Older adults’ domestic kitchen practices associated with an increased risk of listeriosis

Older adults and other groups with weakened immunity are at increased risk of foodborne disease. Further research is important to understand the actual food safety practices of older adults and therefore develop effective food safety education strategies

Comparison of listeriosis risk factors among three ‘at-risk’ consumer groups: pregnant women, older adults and chemotherapy patients

Introduction: Due to weakened immune function, listeriosis is particularly associated with ‘at-risk’ consumers, predominantly affecting pregnant-women, older-adults (aged ≥ 60 years) and people receiving chemotherapy. Sporadic incidence of listeriosis is frequently related to refrigerated ready-to-eat (RTE) food products stored/consumed in the domestic kitchen. Consequently, ‘at-risk’ consumers should implement safe food handling/storage practices, including time and temperature control of RTE-foods to reduce the risks associated with L. monocytogenes. Changes in UK epidemiology data indicate reduced pregnancy associated-cases and increased older-adult and chemotherapy associated-cases. Purpose: Determination and comparison of these ‘at-risk’ consumers’ food-safety reported behaviours and related cognitions may identify listeriosis risk factors and inform the development of targeted food-safety information. Such data is currently lacking in the UK. Methods: Quantitative survey methods (online/paper-based) ascertained food-safety knowledge, self-reported practices and attitudes towards domestic food handling/storage. The study involved pregnant/post-partum (≤12 months) women (n=40), older-adults (≥60 years) (n=100) and chemotherapy-patients/family-caregivers (n=172). Results: Awareness of recommended refrigeration temperatures were significantly more widespread(p0.05), with the majority (58-65%) reporting temperatures would ‘never’ be checked. Older-adults were significantly less knowledgeable of ‘use-by’ dates, had more negative attitudes (p<0.001) towards ‘use-by’ dates and were more likely to report consumption of foods beyond the ‘use-by’ date (p<0.005). Although older-adults’ attitudes were significantly more negative towards consuming RTE foods within two days of opening, no significant differences in knowledge and self-reported practices were determined, with majority of all ‘at-risk’ consumers (82-89%) reporting consumption beyond recommendations. Failing to adhere to recommended food storage practices may increase the risks associated with listeriosis among these ‘at-risk’ consumers. Significance: Significant differences in knowledge, attitudes and self-reported practices between ‘at-risk’ consumers may indicate why reduced pregnancy associated-cases and increased older-adult and chemotherapy associated-cases are reported in the UK. Study findings may be utilised for the development of targeted food-safety education to reduce risks of listeriosis

Video observation of hand-hygiene compliance in a manufacturer of ready-to-eat pie and pastry products

Food-handler hand-hygiene can be a contributory factor for food-borne illness. Cognitive data (knowledge/attitudes/self-reported practices), while informative, are not indicative of behaviour, and are subject to biases. Consequently, observation of behaviour is superior to survey data. However, researcher presence in direct observation increases reactivity, whereas video observation gives comprehensive analysis over a longer period, furthermore, familiarity reduces reactivity. Although video observation has been used to assess food safety at retail/foodservice, this valuable method is under-utilized in food-manufacturing environments. For the study, footage (24 h) was reviewed to assess compliance in a food-manufacturing site with company protocol. Video observation of food-handlers entering production (n = 674) was assessed; upon 70 occasions no attempt to implement hand-hygiene was observed. Of attempted hand-hygiene practices (n = 604), only 2% implemented compliant practices. Although 78% of attempts utilized soap, only 42% included sanitizer. Duration ranged from 1 to 69 s (Median 17 s). The study provides hand-hygiene data in an area that observational data is seldom captured

