Would those Nigerians benefit from B.C.'s FOODSAFE program?

Yesterday, I wrote about food handling practices in street food vendors in Nigeria, and how the research suggested that they food handlers would be well-served by some formal education and training, potentially provided or designed by the government for quality and consistency assurance. B.C. has such a program in place, and last year a group of researchers from one of the province's regional health authorities and the B.C. Centre for Disease Control did a study to determine the level of success of the program.

The researchers did a telephone survey, similar to that performed by the artisan cheese researchers mentioned previously, and looked at worker's knowledge and attitudes about food safety, as well as their (self-reported) hand washing practices. It's worth noting, before we get too far in, that in 2013, once you took FOODSAFE, you were certified for life. There was no expiry date on the certification, and no upgrades or re-training was required.

Unsurprisingly, the research found that workers with FOODSAFE training had scores that were "significantly higher" than untrained workers, and that they also had "significantly better hand washing practices". They also found that after 15 years of being certified, knowledge scores "significantly decreased". It's worth noting that this study interviewed nearly 700 individuals to achieve their data, as compared to the relatively low "n" value of the artisan cheese study.

Linear regression model showing years since
FOODSAFE taken (McIntyre, et al. 2013)

While the fact that trained FOODSAFE workers had a better grasp on food handling and hygiene practices, and hand washing techniques is not at all surprising, it was interesting to note the statistically significant trend in knowledge loss over time. As the regression model to the right shows, the longer it had been since FOODSAFE was taken, the worse the knowledge scores were. The provincial authorities took notice of this study: as of July, 2013 (this study was published in March, 2013), all FOODSAFE certifications have a five year expiry date (for those taken before July, 2013, the expiry date is July, 2018).

The study results mimic what other research has shown: specific, formal, food handling education increases the skills and abilities of workers to provide safe food to consumers. However, it also shows that just giving the education isn't enough to maintain the knowledge base; there is no "set it and forget it" approach that will maintain public health. When considering the quandary of the Nigerians, and their demonstrated need for food handling and hygiene training for street vendors, it's worth keeping the need for recurring training in mind. Granted, one-off training is better than nothing, but it's clearly not the best approach.

Source: McIntyre, L., Vallaster, L., Wilcott, L., Henderson, S.B., Kosatsky, T. (2013). Evaluation of food safety knowledge, attitudes and self-reported hand washing practices in FOODSAFE trained and untrained food handlers in British Columbia, Canada. Food Control, 30, 150-156.

Street food in Nigeria: how safe is it?

Street food is becoming more popular throughout the world. It's not just us first-world people who watch "The Great Food Truck Race" on the Food Network, but globally people are seeking new ways to provide inexpensive, ready-to-eat food products to consumers on the go.

Typically, reducing a food service into a "mobile" location brings with it some inherent food safety challenges: new electricity sources need to be identified, water usage has to be limited to that which can be contained in freshwater and grey water tanks, there's not a lot of storage space, etc. With a good food safety plan, all of these challenges can be reduced. However, therein lies the rub: do mobile food service operators have the food safety acumen to develop a good food safety plan?

A group of Nigerian researchers looked to answer this very question by surveying 160 street food vendors to study food safety behaviors and hygiene practices. What they found wasn't great, if I'm being honest. Nothing in the study made me want to hop aboard a flight to southwestern Nigeria for some street meat. Nearly 62% of respondents had no formal food safety training at all, which was reflected in their hygiene practiced and attitudes toward keeping consumers safe. A stunning 3.8% of respondents "always" store food in the refrigerator, while 76% don't store food at refrigerated temperatures, and 16% don't have any food storage facilities at all.

In terms of personal hygiene, only 17% of respondents "always" washed their hands after using the toilet (though 79% responded that they did so "often"). Unfortunately, 77% of respondents admitted to using a reusable household towel to dry their hands after washing, instead of single-use paper towel.

Given the hygiene behaviors identified during the survey, it's very likely that there's a correlation between worker knowledge on how to prevent food-borne illnesses and formalized food safety training. While socioeconomic factors can reduce an individual's access to this type of training, and their ability to take time away from the workforce to participate, some sort of state-funded option could go a long way toward correcting some of these behaviors. Further, inspections and legislation surrounding street food (full disclosure: I don't know what's already in place in Nigeria) could ensure that vendors have refrigerated storage where necessary, and access to soap and paper towels for hand washing.


Source: Aluko, O.O., Ojeremi, T.T., Olaleke, D.A., & Ajidagba, E.B. (2014). Evaluation of food safety and sanitary practices among food vendors at car parks in Ile Ife, southwestern Nigeria. Food Control, 40, 165-171.

Food safety of artisan cheese in Ontario

There have been a couple notable outbreaks associated with cheese in Canada in the past: Gort's Gouda had the recent (and well-publicized) outbreak of E. coli, 2002 and 2008 both had outbreaks of Listeria associated with both raw and pasteurized cheese products, and 1998 had a nation-wide Salmonella outbreak which was traced back to cheese found in commercially-available lunch packs. For the most part, commercially-produced cheese items are quite safe. They're made with pasteurized milk products, and undergo processing that's well-studied and well-documented. In B.C., the B.C. Centre for Disease Control has dairy specialists on-staff who routinely inspect cheese plants for best practices and adherence to policies and guidelines.

There is also a growing movement for "local" and "artisan" products, which include cheeses. To determine the perceptions around food safety and attitudes about "food safety management programs" in cheese making, a group of researchers from the University of Guelph in Ontario put together an interview for artisan cheesemakers in the area. Their sample size was pretty small (of 50 cheesemakers that were identified, they were only able to get 11 to agree to participate, and of those, only 6 would let their employees speak with the researchers), but the interview questions were based on recommendations from existing research and incorporated a "Risk Assessment Framework".

