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Retail deli slicer cleaning frequency--six selected sites, United States, 2012.

Listeria monocytogenes (Listeria) causes the third highest number of foodborne illness deaths (an estimated 255) in the United States annually, after nontyphoidal Salmonella species and Toxoplasma gondii (1). Deli meats are a major source of listeriosis illnesses (2,3), and meats sliced and packaged at retail delis are the major source of listeriosis illnesses attributed to deli meat (4). Mechanical slicers pose cross-contamination risks in delis and are an important source of Listeria cross-contamination (5,6). Reducing Listeria contamination of sliced meats in delis will likely reduce Listeria illnesses and outbreaks (6). Good slicer cleaning practices can reduce this foodborne illness risk (7). CDC's Environmental Health Specialists Network (EHS-Net) studied how often retail deli slicers were fully cleaned (disassembled, cleaned, and sanitized) at the Food and Drug Administration (FDA) Food Code-specified minimum frequency of every 4 hours and examined deli and staff characteristics related to slicer cleaning frequency (8). Interviews with staff members in 298 randomly-selected delis in six EHS-Net sites showed that approximately half of delis fully cleaned their slicers less often than FDA's specified minimum frequency. Chain-owned delis and delis with more customers, more slicers, required manager food safety training, food safety-knowledgeable workers, written slicer-cleaning policies, and food safety-certified managers fully cleaned their slicers more frequently than did other types of delis, according to deli managers or workers. States and localities should require deli manager training and certification, as specified in the FDA Food Code. They should also consider encouraging or requiring delis to have written slicer-cleaning policies. Retail food industry leaders can also implement these prevention efforts to reduce risk in their establishments. Because independent and smaller delis had lower frequencies of slicer cleaning, prevention efforts should focus on these types of delis.

The FDA Food Code is a model food code offered for adoption by state and local governmental jurisdictions that regulate retail food safety (i.e., states and localities). It contains science-based guidance to improve food safety in retail food service establishments. Although not all states and localities have adopted the latest version of the Food Code (2013), FDA and CDC strongly encourage its adoption at all levels of government. * The FDA Food Code states that food contact surfaces, including slicers, should be cleaned and sanitized at least every 4 hours (4-602.11[C]) (8), and that food contact surfaces should be disassembled before cleaning and sanitizing (4-202.11[A][5]) (8). U.S. Department of Agriculture (USDA) guidance also recommends slicer disassembly before cleaning and sanitizing (6). Knowledge about retail delis' cleaning practices is critical to developing effective interventions. EHS-Net, a collaborative program of CDC, FDA, USDA, and six EHS-Net-funded state and local health departments, ([dagger]) assessed how often deli slicers were fully cleaned (disassembled, cleaned, and sanitized) at the FDA-specified minimum frequency of every 4 hours. EHS-Net also assessed deli and staff characteristics related to slicer cleaning frequency.

Within each EHS-Net site, data collectors chose a convenient geographic area, based on reasonable travel distance, in which to survey delis by telephone to determine study eligibility and request study participation. A software program was then used to select a random sample of delis within in each of the site geographic areas. Delis eligible for the study had at least one slicer, prepared or served ready-to-eat foods (with a delay between purchase and consumption), and had staff members who could be interviewed in English. Data collectors assessed approximately 50 delis in each site. Data were collected during January-September 2012.

Data collectors interviewed deli managers about their characteristics, their deli's characteristics; and how often slicers were fully cleaned ("On average, how many times are food slicers fully cleaned [disassembled, cleaned, and sanitized] during a shift?"). Deli managers also completed a written, eight-item food safety knowledge survey. Data collectors interviewed food workers, away from the manager, about their characteristics and food safety knowledge, and how often each slicer was fully cleaned ("How often do you break down, clean, then sanitize this slicer?"). Simple and multiple logistic regression models were used to examine associations between deli, manager, and worker characteristics and slicer-cleaning frequencies. The cut-off for variable inclusion in the multiple regression models was p<0.10.

Among 691 managers of eligible delis who were contacted, 298 (43%) agreed to be interviewed. In 294 (98.7%) participating delis, data collectors were also able to interview a worker. The majority of delis were chains (55.0%) and had 1-2 slicers (56.8%) (Table 1).

Half of managers (49-5%) said that slicers were fully cleaned at least every 4 hours (Table 1). The remaining managers said that slicers were fully cleaned less frequently. Workers reported that 63.0% (393 of 624) of slicers were fully cleaned at least every 4 hours. Deli-level aggregation of these worker-reported data indicated that in 45.8% of delis, all slicers were fully cleaned at least every 4 hours (Table 1). In the remaining delis, at least one slicer was fully cleaned less frequently. Managers and workers agreed on cleaning frequency in 79.0% of delis (215 of 279, r = 0.587, p<0.001).

Simple regression models showed that the characteristics of deli chain ownership, a higher average number of workers per shift, more shifts per day, more customers served on the busiest day, more slicers, more chubs (plastic tubes of meat) sold daily, deli-required manager food safety training, a written policy on slicer cleaning, manager certification (current or ever), and manager and worker food safety knowledge were significantly associated with both managers and workers indicating that their slicers were fully cleaned at least every 4 hours (Table 2). Worker rating of deli slicers as easy to clean was significantly associated with managers indicating that slicers were fully cleaned at least every 4 hours. Deli-required manager food safety certification and more worker experience in the deli were significantly associated with workers indicating that slicers were fully cleaned at least every 4 hours.

A multiple regression model showed that deli chain ownership, more customers served on the busiest day, and worker food safety knowledge were significantly associated with managers indicating that slicers were fully cleaned at least every 4 hours. A second multiple regression model showed that deli chain ownership, more customers served on the busiest day, more slicers, more chubs sold daily, deli-required manager food safety training, and more worker experience in the deli were significantly associated with workers indicating that slicers were fully cleaned at least every 4 hours. (Table 3).

Discussion

These analyses indicate that many delis have insufficient slicer-cleaning frequency, which could lead to cross-contamination of deli meats with Listeria and other pathogens. In at least half of delis studied, managers and workers reported that slicers were not fully cleaned at the FDA--specified minimum frequency of every 4 hours.

Multiple regression findings indicate that chain delis reported more frequent slicer cleaning than did independent delis, and delis with more slicers, serving more customers, and selling more chubs daily reported more frequent slicer cleaning than did delis with fewer slicers, serving fewer customers, or selling fewer chubs daily. These characteristics are likely indicators of deli size, and these data are consistent with other findings suggesting that both chain and larger establishments' food safety practices tend to be better than those of independent and smaller establishments (9,10). Compared with both independent and smaller delis, chain and larger delis might have more resources, more or better trained staff, or more standardized cleaning procedures.

The association of required manager food safety training and certification with more frequent reported slicer-cleaning is consistent with other findings indicating that training and certification are important in retail food safety (9,10), and highlights the important role that management can play in food safety. The finding that delis with workers with more food safety knowledge and experience had more frequent reported slicer cleaning suggests that workers also play an important role in food safety.

Simple logistic regression findings suggest other characteristics that might improve cleaning frequencies. Written slicercleaning policies and worker ratings of slicers as being easy to clean were both associated with more frequent reported cleaning, suggesting that workplace policies and slicer design can affect cleaning frequency. Finally, delis with a food safety-certified manager had better reported cleaning frequencies, again pointing to the importance of training and certification.

Because slicer-cleaning frequency and disassembly guidance are presented separately from each other in the FDA Food Code, some deli managers might be unaware that cleaning should include disassembly, and might clean and sanitize slicers without disassembling them. It is also possible that some slicers included in this study, especially newer ones, do not need to be disassembled to be fully cleaned.

