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An In-Home Video Study and Questionnaire Survey of Food Preparation, Kitchen Sanitation, and Hand Washing Practices

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An In-Home Video Study and Questionnaire Survey of Food Preparation, Kitchen Sanitation, and Hand Washing Practices AdvAncEmEnt of tHE SCIENCE An In-Home Video Study and Questionnaire Survey of Food Preparation, Kitchen Sanitation, and Hand Washing Practices Elizabeth Scott, PhD Nancie Herbold, RD, EdD million for premature deaths, $30 million for medical care, and $5 million in lost pro- Foodborne illnesses pose a problem to all individuals Abstract ductivity (Frenzen, Drake, Angulo, & the but are especially signifi cant for infants, the elderly, and individuals with Emerging Infections Program FOODNET compromised immune systems. Personal hygiene is recognized as the num- Working Group, 2005). ber-one way people can lower their risk. The majority of meals in the U.S. A new interest has arisen in household are eaten at home. Little is known, however, about the actual application of practices as a result of the understanding that a link exists between contaminated personal hygiene and sanitation behaviors in the home. inanimate surfaces and disease transmis- The study discussed in this article assessed knowledge of hygiene prac- sion and acquisition within settings such tices compared to observed behaviors and determined whether knowledge as the home (Cozad & Jones, 2003). Do- equated to practice. It was a descriptive study involving a convenience sam- mestic sanitation practices, especially those ple of 30 households. Subjects were recruited from the Boston area and a employing wet sponges, cloths, and mops, have been found to further disseminate bac- researcher and/or a research assistant traveled to the homes of study par- teria to other inanimate surfaces and direct- ticipants to videotape a standard food preparation procedure preceded by ly to the hands, leading to cross-contami- fl oor mopping. nation with bacteria and the potential for The results highlight the differences between individuals’ reported beliefs bacteria to reach foodstuffs and the mouth (Scott, 1999). and actual practice. This information can aid food safety and other health Consumers need information about how professionals in targeting food safety education so that consumers under- cross-contamination occurs. Pathogens are stand their own critical role in decreasing their risk for foodborne illness. continuously introduced into the home environment, especially via people, food, and pets (Kramer, Schwebke, &, Kampf, Introduction (CDC, 1996). When unreported cases are 2006). In addition, inanimate surfaces, and Foodborne illnesses can pose a problem considered, an estimated 76 million ill- especially hand and food contact surfaces, to all individuals but are especially signifi - nesses, 325,000 hospitalizations, and 5,000 are a main route of pathogen transmission cant for infants, the elderly, and individu- deaths occur in the U.S. yearly (Mead et al., (Kramer et al., 2006). A number of bacte- als with compromised immune systems. A 1999). The annual economic cost of illness ria such as E. coli, Clostridium diffi cile, and report from the Centers for Disease Control due to foodborne illnesses is estimated to Shigella species can survive for months and Prevention (CDC) indicates that little reach over $3 billion each year. In addition, on dry surfaces, and longer on wet sur- progress has been made in controlling food- the cost of lost productivity is estimated at faces (Beumer et al., 2002; Lin, Guthrie, & borne illness in the U.S. since 2004 and that between $10 billion and $83 billion each Frazao, 1999). enhanced measures are required to educate year (U.S. Food and Drug Administration While it is widely accepted by food ex- consumers about infection risks and preven- [FDA], 2009). Approximately $1 billion is perts that many cases of foodborne illness tion measures (Centers for Disease Control spent annually on medical costs and lost occur as a result of improper food handling and Prevention [CDC], 2008). It is estimated wages due to salmonellosis alone (CDC, and preparation by consumers in their own that an average of 15,000 reported cases of 2005). In 2003, costs for E. coli O157 were kitchens (Scott, 1999), consumers them- foodborne illness occur in the U.S. annually estimated at $405 million, including $370 selves are still largely unaware of this fact. 8 volume 72 • number 10 JEH_6.10_PRINT.indd 8 5/7/10 9:46 AM A d vA n c E m E n t o f t HE SCIENCE The food safety and sanitation question- TABLE 1 naire was based on previously published in- struments (FDA, 2006). The questionnaire Participant-Rated Importance of Various Practices for Lowering also collected demographic data. Study pro- Risk of Foodborne Illness (N = 30) cedures were approved by the Simmons Col- lege Institutional Review Board. Practices Not Important Important Very Important Don’t