Food Safety Talk 65: All My Ports are Engaged

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.

Man who thinks he's European perplexed by maths.

Man who thinks he’s European perplexed by maths.

 

In this episode, Ben is absent, but Don is not alone. Mike Batz, Assistant Director of Food Safety Programs, Emerging Pathogen Institute at the University of Florida, is a guest on the show. He appeared not once, but twice on the podcast before.

Don and Mike start by talking a little about their travels, then, they quickly move to a discussion on the Chobani Yogurt recall. The news article leaves Mike unsure whether Mucor circinelloides was pathogenic to both animals and humans. A brief digression about podcast listening speed reveals that Batz listens at 1.5 speed while Don is more civilized. Returning to yogurt, they discuss the originalmBio article. Don concludes the study did not provide enough evidence to show M. circinelloides is truely pathogenic to humans.

Don asks Mike about a psychology experiment done by Facebook where they manipulated users feeds. Mike was disappointed by Facebook’s methodology since the study never requested an informed consent from the users. They then rambled about again about their various and sundry international travels. Mike resided close to the Rijks Museum (that’s in Amsterdam) for a while and Schaffner shared his experience in Finland (including reindeer tartare) and New Zealand (and beef tartare).

Next, they talked about a document from the FAO marketed as providing a list of the top 10 foodborne parasites ). To continue, they discussed seasonal food safety tips. While Mike confessed to not always follow his own food safety recommendations, Don revealed he is reluctant to eat a cut cantaloupe by a stranger.

Soon after, the discussion shifted to antibiotics in meat. Both agreed that the issue is quite complicated and there is not a straight forward answer.

They concluded the show with a discussion on cross contamination including cutting boardsartisanal cheese and the 5 second rule. Don recommended plastic cutting board for meat and wood cutting board for any other food types.

Schaffner: handwashing is an incomplete science, but we’re working on it

Friend of the blog Don Schaffner of Rutgers University tells the Academic Minute (in a quite professorial tone) that washing keeps bacteria and other pathogens at bay and all research suggests that keeping clean is a good thing, but handwashing is an inexact process.

Don-Schaffner-214x300Dr. Donald W. Schaffner is Extension Specialist in Food Science and Distinguished Professor at Rutgers University. Dr. Schaffner has authored more than 100 peer-reviewed publications, book chapters and abstracts. Dr. Schaffner has educated thousands of Food Industry professionals through numerous short courses and workshops in the United States and more than a dozen countries around the world. Dr. Schaffner was elected a Fellow of the IFT in 2010 and AAM in 2013 and is an Editor for the ASM journal Applied and Environmental Microbiology. Dr. Schaffner is the president of the IAFP 2013-2014.

You’ve probably heard all of your life that hand washing is important to public health.

In fact, the published research supports this quite strongly. Numerous scientific research articles show the positive impact on a variety of target populations when hand washing is encouraged, or in developing countries when something as simple as a bar of soap is provided to people that could not previously afford it.

You may have even heard advice about washing your hands: Things like “wash your hands for 20 seconds”, or you may have heard the same phrase, with 15 seconds or 30 seconds being the recommended time frame. The United States Centers for Disease Control and Prevention (the CDC) recommends teaching your child to wash their hands for as long as it takes to sing the “happy birthday” song twice (approximately 20 seconds).

You might be surprised to learn however, that the scientific basis for 5, 10, 15, 20, or even 30 seconds is virtually nonexistent. Research is currently underway in our lab to better characterize the effect of wash time, as well as other parameters on the effectiveness of a good hand wash. We are quantifying the effect of soap versus no soap, antibacterial versus plain soap, the effect of water temperature, the optimum wash time, and the method of drying.

 So, wash your hands! Especially after handling raw meat, changing a dirty diaper, or after you poop. How long should you wash your hands?

We’re working on it.

Schaffner on hand sanitizers: they’re a good thing

Friend of the blog Don Schaffner of Rutgers University writes in this guest post:

sanitizerI’m willing to go on record as saying that alcohol-based hand sanitizer is a good thing. In fact, we have published research which shows that it works to inactivate a gram-negative surrogate organism present on the hands even in the presence of visible food debris.

As Doug is sure to remind me, every time I mention the benefits of hand sanitizer, it’s not a magic bullet. For example, it doesn’t work very well against some viruses. That said I’m encouraged by research that shows that it is possible to tweak the formulation of such products to get better effectiveness against viruses. Hand sanitizer also doesn’t work very well against parasites like Cryptosporidium.

