ASSESSMENT AND REDUCTION OF PRODUCE FOOD SAFETY RISKS IN TH SCHOOL FOODSERVICE SYSTEM

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: EXTENDED
• Funding Source: OTHER GRANTS
• Reporting Frequency: Annual
• Accession No.: 0222280
• Grant No.: 2010-51110-21081
• Project No.: KS601709
• Proposal No.: 2010-01489
• Program Code: 111
• Project Start Date: Sep 1, 2010
• Project End Date: Aug 31, 2014
• Grant Year: 2014

Project Director
Kwon, J.

Recipient Organization
KANSAS STATE UNIV
(N/A)
MANHATTAN,KS 66506

Performing Department
Hotel, Restaurant, Inst Mgmt and Dietetics

Non Technical Summary
Nearly 30 million students in the U.S. eat at schools daily, raising the significance of food safety in this environment. Fresh produce food safety has become more of a concern as foodborne illness (FBI) outbreaks via fresh produce continue to increase in the U.S. Although recent FBI outbreaks involving fresh produce were due to poor agricultural practices and contamination during processing, studies showed some outbreaks could have been prevented if time and temperature was controlled properly. Existing produce food safety systems are limited to the continuum from farm to distributors, and little is known about produce food safety risks in foodservice particularly in schools. Therefore, this project proposes to assess produce food safety risks in school foodservice systems by observation, laboratory survey, administrator interviews, and a national survey. Based on the findings, a mathematical risk model will be developed to identify critical control points for staff training. A training program will be developed including audiovisual media or an individual training module with supplemental materials. Subsequently, produce food safety training will be provided, and changes in produce handling behaviors and pathogen levels will be measured to evaluate effectiveness of the program. Upon completion, the training program will be distributed to federal and state child nutrition program leaders and all schools participating in the project. After the project is completed, the training program will be continuously marketed and distributed to interested groups for a nominal cost.

Animal Health Component

50%

Research Effort Categories

Basic

50%

Applied

50%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
712	5010	3020	34%
712	5010	3030	33%
712	6099	3020	33%

Knowledge Area
712 - Protect Food from Contamination by Pathogenic Microorganisms, Parasites, and Naturally Occurring Toxins;

Subject Of Investigation
6099 - People and communities, general/other; 5010 - Food;

Field Of Science
3020 - Education; 3030 - Information and communication;

Keywords

produce safety, risk modeling, school foodservice, risk reduction,

employee training

Goals / Objectives
The goals of this project are to identify, assess, and reduce produce food safety risks in school foodservice systems via quantitative and qualitative research techniques and development and evaluation of a food safety training program targeting produce food safety. Specifically, this project will target employees and managers in secondary schools foodservice where self-service salad bars are frequently offered to middle school and high school students. This project has three objectives as follows: To Identify and Assess Produce Food Safety Risks in the School Foodservice System by observation of fresh produce handling, a laboratory survey, school foodservice administrator interviews, and a national survey of school foodservice directors; To Develop a Risk Model for Produce Food Safety; and To Develop, Implement, and Assess Effectiveness of a Training Program to Reduce Food borne Outbreak Risks due to Produce Handling - The program will include employee training materials and lesson plans for trainers along with suggested changes in policies and procedures related to procurement, production, and service of fresh produce. Effectiveness of the program will be evaluated based on surveys, observations of behavior changes and laboratory surveys before and after the intervention using quasi-experimental design. Upon completion of the program evaluation, the food safety training program will be disseminated to school foodservice administrators and their professional affiliations as well as government agencies. Expected outputs of this project include the following activities and products: Activities: Assess produce food safety risks through observation, administrator interview, laboratory survey, and a national survey, Develop a produce food safety risk model Develop a produce food safety program, Train school foodservice staff on produce safety and facilitate changes in foodservice policies and procedures, Disseminate the final program to school food service administrators, Disseminate findings by professional journals. Products: Produce food safety training program including audiovisual training program, lesson plans, supplemental information for trainers, and games and activities to enhance participant learning outcomes.