Know/ (%) (%) (%) No Opinion (%) Results Use paper towel instead of 7 27 63 3 sponge on kitchen counters Participant Sociodemographics Mop before cooking 60 37 3 0 The subjects comprised a mix of elderly, Wash vegetables 0 6.7 93.3 0 middle-aged, and young white adults with Wash raw chicken 7 7 83 3 17 (57%) between the ages of 40 and 59, Check refrigerator temperature 13 53 27 7 9 (30%) under 39, and three (10%) older annually than 59. The majority (75%) were female. Check freezer temperature 17 53 23 7 Thirteen out of the 30 subjects had a bac- annually calaureate degree or higher. Twenty-eight Use a thermometer to check 27 50 17 6 (93%) participants were employed outside hamburgers of the home. Fourteen participants had in- Shop at a clean supermarket 0 23 77 0 comes of $50,000 per year or higher, eight Keep raw meat separate 17 17 60 6 from salad earned $40,000 or less per year, and another Use different plate for raw and 0 17 83 0 eight did not answer. Fourteen homes (46%) cooked meat contained a pet and of these, 10 homes con- Refrigerate macaroni & cheese 7 50 40 3 tained a dog, four had a cat, and three homes within two hours after leaving had both a dog and cat. Most (93%) partici- it at room temperature pant households included between one and Comply with sell by and use 0 30 70 0 four people and two households consisted by dates of five or more people. Food Safety and Sanitation A recent study conducted by the Food and A food safety and sanitation practices Knowledge Questionnaire Drug Administration’s (FDA’s) Center for questionnaire was administered by mail two Participants were asked to rank the impor- Food Safety and Applied Nutrition reported weeks prior to the home videotaping. On tance of various activities for lowering the that respondents named restaurants (56%) the day of the in-home visit, subjects were risk of foodborne illness (Table 1). Sixty- as the most likely site for food poisoning instructed to mop the kitchen floor in their three percent answered that it is very impor- problems to occur while only 14% of the normal fashion and then to prepare a given tant to use paper towels instead of a sponge respondents cited home as a likely site for hamburger sandwich recipe using ground on kitchen counter. Eight-three percent re- problems (FDA, 2006). beef while being videotaped. This video sponded that it is very important to wash The purpose of our study was to collect study was used for a food safety and sanita- raw chicken, 93% responded that it is very data on practices relating to home food prep- tion practices evaluation. important to wash raw vegetables, and 17% aration, personal hygiene, and kitchen sani- Objective food safety data (refrigeration thought it is very important to use a ther- tation in order to examine the relationship and cooking temperature) were also collect- mometer to check hamburger temperature. between consumer knowledge and practice. ed. The videotapes were viewed and coded Participant attitudes about the impor- using a video viewing assessment tool. Every tance of hand washing following a range Materials and Methods hand washing observed on video was timed of activities was ascertained (Table 2). Cer- Our study is a descriptive study involv- with a stopwatch. The inter-rater reliability tain activities triggered an almost 100% ing a convenience sample of 30 households score for the coders was 93 and considered response in the “very important” category recruited from the Boston metro area. A re- acceptable for the study. for hand washing after certain activities, searcher and/or a research assistant traveled Subjects from the metro west and metro namely after petting cats and dogs (97%), to the homes of study participants to vid- south areas of greater Boston were recruit- using the toilet (97%), handling raw meat eotape a standard food preparation proce- ed by word-of-mouth and by flyers and fol- (100%), and taking out the garbage (90%). dure preceded by floor mopping. The video lowed up by personal contact. Criteria for Washing hands after handling foods such method was selected to allow us to analyze inclusion of subjects were that they cooked as eggs and cantaloupe were considered kitchen sanitation and food hygiene practices at home and used mops to clean their “very important” by 73% and 30% of re- in freeze frame. kitchen floors. spondents, respectively. Sixty percent of June 2010 • Journal of Environmental Health 9 JEH_6.10_PRINT.indd 9 5/7/10 9:46 AM A d vA n c E m E n t o f t HE SCIENCE respondents considered it “very important” to wash hands after mopping the floor, 50% TABLE 2 after touching face and hair, and 33% after answering the phone. Importance of Hand Washing After Certain Activities as Reported Another set of questions was used to by Participants (N = 30) probe for the perceived level of effective- ness of various actions in lowering the risk Activity Not Important Important Very Important Don’t Know/ of foodborne illness.
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