Using private, anonymous telephone interviews, the researchers spent approximately 30 minutes speaking with each of the employees and managers from the cheese companies. While they found that nearly all of the respondents were aware of biological risks to food safety in cheese manufacturing, most perceived chemical and physical hazards as a low concern. Of all potentially hazardous biological agents, Listeria was named as the main one, due to its ability to multiply at fridge temperatures, its prevalence in raw milk, and because of awareness from past outbreaks. Interestingly, more than half of the respondents were proponents of using raw milk in cheese manufacturing because of the perceived increase in product quality, customer demand, and the ability of European countries to do so safely.

In terms of risk assessment and mitigation, all respondents were aware of their individual company's biosecurity policies and procedures (such as putting on clean boots before entering the facility), and typical sanitation regimes. However, more than half of those interviewed expressed concerns with the cost of these risk management programs, including the cost of having workers performing "excessive documentation" rather than being on the production floor making cheese. The respondents also spoke to the cost of formal education around best practices and food safety, but realized the value of these education programs, and felt that the cost was outweighed by the benefits they provide. When asked about risk communication, several of those interviewed stated that they didn't think the public was concerned about the safety of their cheese, and that they cared more about "cheese quality".

While the results of this study show that most of those interviewed recognize bacteriological concerns in cheese manufacturing, it also showed that there is still the need for further education around chemical and physical contaminants. Further, while the respondents valued formal food safety education, they felt that HACCP programs took too much time and weren't efficient, especially in small cheese manufacturing plants where there were fewer person-hours of work to go around. There is also a recognized lack of knowledge and commitment to risk communication, with producers thinking that their consumers care more about the quality of the product than its safety.

Since this study looked at such a small subset of the food manufacturing industry (a small number of cheese manufacturers in a geographically small part of Canada), it's hard to say how indicative these results might be of the food processing industry as a whole. However, it certainly highlights how media attention to a specific area of concern (Listeria) can ensure widespread knowledge.


Source: Le, S., Bazger, W., Hill, A.R., & Wilcock, A. (2014). Awareness and perceptions of food safety of artisan cheese makers in Southwestern Ontario: a qualitative study. Food Control, 41, 158-167.

Do people learn from their food hygiene mistakes?

While a large proportion of people who come down with a food-borne illness will blame the last restaurant they ate at (regardless of where or when that was), in reality, many cases come from home kitchens. Whether people fail to properly clean and sanitize their food contact surfaces, or they undercook their potentially hazardous food items, there are more risks at home to becoming ill than when you eat in a restaurant (unless, of course, you've developed HACCP plans for your home recipes, in which case: kudos).

Having a food-borne illness is not a fun time. It's exceedingly unpleasant. So once people have gone through that misery, do they learn anything from it? In other words, will they continue to make the same mistakes, or will they practice exceptional food handling procedures to ensure it never, ever, ever happens to them again. A study in volume 41 of Food Control looked to answer that very question, by looking at the food handling and kitchen hygiene of individuals who had previously suffered from Campylobacter infections.

The case control study used a survey to identify behaviors and perceptions about food safety, and followed up with a "kitchen sampling programme" among a sub-set of the cases and controls. Cases were identified as adults who had lab-confirmed campylobacteriosis, and were age/gender/geography matched to controls. The survey asked some general questions about food practices, as well as some questions that were specifically included to identify optimistic bias (e.g. asking what risk of illness came from their kitchen, vs. the risk in the average home kitchen). The kitchen sampling was done with environmental swabs on counters and cutting boards, and an analysis of the dish towel for bacterial growth.

In identifying optimistic bias, the researchers found that everybody thinks their kitchen is safer than the average home. Whether it was cases or controls, nearly 60% of respondents indicated that the average person is "at a significantly greater risk of getting food poisoning" than themselves. Interestingly, when the same question was asked 6 months in the future (i.e. after the campylobacteriosis was a distant memory), the cases had less of an increase in optimistic bias than the controls. Perhaps, with time to reflect on their illness, they were less convinced that they were as amazing at kitchen hygiene as they had originally thought. It's also noted that controls, who have not yet become ill, likely have increased confidence as time goes on and they continue to remain healthy.

In the "kitchen behavior" part of the survey, cases were found to be more likely to state that they wash their raw chicken pieces and their pre-washed bagged salads. These actions are not recommended, as washing your raw chicken increases the chance of cross-contamination, and your bagged salad is already washed much more thoroughly than you'd be able to achieve. Cases over the age of 60 were much more likely to state that they washed their chicken and their bagged salad.

While the survey part of the study relies on people's honesty and memory in answering questions, the kitchen sampling programme cannot be faked. Based on the responses above and the fact that the cases actually had food poisoning, one would expect their kitchen hygiene to be marginally worse than the controls. In reality, however, there was no difference between the two groups whatsoever. It was noted that the participants were warned that the samplers were coming ahead of time, which could have allowed them to clean beforehand, but they weren't made aware of where the samplers would swab.

The bottom line is that there is still work to be done in convincing the public that kitchen hygiene behaviors at home are an important part of reducing cases of food poisoning. The fact that the controls became more optimistic about their behaviors over time, and that the >60 year old age cohort was practicing unsafe food handling procedures shows that the education is not sinking in. As mentioned in the opening paragraph, people generally like to blame the last restaurant they ate at for their illness, a fact reflected in the optimistic bias. Ensuring that people are aware that their home-cooked meals can cause illness is the first step to reducing the burden on the health care system.

Source: Millman, C., Riby, D., Edward-Jones, G., Lighton, L., & Jones, D. (2014). Perceptions, behaviours and kitchen hygiene of people who have and have not suffered campylobacteriosis: A case control study. Food Control, 41, 82-90.