Consumer Awareness of the Message Not To Wash Raw Poultry, Current Practices, and Barriers to Following That Message.

ABSTRACT: In the United States, an estimated 47.8 million cases of foodborne illness occur each year. Raw poultry is the most common single commodity food associated with foodborne illness. The practice of washing raw poultry is highly prevalent among consumers despite the significant cross-contamination risk. Previous educational campaigns have attempted to reduce the prevalence of washing raw poultry; however, limited information is available on how successful these campaigns have been for changing consumer behavior. An online survey was administered to 1,822 consumers in the United States via SurveyMonkey to determine whether consumers washed raw poultry and whether they were aware of the correct behavior to not wash raw poultry. Consumers who indicated that they were not aware of the correct behavior were presented with the U.S. Department of Agriculture educational message online and then asked how confident they were that they could stop washing raw poultry. The survey also included questions to identify barriers that prevented consumers who were aware of the correct behavior from not washing raw poultry. Results indicate that 73.5% (n = 1,340) of consumers reported washing raw poultry. Of those consumers, 68.1% (n = 913) indicated that they were not aware that the practice is incorrect. When these consumers were presented with the educational message, 81.9% (n = 748) indicated that they were somewhat to very confident that they could stop washing raw poultry. Of the consumers who were aware of the correct behavior but continued to wash raw poultry, 58.4% (n = 244) reported that they continued to do so because they thought they cleaned surfaces well afterward and did not believe that their washing raw poultry was a risk for cross-contamination. Data indicate that a large percentage of consumers are still not aware of the correct behavior to not wash raw poultry and a large subset of that group may easily adopt the practice if made aware of the correct behavior.

Use of Focus Groups to Identify Food Safety Risks for Older Adults in the U.S.

Older adults are vulnerable to foodborne illness; however, many do not follow safe food handling guidelines that would reduce their risk of infection. Virtual focus groups were used to explore older adults' food handling and consumption practices and to understand how to apply the Health Belief Model for food safety research with respect to older adults. Thirty-nine adults between the ages of 56 and 80 participated in the study. Most participants reported eating poultry and eggs, whereas few reported eating precut fruit or raw sprouts. The majority were not using a cooking thermometer for all types of poultry and did report washing raw poultry. Participants were generally resistant to the idea of heating deli meats. Most focus group participants did not perceive themselves as being personally susceptible to foodborne illness. They did, however, express food safety concerns related to specific foods, such as melons and bagged salads, and they reported taking precautions to limit health risks from these foods. Regarding the Health Belief Model, our results indicate that the construct of perceived susceptibility could be expanded to include perceived risk, which refers to an individual's belief about the likelihood that a food might be contaminated with a foodborne pathogen. These results should be confirmed among a nationally representative sample of older adults.

Prevalence of Pathogens and Indicator Organisms in Home Kitchens and Correlation with Unsafe Food Handling Practices and Conditions.

Despite education efforts, consumers often practice unsafe food handling and storage behaviors. Little is known about how these unsafe practices contribute to contamination of the home kitchen with foodborne pathogens. In addition, only a limited number of studies have examined the role of the kitchen as a reservoir for pathogens. The purpose of this study was to characterize microbial contamination and foodborne pathogens found in home kitchens and determine whether contamination was significantly associated with unsafe or unsanitary conditions observed in the kitchen. Swab samples were collected from food contact and preparation surfaces in homes (n = 100) in Philadelphia, PA. The samples were tested for coliforms, fecal coliforms, Escherichia coli , Staphylococcus aureus , Salmonella, Campylobacter, and Listeria. Fecal coliforms were found in 44% of homes (most often in samples from kitchen sinks, sponges, and dishcloths), and E. coli was found in 15% of homes (mostly in samples from kitchen sinks). Nearly half (45%) of the homes tested positive for a foodborne pathogen, and 12% had multiple pathogens present in the kitchen. S. aureus was isolated from 39% of homes, most often from countertops and refrigerator door handles. Listeria spp., including L. monocytogenes and L. innocua , were present in 15% of homes, most often in samples from refrigerator meat drawers. C. jejuni was isolated from 3% of homes. Contamination with Listeria was significantly associated with higher refrigerator temperatures. The contamination of surfaces with fecal coliforms and S. aureus was significantly associated with a lack of cleaning materials: dish soap and paper or cloth towels in the kitchen, and any type of towel in the nearest bathroom. The contamination of a sponge or dishcloth with either fecal coliforms or S. aureus was predictive of other surfaces in the kitchen having the same contamination, indicating that sponges and dishcloths are both reservoirs and vectors for bacteria in the kitchen.

