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

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Introduction

Foodborne illnesses can pose a problem to all individuals but are especially significant for infants, the elderly, and individuals with compromised immune systems. A report from the Centers for Disease Control and Prevention (CDC) indicates that little progress has been made in controlling foodborne illness in the U.S. since 2004 and that enhanced measures are required to educate consumers about infection risks and prevention measures (Centers for Disease Control and Prevention [CDC], 2008). It is estimated that an average of 15,000 reported cases of foodborne illness occur in the U.S. annually (CDC, 1996). When unreported cases are considered, an estimated 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths occur in the U.S. yearly (Mead et al., 1999). The annual economic cost of illness due to foodborne illnesses is estimated to reach over $3 billion each year. In addition, the cost of lost productivity is estimated at between $10 billion and $83 billion each year (U.S. Food and Drug Administration [FDA], 2009). Approximately $1 billion is spent annually on medical costs and lost wages due to salmonellosis alone (CDC, 2005). In 2003, costs for E. coli O157 were estimated at $405 million, including $370 million for premature deaths, $30 million for medical care, and $5 million in lost productivity (Frenzen, Drake, Angulo, & the Emerging Infections Program FOODNET Working Group, 2005).

A new interest has arisen in household practices as a result of the understanding that a link exists between contaminated inanimate surfaces and disease transmission and acquisition within settings such as the home (Cozad & Jones, 2003). Domestic sanitation practices, especially those employing wet sponges, cloths, and mops, have been found to further disseminate bacteria to other inanimate surfaces and directly to the hands, leading to cross-contamination with bacteria and the potential for bacteria to reach foodstuffs and the mouth (Scott, 1999).

Consumers need information about how cross-contamination occurs. Pathogens are continuously introduced into the home environment, especially via people, food, and pets (Kramer, Schwebke, &, Kampf, 2006). In addition, inanimate surfaces, and especially hand and food contact surfaces, are a main route of pathogen transmission (Kramer et al., 2006). A number of bacteria such as E. coli, Clostridium difficile, and Shigella species can survive for months on dry surfaces, and longer on wet surfaces (Beumer et al., 2002; Lin, Guthrie, & Frazao, 1999).

While it is widely accepted by food experts that many cases of foodborne illness occur as a result of improper food handling and preparation by consumers in their own kitchens (Scott, 1999), consumers themselves are still largely unaware of this fact. A recent study conducted by the Food and Drug Administration's (FDA's) Center for Food Safety and Applied Nutrition reported that respondents named restaurants (56%) as the most likely site for food poisoning problems to occur while only 14% of the respondents cited home as a likely site for problems (FDA, 2006).

The purpose of our study was to collect data on practices relating to home food preparation, personal hygiene, and kitchen sanitation in order to examine the relationship between consumer knowledge and practice.

Materials and Methods

Our study is a descriptive study involving a convenience sample of 30 households recruited from the Boston metro area. A researcher and/or a research assistant traveled to the homes of study participants to videotape a standard food preparation procedure preceded by floor mopping. The video method was selected to allow us to analyze kitchen sanitation and food hygiene practices in freeze frame.

A food safety and sanitation practices questionnaire was administered by mail two weeks prior to the home videotaping. On the day of the in-home visit, subjects were instructed to mop the kitchen floor in their normal fashion and then to prepare a given hamburger sandwich recipe using ground beef while being videotaped. …