No matter what your opinion, I hope you would agree that more research is better. One example comes from a manuscript recently accepted for publication in the Journal Travel Medicine and Infectious Disease. I learned about the publication from a Reuters news story that Doug sent my way.  According to the abstract, the authors investigated the potential protective effect of hand sanitizer use on the occurrence of diarrhea and/or vomiting in 200 international travelers, who were returning home, at an international airport.

The authors report that travelers who used hand sanitizer reported diarrhea and vomiting significantly less frequently than those who did not (17% vs. 30%, OR = 0.47; 95% CI [0.21–0.97], p = 0.04). While the reported p value reaches the level necessary for publication, authors schaffner.facebook.apr.14should always beware of what we’ve come to call in my lab the green jellybean effect. There’s also a nice quote in the Reuters news story from Dr. Claire Panosian Dunavan, an infectious disease specialist at the David Geffen School of Medicine at UCLA in Los Angeles  who says “I suspect that the people who use hand sanitizer were more careful in ways that couldn’t be quantified.”

I was thinking the same thing. I was also thinking that someone ought to let those study authors know about Betteridge’s law of headlines.

Will I continue to use hand sanitizer? Of course. Do I think it will magically protect me from any illness?

No.

Should kids be allowed to wash hands at school? Or is sanitizer enough?

Someone wrote me this morning and said at their U.S. elementary school, the 5th graders are not permitted to wash hands after mandatory bathroom times and the teacher stands outside of the bathroom with hand sanitizer squirting it as each child leaves the bathroom. The hand dryers are too loud and the teachers don’t want wet hands because there’s no paper towel.

jon.stewart.handwashing.2002This as UN deputy secretary general, Jan Eliasson, warned the world’s lack of progress in building toilets and ending open defecation is having a “staggering” effect on the health, safety, education, prosperity and dignity of 2.5 billion people.

They may not be related, but proper sanitation requires access to proper tools.

In Denmark, nearly one-quarter of foodborne illness outbreaks from 2005 to 2011 were caused by asymptomatic food handlers, according to researchers from the Statens Serum Institut in Copenhagen.

“Symptoms compatible with norovirus infection among household members, especially children, of food handlers should be taken into account, as mechanical transfer of virus particles from private homes to industrial kitchens appears to be an important cause of outbreaks,” the researchers wrote in The Journal of Infectious Diseases. “Existing guidelines recommend exclusion of symptomatic and post-symptomatic food handlers and strict hand hygiene, when household members are ill with gastroenteritis.”

handwashing.junk.apr.13A study in Finland concluded Noroviruses are easily transferred to ready-to-eat foods via foodservice workers’ handling.

Researchers at the Finnish Food Safety Authority and the University of Helsinki confirm virus-free food ingredients and good hand hygiene are needed to prevent contamination of prepared foods.

Promote hand hygiene, but the tools have to be there.

Better hygiene through humiliation?

I’ve always been a fan of shame and blame, humility and hubris, carrots and sticks.

People can be complicated.

leadAccording to The Atlantic, a number of companies have designed systems that aim to nudge doctors and nurses into washing their hands regularly. One of these devices, a badge made by Biovigil, aims to exploit a very powerful emotion: shame.

When a doctor enters an exam room, the badge chirps and a light on it turns yellow—a reminder to the doctor as well as an alert to the patient that he is about to be touched by someone with unclean hands. If the doctor doesn’t wash her hands, the light flashes red and the badge makes a disapproving noise. After the doctor waves a freshly sanitized hand in front of the badge, alcohol vapors trigger a sensor that changes the light from red to green. Other systems include HyGreen, which also uses badges; Hyginex, a wristband that can tell when a user dispenses hand sanitizer (and vibrates if he or she doesn’t); and SwipeSense, which includes a hand-sanitizer dispenser that clips onto scrubs.

Each of these devices generates a log that’s uploaded to a database of what HyGreen calls “all hand hygiene events in the hospital”—a rundown of who’s washing up, and who isn’t. The data could help hospitals engage in after-the-fact analysis of how an outbreak occurred, and, with any luck, might help them to prevent the next one.

Handwashing is never enough: Minnesota paper says require handwashing stations at petting zoos

I was talking to my friend John this morning at my church – the ice arena – while the women were skating.

amy.hubbell.skates.jul.13 We talked about getting out of the rat race, and how it was nice we had wives to sorta support us, and he mentioned he was going to the Ekka today, and I said, beware the petting zoo, and got the usual response of, I never heard there was a risk.

As the Post Bulletin in Minnesota writes, every summer, there’s an E. coli outbreak originating from a traveling petting zoo, with the latest occurring at the Olmsted County Fair.

The report that at least 13 people, including three in Olmsted County, have been sickened by Escherichia coli O157:H7 after visiting the Zerebko Zoo Tran exhibit is a reminder that even healthy, well-cared-for animals can be vectors for disease.

