Culture change isn’t about training, education and environment

Over the past decade lots of folks have been throwing around the term food safety culture to describe how a business operates. Education, training, equipment, tools, the environment, investment and support from higher-ups all influence how well an organization addresses risk, there’s something else that binds it together.

The culture, or value system, can be difference between having an outbreak or not. The values dictate decisions from the front-line staff to the CEO.

Maybe it’s the hippie in me but it’s sort of like the vibe of the organization that can be gauged by asking does anyone really care?

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And if they do, do they know what they should be caring about?

The health care world struggles with the same issues, with similar consequences. According to Yahoo News the Vanderbilt University Hospital dealt with a culture change around infection control. And it’s taken six years to turn things around.

Dr. Gerald Hickson had two primary concerns after his wife’s double-knee replacement operation at Vanderbilt University Hospital in July 2008: making sure she received appropriate pain control and getting her moving as quickly as possible to avoid blood clots. But as he sat with her during her recovery, Hickson made a disturbing discovery. Most of the nurses, doctors and other hospital workers filing in and out of the room to care for his wife, who was at risk of contracting an infection after surgery, were not washing their hands.

A compulsive person by nature, Hickson started counting. He found 92 instances when staff members should have soaped up or used antiseptic foam. The total number of times they actually did? 32. Hickson did not want to humiliate anyone, but he was also fiercely committed to protecting his wife. With polite Southern collegiality, he calmly pointed out the 60 opportunities when staffers could have provided safer care but didn’t. Some staffers were immediately embarrassed. Several wondered if he was kidding, got defensive and offered explanations for their lapses. 

Hickson reported his findings to Dr. Tom Talbot, VUMC’s chief epidemiologist, and Talbot ran with it, spearheading an ambitious clean hands initiative that was launched in July 2009. Since then, hand-washing rates at Vanderbilt have jumped from 58 percent to 97 percent; at the same time, the number of several stubborn infections has dropped, one of them by as much as 80 percent. “We get into bad habits, all of us do, and sometimes we need somebody to remind us to get back on the right pathway,” says Hickson. “That’s the key to transforming health care.”

Talbot orchestrated a number of practical changes right away, including installing additional hand sanitizer dispensers at the entrance and exit of every patient’s room or bay and within easy reach inside. Staffers were instructed to clean their hands before and after every encounter with patients, even if all they planned to do was have a conversation. Even the smallest details were addressed. Clinicians who complained that their skin had become irritated by excess antiseptic gel were told to cut back to a dime-size portion, and moisturizing lotion dispensers were added throughout the hospital.

That was the easy part. Talbot knew that it would take an all-out culture shift to see dramatic improvement. A prior hand-washing program, which focused largely on education and random surveillance, had done little to boost rates. This time, Talbot drilled down on what he believed would be the keys to success: training, communication and shared accountability up and down the staff hierarchy.

Because the hospital’s top leadership would be the ultimate enforcers, Hickson and Talbot knew they needed buy-in before the program was officially launched. The old days of giving high-performing doctors a pass on unprofessional conduct — “Oh, that’s just Dr. So and So, that’s how he is” — would be over. Every hospital worker, no matter his or her rank, would be held to the same high standards. “We had to have support from leadership, so if we had pushback, we would elevate that up and they wouldn’t blink,” says Talbot. “Instead, they would say, ‘That’s not the kind of behavior we expect here.’”

Competition is a big motivator at Vanderbilt, too. Hand-washing scores for individual units and departments are tallied up from highest to lowest, and results are posted every month in break rooms and other staff areas so that everyone can see how his or her team compares with the one down the hall. “You want to look better than other services when that scorecard comes out,” says Johnson. “You don’t want to be at the bottom. That’s just human nature.”

Today, after more than 200,000 hand-washing observations, Vanderbilt’s overall hand-washing compliance rate has almost doubled. At the same time, three major types of infections linked to the insertion of tubes and catheters have been reduced considerably, according to Talbot. Urinary tract infections related to catheters in intensive care units have dropped by 33 percent; pneumonia linked to ventilators by 61 percent; and bloodstream infections associated with central lines — the tubing that delivers fluids and medications to patients — by 80 percent in ICUs.

Culture change is not about mission statements and core values written on a poster. It’s about fostering feelings within the organization from top-to-bottom that this stuff matters.

Sandwich artist says Subway manager made her work while ill

Norovirus is the perfect human pathogen. With its low median infectious dose and stability, norovirus is built to be transferred. Beyond its durability, billions of particles can be shed in every gram of feces and vomit from an infected individual and can be transferred well via fomites, food and water.