Development of a modified gentamicin protection assay to investigate the interaction between Campylobacter jejuni and Acanthamoeba castellanii ATCC 30010.

Campylobacter jejuni is one of the leading causes of diarrheal illness worldwide. It is persistent in the environment and on poultry despite its microaerophilic nature and sensitivity to dessication and pH. Studies have demonstrated that C. jejuni co-incubated with Acanthamoeba spp. may be protected from harmful environmental factors. Research in this area, however has included a range of different methodologies for co-incubation, recovery of bacteria and amoebae, and verification of internalization. In this study a modified gentamicin protection assay (mGPA) was developed with a standardized co-incubation procedure. The mGPA addresses limitations of the traditional GPA by providing quantification of the rate of internalization, or lack of internalization, of C. jejuni by Acanthamoeba castellanii. The mGPA described here utilizes tubes instead of cell culture plates allowing for determination of exact numbers of A. castellanii and C. jejuni to be co-incubated prior to addition to tubes. Additionally, the mGPA allows for the incorporation of C. jejuni-only controls to determine the fate of C. jejuni throughout the assay in the absence of A. castellanii. Using the mGPA it was determined that on average 1.6×10(5) C. jejuni (or 0.006% of initial 1×10(9) inoculum) survive the assay in the absence of A. castellanii. Additionally, results obtained with the mGPA demonstrated that while co-incubation with amoebae sometimes (56% of co-incubations) provided a protective effect for C. jejuni, in other cases it did not provide any protective effect (39% of co-incubations), and in at least one case there was a statistically significant higher recovery of C. jejuni in controls when compared to C. jejuni co-incubated with amoebae. The modified gentamicin protection assay described here allows better quantification of the rate and incidence of internalization of bacteria by amoebae. Use of the standardized mGPA developed here with varying environmental parameters and/or strains of bacteria and amoebae may provide insight into factors which are involved in the initiation of internalization of bacteria by amoebae.

Foodborne illness incidence rates and food safety risks for populations of low socioeconomic status and minority race/ethnicity: a review of the literature.

While foodborne illness is not traditionally tracked by race, ethnicity or income, analyses of reported cases have found increased rates of some foodborne illnesses among minority racial/ethnic populations. In some cases (Listeria, Yersinia) increased rates are due to unique food consumption patterns, in other cases (Salmonella, Shigella, Campylobacter) it is unclear why this health disparity exists. Research on safe food handling knowledge and behaviors among low income and minority consumers suggest that there may be a need to target safe food handling messages to these vulnerable populations. Another possibility is that these populations are receiving food that is less safe at the level of the retail outlet or foodservice facility. Research examining the quality and safety of food available at small markets in the food desert environment indicates that small corner markets face unique challenges which may affect the quality and potential safety of perishable food. Finally, a growing body of research has found that independent ethnic foodservice facilities may present increased risks for foodborne illness. This review of the literature will examine the current state of what is known about foodborne illness among, and food safety risks for, minority and low socioeconomic populations, with an emphasis on the United States and Europe.

The need for additional training for nutritional management of diabetes.

The purpose of this study was to investigate nurses' and nursing students'knowledge and perceived role in assisting patients with the nutritional management of diabetes. Three focus groups were conducted and the results were used to modify a previously developed survey regarding the nutritional management of diabetes. The survey was administered via an online survey tool and completed by 231 nurses and students. Over 70% of respondents agreed that nurses have an important role in reinforcing patient nutritional education. Results indicated,however, that knowledge gaps in the nutritional management of diabetes exist among nurses, including not knowing the carbohydrate content of 120ml of orange juice, a common treatment for hypoglycaemia (47.5%), not knowing where to locate carbohydrate content on a food label (60%), and not identifying the correct treatment for hypoglycaemia (47.5%). These results indicate that there may be a need to improve the nutritional education of nurses with respect to diabetes management.

