Hand Hygiene Promotion: An Essential Strategy for Preventing Foodborne Illness in Elementary Schools

<p>NON-TECHNICAL SUMMARY:<br/> From 2005 to 2008, 50% of foodborne outbreaks of known etiology associated with schools were attributed to Human Norovirus (HuNoV). The number of cases could increase as many schools now offer self-service, including salad bars and bowls of fresh fruit. Hand hygiene is an effective way to reduce infections from HuNoV but compliance is low. Our goal is to decrease foodborne infections in elementary schools by: 1. Identifying individual, environmental, and institutional factors that influence hand hygiene practices in the elementary school environment. 2. Establishing a hierachy of handwashing activities to determine if and when alcohol-based hand rubs (ABHRs) can be used to replace traditional handwashing. 3. Developing, delivering, and evaluating a hand hygiene campaign in the elementary school environment. We will conduct site visits at ten
elementary schools in South Carolina to determine factors that influence hand hygiene. These data will feed into a mathematical exposure model for HuNoV transmission in elementary schools to determine if and when ABHRs could replace handwashing. We will communicate our findings in a promotion campaign based on the findings of Objectives 1 and 2. Knowledge about the practicality of current handwashing guidelines and reasons for low compliance will be improved by the proposed project.
<p>APPROACH:<br/> OBJECTIVE 1: School staff will be surveyed about their knowledge, perceptions, and practices related to hand hygiene, which includes and use of alcohol-based hand rubs (ABHR). This data will be combined with observational data and focus group results to provide the research platform for the Year 3 hand hygiene (HH) promotion campaign. Three trained data collectors will also conduct a site visit at the ten elementary schools where the survey instrument was administered. The data collectors will record information about school-wide facilities available for hand washing. They will also prepare a layout of the serving and dining areas of the cafeteria and two third grade classrooms. In schools where ABHR stations are installed in or near the cafeteria, data collectors will observe and record how children and school staff use the ABHRs during one entire lunch
period. They will also observe behaviors of foodservice workers and children at the serving line and at self-service bars. Environmental samples will be collected from 10 surfaces. Co-PD Jaykus' group will be responsible for the microbiological analysis of environmental samples. OBJECTIVE 2: Co-PD Jaykus' group will construct the mathematical exposure model for human HuNoV transmission for elementary schools based on data generated in Objective 1. This model will quantify the potential exposure to HuNoV particles in schools via several key pathways including consumption of contaminated foods, contacts with contaminated surfaces and individuals, and through aerosols created during vomiting events. The model will be developed for a typical elementary school building for which a selected number of food service staff members work during a shift. OBJECTIVE 3: PI Fraser and Co-PD Salmon will
evaluate the effect of a promotion campaign using a randomized control design; six public elementary schools will be randomly selected and randomly assigned to the control group (n=3) or the intervention group (n=3). A pre-/post-design will be used to collect data to determine effect of the campaign on improving hand hygiene practices in the classroom prior and reducing absenteeism. Data collection will take place in two phases - one month before the campaign is launched (campaign duration will be three months) and one month after the campaign is complete. We will administer the same instrument used to collect baseline data about school staff hand hygiene knowledge, perceptions, and practices (described under Objective 1). In addition, we will also collect data on absenteeism. After the campaign is over, the participating third grade teachers will each be interviewed to assess their
experiences with the promotion campaign and how they personally believe it changed their students' hand hygiene practices.
<p>PROGRESS: 2012/08 TO 2013/08<br/>Target Audience: Our target population has been identified--the 200 elementary schools located in 10 upstate South Carolina counties (Oconee, Pickens, Anderson, Greenville, Spartanburg, Laurens, Abbeville, Greenwood, Union, and Cherokee). Our sample size, determined by performing power calculations, will be between 20 and 26 schools. The schools that agree to participate will be randomly assigned to either the intervention or control group. Changes/Problems: Initially we proposed collecting environmental samples on select surfaces in the school cafeteria. The samples were to be tested for the presence of select microorganisms as an indicator of cleanliness. The number of samples we would be able to collect is small and would not yield meaningful results. Therefore, we will determine the cleanliness of select surfaces using an ATP
meter. Using the ATP meter will allow us to collect 10X the number of samples. It also is a widely used indicator of general cleanliness and sanitation in food production settings. What opportunities for training and professional development has the project provided? Nothing Reported 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? SYSTEMATIC LITERATURE REVIEW: The manuscript will be submitted to the Journal of the American Public Health Association in February 2014. HAND HYGIENE DATABASE/CONTENT ANALYSIS: Coding of all 100 curricula will be completed, the data will be analyzed, and a publication prepared for submission. SAMPLE RECRUITMENT: Schools will be contacted and recruited for inclusion in this study beginning in January 2014. SELF-SERVICE SURVEY: The web-based
survey will be administered to all public elementary schools in South Carolina in early 2014. FACILITY VISIT: The site visit protocol will be finalized and site visits will begin August 2014. A no-cost extension will be requested to fulfill the objectives of this project. FOCUS GROUPS: We will train a focus group moderator and conduct between 4 and 6 focus groups with children at the intervention schools in Spring 2014. EDUCATION CAMPAIGN: We will begin training intervention schools in August 2014.
<p>PROGRESS: 2011/09/01 TO 2012/08/30<br/>OUTPUTS: From 2005 to 2008, 50% of foodborne outbreaks of known etiology associated with schools were attributed to Human Norovirus (HuNoV). The number of cases could increase as many schools now offer self-service, including salad bars and bowls of fresh fruit. Hand hygiene is an effective way to reduce infections from HuNoV but compliance is low. This proposal addresses two priority areas: (1) 111.A Providing food safety education and training for consumers of all ages, including those at increased risk for foodborne illnesses and (2) 111.B Providing food safety education, training, and certification for farmers, industry, and retail, including small farm direct-food-sales vendors and processors. Our goal is to decrease foodborne infections in elementary schools by: (1) Identifying individual, environmental, and institutional
factors that influence hand hygiene practices in the elementary school environment; (2) Establishing a hierachy of handwashing activities to determine if and when alcohol-based hand rubs (ABHRs) can be used to replace traditional handwashing; and (3) Developing, delivering, and evaluating a hand hygiene campaign in the elementary school environment. The data collection protocol for the phases 1 and 2 site visits has been drafted and is currently under review by team members at NCSU and MSU. A survey instrument to assess self-service activities and handwashing facilities/policies in U.S. and South Carolina schools has drafted and reviewed by a survey design expert. The IRB to administer the survey has been submitted to the Clemson University IRB and is currentely under review. The protocol for phases 1 and 3 will be finalized in January 2012. We will conduct site visits at ten elementary
schools in South Carolina to determine factors that influence hand hygiene. These data will feed into a mathematical exposure model for HuNoV transmission in elementary schools to determine if and when ABHRs could replace handwashing. We will communicate our findings in a promotion campaign based on the findings of Objectives 1 and 2. Knowledge about the practicality of current handwashing guidelines and reasons for low compliance will be improved by the proposed project. PARTICIPANTS: Angela M. Fraser, Ph.D., Associate Professor/Food Safety Specialist, Clemson University, Clemson, SC Cecilia "Xi" Chen, M.S. candidate, Clemson University, Clemson, SC Cortney Miller, M.S., Project Coordinator, Clemson University, Clemson, SC Lee-Ann Jaykus, Ph.D., Professor, NC State University, Raleigh, NC Maria Lapinski, Ph.D., Associate Professor, Michigan State University, East Lansing, MI TARGET
AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.