Microwave Cooking Practices in Minnesota Food Service Establishments.

Uneven cooking due to consumer use of microwave ovens to cook food products that have been prepared but are not ready to eat has been a documented risk factor in several foodborne disease outbreaks. However, the use of microwave ovens in restaurants and other food service establishments has not been well documented. The aim of this study was to describe the types of food service establishments that use microwave ovens, how these ovens are used, types of foods heated or cooked in these ovens, types of microwave ovens used in food service establishments, and the level of compliance with U.S. Food and Drug Administration (FDA) guidelines. From 2008 to 2009, the Minnesota Department of Health collected data from a convenience sample of 60 food establishments within the state. Facility types included fast-food restaurants, sit-down restaurants, school food service, nursing homes, hotels and motels, and daycare centers. Food preparation practices were classified as prep-serve, cookserve, or complex. Minnesota environmental health specialists administered a study questionnaire to managers during routine inspections. Establishments included in this study reported using microwave ovens primarily to warm commercial ready-to-eat products (67%) and to warm foods for palatability (50%). No minimum temperatures are required for these processes because these foods do not require pathogen destruction. However, food establishments using complex preparation practices more often reported using microwave ovens for multiple processes and for processes that require pathogen destruction. For establishments that did report microwave oven use for food requiring pathogen destruction, the majority of managers reported following most FDA recommendations for cooking and reheating for hot-holding potentially hazardous foods, but many did not report letting food stand for 2 min after cooking. Additional training on stand time after microwave cooking could be beneficial because of low reporting of this practice among study participants.

Food Allergy Knowledge and Attitudes of Restaurant Managers and Staff: An EHS-Net Study.

Dining outside of the home can be difficult for persons with food allergies who must rely on restaurant staff to properly prepare allergen-free meals. The purpose of this study was to understand and identify factors associated with food allergy knowledge and attitudes among restaurant managers, food workers, and servers. This study was conducted by the Environmental Health Specialists Network (EHS-Net), a collaborative forum of federal, state, and local environmental health specialists working to understand the environmental factors associated with food safety issues. EHS-Net personnel collected data from 278 randomly selected restaurants through interviews with restaurant managers, food workers, and servers. Results indicated that managers, food workers, and servers were generally knowledgeable and had positive attitudes about accommodating customers' food allergies. However, we identified important gaps, such as more than 10% of managers and staff believed that a person with a food allergy can safely consume a small amount of that allergen. Managers and staff also had lower confidence in their restaurant's ability to properly respond to a food allergy emergency. The knowledge and attitudes of all groups were higher at restaurants that had a specific person to answer food allergy questions and requests or a plan for answering questions from food allergic customers. However, food allergy training was not associated with knowledge in any of the groups but was associated with manager and server attitudes. Based on these findings, we encourage restaurants to be proactive by training staff about food allergies and creating plans and procedures to reduce the risk of a customer having a food allergic reaction.

Restaurant manager and worker food safety certification and knowledge.

Over half of foodborne illness outbreaks occur in restaurants. To combat these outbreaks, many public health agencies require food safety certification for restaurant managers, and sometimes workers. Certification entails passing a food safety knowledge examination, which is typically preceded by food safety training. Current certification efforts are based on the assumption that certification leads to greater food safety knowledge. The Centers for Disease Control and Prevention conducted this study to examine the relationship between food safety knowledge and certification. We also examined the relationships between food safety knowledge and restaurant, manager, and worker characteristics. We interviewed managers (N=387) and workers (N=365) about their characteristics and assessed their food safety knowledge. Analyses showed that certified managers and workers had greater food safety knowledge than noncertified managers and workers. Additionally, managers and workers whose primary language was English had greater food safety knowledge than those whose primary language was not English. Other factors associated with greater food safety knowledge included working in a chain restaurant, working in a larger restaurant, having more experience, and having more duties. These findings indicate that certification improves food safety knowledge, and that complex relationships exist among restaurant, manager, and worker characteristics and food safety knowledge.

Handling practices of fresh leafy greens in restaurants: receiving and training.

Multiple foodborne illness outbreaks have been associated with the consumption of fresh produce. Investigations have indicated that microbial contamination throughout the farm-to-fork continuum often contributed to these outbreaks. Researchers have hypothesized that handling practices for leafy greens in restaurants may support contamination by and proliferation and amplification of pathogens that cause foodborne illness outbreaks. However, limited data are available on how workers handle leafy greens in restaurants. The purpose of this study was to collect descriptive data on handling practices of leafy greens in restaurants, including restaurant characteristics, types of leafy greens used, produce receipt, and food safety training and certification. As a federal collaborative partner with the Environmental Health Specialists Network (EHS-Net) of the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration (FDA) recommended that EHS-Net participants survey handling practices for leafy greens in restaurants. The recommendations in the FDA's Guide to Minimize Microbial Food Safety Hazards of Leafy Greens are significant to this study for comparison of the results. The survey revealed that appropriate handling procedures assist in the mitigation of other unsafe handling practices for leafy greens. These results are significant because the FDA guidance for the safe handling of leafy greens was not available until 2009, after the survey had been completed. The information provided from this study can be used to promote additional efforts that will assist in developing interventions to prevent future foodborne illness outbreaks associated with leafy greens.

