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Régis Pouillot - FDA/CFSANMeryl Silverman - FSIS
formerly with the University of Maryland, Joint Institute for Food Safety and Applied Nutrition
Handling and Preparation of RTE Foods at retail: Observation Studies
Interagency Risk Assessment - L. monocytogenes in Retail Delicatessens Public Meeting
Washington, DC - May 22, 2013
Food Safety Practices of Food Handlers
• Several studies have assessed food employees’ behavior in food service settings.
• Few have taken place in deli departments.
• Methods used include:– Self-reports in which food employees report past
behavior or estimate future behavior.– Observational designs in which actions are recorded
as they occur.
2May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Green et al., 2005 (EHS-Net)
• Method:– Telephone survey of food service workers in the U.S.
(n=486).– Asked about performance of four types of behaviors.
• Key findings:
– 40% reported always wearing gloves while touching RTE food.
– 77% reported washing their hands between touching raw meat or poultry and RTE food.
– 67% reported changing gloves between touching raw meat or poultry and RTE food.
3May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
4
FDA Report on Foodborne Illness Risk Factors (2004 & 2009)
• Method– Observed employees
for ~90 minutes at approximately 100 establishments.
– Recorded specific behaviors using a form based on 1997 Food Code.
– Either IN or OUT of compliance.
May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
5
Food workersBehavior Events
A Specific Data Gap for the Risk Assessment Model
May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Clayton and Griffith 2004 Br Food J 106(3): 211-7
• Method– Observed food employees at catering establishments in South
Wales (n=115).
– Used Notational Analysis which allows for tracking of cross-contamination
– Recorded actions related to hand-washing and cleaning along with whether they were required and/or performed adequately.
– Method also used inGreen et al., 2006 J Food Prot, 69(10): 2417-23
6May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Study Objectives
• The primary objectives of this study were to identify realistic ranges of:
• Frequency and sequence of contact between any object and the considered product before sale;
• Frequency, procedure and sequence of hand washing and glove changing;
• Frequency, procedure and sequence of equipment, utensil and surface cleaning.
To be used in the L. monocytogenes in retail delicatessens model
7May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Study Objectives (continued)
– Identify routine cleaning, storage, and preparation practices in deli operations as well as average daily and weekly throughput.
– Develop and validate an observational method.
8May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Participants
• Nine retail facilities which sell deli meat, cheese, and deli-type salads were selected for the study based on size, location, and other criteria.
– Six were chain retail stores– Three were independent retail stores– Maryland and Virginia
9May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Object/Equipment Food
DIS – Dish (food container, bowls, platters, tray)
SAL – Salami (chub)
SUR (ST, PL) – Work surface * (Stainless steel, plastic)
CRB – Corned beef
SLI –Slicer* FRT – Fruit
CTB – Cutting board* BOL - Bologna
SK – Sink* KT – Ketchup*
SCL – Scale* RFS – Raw seafood
K – Knife* MY – Mayo*
IM – Ice-maker CHE – Processed Cheese
CL – Reach-in cooler TRK – Turkey
FR – Walk-in refrigerator TM – Tomato
FRH – Walk-in refrigerator handle
BRD – Bread
SPI – Spigot* RCH – Raw chicken
Coding Scheme
• A coding scheme was developed based on common food preparation behaviors and the Food Code requirements.
• The coding scheme was then pilot tested and refined during a visit to a retail facility.
10May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Example Notational Analysis Chart
10
9
8
7
6
5
4
3
2
1-TIME:
AdequateAttemptedRequiredAction
Specific Food Safety ActionNotesAction SequenceAction No.
10
9
8
7
6
5
4
3
2
1-TIME:
AdequateAttemptedRequiredAction
Specific Food Safety ActionNotesAction SequenceAction No.
P SAL ON SLI #3
10AM
CLS CAS
OPN CAS
WS HDS No soap WS X XPON GLVS
PUP SAL
SL SAL ONTO GLV
11May 22nd, 2013 Interagency Risk Assessment - Listeria monocytogenes in Retail Delicatessens Public Meeting
ResultsChain Independent
No. Employees 25 8
Total time (min.) 885 266
No. Actions 3073 1098
Avg. time (min.)/employee
35.4 33.3
Avg. no. actions/employee
123 137
Avg. no. actions/min.