Salmonella and Escherichia coli O157:H7 survival in soil and translocation into leeks (Allium porrum) as influenced by an arbuscular mycorrhizal fungus (Glomus intraradices).

A study was conducted to determine the influence of arbuscular mycorrhizal (AM) fungi on Salmonella and enterohemorrhagic Escherichia coli O157:H7 (EHEC) in autoclaved soil and translocation into leek plants. Six-week-old leek plants (with [Myc+] or without [Myc-] AM fungi) were inoculated with composite suspensions of Salmonella or EHEC at ca. 8.2 log CFU/plant into soil. Soil, root, and shoot samples were analyzed for pathogens on days 1, 8, 15, and 22 postinoculation. Initial populations (day 1) were ca. 3.1 and 2.1 log CFU/root, ca. 2.0 and 1.5 log CFU/shoot, and ca. 5.5 and 5.1 CFU/g of soil for Salmonella and EHEC, respectively. Enrichments indicated that at days 8 and 22, only 31% of root samples were positive for EHEC, versus 73% positive for Salmonella. The mean Salmonella level in soil was 3.4 log CFU/g at day 22, while EHEC populations dropped to ≤ 0.75 log CFU/g by day 15. Overall, Salmonella survived in a greater number of shoot, root, and soil samples, compared with the survival of EHEC. EHEC was not present in Myc- shoots after day 8 (0/16 samples positive); however, EHEC persisted in higher numbers (P = 0.05) in Myc+ shoots (4/16 positive) at days 15 and 22. Salmonella, likewise, survived in statistically higher numbers of Myc+ shoot samples (8/8) at day 8, compared with survival in Myc- shoots (i.e., only 4/8). These results suggest that AM fungi may potentially enhance the survival of E. coli O157:H7 and Salmonella in the stems of growing leek plants.

Development and Piloting of a Food Safety Audit Tool for the Domestic Environment.

Research suggests that consumers often mishandle food in the home based on survey and observation studies. There is a need for a standardized tool for researchers to objectively evaluate the prevalence and identify the nature of food safety risks in the domestic environment. An audit tool was developed to measure compliance with recommended sanitation, refrigeration and food storage conditions in the domestic kitchen. The tool was piloted by four researchers who independently completed the inspection in 22 homes. Audit tool questions were evaluated for reliability using the κ statistic. Questions that were not sufficiently reliable (κ < 0.5) or did not provide direct evidence of risk were revised or eliminated from the final tool. Piloting the audit tool found good reliability among 18 questions, 6 questions were revised and 28 eliminated, resulting in a final 24 question tool. The audit tool was able to identify potential food safety risks, including evidence of pest infestation (27%), incorrect refrigeration temperature (73%), and lack of hot water (>43 °C, 32%). The audit tool developed here provides an objective measure for researchers to observe and record the most prevalent food safety risks in consumer's kitchens and potentially compare risks among consumers of different demographics.

Identification of unique food handling practices that could represent food safety risks for minority consumers.

Foodborne illness caused by Salmonella and Campylobacter is a concern for consumers, and there is evidence that minority racial-ethnic populations experience greater rates of illness because of these pathogens. The limited body of research concerning food safety knowledge and practices among minority consumers has focused more on general food safety knowledge than on culturally specific food handling practices. The purpose of the research reported here was to explore food handling behaviors of minority racial-ethnic consumers through in-depth discussions in focus group settings. In this way, we hoped to identify potential unique, previously unidentified food handling practices among these consumers. Nine focus groups were held in Philadelphia, PA. Three focus groups were conducted with African American consumers, three with Hispanic consumers, and three with Asian consumers. In all, 56 consumers participated. Data were recorded, transcribed, and analyzed for unique and potentially unsafe food handling behaviors. Potentially unsafe food handling practices identified among all three groups included extended time to transport food from retail to home and washing of raw poultry. Culturally unique behaviors within groups included (i) using hot water (Asian, Hispanic) or acidic solutions (African American, Hispanic) to clean raw poultry, (ii) purchasing live poultry (Asian, Hispanic), (iii) cooking poultry overnight (African American), and (iv) preparing bite-size pieces of meat prior to cooking (Asian, Hispanic). To have focus groups include a limited number of participants and nonrandom sampling means that these themes and trends cannot be extrapolated to represent food mishandling among these populations in general. Results presented here allow modification of an existing food safety survey to identify the prevalence of these food handling practices among consumers of different demographics.

Identification of Cj1051c as a major determinant for the restriction barrier of Campylobacter jejuni strain NCTC11168.

Campylobacter jejuni is a leading cause of human diarrheal illness in the world, and research on it has benefitted greatly by the completion of several genome sequences and the development of molecular biology tools. However, many hurdles remain for a full understanding of this unique bacterial pathogen. One of the most commonly used strains for genetic work with C. jejuni is NCTC11168. While this strain is readily transformable with DNA for genomic recombination, transformation with plasmids is problematic. In this study, we have identified a determinant of this to be cj1051c, predicted to encode a restriction-modification type IIG enzyme. Knockout mutagenesis of this gene resulted in a strain with a 1,000-fold-enhanced transformation efficiency with a plasmid purified from a C. jejuni host. Additionally, this mutation conferred the ability to be transformed by plasmids isolated from an Escherichia coli host. Sequence analysis suggested a high level of variability of the specificity domain between strains and that this gene may be subject to phase variation. We provide evidence that cj1051c is active in NCTC11168 and behaves as expected for a type IIG enzyme. The identification of this determinant provides a greater understanding of the molecular biology of C. jejuni as well as a tool for plasmid work with strain NCTC11168.

Treatment of raw poultry with nonthermal dielectric barrier discharge plasma to reduce Campylobacter jejuni and Salmonella enterica.

Nonthermal plasma has been shown to be effective in reducing pathogens on the surface of a range of fresh produce products. The research presented here investigated the effectiveness of nonthermal dielectric barrier discharge plasma on Salmonella enterica and Campylobacter jejuni inoculated onto the surface of boneless skinless chicken breast and chicken thigh with skin. Chicken samples were inoculated with antibiotic-resistant strains of S. enterica and C. jejuni at levels of 10(1) to 10(4) CFU and exposed to plasma for a range of time points (0 to 180 s in 15-s intervals). Surviving antibiotic-resistant pathogens were recovered and counted on appropriate agar. In order to determine the effect of plasma on background microflora, noninoculated skinless chicken breast and thighs with skin were exposed to air plasma at ambient pressure. Treatment with plasma resulted in elimination of low levels (10(1) CFU) of both S. enterica and C. jejuni on chicken breasts and C. jejuni from chicken skin, but viable S. enterica cells remained on chicken skin even after 20 s of exposure to plasma. Inoculum levels of 10(2), 10(3), and 10(4) CFU of S. enterica on chicken breast and chicken skin resulted in maximum reduction levels of 1.85, 2.61, and 2.54 log, respectively, on chicken breast and 1.25, 1.08, and 1.31 log, respectively, on chicken skin following 3 min of plasma exposure. Inoculum levels of 10(2), 10(3), and 10(4) CFU of C. jejuni on chicken breast and chicken skin resulted in maximum reduction levels of 1.65, 2.45, and 2.45 log, respectively, on chicken breast and 1.42, 1.87, and 3.11 log, respectively, on chicken skin following 3 min of plasma exposure. Plasma exposure for 30 s reduced background microflora on breast and skin by an average of 0.85 and 0.21 log, respectively. This research demonstrates the feasibility of nonthermal dielectric barrier discharge plasma as an intervention to help reduce foodborne pathogens on the surface of raw poultry.

Retail food safety risks for populations of different races, ethnicities, and income levels.