The findings in this study are subject to at least three limitations. First, the interview data might be affected by social desirability bias, which might have resulted in overreporting of cleaning frequency. Second, because interviewed workers were selected by managers, and not at random, worker data might not represent all workers. Finally, because the data were collected from English-speaking staff members only, they might not reflect practices in delis with no English-speaking staff. It is also important to note that the data from this study do not allow causal inferences about relationships between characteristics and cleaning frequency nor do they link slicer cleaning frequency with foodborne illness.

States and localities should require deli manager training and certification, as specified in the FDA Food Code. They should also consider providing education on the topics of slicer-cleaning frequency and the importance of slicer disassembly, and encouraging or requiring delis to have written slicer-cleaning policies. Retail food industry leaders can also implement these prevention efforts to reduce risk in their food establishments. Because frequencies of slicer cleaning were lower at independent and smaller delis, prevention efforts should focus on these types of establishments.

Summary

What is already known about this topic?

Listeria monocytogenes (Listeria) causes the third highest number of foodborne illness deaths in the United States annually. Listeria contamination of sliced deli meats at retail locations contributes to Listeria illness and outbreaks. Mechanical slicers pose cross-contamination risks in retail delis and are an important source of Listeria cross-contamination. Good slicer cleaning practices can reduce this risk.

What is added by this report?

In approximately half of retail delis studied in six Environmental Health Specialists Network sites, slicers were fully disassembled, cleaned, and sanitized less frequently than the minimum 4 hours specified in the Food and Drug Administration (FDA) Food Code. Slicers were fully cleaned more frequently in chain delis, and in delis with more customers, more slicers, required manager food safety training, food safety-knowledgeable workers, written slicer cleaning policies, and food safety-certified managers than in delis in other categories.

What are the implications for public health practice?

To help ensure that deli slicers are cleaned at least every 4 hours as a foodborne illness prevention measure, states and localities should require deli manager training and certification, as specified in the FDA Food Code. They should also consider encouraging or requiring delis to have written slicer-cleaning policies. Retail food industry leaders can also implement these prevention efforts to reduce risk in their food establishments. Because independent and smaller delis show lower frequencies of slicer cleaning, prevention efforts should focus on these types of delis.

Acknowledgments

Participating deli managers and workers; EHS-Net site staff members; Food and Drug Administration (FDA), U.S. Department of Agriculture; Brenda Le, Carol Selman, CDC; Denita Williams, FDA.

References

(1.) Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States--major pathogens. Emerg Infect Dis 2011; 17:7-15. http://dx.doi.org/10.3201/eid1701.P11101

(2.) Batz MB, Hoffmann S, Morris JG Jr. Ranking the disease burden of 14 pathogens in food sources in the United States using attribution data from outbreak investigations and expert elicitation. J Food Prot 2012; 75:1278-91. http://dx.doi.org/10.4315/0362-028X.JFP-11-418

(3.) Cartwright EJ, Jackson KA, Johnson SD, Graves LM, Silk BJ, Mahon BE. Listeriosis outbreaks and associated food vehicles, United States, 1998-2008. Emerg Infect Dis 2013; 19:1-9. http://dx.doi.org/10.3201/ eid1901.120393

(4.) US Department of Agriculture. FSIS comparative risk assessment for Listeria monocytogenes in ready-to-eat meats and poultry deli meats. Washington, DC: US Department of Agriculture; 2010. http://www.fsis. usda.gov/wps/wcm/connect/c2ac97d0-399e-4c4a-a2bc-d338c2e201b3/ Comparative_RA_Lm_Report_May2010.pdf?MOD=AJPERES

(5.) US Department of Agriculture. Interagency risk assessment: Listeria monocytogenes in retail delicatessens. Washington, DC: US Department of Agriculture; 2013. http://www.fsis.usda.gov/wps/wcm/connect/ c0c6dfbc-ad83-47c1-bcb8-8db6583f762b/Lm-Retail-Technical-Report. pdf?MOD=AJPERES

(6.) US Department of Agriculture. FSIS best practices guidance for controlling Listeria monocytogenes (Lm) in retail delicatessens. Washington, DC: US Department of Agriculture; 2015. http:// www.fsis.usda.gov/wps/wcm/connect/29d51258-0651-469b- 99b8e986baee8a54/Controlling-LM-Delicatessens.pdf?MOD=AJPERES

(7.) Hoelzer K, Pouillot R, Gallagher D, Silverman MB, Kause J, Dennis S. Estimation of Listeria monocytogenes transfer coefficients and efficacy of bacterial removal through cleaning and sanitation. Int

J Food Microbiol 2012; 157:267-77. http://dx.doi.org/10.1016Zj. ijfoodmicro.2012.05.019

(8.) Food and Drug Administration. Food and Drug Administration Food Code. Chapter 4. equipment, utensils, and linens. Silver Springs, MD: US Department of Health and Human Services, Food and Drug Administration; 2013. http://www.fda.gov/downloads/Food/ GuidanceRegulation/RetailFoodProtection/FoodCode/UCM374510.pdf

(9.) Bogard AK, Fuller CC, Radke V, Selman CA, Smith KE. Ground beef handling and cooking practices in restaurants in eight States. J Food Prot 2013; 76:2132-40. http://dx.doi.org/10.4315/0362-028X.JFP-13-126

(10.) Brown LG. EHS-Net restaurant food safety studies: what have we learned? J Environ Health 2013; 75:44-5.

* Introduction to the 2013 Food Code. http://www.fda.gov/downloads/Food/ GuidanceRegulation/RetailFoodProtection/FoodCode/UCM374510.pdf.

([dagger]) California Department of Public Health, Minnesota State Department of Health, New York State Department of Health, New York City Department of Health and Mental Hygiene, State of Rhode Island Department of Health, and Tennessee State Department of Health.

Laura G. Brown, PhD [1]; E. Rickamer Hoover, PhD [1]; Danny Ripley [2]; Bailey Matis, MPH [3]; David Nicholas, MPH [4]; Nicole Hedeen, MS [5]; Brenda Faw [6]

[1] Division of Emergency and Environmental Health Services, National Center for Environmental Health, CDC, [2] Tennessee Department of Health, [3] New York City Department of Health and Mental Hygiene, [4] New York State Department of Health, [5] Minnesota Department of Health; 6California Department of Public Health.

Corresponding author: Laura G. Brown, lrgreen@cdc.gov, 770-488-4332.
TABLE 1. Reported slicer cleaning frequency, and deli, manager, and
worker characteristics, obtained from manager interviews and
surveys, and worker interviews *--six EHS-Net sites, ([dagger]) 2012

Reported slicer cleaning frequency                         No. (%)
(fully cleaned) ([section])

Manager-reported (N = 297)
Every 4 hours                                              147 (49.5)
Less frequently than every 4 hours                         150 (50.5)
Worker-reported (N = 273)
Every 4 hours                                              125 (45.8)
Less frequently than every 4 hours                         148 (54.2)
Deli characteristic
Ownership type (N = 298)
  Chain                                                    164 (55.0)
  Independent                                              134 (45.0)
Number of managers (N = 298)
  1                                                        102 (34.2)
  >1                                                       196 (65.8)
Average number of workers per shift (N = 298)
  <2                                                       106 (35.6)
  [greater than or equal to] 2                             192 (64.4)
Number of shifts in typical day (N = 298)
  1-2                                                      150 (50.3)
  [greater than or equal to] 3                             148 (49.7)
Number of hours in typical shift (N = 298)
  <8                                                        91 (30.5)
  [greater than or equal to] 8                             207 (69.5)
Number of customers on busiest day (N = 262)
  0-99                                                      85 (32.4)
  100-299                                                   92 (35.1)
  [greater than or equal to] 300                            85 (32.5)
Number of slicers (N = 294)
  1-2                                                      167 (56.8)
  [greater than or equal to] 3                             127 (43.2)
Maximum number of chubs sold daily (N = 274)
  <30                                                      134 (48.9)
  [greater than or equal to] 30                            140 (51.1)
Manager food safety training required by deli (N = 295)
  Yes                                                      220 (74.6)
  No                                                        75 (25.4)
Manager food safety certification required by deli
(N = 291) ([paragraph])
  Yes                                                      145 (49.8)
  No                                                       146 (50.2)
Written policy for cleaning and sanitizing slicers
(N = 296)
  Yes                                                      194 (65.5)
  No                                                       102 (34.5)
Worker-rated difficulty of slicer cleaning (N = 293)
  Easy                                                     216 (73.7)
  More difficult **                                         77 (26.3)

Manager characteristic
Experience in retail food industry (yrs) (N = 298)
  [less than or equal to] 10                                77 (25.8)
  >10-15                                                    50 (16.8)
  >15                                                      171 (57.4)
Experience as manager in current deli (yrs) (N = 298)
  [less than or equal to] 5                                156 (52.3)
  >5                                                       142 (47.7)
Ever food safety certified (N = 297) ([paragraph])
  Yes                                                      203 (68.4)
  No                                                        94 (31.6)
Currently food safety certified (N = 297) ([paragraph])
  Yes                                                      164 (55.2)
  No                                                       133 (44.8)
Food safety knowledge assessment (N = 298)
  <75% correct                                              97 (32.6)
  [greater than or equal to] 75% correct                   201 (67.4)
Worker characteristic
Experience in retail food industry (yrs) (N = 293)
  [less than or equal to] 10                               163 (55.6)
  >10-15                                                    57 (19.5)
  >15                                                       73 (24.9)
Experience in current deli (yrs) (N = 294)
  [less than or equal to] 5                                190 (64.6)
  >5                                                       104 (35.4)
Food safety knowledge assessment (N = 294)
  <100% correct                                            157 (53.4)
  100% correct                                             137 (46.6)

Abbreviation: EHS-Net = Environmental Health Specialists Network.

* Numbers vary because of missing data.

([dagger]) California, Minnesota, New York, New York City, Rhode
Island, and Tennessee.

([section]) Disassembled, cleaned, and sanitized.

([paragraph]) Certification defined as having taken and passed a food
safety test and been issued a certificate.

** Somewhat easy, neither easy nor difficult to clean, somewhat
difficult, or difficult.

TABLE 2. Simple logistic regression models of deli, manager, and
worker characteristics associated with managers and workers reporting
that slicers in their delis are fully cleaned * at the FDA-specified
frequency (at least every 4 hours)--six EHS-Net Sites, ([dagger]) 2012

Characteristic                                  Comparison ([section])

Deli characteristic
Ownership type                                            Chain versus
                                                           independent
Number of managers                                         1 versus >1
Average number of workers per   [greater than or equal to] 2 versus <2
  shift
Number of shifts in a typical      [greater than or equal to] 3 versus
  day                                                           1 or 2
Number of hours in a typical    <8 versus [greater than or equal to] 8
  shift
Number of customers on busiest                          100-299 versus
  day **                                                          0-99
                                        [greater than or equal to] 300
                                                           versus 0-99

Number of slicers                  [greater than or equal to] 3 versus
                                                                1 or 2
Maximum number of chubs sold      [greater than or equal to] 30 versus
  daily                                                            <30
Manager food safety training                             yes versus no
  required by deli
Manager food safety                                      yes versus no
  certification required by
  deli ([dagger][dagger])
Written policy for slicer                                yes versus no
  cleaning and sanitizing
Worker-rated difficulty of                  Easy versus more difficult
  slicer cleaning                                 ([section][section])

Manager characteristic
Experience in retail food            [less than or equal to] 10 versus
  industry (yrs)                         [greater than or equal to] 15
  ([paragraph][paragraph])        >10-15 versus [greater than or equal
                                                                to] 15

Experience as manager in           [less than or equal to] 5 versus >5
  current deli (yrs)
Ever food safety certified                               yes versus no
Currently food safety                                    yes versus no
  certified
Food safety knowledge           [greater than or equal to] 75% correct
  assessment                                       versus <75% correct

Worker characteristic
Experience in retail food        [less than or equal to] 10 versus >15
  industry (yrs) ***                                 >10-15 versus >15

Experience in current deli         [less than or equal to] 5 versus >5
  (yrs)
Food safety knowledge                              100% correct versus
  assessment                                             <100% correct

                                     Managers reported that
                                    slicers are fully cleaned
                                     at least every 4 hours

                                     No.
Characteristic                  ([paragraph])       OR (95% CI)

Deli characteristic
Ownership type                       293         4.41 (2.36, 8.25)

Number of managers                   293         0.74 (0.41, 1.33)
Average number of workers per        293         3.51 (1.85, 6.65)
  shift
Number of shifts in a typical        293         2.92 (1.60, 5.32)
  day
Number of hours in a typical         293         1.06 (0.59, 1.93)
  shift
Number of customers on busiest       257        5.84 (2.59, 13.21)
  day **
                                     257        5.05 (2.29, 11.13)

Number of slicers                    293         3.23 (1.77, 5.91)

Maximum number of chubs sold         269         2.68 (1.47, 4.91)
  daily
Manager food safety training         291         2.29 (1.08, 4.85)
  required by deli
Manager food safety                  286         1.48 (0.81, 2.69)
  certification required by
  deli ([dagger][dagger])
Written policy for slicer            291         4.46 (2.21, 9.01)
  cleaning and sanitizing
Worker-rated difficulty of           292         1.98 (1.02, 3.82)
  slicer cleaning

Manager characteristic
Experience in retail food            293         0.88 (0.46, 1.69)
  industry (yrs)
  ([paragraph][paragraph])           293         1.18 (0.54, 2.59)

Experience as manager in             293         1.51 (0.87, 2.63)
  current deli (yrs)
Ever food safety certified           292         1.72 (0.90, 3.27)
Currently food safety                292         2.06 (1.08, 3.93)
  certified
Food safety knowledge                293         3.28 (1.65, 6.53)
  assessment
Worker characteristic
Experience in retail food            293         1.47 (0.76, 2.88)
  industry (yrs) ***                 293         1.04 (0.45, 2.40)

Experience in current deli           293         0.99 (0.56, 1.75)
  (yrs)
Food safety knowledge                293         2.53 (1.41, 4.52)
  assessment

                                 Managers reported that
                                slicers are fully cleaned
                                 at least every 4 hours

Characteristic                   p-value for comparisons

Deli characteristic
Ownership type                   [less than or equal to] 0.001

Number of managers                        0.310
Average number of workers per             0.003
  shift
Number of shifts in a typical            <0.001
  day
Number of hours in a typical              0.841
  shift
Number of customers on busiest           <0.001
  day **
                                         <0.001

Number of slicers                        <0.001

Maximum number of chubs sold              0.001
  daily
Manager food safety training              0.032
  required by deli
Manager food safety                       0.200
  certification required by
  deli ([dagger][dagger])
Written policy for slicer                <0.001
  cleaning and sanitizing
Worker-rated difficulty of                0.043
  slicer cleaning

Manager characteristic
Experience in retail food                 0.532
  industry (yrs)
  ([paragraph][paragraph])                0.554

Experience as manager in                  0.140
  current deli (yrs)
Ever food safety certified                0.099
Currently food safety                     0.028
  certified
Food safety knowledge                     0.001
  assessment
Worker characteristic
Experience in retail food                 0.209
  industry (yrs) ***                      0.675

Experience in current deli                0.962
  (yrs)
Food safety knowledge                     0.002
  assessment

                                      Workers reported that
                                     slicers are fully cleaned
                                       at least every 4 hours

                                     No.
Characteristic                  ([paragraph])       OR (95% CI)

Deli characteristic
Ownership type                       272        5.21 (2.50, 10.85)

Number of managers                   272         1.02 (0.53, 1.94)
Average number of workers per        272         3.48 (1.63, 7.40)
  shift
Number of shifts in a typical        272         2.63 (1.37, 5.02)
  day
Number of hours in a typical         293         1.52 (0.80, 2.87)
  shift
Number of customers on busiest       236        8.71 (3.12, 24.33)
  day **
                                     236        6.75 (2.49, 18.26)

Number of slicers                    272         4.47 (2.33, 8.55)

Maximum number of chubs sold         250         3.66 (1.86, 7.20)
  daily
Manager food safety training         270        4.55 (1.69, 12.46)
  required by deli
Manager food safety                  270         2.82 (1.42, 5.59)
  certification required by
  deli ([dagger][dagger])
Written policy for slicer            271        6.02 (2.59, 14.00)
  cleaning and sanitizing
Worker-rated difficulty of           271         1.54 (0.77, 3.10)
  slicer cleaning

Manager characteristic
Experience in retail food            272         0.82 (0.39, 1.70)
  industry (yrs)
  ([paragraph][paragraph])           272         1.00 (0.43, 2.33)

Experience as manager in             272         1.22 (0.67, 2.24)
  current deli (yrs)
Ever food safety certified           271         2.29 (1.12, 4.72)
Currently food safety                271         1.74 (0.97, 3.12)
  certified
Food safety knowledge                272         3.15 (1.42, 7.01)
  assessment
Worker characteristic
Experience in retail food            272         0.87 (0.41, 1.78)
  industry (yrs) ***                 272         1.48 (0.59, 3.69)

Experience in current deli           272         0.51 (0.27, 0.97)
  (yrs)
Food safety knowledge                272         1.93 (1.03, 3.62)
  assessment

                                  Workers reported that
                                slicers are fully cleaned
                                 at least every 4 hours

Characteristic                   p-value for comparisons

Deli characteristic
Ownership type                           <0.001

Number of managers                        0.960
Average number of workers per             0.007
  shift
Number of shifts in a typical             0.004
  day
Number of hours in a typical              0.198
  shift
Number of customers on busiest           <0.001
  day **
                                         <0.001

Number of slicers                        <0.001

Maximum number of chubs sold              0.001
  daily
Manager food safety training              0.003
  required by deli
Manager food safety                       0.003
  certification required by
  deli ([dagger][dagger])
Written policy for slicer                <0.001
  cleaning and sanitizing
Worker-rated difficulty of                0.223
  slicer cleaning

Manager characteristic
Experience in retail food                 0.600
  industry (yrs)
  ([paragraph][paragraph])                0.808

Experience as manager in                  0.517
  current deli (yrs)
Ever food safety certified                0.024
Currently food safety                     0.063
  certified
Food safety knowledge                     0.005
  assessment
Worker characteristic
Experience in retail food                 0.287
  industry (yrs) ***                      0.251

Experience in current deli                0.039
  (yrs)
Food safety knowledge                     0.041
  assessment

Abbreviations: CI = confidence interval; EHS-Net = Environmental
Health Specialists Network; FDA = Food and Drug Administration;
OR = odds ratio.

* Disassembled, cleaned, and sanitized.

([dagger]) California, Minnesota, New York, New York City, Rhode
Island, and Tennessee.

([section]) The reference level is the second category listed. Thus,
the odds ratio is for the first category listed compared to the second
category listed.

([paragraph]) Numbers vary because of missing data.

** P-values for the overall ORs: p = 0.001 and p < 0.001 for the
manager and worker models, respectively.

([dagger][dagger]) Certification defined as having taken and passed a
food safety test and been issued a certificate.

([section][section]) Somewhat easy, neither easy nor difficult to
clean, somewhat difficult, or difficult.

([paragraph][paragraph]) P-values for the overall ORs: p = 0.803 and p
= 0.856 for the manager and worker models, respectively.

*** P-values for the overall ORs: p = 0.441 and p = 0.445 for the
manager and worker models, respectively.

TABLE 3. Multiple logistic regression models * of deli, manager, and
worker characteristics associated with managers and workers indicating
that in their deli, slicers are fully cleaned ([dagger]) at the FDA-
specified frequency (at least every four hours)--six EHS-Net sites,
([section]) 2012

Characteristic                               Comparison ([paragraph])

Manager model (N = 257)
Ownership type                               Chain versus independent
Number of customers on busiest                    100-299 versus 0-99
  day **                               [greater than or equal to] 300
                                                          versus 0-99
Worker food safety knowledge        100% correct versus <100% correct
  assessment

Worker model (N = 222)
Ownership type                               Chain versus independent
Number of customers on busiest                    100-299 versus 0-99
  day ([dagger][dagger])               [greater than or equal to] 300
                                                          versus 0-99
Number of slicers                        [greater than or equal to] 3
                                                        versus 1 or 2
Maximum number of chubs sold            [greater than or equal to] 30
  daily                                                    versus <30
Manager food safety training                            yes versus no
  required by deli
Worker experience in current      [less than or equal to] 5 versus >5
  deli (yrs)
                                                       p-value for
Characteristic                       OR (95% CI)       comparisons

Manager model (N = 257)
Ownership type                    2.78 (1.30, 5.96)       0.008
Number of customers on busiest   4.32 (1.85, 10.11)      <0.001
  day **                          2.71 (1.10, 6.70)       0.031

Worker food safety knowledge       2.15 (1.11,4.17)       0.023
  assessment

Worker model (N = 222)
Ownership type                   4.65 (1.52, 14.25)       0.007
Number of customers on busiest   3.42 (0.96, 12.16)       0.057
  day ([dagger][dagger])          0.76 (0.18, 3.26)       0.713

Number of slicers                 2.42 (0.92, 6.39)       0.074

Maximum number of chubs sold      2.36 (0.85, 6.54)       0.098
  daily
Manager food safety training     4.30 (0.93, 19.87)       0.062
  required by deli
Worker experience in current      0.45 (0.20, 1.04)       0.061
  deli (yrs)

Abbreviations: CI = confidence interval; EHS-Net = Environmental
Health Specialists Network; FDA = Food and Drug Administration; OR =
odds ratio.

* Manager overall model ([X.sup.2] = 36.54, degrees of freedom (df) =
4, p < 0.001) created using forward selection criteria of p [less than
or equal to] 0.10. Worker overall model ([X.sup.2] = 54.96, df = 7, p
< 0.001) created using forward selection criteria of p [less than or
equal to] 0.10. When employing a forward selection procedure, all
predictors of interest (i.e., deli, manager, and worker
characteristics in this study) are systematically individually tested
to see which is most significant within the model. Once identified,
this predictor is added to the model and the remaining predictors are
retested. This procedure is repeated until all remaining predictors
fail to meet the entrance criteria. Each final model presented above
simultaneously included all variables shown in the table. Individual
inclusion steps are not presented.

([dagger]) Disassembled, cleaned, and sanitized.

([section]) California, Minnesota, New York, New York City, Rhode
Island, and Tennessee.

([paragraph]) The reference level is the second category listed. Thus,
the odds ratio is for the first category listed compared to the second
category listed.

** P-value for the overall OR: p = 0.003.

([dagger][dagger]) P-value for the overall OR: p = 0.006.
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Author:Brown, Laura G.; Hoover, E. Rickamer; Ripley, Danny; Matis, Bailey; Nicholas, David; Hedeen, Nicole;
Publication:Morbidity and Mortality Weekly Report
Date:Apr 1, 2016
Words:4845
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