The Minnesota Department of Health encourages the installation of hand-washing stations near animal exhibits and the display of posters on hand-washing. Some county fairs and festivals voluntarily comply, but we believe it should go a step further and make it a legal requirement to post signs and hand-washing stations at all livestock exhibits.

Kirk Smith, an epidemiology program manager with the state Health Department, said guidelines are sent to county fair and festival managers every year, but compliance is “modest to poor, so it’s really a frustrating issue for us.”

Five percent to 10 percent of children who get infected go on to develop severe complications, said Smith, pointing an 2012 outbreak in North Carolina, where a child died of an E. coli infection after visiting a county fair.

“If parents understand that there’s any appreciable risk from a bug that can cause kidney failure that’s fatal in 5 percent of the cases, they’ll manage that risk a lot better,” Smith said.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Sanitizers or handwashing? Or both?

Installing alcohol-based hand sanitizer dispensers in classrooms may not mean fewer sick days for kids, a New Zealand study has suggested.

genitals.hand.sanitizerThe study, published today in the journal PLOS Medicine, found absence rates at schools that installed dispensers in classrooms as part of the survey were similar at those “control” schools which did not.

The research, led by Associate Professor Patricia Priest and University of Otago colleagues, involved 68 schools in Christchurch, Dunedin and Invercargill and nearly 2,500 pupils.

In schools randomly assigned to the “intervention” group, alcohol-based hand sanitizer dispensers were installed in the classrooms over two winter terms and the children were asked to use the dispensers after coughing or sneezing and on the way out of the classroom for breaks.

Dr Priest emphasizes that the study’s findings were not relevant to the importance of hand hygiene in general, nor did it change the message of cleaning hands before eating or after using the toilet, coughing or touching pets.

In a related story, the USA Today reports that alcohol-based hand sanitizers are better at killing germs and that soap and water is generally the best option but, hand sanitizers come in handy when you aren’t close to a sink.

50 sickened with E. coli last year in Brisbane; state fair risks poorly managed

For some reason, this colony of convicts refers to its mayors as “The Lord Mayor.”

ekka.petting.zooIt’s almost that time of year again for one of the city’s most loved annual events to roll into town. The Ekka will light up the RNA Show grounds at Bowen Hills from 8-17 August. If you are heading along, don’t forget to drop by Brisbane City Council’s stand in the Woolworths Pavilion. Always fun and interactive, this year’s stand showcases the many roles Council plays in our community as well as some of the things we all love about Brisbane.”

High-five.

Except last year at the Ekka, the equivalent of a U.S. state fair, at least 50 people were stricken with E. coli O157 from the animal contact in the petting zoo.

There has been no public follow up, no reference to what is being done to improve the situation this year, and no chance we’ll be attending.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

http://barfblog.com/2013/09/49-now-sick-with-e-coli-o157-from-brisbane-state-fair-over-100-being-tested/

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Fist bumps are less germy than handshakes

I went to the Apple store in Brisbane to fix my iPhone and got a lot of handshakes.

Then I watched staff shake a lot of other hands.

Wonder_Twins-fist-bumpI was a dumbass.

So says science.

“A short, sweet fist bump will transmit the least bacteria,” and even a high-five is better than a traditional shake, says David Whitworth, a senior lecturer in biochemistry at Aberystwyth University-Ceredigion in the United Kingdom.

Whitworth and a colleague systematically tested the three greetings for a study published Monday in the American Journal of Infection Control.

For the experiment, one of them repeatedly dipped a gloved hand into a container loaded with a not-too-dangerous strain of E. coli bacteria. The dirty-gloved scientist let the film dry, then shook, fist-bumped or high-fived the other person’s clean, gloved hand. Finally, the receiving gloves were tested for bacteria.

Result: The shakes transmitted about 10 times more bacteria than the fist bumps and about two times more than the high fives. The longest, firmest shakes transmitted the most.

In a separate round in which the gloves were dipped in paint rather than bacteria, the researchers found one rather obvious explanation: Bigger areas of the hands touched during the shakes. Handshakes also tended to last longer, but the researchers found more clinging germs even when they compared shakes to fist bumps and high-fives of the same duration.

Whitworth’s findings “are not surprising,” says Mary Lou Manning, an associate professor in the school of nursing at Thomas Jefferson University in Philadelphia and president-elect of the Association for Professionals in Infection Control and Epidemiology.

She is not enthusiastic about replacing handshakes with fist bumps in hospitals. The better, more hygienic idea, she says, is to promote rigorous hand-washing and ban hand-to-hand greetings altogether. “That’s already starting to happen” in a lot of places, she says.

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?

images-1

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.