Project Methods
The first objective is to identify and assess produce food safety risks in school foodservice systems. Multifaceted data will be collected including observation of employee produce handling, laboratory (lab) survey, and school foodservice administrator interview at 30 schools in KS and TX. Secondary schools with self-service salad bars, preferably from different vendors will be involved. Trained researchers and assistants will observe handling behavior from procurement to preparation. Sample lettuce and tomatoes (180 samples each - 3 samples/day@2 day observation @30 facilities) will be collected aseptically after receiving, before and after services. Serving utensils will be swabbed and swab and food samples will be shipped within 24 hours for analyses. Series of microbiological analyses will be performed to confirm existence of bacteria. Foodservice directors of school districts selected for the research will be interviewed for policies and procedures of produce handling. Based on the findings, a questionnaire will be development, pilot-tested, and revised for a national survey. The questionnaire will ask knowledge, attitudes, and beliefs of the school foodservice directors regarding produce food safety; and demographic information. Descriptive statistics, t-tests and ANOVA, hierarchical linear model techniques, MANOVA, and MANCOVA will be used to analyze the results. The second objective is to develop risk model for produce food safety that will describe transmission of identified hazards from the moment a contaminated product enters a foodservice facility through consumption. The risk model will be constructed based on Risk Assessment scheme that encompass Exposure Assessment, Hazard Characterization, and Risk Characterization using data collected previously using mathematical modeling techniques. The third objective is to develop, implement, and assess effectiveness of a training program to reduce foodborne outbreak risks due to produce handling. Produce safety topics and preferred medium will be identified from previous data collection. Scripts will be written and reviewed by experts. Multi-formats activities are possible depended on types of media preferred. Upon completion, the program will be evaluated at 30 schools which will be randomly divided into test and control groups. Knowledge and attitude tests, observations, and lab surveys will be used to evaluate the effectiveness of the program. Knowledge and attitude tests will be conducted before and two weeks after the intervention, and observations and lab surveys will be conducted three months after the intervention. MANOVA will be conducted to test for differences between intervention and control groups on the post-test scores. MANCOVA will be used if baseline difference is found. Observation and lab survey data collected after the intervention will be used to evaluate the produce food safety risks after intervention. Copies of training materials will be sent to state and local child nutrition program directors, the School Nutrition Association, the National Food Service Management Institute, and other related professional organizations for dissemination and further marketing.

Progress 09/01/12 to 08/31/13

Outputs
Target Audience: The target audience of this project is secondary school foodservice employees and management personnel. We will train the target audience when we finish developing the training media. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Research assistants: One graduate and one undergraduate research assistants were involved in survey data collection and content development for the training program. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? We are in progress of identifying food safety training program contents. Once we finalize, we will produce the media and supporting materials for training school foodservice employees to improve their produce handling and personal hygiene practices. The program will be pilot tested and effectiveness of training will be evaluated and documented.

Impacts
What was accomplished under these goals? We completed a national survey of school foodservice directors evaluating food safety training priorities, attitudes toward food safety and training, perceived barriers to safe food handling and training, and effective food safety training methods for employees. Results have been compiled and used to develop contents for the produce food safety training media. This survey also confirmed computer-based or web-based training modules will not be convenient for stakeholders. Therefore, produce and general food safety training media will be developed for school foodservice directors’ and trainers’ use.

Publications

• Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Perez-Rodrigues, F., Kwon, J., Sauer, K., & Todd, E. (2013). Probabilistic model of Norovirus transmission during handling and preparation of fresh produce at school foodservices. Journal of Food Protection, 76(Supp.), 42.

Progress 09/01/11 to 08/31/12

Outputs
OUTPUTS: 1. We completed food handling and handwashing behavior observations and data analyses from 14 secondary schools in Kansas and Texas. A variety of schools were included in the sample from central production facilities to satellite kitchens. Along with observations, we collected and analyzed produce samples and swab samples taken from various work areas. The analyzed data microbial analyses data, then, were used to develop a produce food safety risk model. 2. We completed school foodservice director interviews with nine district directors. Through interviews, participants provided the researchers with information about (a) current challenges with food safety, especially produce food safety related to employee behaviors and supplier relationships, (b) perceived risks related to produce handling in their districts, (c) current practices related to produce procurement, production, and service, and (d) strategies for motivating their employees to handle produce safely including proper handwashing. The data from the interviews were transcribed verbatim and analyzed to extract key ideas for a national survey. 3. A survey instrument for a national food safety of school foodservice directors was finalized and will be launched in January 2013. The purpose of the survey is to identify produce food safety training program content and delivery strategies. PARTICIPANTS: 1. Graduate research assistants: Three graduate research assistants were involved in observation, microbiological survey sampling, and analysis of qualitative data analyses. Starting fall 2012, a new research assistant has been involved in survey development from qualitative research results. 2. Private Consultant, Dr. Ewen Todd and Dr. Fernando Rodriguez have developed the produce food safety risk model for school foodservice operations for norovirus and fecal pathogenic bacteria. TARGET AUDIENCES: 1. The target audience of this project is secondary school foodservice employees and management personnel. Because we were collecting baseline data, we did not attempt to train the target audience when we were at each location. However, school foodservice directors were debriefed our findings so that he/she can address during their food safety training. Key findings for improvement include handwashing behaviors including improper glove use, cross-contamination due to work area conflicts, and time and temperature control of produce items prior and after production is completed. PROJECT MODIFICATIONS: 1. One of the Co-PI changed the institution as of August 2012. This change required a minor adjustment and slight delay of the research progress. Approval for the new budget has not yet been established as of January 15, 2013. 2. Original project included post-test microbial survey. However, our previous microbiological surveys found that produce items purchased for schools were rarely contaminated with microorganism. Therefore, we decide not to repeat the microbial survey. The initial data were used for the food safety risk model and provide insights for relative risks of produce handling conditions. 3. We anticipated creating produce food safety training materials using DVD format, most user friendly simplest media. However, after our interactions with school foodservice employees and managers, we decided to leave the format open to include computer-based interactive food safety training programs for individual and group training sessions. The main reason for this decision is due to poor handwashing behaviors. Even though employees had adequate knowledge and attitudes about proper handwashing, a very limited number of handwashing behaviors were observed during our observation. More creative motivation strategies and tactics may be necessary to results in behavior changes in school foodservice operations including establishing food safety culture. 4. School foodservice directors indicated that more hands-on training programs allowing their employees to recognize risks of each poor food handling behavior would motivate their employees. Aside from previous determined media producers, we have explored potential contractors who may develop a computer-based program based on directors' input. Final decisions, however, will be made based on national survey to make sure the program will be useful and well received by stakeholders, school foodservice directors.