A Review of UK Food Safety Information Provision for Chemotherapy Patients

Introduction: Chemotherapy patients have an increased risk of foodborne illnesses as a result of immunosuppression, and are reported to have a five-times greater risk of listeriosis. To enable chemotherapy patients/carers to minimise risk of illness by implementation of risk-reducing behaviours is essential. Provision of food safety information prior to and during treatment is needed to raise awareness of the potential risks relating to foodborne illness by informing patients/carers of control measures and responsibilities of reducing critical risk factors. Purpose: The aim of this study was to review food-related information available to chemotherapy patients/carers in the UK and evaluate the inclusion of risk-reducing food-safety behaviours. Methods: Food-related information available to chemotherapy patients/carers in the UK were collected from health care providers including UK NHS trusts. Sources were reviewed and analysed using a content analysis approach. Findings were summarized according to key topics critical to food safety and listeriosis, (e.g. refrigeration practices, cross-contamination, consumption of at-risk food products). Results: Overall, food-related information for cancer patients was obtained from 42 of 141 NHS chemotherapy providers and three UK cancer charities. Although 64% explained why patients are at an increased risk of developing infection during treatment, many failed to highlight the importance of food safety to prevent infection. Recommendations to ensure thorough cooking were most frequently included, although 42% recommended the avoidance of raw meat, poultry and fish, only 9% recommended the use of a thermometer to achieve a core temperature of 75°C. Practices relating to avoiding listeriosis were particularly lacking. Significance: Although information is available, considerable gaps exist and information provided varies greatly between sources. There is a need to establish the potential impact of such food-related information sources on cancer patient/carer food safety knowledge, attitudes towards reducing the risks of foodborne disease during chemotherapy treatment and implementation of risk-reducing food safety practices in the home during chemotherapy. Such data will inform the development of food safety education interventions targeting patients/carers

An assessment of food safety information provision for UK chemotherapy patients to reduce the risk of foodborne infection

Objectives: Given the increased risk of foodborne infection to cancer patients receiving chemotherapy treatment, and the risk of listeriosis reportedly five-times greater to this immunocompromised patient group, there is a need to ensure the implementation of domestic food safety practices among chemotherapy patients and their family caregivers. However, information regarding the adequacy of resources to inform and enable patients to implement domestic food safety practices to reduce the risk of foodborne infection are limited. Consequently, this study aimed to evaluate the provision of food safety information available to UK chemotherapy patients. Study Design: In-depth semi-structured interviews and content-analysis of online patient information resources. Methods: Interviews with patients and family caregivers (n=15) were conducted to explore food-related experiences during chemotherapy treatment. Online food-related information resources for chemotherapy patients (n=45) were obtained from 35 of 154 National Health Service (NHS) chemotherapy providers in England, Scotland and Wales, the Department of Health (DoH) and three of 184 identified UK cancer charities. Identified food-related information resources were reviewed using a content-analysis approach to assess the inclusion of food safety information for chemotherapy patients. Results: In-depth interviews established that many patients indicated awareness of immunosuppression during treatment. Although patients reported practicing caution to reduce the risk of communicable diseases by avoiding crowded spaces/public transport, food safety was reported to be of minimal concern during treatment and the risk of foodborne infection was often underestimated. The review of online food-related patient information resources established that many resources failed to highlight the increased risk of foodborne infection and emphasize the importance of food safety for patients during chemotherapy treatment. Considerable information gaps exist, particularly in relation to listeriosis prevention practices. Cumulatively, information was inconsistent, insufficient and varied between resources. Conclusion: The study has identified the need for an effective, standardized food safety resource specifically targeting chemotherapy patients and family caregivers. Such intervention is essential to assist efforts in reducing the risks associated with foodborne infection among chemotherapy patients

A review of consumer food safety research to identify domestic risk factors associated with listeriosis

Introduction: Listeriosis is associated with the highest hospitalization and mortality rates of foodborne illnesses; listeriosis incidence has doubled in recent years in Europe. Consumer recommendations to reduce listeriosis risk factors include following ‘use-by’ dates on unopened ready-to-eat (RTE) food products, avoiding prolonged storage of opened RTE foods and ensuring safe refrigeration temperatures. Currently, data detailing consumer cognition and behaviour associated with listeriosis risk factors are lacking. Purpose: This study aimed to review consumer food safety studies to consolidate and cumulatively determine consumer cognitive and behavioural risk factors that may be associated with listeriosis in the home. Methods: Consumer food safety research data (n=200) were reviewed and analysed using a content analysis approach. Findings were summarized according to assessment of knowledge, attitudes, self-reported practices, and/or actual behaviours of listeriosis risk factors. Results: Overall, only 43% of studies assessed consumer cognitive or behavioural data associated with listeriosis risk factors; 27% assessed refrigeration practices, 23% determined storage length of opened RTE foods and 21% ascertain adherence of ‘use-by’ dates. Majority (71%) of studies utilized survey based data collection methods (questionnaires/interviews), consequently, the majority of findings were based on self-report (78%) and knowledge (59%). Observation (21%) and focus groups (8%) were less commonly used. Consequently findings of this study indicate that actual behaviours and attitudinal data relating to listeriosis risk factors are lacking. Although findings suggest consumers may deviate from recommended practices, a lack of observational data suggests a need to determine the actual behaviours of consumers in domestic kitchens in relation to listeriosis risk factors. Significance: This review reveals a need for in-depth research to determine food safety attitudes and actual behaviours of consumers in conjunction with self-reported practices and knowledge of listeriosis risk factors. Such data combined with review findings would inform development of targeted food safety education to reduce risks associated with listeriosis in the home

