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Research paper on the topic of Food Handler knowledge and Foodborne Illness
English 1A: 1:00 TR
18 October 2016
“Hi, my name is Noro, I’ll be your server tonight.”
Food – it’s essential to life and a centerpiece of every culture. Whether it’s a birthday, a religious celebration, a wedding, or a myriad of other reasons to celebrate, across the globe, life is celebrated with food. These common celebrations are mostly enjoyed en masse at restaurants where people expect professional food service and a clean environment. According to the 2014 published report of the Centers for Disease Control and Percent, “864 foodborne disease outbreaks were reported, resulting in 13,246 illnesses, 712 hospitalizations, 21 deaths, and 21 food recalls” (CDC). What many people don’t know is that they can become sick from eating contaminated food in restaurants and it could be because food servers don’t know how to handle food properly; while Kern County has a fairly robust and attentive Department of Public Health, the community can do more to support the constant vigil against food contamination in restaurants, such as, signing a petition to enact legislation that will require food service workers to be licensed prior to beginning work in a food service establishment and display that license on their person while working, utilizing social media in an effectual manner to inform people of the actual conditions of food service establishments, and utilizing mobile apps such as “Safe Diner” to inform public health officials, and the public, of discrepancies that occur between inspections.
Foodborne illness is a nationwide epidemic that is tracked by the Centers for Disease Control and Prevention, more commonly known as the CDC, in Atlanta, Georgia. The CDC publishes their findings in an annual report entitled “Surveillance for Foodborne Disease Outbreaks United States.” The title is somewhat ironic because the organization is about 18 months behind in publishing the report. This irony tends to underscore another reason why the prevalence of foodborne illness is not widely known. The symptoms of foodborne illness may not be recognized by healthcare practitioners because they are common to many other ailments, and often, people afflicted with foodborne illnesses do not seek medical treatment because they do not realize that what they ate has made them sick. Foodborne illness can come from quite a number of sources, “etiologies were grouped as bacterial, chemical and toxin, parasitic, or viral” (CDC). The findings listed in the report for 2015 contain the following:
A single etiologic agent was confirmed in 462 (53%) outbreaks (Table 1) which resulted in 8,810 (67%) illnesses. Bacteria caused the most outbreaks (247 outbreaks, 53%), followed by viruses (161, 35%), chemicals (46, 10%), and parasites (7, 2%). Norovirus was the most common cause of confirmed, single-etiology outbreaks, accounting for 157 (34%) outbreaks and 3,835 (43%) illnesses. Salmonella was next, accounting for 140 (30%) outbreaks and 2,395 (27%) illnesses. Among the 131 confirmed Salmonella outbreaks with a serotype reported, Enteritidis was the most common (40 outbreaks, 31%), followed by Typhimurium (15, 11%), I 4,,12:i:- (6, 5%), Javiana (6, 5%), and Newport (6, 5%). Shiga toxin-producing Escherichia coli (STEC) caused 23 confirmed, single-etiology outbreaks, of which 12 (52%) were caused by serogroup O157, 3 (13%) by O111, 3 (13%) by O26, 2 (9%) by O121, 1 (4%) by O103, 1 (4%) by O145, and 1 (4%) by O186. (CDC)
According to the organization Stop Foodborne Illness, “Salmonella bacteria are the most frequently reported cause of foodborne illness. Salmonella is a gram-negative, rod-shaped bacillus that can cause diarrheal illness in humans. They are passed from the feces of people or animals to other people or other animals” (STOP Foodborne Illness). The symptoms of Salmonellosis resemble those of the flu and many people do not seek treatment for it as they generally recover on their own if they have a healthy immune system. “Norovirus is a very contagious virus that can infect anyone. A person can contract norovirus from contaminated food or water, an infected person, or by touching contaminated surfaces” (STOP Foodborne Illness). Norovirus typically causes vomiting and diarrhea due to its attack on the stomach and intestines. Although food workers are prohibited from working when they have vomiting or diarrhea, Lynne Shallcross, a reporter for The Salt, a publication of Valley Public Radio, writes, “Fifty-one percent of food workers – who do everything from grow and process food to cook and serve it – said they ‘always’ or ‘frequently’ go to work when they’re sick, according to results of a survey…” (Shallcross). Most people who are employed as food handlers cannot afford to miss hours due to sickness, so they continue to work even though they may be contagious. This is a particular problem because “fruits and vegetables, and in particular, leafy greens that are consumed raw, are increasingly being recognized as important vehicles for transmission of human pathogens that were traditionally associated with foods of animal origin” (Berger). In the past, food safety training programs were concerned mostly with the spread of microbes connected with raw meats, dairy products, and eggs, but new information revealed in current studies indicate that crop foods such as lettuce, peppers, and cilantro, to name just a few, are being contaminated with disease causing bacteria and viruses.