Sort of a nightmare for a restaurant if one of their kitchen staff shows up to work ill.

And a worse situation is when a manager says to an ill food handler that she can’t go home until after the lunch rush.images

Which is apparently what happened at a Freeport, Texas Subway. According to Emily Thomas at the Huffington Post, former sandwich artist Elizabeth Taff was eventually fired for wanting to go home because she had vomited.

A Subway worker in Freeport, Texas, claims she was forced to continue working her shift while suffering from a stomach bug, then was fired the same day.

Elizabeth Taff, 24, says she was so sick she could barely stand up straight and vomited several times during her shift on July 11, but her manager refused to let her leave unless she found someone to cover her shift.

“About 40 minutes into my shift I felt nauseous. My mouth started watering, and I knew I was about to vomit. I ran into the restroom and vomited repeatedly,” Taff told The Huffington Post. “I went and let my manager know, [but] she told me to find my own replacement after lunch rush.”

Taff says she then summoned enough strength to get through the lunch rush, hoping to track down another employee to fill in for her. But no one else was available, she said.

She noticed vomit on her work clothes and, rather than take a pay cut for a new work shirt, phoned home for someone to bring her a clean outfit, she said. She also maintains she didn’t leave work for fear of getting fired and losing her paycheck.

Speaking to local news outlet KPRC, Taff expressed concern for the impact her sickness could have had on customers.

“I was touching everybody’s sandwiches,” she said. “I’m like, ‘This ain’t right.’ I had gloves on but that doesn’t matter.”

Ultimately, though, she was fired that day. Subway asserts the decision was due to her “poor performance and insubordination,” reports KPRC.

“I was on my knees [on the grass outside the restaurant], while [the manager] berated me with remarks such as ‘you’re so stupid, if you cant handle working while feeling ill you don’t need to work here, all you had to do was switch shirts and finish your shift,’” Taff told HuffPost. “She told me I was fired since I was unable to talk, due to vomiting all over the place.”

Food safety fairy tales: how industry, government and academia collaborate to fail

That was the title of the chat I had with the Canadian Institute for Public Health Inspectors in Newfoundland last night.

I was in Brisbane.

The slides are available at http://barfblog.com/wp-content/uploads/2014/07/powell.ciphi_.jul_.14.public.health-copy.ppt

And the video is below and at http://youtu.be/deejYx8HQDo

Comments welcome.

Food Safety Talk 63: The Great One

Food Safety Talk, a bi-weekly podcast for food safety nerds, by food safety nerds. The podcast is hosted by Ben Chapman and barfblog contributor Don Schaffner, Extension Specialist in Food Science and Professor at Rutgers University. Every two weeks or so, Ben and Don get together virtually and talk for about an hour.  They talk about what’s on their minds or in the news regarding food safety, and popular culture. They strive to be relevant, funny and informative — sometimes they succeed. You can download the audio recordings right from the website, or subscribe using iTunes.1405348895819

Don and Ben have Skype issues but this time it was actually Don. Don announced that there will be help for people like Ben who aren’t so good at managing their time and attention at IAFP 2014, with Merlin Mann presenting on Wednesday in a special lunch session. The guys estimate about 0.1% of IAFP annual meeting attendees will be excited to see him – including Ben and Don, and probably Batz. Ben mentions his excitement that Professor Dr. Donald Schaffner, PhD was name checked on Back to Work Episode 173.

The first mention of The Wire comes at 12 minutes in when the guys give a shout out to Baltimore resident Manan Sharma who says that this is his favorite part of the show.

In follow-up from Episode 61, friend of the show MDD says that there are not rats in Alberta  Ben and Don remark while there may not be any snakes in New Zealand and Ireland (although Ben thinks that Don is thinking of potatoes) there are rats in small pockets in Alberta. While Alberta has had a rat eradication program since the 1950s, a colony of Norwegian rats, of Roanoke Island proportion, was found in Medicine Hat (that’s in Canada) in 2012 and 2014. Ben tells Don that he wears big pockets to avoid rats, and that and on a pilgrimage to Edmonton to see a statue of The Great One, his pockets were not checked.

The guys then talk about a question from IAFP’s Dina (not Dinah). Dina asked the guys to discuss their thoughts on a recent JFP paper about non-intact steak cooking using temperature, flipping/turning and different cooking methods. The practical, take-home message (as dictated using Dragon Dictate) was that that flipping and covering with a lid (which allows cooking to occur both through conduction and convection heat) and using a thermometer for all cuts of meat helps reduce risk.

