Mitigating Risks of Foodborne Illness Associated with Handling Leafy Greens in Retail Foodservice Establishments Serving Aging Populations

<p>NON-TECHNICAL SUMMARY: Because the American population is aging, with 16% over the age of 62 (21% increase from 2000), the emphasis on food safety in retail foodservice operations is paramount. The use of potentially hazardous fresh produce items, including leafy greens, can result in foodborne illness if mishandling by foodservice staff occurs. Additionally, procurement source and form of these items may contribute to microbial risk. Therefore, the goal of this project is to determine and mitigate risk from employee contamination of leafy greens in retail foodservice operations that serve aging Americans. Specific objectives follow. Identify current foodservice employee handling practices of leafy greens. Conduct microbial assessment of leafy greens considering procurement form and source and contact surfaces in the foodservice. Develop effective food safety
messaging for foodservice staff about handling leafy greens. Implement and evaluate safe food handling messaging in different foodservice operations (long-term facilities, hospitals, assisted living facilities, and restaurants) that serve aging Americans with varying risk and health statuses. Disseminate food safety messaging materials through websites and other outlets. A mixed methods research approach will be taken whereby qualitative and quantitative data will be collected and analyzed prior to development of food safety messaging materials. After development, the effectiveness of messaging materials will be assessed. Observations to determine employee behavior change and microbial tests to determine microbial count changes will be conducted. Validated messaging materials will be made available to all retail foodservice operators through Iowa State University and Kansas State
University food safety websites.
<p>APPROACH: Methods, including analysis, for each objective have been identified below. Objective #1: Identify foodservice employees' handling practices of fresh whole and fresh cut leafy greens from local and from national sources. To identify employee food handling practices of leafy greens, initial site visits to 8 foodservice operations (2 hospitals, 2 long term care facilities, 2 assisted living facilities, and 2 restaurants) serving elderly populations with varying health statuses will be conducted in year one. Matched foodservice operations in Iowa and Kansas (i.e. one hospital in Kansas and one in Iowa) will be selected. Visits will coincide with menus where at least one fresh leafy green product is being served. Sourcing (local and national) and processing (whole or fresh cut [prewashed and chopped]) will be considered as well to ensure all variables are
included in data collection. At each site visit we will observe the employees primarily responsible for handling leafy greens, observe current operational aspects (i.e. food safety messaging, standard operating procedures regarding leafy greens, facility design and equipment), and interview the observed employee. Observational data will be analyzed quantitatively (i.e. frequency of practice) and qualitatively (i.e. verbal comments and work situations observed). After the observational period is completed, the employees will be interviewed by the observer as to how and why food safety practices were/were not followed. A structured interview script will be used with length of interview no longer than 15 minutes to avoid undue disruption for the employer. These interviews will be taped, transcribed, and analyzed using a combination of hand coding and software data display (ATLAS.ti).
Objective #2: Conduct microbial assessment of the food and food contact surfaces where local leafy greens are handled in retail foodservice operations serving the elderly. During site visits, microbial evaluation of the fresh leafy greens will occur pre intervention and twice post intervention (1 month and 3-6 month) at each location (3 site visits to 8 locations). Thus, a total of 3 fresh leafy green samples will be collected at each of the 8 participating facilities each of three visits (24 samples pre intervention and 48 post intervention for a total of 72). At least a 250 gram sample of leafy green product will be sampled when the food is received by the operation, at the beginning of preparation, and as the product is served. All samples will be collected with washed and gloved hands following a specified protocol and placed into a sterile sampling bag. The bag of collected food
product will be labeled with site identification number, name of food product, package date/description, procurement information, service style, and point in process (receiving, beginning of production, and at time of service) and then placed in a cooler. The food sample will be transported to Dr. Angela Shaw's lab at Iowa State University in the cool cooler within four hours of collection if in Iowa and overnight mailed with cold packs from Kansas. Temperatures will be monitored during transit with a data logger placed in the cooler; this will alert to any disruptions in temperature control. In the event different foods from the two categories are sampled (such as spinach as product is received and iceberg lettuce at preparation), results will be presented for specific food items (i.e. counts for spinach and counts for iceberg). A comparison in bacterial cell counts at each point in
the process will be made to identify which points in flow are most critical for fresh leafy greens. The same sampling procedure will be used 1 month and 3-6 months post intervention. Comparisons will be made between pre- and two post-intervention cell counts of identified pathogens at each collection point for all facilities and for averages by sector of retail foodservice both in Iowa and Kansas. Data will be entered into an electronic spreadsheet and independently validated. Data will then be imported into a commercially available software package. Mixed-model methodologies will be used to evaluate specific response variables to determine the amount of change in fecal coliforms at the three time points (as received, handling, service) in the leafy greens and on the different contact surfaces. Specific Objective #3: Develop effective food safety messaging for foodservice staff about
handling fresh and fresh cut leafy greens. Food safety messaging will be developed to convey key messages for safe leafy greens procurement, handling, and service as outlined by the National Good Agricultural Practices Initiative and the Food and Drug Administration (FDA, 2009). Elements of messages such as buyer diligence in ensuring on farm food safety practices are followed when sourcing fresh leafy greens, handwashing, produce cleaning, storage, handling, and risks of cross contamination from personnel and food contact surfaces are likely to be included. An evaluation process will involve obtaining feedback from four distinct groups; a) Advisory Board (n = 5), b) foodservice managers in hospitals, assisted living, long term care and restaurants (n=4), c) students enrolled in hospitality sanitation and safety course at Iowa State University (n= 50) and Kansas State University (n
=50) and d) at least two employees involved with food handling from each type of the four operations will review the messages (n= 8, with at least 2 employees who read Mandarin Chinese as their primary reading language and another 2 who read Spanish as their primary reading language) and provide feedback. The frequency and type of changes (i.e. editorial or content) suggested by each group (demographic characteristics such as language and age of reviewers) will be tracked which will be provide information about which aspects of messaging are perceived as important effective messaging. Objective #4: Implement and evaluate safe food handling messaging in different foodservice operations that serve aging Americans with varying risk and health statuses, including long-term facilities, hospitals, assisted living facilities, and restaurants. To assess change in behavior, site visits will be
made one month post-distribution of the materials and 3-6 months following beginning of intervention. Observational data and interview data will be collected using the same methods described for Objective #1, concurrent with collection of product samples and food contact swabs. During the one month post intervention visit, the researchers will determine whether message materials need to be relocated. Data collected from observations and interviews will be analyzed similar to procedure described in objective 1. Frequency of observed practices and compliance ratio and identification of themes from interview analysis will be compared with findings pre-intervention. Specific Objective #5: Disseminate food safety messages through the Iowa State University Extension and Kansas State University food safety websites and other communication outlets. A variety of dissemination methods will be used
to inform food safety educators, environmental health inspectors, and practitioners about project outcomes. Reputable web sites, state and national list serves, professional organizations, professional meetings and in-service trainings will be used. Iowa State University hosts an award winning food safety web site targeted for consumers, retail foodservices, regulatory personnel, and educators at www.iowafoodsafety.org.The project findings and developed messages will be presented at professional meetings for those involved with foodservice for all at risk populations, beyond just those serving older adults.