Prevention of food worker transmission of foodborne pathogens: risk assessment and evaluation of effective hygiene intervention strategies

Abstract

The infected food handler can be responsible for the transmission of infectious intestinal diseases (IID) caused by foodborne pathogens. It is believed that personal hygiene practices with varying levels of complexity can help prevent foodborne pathogens from entering the food chain. Overall, it has been difficult to reach a consensus among stakeholders on precisely which intervention measures should be employed in food handling environments to effectively reduce IID rates. Through a study of over 300 reports of outbreaks attributed to ill or asymptomatic food handlers, hazards and contributory factors responsible for foodborne illness outbreaks were identified. With the use of the risk analysis software platforms of Analytica^®, @Risk, and GoldSim^®, models were created to explore measures of hygiene effectiveness. Through the use of appropriate models, results of various personal hygiene intervention measures were explored for the development of preventive management strategies, designed to improve food-handling practices at various levels of the food chain. These included exclusion of ill food handlers, vaccination for hepatitis A virus, handwashing combined with drying, wearing of gloves, and use of instant hand sanitizers and fingernail brushes. This was accomplished by modeling pathogen transfer and transmission routes from food handler via foods, beverages and common contact surfaces using GoldSim^® and Monte Carlo simulations. A lottery model was also created to understand risk as an interrelated overlapping extremes driven system, comprised of the three components of hygiene frequency, efficacy and cross-contamination. Data gaps were identified with respect to areas where considerable variability and uncertainty exists in order to establish research priorities.