Impacts
1. Results of observation and microbial survey studies were shared with school foodservice directors during summer and fall 2012, after each interview. Directors also had a chance to ask specific questions related to our findings. We specifically shared persistent issues with improper handwashing behaviors and unsafe storage conditions of fresh produce. Directors may use our findings for food safety training for their employees. 2. Findings from observations and microbiological surveys were used to create the produce food safety risk model for norovirus and other fecal pathogenic bacteria. This model will be used to prioritizing training contents for upcoming program development. Using this mathematical model, we plan to develop interactive visuals into produce food safety training program to reveal negative consequences of poor produce handling as well as to motivate school foodservice employees to follow proper food handling behaviors. Specific format of the training program is yet to be determined. Possible formats include computer-based training program, which will use animations to show food handlers consequences of poor food handling behaviors.

Publications

• Kwon, J., Sauer, K., Lee, Y. M., Liu, P., Choi, J. W., Todd, E., & Ryu, D. (2012). Produce handlers handwashing behaviors in secondary school foodservice facilities. Journal of Food Protection, 74(Supp.), 50.

Progress 09/01/10 to 08/31/11

Outputs
OUTPUTS: 1. We have established the produce handling and handwashing observation protocols in the first year. Based on the protocol that is established and pilot tested, we are currently observing produce handling practices in secondary schools in Kansas. To date, we have completed observations at 16 secondary schools among 8 school districts and two central production facilities for school districts using a commissary system. Findings are forthcoming and will be provided to support produce handling at those schools participated. 2. Observations indicate employee challenges with handwashing while preparing fresh produce items, eliminating cross-contamination, and time and temperature controls of prepared produce items. 3. In addition, we have collected produce and swab samples to assess microbial risks related to produce food safety. We will forward findings to risk modeling experts to develop produce food safety risk model. In addition, administrator interview and national survey protocol is being prepared. PARTICIPANTS: 1. Graduate research assistants: Three graduate research assistants have been trained on produce handling observation and microbiological survey sampling methods. They have participated in developing and pilot testing the research protocol, and they are able to independently collect data at various locations. 2. Researchers from Texas Woman's University (Dr. Dojin Ryu) and University of Nebraska at Lincoln have supported microbiological survey, and Dr. Ewen Todd has served the research team as consultant for risk modeling procedures. TARGET AUDIENCES: The target audience of this project is secondary school foodservice employees and management personnel. We have observed and interacted with 60+ school foodservice employees since the start of this project. Because we are currently collecting baseline data, no attempt to train the target audience on proper produce handling has occurred. However, when asked, we have provided suggestions for proper produce handling procedures including time and temperature control. PROJECT MODIFICATIONS: 1. One of the Co-PI left the university as of January 1, 2011 and required a major revision of budget and approval. This process has delayed the research progress significantly. Approval for the new budget was approved and subcontract has been issued on April 2011. 2. Original project included two-day observation for each school foodservice operation. However, after initial observation and pilot test, we realized that the second day observation would not bring new data. Therefore, we decided to observe produce handling in each school for one day only. Efforts were made to observe receiving practices, but again, due to lack of significance of produce receiving at school foodservice (i.e., the amount of fresh produce received is not large enough to cause significant risks during receiving practices), no further effort to find observation dates for receiving was made. Rather, school foodservice directors' suggested dates when a large amount of produce is being prepared and handled were considered when deciding observation dates. 3. We proposed to run tests for E. coli O157 and Salmonella along with total plate count, total coliforms/E. coli. However, first several cases showed absence of pathogenic organisms exist in the samples. Therefore, we modified the method to check for Salmonella only when the other tests come with high number, not for all samples. We are also running Enterobacteriaceae test to catch bigger group than coliforms as proposed at the beginning of the project.

Impacts
Although the results are still being compiled, directors and foodservice managers of school foodservice facilities have been notified about proper or improper produce handling practices observed. Through this information, we attempted to increase awareness of produce food safety risks. We plan to accomplish increased knowledge and improved attitudes related to produce food handling after we develop and implement the training program. At this time, we are in process of gathering base data and are not ready to accomplish such outcomes.

Publications

• No publications reported this period