Food worker experiences with and beliefs about working while ill.

Transmission of foodborne pathogens from ill food workers to diners in restaurants is an important cause of foodborne illness outbreaks. The U.S. Food and Drug Administration recommends that food workers with vomiting or diarrhea (symptoms of foodborne illness) be excluded from work. To understand the experiences and characteristics of workers who work while ill, workplace interviews were conducted with 491 food workers from 391 randomly selected restaurants in nine states that participated in the Environmental Health Specialists Network of the Centers for Disease Control and Prevention. Almost 60% of workers recalled working while ill at some time. Twenty percent of workers said that they had worked while ill with vomiting or diarrhea for at least one shift in the previous year. Factors significantly related to workers having said that they had worked while ill with vomiting or diarrhea were worker sex, job responsibilities, years of work experience, concerns about leaving coworkers short staffed, and concerns about job loss. These findings suggest that the decision to work while ill with vomiting or diarrhea is complex and multifactorial.

Recordkeeping practices of beef grinding activities at retail establishments.

Ground beef has been implicated as a transmission vehicle in foodborne outbreaks of infection with pathogens such as Escherichia coli O157:H7 and Salmonella. During outbreak investigations, traceback of contaminated beef to the producing facility is often unsuccessful because of inadequate recordkeeping at retail establishments that grind beef products. We conducted a survey in three states participating in the Environmental Health Specialists Network to describe beef grinding and recordkeeping practices at retail establishments. In each establishment that maintained grinding logs, three randomly selected records were reviewed to determine whether important data elements for traceback investigations were recorded. One hundred twenty-five stores were surveyed, of which 60 (49%) kept grinding logs, including 54 (74%) of 73 chain stores and 6 (12%) of 51 independent stores. One hundred seventy-six grinding records from 61 stores were reviewed. Seventy-three percent of the records included the establishment code of the source beef, 72% included the grind date and time, and 59% included the lot number of the source beef. Seventy-five percent of records noted whether trimmings were included in grinds, and 57% documented cleanup activities. Only 39 (22%) records had all of these variables completed. Of stores that did not keep grinding logs, 40% were unaware of their purpose. To facilitate effective and efficient traceback investigations by regulatory agencies, retail establishments should maintain records more detailed and complete of all grinding activities.

Factors related to food worker hand hygiene practices.

To identify factors related to food worker hand hygiene practices, we collected (i) observational data on food worker (n = 321) hand hygiene practices (hand washing and glove use) and (ii) observational and interview data on factors related to hygiene behavior, such as worker activity, restaurant characteristics, worker food safety training, and the physical and social environment. Results indicated that hand washing and glove use were more likely to occur in conjunction with food preparation than with other activities (e.g., handling dirty equipment) and when workers were not busy. Hand washing was more likely to occur in restaurants whose food workers received food safety training, with more than one hand sink, and with a hand sink in the observed worker's sight. Glove use was more likely to occur in chain restaurants and in restaurants with glove supplies in food preparation areas. Hand washing and glove use were also related to each other--hand washing was less likely to occur with activities in which gloves were worn. These findings indicate that a number of factors are related to hand hygiene practices and support suggestions that food worker hand hygiene improvement requires more than food safety education. Instead, improvement programs must be multidimensional and address factors such as those examined in this study.

Food worker hand washing practices: an observation study.

Improvement of food worker hand washing practices is critical to the reduction of foodborne illness and is dependent upon a clear understanding of current hand washing practices. To that end, this study collected detailed observational data on food worker hand washing practices. Food workers (n = 321) were observed preparing food, and data were recorded on specific work activities for which hand washing is recommended (e.g., food preparation, handling dirty equipment). Data were also recorded on hand washing behaviors that occurred in conjunction with these work activities. Results indicated that workers engaged in approximately 8.6 work activities per hour for which hand washing is recommended. However, workers made hand washing attempts (i.e., removed gloves, if worn, and placed hands in running water) in only 32% of these activities and washed their hands appropriately (i.e., removed gloves, if worn, placed hands in running water, used soap, and dried hands) in only 27% of these work activities. Attempted and appropriate hand washing rates varied by work activity--they were significantly higher in conjunction with food preparation than other work activities (46 versus < or = 37% for attempted hand washing; 41 versus < or = 30% for appropriate hand washing) and were significantly lower in conjunction with touching the body than other work activities (13 versus > or = 27% for attempted hand washing; 10 versus > or = 23% for appropriate hand washing). Attempted and appropriate hand washing rates were significantly lower when gloves were worn (18 and 16%) than when gloves were not worn (37 and 30%). These findings suggest that the hand washing practices of food workers need to be improved, glove use may reduce hand washing, and restaurants should consider reorganizing their food preparation activities to reduce the frequency with which hand washing is needed.