Ben talked a bit about some future work that his group is doing looking at mechanically tenderized beef messaging, perception and behavior – including cubed steak.  Cube steak is sometimes made by slapping two pieces of meat together and running through a cuber – although not according to Wikipedia, which is never wrong. The discussion moved to steak eating preferences as detailed by FiveThirtyEight Nate Silver’s cadre of numbers nerds who dissect a lot of pop culture and sports questions.

The guys then both talked about message variability projects they have going on. Ben’s group is looking at  cook book recipes (and how the messages and instructions in the culinary world often are not evidence-based). And Don’s group is looking at messaging on handwashing signs, something that his second favorite graduate student Dane, is undertaking.

In outbreak flashback the guys talked about 1854’s Broad St. Pump  cholera outbreak. Using a map and analyzing cases of human disease, John Snow, largely recognized as one of the founders of epidemiology, created a blueprint for the next generation of disease hunters. Removing the handle on the pump is commonly thought to have ended the outbreak except that modern epi-curve analysis suggests that the outbreak was already on the decline. Ben’s favorite part was what one of his undergraduate professors, Anthony Clarke talked about in class 15 years ago: the monks in a local monastery did not get sick because they didn’t drink the water, just home brewed beer.

The guys then ended the show talking about an outbreak linked to food service hamburgers made by Wolverine Packing. Or is that Wolverine Packing with it’s adamantium slicers and grinders? In either case, It’s unclear whether illnesses are linked to undercooked burgers or cross contamination – although anecdotally undercooked burgers have been reported. One of Ben’s graduate student’s Ellen Thomas has been working on a project related directly to this type of product, where secret shoppers have been speaking with servers at burger-serving family style restaurants throughout the U.S. The results of the project will be shared at IAFP in Indianapolis.

In after dark the guys chuckle and guffaw about Ben’s Beatles references, time and attention management, and Tony Robbins who Ben thinks is in prison. But he’s not. He was thinking of James Arthur Ray. Don mentions that the author Kurt Vonnegut (who explains the universal shapes of storytelling) has a memorial library in Indianapolis.

Festival vendors need food safety too

Back before kids, Dani and I lived in Kansas for a few months and spent every weekend traveling around the state looking for quirky stuff to do and see.

And fried chicken.

The quest for festivals and attractions took us to Leavenworth and Garden City as well as lesser known spots like Cawker City and Lucas.Screen Shot 2014-07-07 at 8.37.03 AM

Our boys are now old enough (and manageable enough) for day trips and we’re going to hit a few events here in North Carolina this summer – and some will have food trucks and concession stands.

Festival food vendors have have been linked to multiple outbreaks in the past including over 800 cases of salmonellosis at the Taste of Chicago and 37 cases of E. coli O157 linked to Folklorama  which led to this research on training temporary event vendors).

According to Greensboro NC’s WFMY, festival vendors aren’t exactly the same as the restaurants when it comes to inspection.

90 percent of food vendors at festivals don’t get inspected by the health department. Here’s why. They serve baked, sweet or frozen items. Bakeries, ice cream parlors and popcorn places aren’t considered restaurants. The department of agriculture regulates them instead. But the health department does inspect mobile food trucks and even push carts. 

James Howell’s hot dog push cart has a perfect 100 sanitation score. “Safety is probably number one and then the product that you use is number two in a business like this.”

Health inspector Paula Cox says just because the food business is on wheels doesn’t mean vendors get to roll on by un-noticed. “It’s a very condensed, mini-inspection – but it still follows the same process that we look for when we’re looking at a larger place. It’s just a smaller menu.”

Push carts are inspected twice a year. But the only day that really matters is the day you eat from one. Paula says watch how the cart operator works:

  • Do they wear gloves when handling food?
  • Do they use utensils to dish out or serve food?
  • Do they have a way to sanitize their hands between food and money handling?

All good stuff for a patron to look for.

Risk, communication and trust: Towards an emotional understanding of trust

Current discussions on public trust, as well as on risk communication, have a restricted rationalistic bias in which the cognitive-reflexive aspect of trust is emphasized at the expense of its emotional aspect.

communication.context.13This article contributes to a substantive theory of trust by exploring its emotional character. Drawing on recent discussions in science and technology studies, social psychology, and general social theory, it argues that trust is a modality of action that is relational, emotional, asymmetrical, and anticipatory. Hence, trust does not develop through information and the uptake of knowledge but through emotional involvement and sense-making. The implications of this conception of trust for public understandings of science and for risk communication are discussed.