Safe food is a concern of everyone alive because we cannot survive without sustenance. Every government in developed countries throughout the world concerns itself with safeguarding its national food supply and foodservice establishments. The Obama administration signed the “Foodservice Modernization Act” (FSMA) into law on January 4th, 2011. Margaret Hamburg, M.D. is the Commissioner of Food and Drugs and she writes,
The idea of prevention is not new. FDA has established prevention oriented standards and rules for seafood, juice, and eggs, as has the U.S. Department of Agriculture for meat and poultry, and many in the food industry have pioneered ‘best practices’ for prevention. What’s new is the recognition that, for all the strengths of the American food system, a breakdown at any point on the farm-to-table spectrum can cause catastrophic harm to the health of consumers and great disruption and economic loss to the food industry. (Hamburg)
One of the most critical points of food preparation and consumption are the personnel who prepare and serve the food. In California, “Pursuant to SB 602 enacted into law in 2010, Health and Safety Code 113790 et seq., (“California Food Handler Card Law”), food handlers, as defined, will be required to obtain a food handler card after taking a food safety training course and passing an exam” (CCDEH). In light of the FMSA, all states have developed their own laws to mandate that foodservice workers receive proper training; however, the training or the trainee may still be lacking in their performance of food safety practices. The ServSafe program is utilized by most California counties to administer training and certification of food handlers; however, the training and certification test can be taken online and does not require identification of the person receiving the certification. This makes it possible for friends or relatives to take the test using someone else’s name to obtain a food handler card for them. Moreover, food handlers are not required to keep their cards on their person, which makes it impossible for a patron or a public health inspector to ask to see it. The restaurant managers are only required to keep a copy on file and that could very easily be suborned by digital forgery. In a study conducted by the University of Illinois at Chicago, 72 food service workers were polled “to test their familiarity with meat and poultry handling protocol. Of those surveyed, only half received a score of 70 percent or above” (Goetz). In another study conducted by Valeria K. Pilling, et al. and published in “Food Protection Trends,” results indicated that only 72 percent of observed food service employees “washed their hands when starting their shift” and more alarmingly, only 52 percent were observed to “wash their hands when returning to work after smoking, eating, chewing gum or tobacco, bussing tables, or using the bathroom.” While observing the handwashing procedures, none of the objective behaviors was performed 100 percent (Pilling). Even though training and certification programs have been mandated across the country, the consumer may still be at risk because the food handler has insufficient training and understanding of what it takes to prevent contamination of food with harmful pathogens. In a peer reviewed article published in the International Journal of Environmental Health Research, Mitchell et al. report on a 2005 study conducted by Lillquist et al. The study involved three groups of 22 participants each. One group was a control group, another group watched a “standard video presentation on hand washing,” and the last group watched the standard video presentation and participated in a “hand washing demonstration exercise.” When given a test following the training, the participants from the interactive group scored higher than the participants from the other groups. “Despite the small sample size, group differences were statistically significant” (Mitchell). Mere certification is not enough, an active program of supervision is required and consumers also need to be proactive to protect their health and the health of their loved ones. Handwashing sinks should be in the public view and should remain adequately stocked so as to encourage proper handwashing procedures and patrons should not fear to ask their server to wash their hands.
“Dr. Ben Chapman is an assistant professor and food safety extension specialist at North Carolina State University in Raleigh, North Carolina.” In an article fir “Food Safety Magazine” he writes, “Ideally, food safety in foodservice establishments begins with managers who are knowledgeable about the following: where contaminants exist, how they transfer to food, the steps to control or eliminate hazards” (Chapman). Managers need to analyze their establishment and their staff to determine where any risks of contamination enter the establishment and service of food. Manufacturing and processing of foods involves what is known as process control, which Jim Mann writes about in “A Recipe for Hand Hygiene Process Control.” The training, understanding, and implementation of a successful hygiene program for food service workers can be developed in the same manner as a process control. The purpose of process control is to remove obstacles to the efficiency and efficacy of the process. At times in monitoring a process, changes to the infrastructure mat be indicated. Although such changes are costly, the restaurateur needs to weigh the cost against the potential losses caused by a lawsuit stemming from a foodborne illness being tracked back to the establishment. A successful process control for handwashing will change the antecedent behaviors of staff. “Food workers must understand the risks associated with contaminated hands, hands that more than likely look clean. It is critical for staff to connect their good behaviors with personal, family, and customer wellness” (Mann). It is not sufficient for restaurateurs and managers to discover the pattern of their public health inspections and make sure that the facility is in tip-top-shape to receive an A grade. When customers and staff realize the personal stake they have in promoting public health, the establishment will consistently avoid the risks of food contamination and bolster the reputation of the restaurant.
