1. Régis Pouillot - FDA/CFSAN Meryl Silverman - FSIS formerly with the University of Maryland, Joint Institute for Food Safety and Applied Nutrition Handling and Preparation of RTE Foods at retail: Observation Studies Interagency Risk Assessment - L. monocytogenes in Retail Delicatessens Public Meeting Washington, DC - May 22, 2013

2. Food Safety Practices of Food Handlers Several studies have assessed food employees’ behavior in food service settings. Few have taken place in deli departments. Methods used include: –Self-reports in which food employees report past behavior or estimate future behavior. –Observational designs in which actions are recorded as they occur. 2 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

3. Green et al., 2005 (EHS-Net) Method: –Telephone survey of food service workers in the U.S. (n=486). –Asked about performance of four types of behaviors. Key findings: –40% reported always wearing gloves while touching RTE food. –77% reported washing their hands between touching raw meat or poultry and RTE food. –67% reported changing gloves between touching raw meat or poultry and RTE food. 3 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

4. 4 FDA Report on Foodborne Illness Risk Factors (2004 & 2009) Method –Observed employees for ~90 minutes at approximately 100 establishments. –Recorded specific behaviors using a form based on 1997 Food Code. –Either IN or OUT of compliance. May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

5. 5 Food workers Behavior  Events A Specific Data Gap for the Risk Assessment Model May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

6. Clayton and Griffith 2004 Br Food J 106(3): 211-7 Method –Observed food employees at catering establishments in South Wales (n=115). –Used Notational Analysis which allows for tracking of cross- contamination –Recorded actions related to hand-washing and cleaning along with whether they were required and/or performed adequately. –Method also used in Green et al., 2006 J Food Prot, 69(10): 2417-23 6 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

7. Study Objectives The primary objectives of this study were to identify realistic ranges of: Frequency and sequence of contact between any object and the considered product before sale; Frequency, procedure and sequence of hand washing and glove changing; Frequency, procedure and sequence of equipment, utensil and surface cleaning.  To be used in the L. monocytogenes in retail delicatessens model 7 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

8. Study Objectives (continued) –Identify routine cleaning, storage, and preparation practices in deli operations as well as average daily and weekly throughput. –Develop and validate an observational method. 8 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

9. Participants Nine retail facilities which sell deli meat, cheese, and deli-type salads were selected for the study based on size, location, and other criteria. –Six were chain retail stores –Three were independent retail stores –Maryland and Virginia 9 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

10. Object/EquipmentFood DIS – Dish (food container, bowls, platters, tray) SAL – Salami (chub) SUR (ST, PL) – Work surface * (Stainless steel, plastic) CRB – Corned beef SLI –Slicer*FRT – Fruit CTB – Cutting board*BOL - Bologna SK – Sink*KT – Ketchup* SCL – Scale*RFS – Raw seafood K – Knife*MY – Mayo* IM – Ice-makerCHE – Processed Cheese CL – Reach-in coolerTRK – Turkey FR – Walk-in refrigeratorTM – Tomato FRH – Walk-in refrigerator handle BRD – Bread SPI – Spigot*RCH – Raw chicken Coding Scheme A coding scheme was developed based on common food preparation behaviors and the Food Code requirements. The coding scheme was then pilot tested and refined during a visit to a retail facility. 10 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

11. Example Notational Analysis Chart P SAL ON SLI #3 10AM CLS CAS OPN CAS WS HDS No soap WS X X PON GLVS PUP SAL SL SAL ONTO GLV 11 May 22 nd, 2013 Interagency Risk Assessment - Listeria monocytogenes in Retail Delicatessens Public Meeting

12. Results ChainIndependent No. Employees258 Total time (min.)885266 No. Actions30731098 Avg. time (min.)/employee 35.433.3 Avg. no. actions/employee 123137 Avg. no. actions/min. 4.55.7 12 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

13. Sequence of Actions 13 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

14. Wash hands Put on gloves Open deli case Spray slicerTouch clothesTouch body Pick up Swiss Open walk-in Close deli case Unwrap SwissOver trash canOn FCSOn SlicerOver sink Sequence of Actions (Alternatives) 14

15. Bare-hand contact – Hand Washing No bare hand contact was observed with RTE food. Hand washing –when and where according to FDA Food Code 2009 15 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

16. Frequency of Occasions Hand-washing Actions were Required and Performed Work activityChain (n=25)Independent (n=8) Required Action Performed Required Action Performed After touching body7430 After eating/coughing1021 Before donning gloves 11656223 After handling soiled equipment 29502350 To prevent cross- contamination 141311 After other activities21102 Total43973*2734* *Some actions fulfilled more than one requirement 16

17. Frequency of Hand-washing Actions After Handling Soiled Equipment EquipmentChain (n=25)Independent (n=8) Required Action Performed Required Action Performed Deli-case handle17801540 Scale730490 Slicer knob240190 Refrigerator handle 160130 Fryer4000 Total29502350 17 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

18. Hand-washing Benchmark Hand-washing benchmark per hour per employee = Benchmark observed = 30 times/hour Previously reported benchmarks: –Delicatessens = 6 times/hour 1 –Schools = 11 times/hour 2 –Restaurants = 29 times/hour 2  Reconfiguration of job duties and/or effective sequencing of work tasks 3,4 1 Paez et al. 2007. Food Prot Trends 27(11): 903-908. 2 Strohben et al. 2008. J. Food Prot 71(8): 1641-1650 3 Clayton and Griffith. 2004 Br Food J. 106(3): 211-7 4 Green et al. 2006 J Food Prot 69(10): 2417-23 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

19. Frequency of Occasions Cleaning & Sanitizing Actions were Required and Performed Adequately Surface typeChain (n=25)Independent (n=8) Required Action Action Performed Adequately Required Action Action Performed Adequately Food contact surfaces/utensils 11 00 Non-food contact surfaces 0000 Total11 00 19 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

20. Surface typeChain (n=25)Independent (n=8) AttemptedAdequateAttemptedAdequate Food contact surfaces/utensils 10013110 Non-food contact surfaces 11000 Total11013110 Frequency of Additional Occasions Cleaning & Sanitizing Actions were Attempted or Performed Adequately 20 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

21. Frequency of Additional Cleaning & Sanitizing of Food Contact Surfaces/Utensils Surface typeChain (n=25)Independent (n=8) AttemptedAdequateAttemptedAdequate Work surface24040 Cutting board1020 Dish1000 Utensil5000 Knife6110 Slicer621240 Sink1000 Total10013110 21 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

22. Conclusions Notational analysis enabled recording and identification of common sequences of actions (as well as deviations) for deli meat, deli cheese, and deli salad preparation to be used in a risk assessment model.  Directly implemented in the L. monocytogenes in Retail Delicatessens Risk Assessment model 22 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

23. 23 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

24. Conclusions (continued) Results demonstrated that food employees engaged in a large amount of contact between objects, gloved hands, and RTE food highlighting potential risk mitigation measures. To better understand variability in actions (inter- and intra-store), a larger study is needed with: –A larger sample of stores (both chain and independent) distributed in a wider geographical range and –Multiple coders 24 May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting

25. Supported by –Joint Institute for Food Safety and Applied Nutrition –University of Maryland –an appointment to the Research Participation Program at the CFSAN administered by the ORISE through an interagency agreement between the U.S. DOE and the U.S. FDA Thanks to –Food Marketing Institute –Caren Kieswetter, FDA/CFSAN May 22 nd, 2013 Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens Public Meeting