Public Understanding of Science

Emma Engdahl and Rolf Lidskog

http://m.pus.sagepub.com/content/23/6/703

Food safety for summer – and the other seasons

When Liz Szabo of USA Today called me a few weeks ago, my immediate thought was, not another food safety tip story, because most of them are as exciting as watching soccer or listening to Springsteen.

barfblog.Stick It InBut, I changed my mind because anyone can be a critic – gotta come up with some solutions.

I told Liz, let me talk to some of my colleagues and we’ll take a shot at something decent, because food safety encompasses a lot of areas, and the older I get, the less I know.

(Below is an edited version of the story, with a few annotations from me.

Doug Powell doesn’t bring wine when he’s invited to dinner.

He brings a food thermometer.

(I do bring wine, and I sometimes forget the thermometer, like the trip we’re on now up at Rainbow beach and Fraser Island in Queensland). Consistency matters and I try, but sometimes, stuff happens.)

As a food safety scientist and creator of barfblog.com, Powell knows way too much about the dangers of undercooked meat to take chances on the barbecue.

colbert.soccerSo he brings a food thermometer to every summer cookout. “I don’t get invited to dinner much,” he says.

• Always use a meat thermometer, Powell says. With practice, people can learn to stick them in burgers without slicing the patties in half. “Pick the meat up with tongs and insert the thermometer sideways, or through the top,” Powell suggests. Beef hamburgers should reach 160 degrees to kill germs, says Benjamin Chapman, assistant professor of food safety at North Carolina State University and a food safety specialist at the North Carolina Cooperative Extension. Temperature matters far more than color when it comes to meat, Chapman says; even thoroughly browned burgers can harbor bugs. “I was not a popular person at a family cookout a few years back when I insisted we ‘temp’ the chicken as we grilled in the rain,” says Donald Schaffner, a professor and extension specialist at Rutgers University in New Jersey. “But nobody got sick.”

• Slice your own cantaloupes. Although cantaloupes are loaded with vitamins, they’ve also caused some of the biggest outbreaks of food-borne illness in recent years. More than 260 people were sickened in a salmonella outbreak in 2012; nearly 100 were hospitalized and three died, according to the Centers for Disease Control and Prevention. Cantaloupes spread disease more easily than watermelon or honeydew because their soft, bumpy skins soak up bacteria like a sponge, Powell says. Washing doesn’t help (much), and cutting amy.thermometer.05through the outer rind allows bacteria to infect the edible portion of the melon. While people don’t have to stop eating cantaloupes, they should keep sliced portions refrigerated, because cold temperatures slow bacterial growth. But stores are asking for trouble when they slice melons in half, wrap them in plastic and leave them at room temperature in the produce aisle, Powell says: “This is microbiological disaster waiting to happen.”

• Use a cooler — for cantaloupe, potato salad or other picnic foods. “Bacteria will grow if left out at warm temperatures long enough,” Powell says.

• But don’t be afraid of mayonnaise. The egg-based spread has gotten a bad rap, and some people have been afraid to take it on summer picnics. But “commercial mayo uses pasteurized eggs and has high levels of vinegar,” whose acid content helps control bacteria, Powell says. Homemade mayo, on the other hand, could be riskier. (See  http://barfblog.com/wp-content/uploads/2014/03/raw-egg-related-outbreaks-australia-3-3-14.xlsx

• Don’t wash poultry and other meat. “It just spreads bugs,” Powell says.

kevin.allen.sproutSo are there any foods these three food experts won’t touch?

• Sprouts. Seeds and beans need warm, humid conditions to sprout and grow. So do bacteria, such as salmonella, listeria and E. coli. Raw or lightly cooked sprouts have caused at least 30 reported outbreaks of food-borne illness since 1996, according to FoodSafety.gov. Home-grown sprouts are no safer, because the bacteria can be found in the seeds themselves. So no matter how clean your house, bacteria can grow to dangerous levels. “Some providers test seed and provide sufficient controls, but consumers have no way of knowing which sprouts are good or not,” Powell says.

• Raw shellfish. Even a fancy dish such as raw oysters, served in high-end restaurants, can pose a huge risk, Powell says, because they can be exposed to raw waste while under water. “The bacteria Vibrio found on raw oysters produces a toxin that attacks vulnerable livers,” Powell says. “Raw shellfish is risky.”

• Raw milk  can also contain dangerous bacteria, including salmonella, listeria, campylobacter and brucella, according to the CDC. Younger children, old people and those with weak immune systems are most at risk. “Getting sick from raw milk can mean many days of diarrhea, stomach cramping, and vomiting,” the CDC says. “Less commonly, it can mean kidney failure, paralysis, chronic disorders and even death.”

Leftover food sharing in Germany leaves a bad taste in my mouth

My role as dad and food dude has morphed in the past year –  I now do most of our food shopping and cooking. Two or three days a week I make meals with the plan that they will also be used for a couple of lunches. I get that this isn’t revolutionary (note the large market for Tupperware) but is new for me.2008_12_4-Leftovers2

There is apparently a subgroup of leftover-avoiding folks out there who are also concerned with food waste, leading to the development of a leftover sharing ap in the U.S. LeftoverSwap and now it’s German counterpart foodsharing.de.

According to NPR, child psychiatrist Vero Buschmann was looking for a way to get rid of leftovers without having to throw them away. And she was looking to create a community around similar food waste values.

She found a nonprofit website in Germany that allows her to do both. On a recent evening, her doorbell rings and she buzzes Franzi Zimmerman in to her fifth-floor apartment.

“I have a whole bunch of baked goods I just picked up from the baker,” Buschmann tells her 29-year-old guest. “You can take as much as you want!” She also offers some soup and chutney, made from her leftover produce.

Zimmerman laughs and replies: “Wow, that’s really great. Homemade soup? It doesn’t get better than that!”

Such exchanges between strangers are happening in more than 240 cities across Germany through Foodsharing.de (for English, click on the tiny British flag on the top left), a website that connects people who have free food to give away with people seeking those items.

Some 40 tons of food have been given away via the network since it began online 18 months ago. More than 41,000 people have signed up. The nonprofit website’s creators say their goal is to prevent large amounts of produce, bread and other perishable food from being thrown away.

Food waste is not just a German problem, says website co-founder Valentin Thurin. He’s a Cologne-based filmmaker whose documentary, Taste the Waste, lays out in jolting terms just how much food Europeans throw away each year – 90 million tons worth, to be exact. It’s a phenomenon that costs the European economy more than $130 billion every year — up to half of fruits and vegetables picked at harvest time, he says.

“With food, obviously there is a health risk associated, so we needed to establish some rules,” Thurin says. He says the Web team worked with lawyers to ensure the network didn’t violate any German or European regulations governing food.

As a result, it doesn’t offer meats or other products that have “sell by” dates, concentrating instead on food items with “best before” labels.

There are no inspectors checking on food offered through the network, but consumers are encouraged to go online and rate the food they’ve received, Thurin says.

After a quick review of the food safety guidance at foodsharing.de  there might be some stuff that is lost in translation. There is a listing of types of high risk foods (or extra delicate foods) and suggestions on transportation, refrigeration and cleaning and sanitation. The lack of safe endpoint temperatures and proper cooling guidance is a glaring omission.

 

Dirt on the menu? It’s ‘hyper-local’

My friend Steve managed his four kids and mealtime with frozen veggies, and I sorta did the same.

mqdefaultBut in provactive food porn, for those who’s lives are hopelessly dull, Toronto’s Globe and Mail reports chef Justin Cournoyer is heading north of Toronto in his Subaru Forester (because only soilvares would drive a Subaru, or that it would matter) to forage in the wilderness. He’s on one of his biweekly pilgrimages to harvest wild bounty, such as chamomile, ginger, peas, woodruff or ground elder. These he will place into a cooler to take back to his small hyper-local Ossington Avenue restaurant, Actinolite. While he’s out, he’s also seeking an ingredient that the average forager might overlook: soil.

“You want soil that is near maples and pines,” he says. “If it’s too into the pines, it’s too acidic.”

He prefers not the silty topsoil that one could procure from a front lawn, but the stuff that is rife with pine needles, decaying organic matter and broken-down leaves. He wants the scents and sensations of an Ontario forest captured in a handful of dirt, and he wants to cook with that dirt.

(This is satire): FDA recalls food, out of an abundance of caution

Saying it was vitally important that citizens avoid consuming any of the affected items, the U.S. Food and Drug Administration issued a nationwide recall of all food Wednesday. “We are asking all Americans to return any edible products they own to the store where these items were purchased or to discard such items immediately,” margaret_hamburgsaid FDA commissioner Margaret Hamburg at a morning press conference, specifying that under no circumstances should Americans eat grains, meats, produce, nuts, dairy products, processed foodstuffs, sweets, spices, or any other source of sustenance, nor should they feed any of these foods to animals or leave them within the reach of children.

“If you are eating something right now, please discontinue doing so. We will let you know when it is okay to consume food again.” Hamburg noted that salt, baking soda, and all foods manufactured before 2002 were unaffected by the recall.