4.5 5.7
12May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Sequence of Actions
13May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Wash hands
Put on gloves
Open deli case
Spray slicer Touch clothes Touch body
Pick up Swiss
Open walk-in
Close deli case
Unwrap Swiss Over trash can On FCS On SlicerOver sink
Sequence of Actions(Alternatives)
14
Bare-hand contact – Hand Washing• No bare hand contact was observed with RTE food.
• Hand washing – when and where according to FDA Food Code 2009
15May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Frequency of Occasions Hand-washing Actions were Required and Performed
Work activity Chain (n=25) Independent (n=8)
Required
Action
Action
Performed
Required
Action
Action
Performed
After touching body 7 4 3 0
After eating/coughing 1 0 2 1
Before donning gloves
116 56 22 3
After handling soiled equipment
295 0 235 0
To prevent cross-contamination
14 13 1 1
After other activities 2 1 10 2
Total 439 73* 273 4*
*Some actions fulfilled more than one requirement16
Frequency of Hand-washing Actions After Handling Soiled Equipment
Equipment Chain (n=25) Independent (n=8)
Required
Action
Action
Performed
Required
Action
Action
Performed
Deli-case handle 178 0 154 0
Scale 73 0 49 0
Slicer knob 24 0 19 0
Refrigerator handle
16 0 13 0
Fryer 4 0 0 0
Total 295 0 235 0
17May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Hand-washing Benchmark• Hand-washing benchmark per hour per employee =
• Benchmark observed = 30 times/hour
• Previously reported benchmarks:– Delicatessens = 6 times/hour1
– Schools = 11 times/hour 2
– Restaurants = 29 times/hour2
Reconfiguration of job duties and/or effective sequencing of work tasks3,4
Total # times hands should have been washedTotal # hours observed
1Paez et al. 2007. Food Prot Trends 27(11): 903-908.2Strohben et al. 2008. J. Food Prot 71(8): 1641-16503Clayton and Griffith. 2004 Br Food J. 106(3): 211-74Green et al. 2006 J Food Prot 69(10): 2417-23
May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Frequency of Occasions Cleaning & Sanitizing Actions were Required and
Performed Adequately
Surface type Chain (n=25) Independent (n=8)
RequiredAction
Action PerformedAdequately
RequiredAction
Action PerformedAdequately
Food contact surfaces/utensils
11 11 0 0
Non-food contact surfaces
0 0 0 0
Total 11 11 0 0
19May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Surface type Chain (n=25) Independent (n=8)
Attempted Adequate Attempted Adequate
Food contact surfaces/utensils
100 13 11 0
Non-food contact surfaces
11 0 0 0
Total 110 13 11 0
Frequency of Additional Occasions Cleaning & Sanitizing Actions were Attempted or
Performed Adequately
20May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Frequency of Additional Cleaning & Sanitizing of Food Contact Surfaces/Utensils
Surface type Chain (n=25) Independent (n=8)
Attempted Adequate Attempted Adequate
Work surface 24 0 4 0
Cutting board 1 0 2 0
Dish 1 0 0 0
Utensil 5 0 0 0
Knife 6 1 1 0
Slicer 62 12 4 0
Sink 1 0 0 0
Total 100 13 11 0
21May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Conclusions
• Notational analysis enabled recording and identification of common sequences of actions (as well as deviations) for deli meat, deli cheese, and deli salad preparation to be used in a risk assessment model.
Directly implemented in the L. monocytogenes in Retail Delicatessens Risk Assessment model
22May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
23 23May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
Conclusions (continued)
• Results demonstrated that food employees engaged in a large amount of contact between objects, gloved hands, and RTE food highlighting potential risk mitigation measures.
• To better understand variability in actions (inter- and intra-store), a larger study is needed with: – A larger sample of stores (both chain and
independent) distributed in a wider geographical range and
– Multiple coders
24May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting
• Supported by – Joint Institute for Food Safety and Applied Nutrition
– University of Maryland
– an appointment to the Research Participation Program at the CFSAN administered by the ORISE through an interagency agreement between the U.S. DOE and the U.S. FDA
• Thanks to– Food Marketing Institute– Caren Kieswetter, FDA/CFSAN
May 22nd, 2013Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting