Oregon Statewide Handwashing Intervention. Handwashing Legends Project (HLP)

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1 Oregon Statewide Handwashing Intervention Handwashing Legends Project (HLP) Erica Van Ess, REHS Oregon DHS, Public Health Division Food, Pool and Lodging Health & Safety Section

2 The Beginning Oregon Baseline Study 2002

3 Why do the Baseline? To meet the FDA Voluntary Program Standard #9 To see what is out there in Oregon A way to gather statistically significant values to measure the effectiveness of the statewide restaurant program over time

4 DHS Goals: Use the results of the baseline to set program goals Design interventions statewide to reduce the number of Out of Compliance values for items of concern

5 More about the data It is important to note that the data collection was not designed to determine an individual establishment s compliance with its regulatory code The baseline is not a regulatory standard, just a measure against the 1997 food code Not intended to use to compare groups of facilities

6 What did we learn? Not enough food service workers are washing their hands when required! Which we already suspected, but now we have a quantitative way to measure the success of interventions to promote handwashing statewide

7 The Future Because it had the highest out of compliance rate, the Foodborne Illness Prevention Program (FIPP) chose the lack of proper adequate handwashing as the intervention focus for 2005 (to present).

8 Food Worker Focus Groups 2004 Aimee Pragle, MS Oregon State University

9 Why Aren t They Washing? The objectives of this study were to identify the handwashing knowledge, attitudes, practices and barriers of food workers in the restaurant environment.

10 Focus Groups Focus groups were conducted in Multnomah and Benton counties during January Food workers served as panels of experts involved in a cooperative exploration of handwashing practices based on participants experiences.

11 Focus Group Results-Barriers The focus groups identified several barriers to handwashing, including: Availability of supplies/sink accessibility Time pressure/high volume of business Lack of accountability Lack of onsite training regarding handwashing Inadequate foodhandler training regarding handwashing

12 Focus Group-Solutions? The focus groups also identified what was needed in their facility to promote proper handwashing, including: Handwashing posters/signs Proactive health departments-inspectors that educate and make useful suggestions for improvement More hands-on training in the restaurant Stricter rules in the facility regarding handwashing

13 Conclusions In order to encourage and support handwashing many factors are required: 1. Adequate supplies and an easily accessible sink. 2. Active support from both managers and coworkers. 3. Providing hands-on training within the restaurant environment with involvement from managers and coworkers. 4. Visual reminders; signs and posters.

14 Conclusions, cont 5. Involved health departments and inspectors; providing consultation and suggestions for improvement. 6. Continuing support from managers and health departments in providing handwashing education. 7. Promoting an organizational structure that places handwashing as a priority and encourages safe practices.

15 What s the next step? FIPP reviewed the Program Plan and determined potential interventions that match existing priorities based on the information gathered from the baseline and Aimee s study. i.e. Changing the food rules to include lack of soap and towels as a critical violation.

16 Print vs. Oral Culture Study 2004 Donna Beegle, PhD

17 She studied the difference in the way people communicate and found: Higher-income (and usually collegeeducated) families are typically print culture Use written material to gather information Are efficiency-oriented Lower-income families are typically oral culture Use vivid, memorable stories and conversation to gather information Like to take time for conversation to build relationships

18 Final Products Based on the Results of These 3 Studies 1. Statewide Baseline 2. Food Worker Focus Groups- OSU, EHS-Net, CDC 3. Communication-Donna Beegle, EHS- Net

19 Meaningful Message Creation of the Handwashing Legends Project (HLP) stories and illustrations by professional social marketers to promote handwashing

20 Partner Buy-in Presentation at CLEHS, FSAC, ORA Inspector focus groups

21 Final versions of the stories and illustrations were tested on food workers and managers and all agreed that the products were meaningful and memorable to them

22 Final Product-Phase 1

23 Final Product-Phase 2

24 Plan for Implementation 1. Deliver one illustration to each restaurant during your semi-annual inspection: Illustration #1--July 1 through Dec. 31, 2007 Illustration #2--January 1 through June 30, Ask operator for permission to place near their existing HW sign at main kitchen handsink. Small reminder stickers can go on any other kitchen handsinks.

25 Plan for Implementation 3. Talk about story with manager, ask them to discuss it with staff at their next meeting 4. Reiterate the importance of handwashing and Oregon s focus on improving it statewide 5. Be a good example during your inspections!!!

26 What next? Complete our second Risk Factor Study 2009 and 2010 FDA has asked for permission to give our materials/procedure to other states Incorporate another intervention before our third Risk Factor Study

27 Website Link to original Baseline Report Download the illustrations in English, Spanish, Chinese Link to actual stories used with references

28 Questions?

Adventures in Handwashing

Adventures in Handwashing A review of studies on handwashing, foodborne illness, and the effectiveness of food worker training on handwashing behaviors Many Foodborne Pathogens are Associated with Personal