be interpreted to propose sound policy options. The conversion of sound science into an appropriate regulatory policy to protect the public health is most important.