The expression, “It takes a village,” is usually connected with raising a child, but it is apropos to public health as well. The health and well-being of all of the members of a society depends upon the interaction of each member of that society. Eating is such a basic necessity that we sometimes forget about the importance of making sure our food is safe. Dining out is typically a social occasion and people frequently talk about their experiences, whether positive or negative, in person with friends, and on social media such as Facebook, Twitter, Yelp, and Pinterest. This is a behavior that restaurateurs should encourage by offering coupons to restaurant patrons for writing objective reviews about their experience. Even a negative review has value toward improving the service when it might be found lacking, or worse, risky. The Kern County Department of Public Health has offered a mobile application called “Safe Diner” that works with GPS location to load a restaurant’s most recent inspection grade and report when a patron walks into the restaurant with their enabled device. The app includes a place for the public to report a restaurant that may not be living up to the a grade on the door. Honest and objective reporting by the public helps the community to rely on the grades that are posted and dine in comfort and safety. Lastly is a novel thought. When we drive our cars, we are mandated by law to have a valid license to drive and carry that license on our person whenever we operate a motor vehicle. The law requires a physician to post their qualifications, certifications, and affiliations in a conspicuous place in their office. Unfortunately, when we go to a restaurant, we have no means of knowing that the person who is serving our food, or the people who have prepared it, are qualified to do so. We cannot identify our server as having a definitively identified certification to serve food in a safe manner. The only way to change this shortcoming in the Food Service Modernization Act is to petition the government to enact legislation that will amend the requirement of SB 603 in California to require that ServSafe implements a means of unequivocal identification of the person being trained and certified and that there is a photo identification badge issued to food service workers that they must wear while working with food.
Berger, Cedric N., et al. “Fresh Fruit and Vegetable as Vehicles for the Transmissions of Human Pathogens.” Environmental Microbiology, vol. 2, no. 9, 2010, pp. 2385-397. Academic Search Premier, EBSCO.
Chapman, Ben. “Food Safety for Food Handlers.” Food Safety Magazine, Magazine Archive, Dec. 2010/Jan. 2011. Web.
Goetz, Gretchen. “Kitchen Confusion: Food Workers Score Poorly on Safe Handling Test.” Food Safety News, 29 Aug. 2011. Web.
Hamburg, Margaret A. “Food Safety Modernization Act: Putting the Focus on Prevention.” FoodSafety.gov. Web.
Kern County Public Health. Safe Diner 18 May 2017. Web.
Mann, Jim. “A Recipe for Hand Hygiene Process Control.” Food Quality & Safety, 21 Sep. 2011. Web.
Mitchell, Roger E., et al. “Preventing Foodborne Illness in Food Service Establishments: Broadening the Framework for Intervention and Research on Safe Food Handling Behaviors.” International Journal of Environmental Health Research, vol. 17, no. 1, Feb. 2007, pp. 9-24. Academic Search Premiere, EBSCO.
Pathogens 101. STOP Foodborne Illness. Web.
Pilling, Valerie K., et al. “Food Safety Training Requirements and Food Handlers’ Knowledge and Behaviors.” Food Protection Trends, vol. 28, no. 3, Mar. 2008, pp. 192 – 200. K-State Research Exchange, Kansas State University.
SB 602 Food Handler Card Requirements. California Conference of Directors of Environmental Health (CCDEH). 28 May 2015. Web.
Shallcross, Lynne. “Survey: Half of Food Workers Go to Work Sick Because They Have To.” The Salt, NPR Valley Public Radio, 19 Oct. 2015. Web.
Surveillance for Foodborne Disease Outbreaks, United States, 2014, Annual Report. Centers for Disease Control and Prevention (CDC). 18 Mar. 2016. Web.
Hidalgo 10he expression, “It takes a village,” is usually connected with raising a child, but it is apropos to public health as well. The health and well-being of all of the members of a society depends upon the interaction of each member of that society. Eating is such a basic necessity that we sometimes forget about the importance of making sure our food is safe. Dining out is typically a social occasion and people frequently talk about thei