Laboratory re-enactment of storage practices of older adults to determine potential implications for growth of listeria monocytogenes

Older adults are more susceptible to listeriosis, and many frequently consume ready-to-eat (RTE) foods associated with Listeria monocytogenes. Consequently, safe storage of RTE-food is essential to reduce the risks of listeriosis. This study aimed to re-enact domestic food-storage malpractices of older adult consumer in a laboratory to assess the potential impact on L. monocytogenes. Observed and self-reported data relating to domestic food-storage malpractices included prolonged storage of RTE foods and/or refrigeration temperatures exceeding recommendations (>5.0°C). Re-enactment occurred using soft-cheese and RTE meat inoculated with ~3.7 log CFU L. monocytogenes, stored at recommended temperatures (2.5°C)(n=110); temperatures exceeding recommendations (7.8°C)(n=110) and ambient-temperature (19.5°C)(n=55). Samples were analyzed every 24h for <21d. Results indicated L. monocytogenes grew at all storage temperatures. Average generation times indicated slower growth of L. monocytogenes at 2.5°C (94h t-1) than at 7.8°C (21.5h t-1) and 19.5°C (11h t-1), suggesting prolonged storage of RTE foods at increased L. monocytogenes populations (<7.6 log CFU/g), potentially making such foods unsafe for consumption. Findings indicate storage malpractices contrary to consumer recommendations intended to reduce the risk of foodborne disease, increase L. monocytogenes populations, thus increasing the potential for foodborne disease

Identifying Vulnerable Populations at Risk of Foodborne Infection: 3 People with Diabetes Mellitus

It is well documented that individuals with compromised immunity have an increased risk of foodborne infection; however, many often do not have an awareness that they are more vulnerable to foodborne infection. Consequently, such individuals need to be made aware of their increased risk and of food safety practices necessary to reduce the potential risk of foodborne disease. Consumer food safety research suggest highly focused, targeted interventions are the most impactful for effective consumer food safety education. Interventions that enable immunocompromised individuals to understand their increased susceptibility to infection may empower this vulnerable group to adopt risk reducing food safety practices. The aim of this paper is to explore the association between foodborne infection and diabetes mellitus to increase understanding of this under-represented group within food safety research. Findings may help inform the development of future food safety educational interventions specifically intended for people living with diabetes mellitus

Exploring Novel Technologies to Enhance Food Safety Training and Research Opportunities

In food safety research, be it focused on consumers in the domestic setting, or food handlers in the industry; technology capabilities have enhanced in recent years that have improved the rigour of research findings, reduce research biases, simplified data collection methods or enhanced the delivery of food safety education and training. For example, utilisation of online surveys can save time compared to paper-based surveys where the task of data entry is eliminated and approach to data analysis is simplified(43).The cost, availability and portability of surveillance equipment has enabled an increase in covert observational research of consumer food safety practices in domestic environments (33, 34, 81) or of food handlers in industry based settings (19, 35, 36).The 21st century has become the era of new technologies which afford many new opportunities to interact with target audiences. These evolving technologies are changing the way in which screens are used and could be the next big thing that the food industry and researchers can take advantage of; creating new and stimulating experiences that benefit areas such as food safety behaviour, cognition and training. Given advancements in technology, a food safety researcher and a user centred design researcher, have joined forces to explore novel technologies that can be utilised to enhance food safety training and research opportunities. The aim of this general interest article is to explore alternative technologies such as biometric and realities technologies that can be utilised by food safety researchers to enhance understanding of food safety practices, increase industry insight on food safety behaviours and present opportunities to optimise food safety education prospects.Additionally, this article gives an overview of several physiological and psychological technologies which are utilized alongside simulated environments, within applied user testing, product development and behavioural analysis research