Research has found that populations with low socioeconomic status (SES) and minority populations have greater access to small corner markets and less access to supermarkets than high-SES and Caucasian populations. This represents a significant difference in the farm-to-fork continuum that these populations experience. This research examined whether differential retail access to foods results in different food safety risks at the retail level for consumers with different demographics. U.S. Census Bureau census tracts with high African American, Asian, Hispanic, Caucasian, low-SES, and high-SES populations were identified in Philadelphia, PA. Approximately 60 retail food establishments were sampled in each census tract category from June 2008 to June 2010. Food samples collected at stores included milk, eggs, lunchmeat, sandwiches, and ready-to-eat (RTE) fresh fruit, greens, and herbs, when available. With the exception of milk and eggs, only food that had been handled and/or prepared at the retail level was sampled. Food samples were tested for temperature, aerobic plate count, coliforms, fecal coliforms, Escherichia coli, Staphylococcus aureus, and Listeria monocytogenes. The results indicated that internal egg temperatures were higher in samples from low-SES census tracts than in eggs from Caucasian census tracts, and eggs were more often found unrefrigerated in markets in low-SES and Asian census tracts. Milk samples from markets in Hispanic and low-SES census tracts had higher aerobic plate counts than high-SES census tract samples. Sandwiches from markets in high-SES census tracts had higher coliform counts than sandwiches from markets in all other census tract categories. Markets in Asian census tracts had a higher incidence of fecal coliform contamination on sandwiches than markets in Caucasian census tracts. Fecal coliforms were present in a percentage of RTE greens from markets in all census tracts except African American, with the highest percentages of RTE greens positive for fecal coliforms in low-SES (100%), Asian (71.4%), and Caucasian (45.5%) markets.

Use of geographic information systems technology to track critical health code violations in retail facilities available to populations of different socioeconomic status and demographics.

Research shows that community socioeconomic status (SES) predicts, based on food service types available, whether a population has access to healthy food. It is not known, however, if a relationship exists between SES and risk for foodborne illness (FBI) at the community level. Geographic information systems (GIS) give researchers the ability to pinpoint health indicators to specific geographic locations and detect resulting environmental gradients. It has been used extensively to characterize the food environment, with respect to access to healthy foods. This research investigated the utility of GIS in determining whether community SES and/or demographics relate to access to safe food, as measured by food service critical health code violations (CHV) as a proxy for risk for FBI. Health inspection records documenting CHV for 10,859 food service facilities collected between 2005 and 2008 in Philadelphia, PA, were accessed. Using an overlay analysis through GIS, CHV were plotted over census tracts of the corresponding area. Census tracts (n = 368) were categorized into quintiles, based on poverty level. Overall, food service facilities in higher poverty areas had a greater number of facilities (with at least one CHV) and had more frequent inspections than facilities in lower poverty areas. The facilities in lower poverty areas, however, had a higher average number of CHV per inspection. Analysis of CHV rates in census tracts with high concentrations of minority populations found Hispanic facilities had more CHV than other demographics, and Hispanic and African American facilities had fewer days between inspections. This research demonstrates the potential for utilization of GIS mapping for tracking risks for FBI. Conversely, it sheds light on the subjective nature of health inspections, and indicates that underlying factors might be affecting inspection frequency and identification of CHV, such that CHV might not be a true proxy for risk for FBI.

Microbial quality of food available to populations of differing socioeconomic status.

BACKGROUND: Low SES has been shown to be linked to poorer-quality diets, decreased consumption of fresh produce, and an increased reliance on small retail stores. PURPOSE: The objective of this research was to determine if there is a difference in the microbial quality and potential safety of food available to low-SES versus high-SES populations at the retail level. METHODS: Aerobic plate count (APC); yeast and mold counts (Y & M); and total coliforms were determined in ready-to-eat (RTE) greens, pre-cut watermelon, broccoli, strawberries, cucumbers, milk, and orange juice and compared among products purchased in stores in low- versus those purchased in high-SES neighborhoods between June 2005 and September 2006. APC, fecal coliforms, and E. coli in ground beef and the presence of Salmonella and Campylobacter in chicken were also compared. RESULTS: Results showed higher microbial loads on produce from markets in low-SES areas. Significant differences observed included (1) APC and Y&M in RTE greens, (2) APC and Y&M in strawberries, and (3) YMCs in cucumbers. No difference was detected in the level of pathogens in raw meat and poultry; however, the APC in ground beef available in high-SES markets was significantly higher compared with that found in low-SES markets. CONCLUSIONS: The results presented here indicate that populations of low SES may be more likely to experience produce of poorer microbial quality, which may have an impact on both the appeal and potential safety of the produce.