Introduction

Safety is a critical issue facing the food system. Outbreaks of foodborne illness result in substantial costs to consumers, producers, and the national economy. Microbial foodborne pathogens are a major food safety concern, causing millions of cases of foodborne illness each year in the United States and up to 9,000 deaths. In addition to significant morbidity and mortality, foodborne illnesses incur substantial costs to individuals who become ill, the food industry, and the national economy, estimated at $7.7 - 23 billion per year (Council for Agricultural Science and Technology (CAST), 1995).

Approximately 75% of reported foodborne illness is due to mishandling of food in food service operations. The improper food service practices that cause these outbreaks have been well documented by the Centers for Disease Control and Prevention (Bean & Griffin, 1990; Bryan, 1988) and typically involve time and temperature abuse (improper heating, cooling, and holding) and contamination (poor personal hygiene, cross-contamination, etc.). These outbreaks basically represent the failure of food service personnel to follow good food preparation practices. With 52% of the consumer food dollar being spent on eating out and increasing (McGorry, 1998), food safety is critically important.

Food safety experts agree that a significant amount of foodborne illness could be prevented if the food industry implemented Hazard Analysis Critical Control Point (HACCP) food safety systems in their operations. Therefore, the Food and Drug Administration and the U.S. Department of Agriculture have implemented regulations that mandate the implementation of HACCP in various types of food processing plants. Unfortunately, these rules do not mandate HACCP in food service operations, where a significant proportion of foodborne illnesses occur.

The FDA developed and distributed a Model Food Code in 1993 (with updates in 1995 and 1997) to state health agencies for potential adoption as a regulatory document. It has HACCP integrated into its contents but the adoption of the Model Food Code by states is strictly voluntary. The Model Food Code does not specify how state and public health officials should address the critical topic of HACCP training for food service managers and employees.

Even though the causes of foodborne illness (improper temperature control and contamination) and the means to prevent foodborne illness (HACCP) have been clearly identified, the incidence of foodborne illnesses in the United States has not decreased, and in the case of some pathogens, such as Salmonella and E. coli 0157:H7, may actually be increasing. Many state and local health officers and sanitarians, food service managers, and employees do not yet understand HACCP or their role in the HACCP system.

Formation of a government-industry-university partnership that results in comprehensive, cooperative, and integrated training of state and local public health officials, food service managers, and employees is currently lacking. This deficiency and the lack of an efficient economical delivery system prevents successful implementation of HACCP in food service operations. As a result, food service managers and employees throughout the United States are often isolated, ill-informed, and ill-prepared to help implement effective HACCP systems.

The project reported in this study was designed to integrate existing and new training programs for training food service managers and food handlers in effective methods of food preparation and handling. This was accomplished by using a Train-the-Trainer approach that has a multiplier effect in reaching those ultimately responsible for food safety, food service managers and employees. County Extension agents had a key role in the program delivery and training. The methods of instruction included the use of interactive distance education (satellite) workshops, and on-site education in the form of CD-ROM, video, textbook and individual instruction. One of the products of the project is a CD-ROM that can be used to train food service. Entitled "Retail/Food Service: HACCP on the Front Lines", the program discusses retail/food service critical control points, process control, monitoring, verification, and corrective actions during the preparation and serving of food.

This article reports on a multi-state, multi-institutional effort to implement a Train-the-Trainer model program that utilizes new technologies and partnerships to provide HACCP-based training to local public health officials, sanitarians and managers of food service establishments. The Pennsylvania State University, Texas A & M University, and Utah State University worked together on this project which was funded by a USDA 1996 CSREES Agriculture Telecommunications grant.

A national survey was conducted to obtain information on food safety training needs. A training curriculum was developed and made available through local satellite downlinks, many of them organized through county Cooperative Extension offices. County Extension agents served as on-site educators and facilitators for the three days of training. Participant evaluations of the training sessions focused on knowledge gain and instructor and course effectiveness. Participant evaluations of the training sessions were conducted at the conclusion of each day. A follow-up participant survey was conducted two months after the training to gather initial impact data.

State Food Safety Training Needs

A national survey was developed to assess the food safety training needs of the states. Individuals from government and academic institutions who are involved in delivering and/or supervising food safety training were contacted. Respondents included Cooperative Extension and other university food safety specialists, individuals from state departments of health, environmental health, agriculture and other government agencies, and regional Food and Drug Administration officials involved in food safety training. The telephone survey was conducted between February and July 1996. A total of 76 individuals were surveyed representing all 50 states.

Food safety in the food service industry is a very complex topic. Training, certification, and regulation may be a shared responsibility across state agencies, local governments, and educational institutions. Therefore, it would require interviews and surveys of numerous individuals in each state to get an exact picture of food safety needs and requirements in all states. Consequently, a decision was made to use the responses from one knowledgeable individual from each state to get a sense of food safety programming and training needs in each state. Of this group, 29 (58%) were university-based 20 (40%), were with Cooperative Extension), and 20 (40%) were with state departments of health or agriculture. One respondent was from a county health department. The respondents were identified through food safety networks of Cooperative Extension specialists, state-level individuals identified by Cooperative Extension contacts, and regional Food and Drug Administration officials.

The results reported here represent information on: (a) general knowledge and perceptions relating to certification and training requirements, (b) providers of training, and (c) useful educational resources for meeting food safety training needs in the food service industry. This information provides the background and rationale for the Train-the-Trainer model program that is described below.

Training and Certification Requirements

Twenty-seven states (54%) have adopted either the 1993 or 1995 Food Code. It is anticipated that other states will adopt the recently released 1997 Food Code. HACCP is a critical part of the 1997 Food Code. As a relatively recent approach to food safety in the food service industry, there is evidence of the need for training and certification in HACCP-based food safety. This need will grow as additional states adopt the Food Code.

Differences exist in the training and certification requirements for government food service personnel (including restaurant inspectors, local health officers, environmental health specialists, etc.), and food service managers and employees in commercial and institutional food service establishments. As the results in Table 1 show, in general, government food service personnel are more likely to be trained and certified than non-government food service personnel. Likewise, institutional food service managers are more likely to be trained and certified than commercial food service managers, and institutional food service employees are more likely to be trained than commercial food service employees. Twenty-two states (44%) expected that additional certification requirements would be instituted in the next year or two.

Who Provides Food Safety Training?

A number of providers of food safety training were identified in the survey. Table 2 indicates the providers identified by respondents. Cooperative Extension was identified most frequently followed by state departments of health, other university academic programs, and the private food industry. Training programs by state restaurant associations, associations of food and drug officials, and state departments of agriculture and environmental safety were also identified as important training resources.

The numerous sources of materials identified suggests the need to draw from the various curricula to develop a standardized food safety training curriculum. A related question looked at the interest of respondents in participating in national or regional training programs. Thirty-eight states (76%) indicated an interest in participating in these programs. As evidence of this interest, all but three states attended one of two conferences held in Denver and Atlanta in 1997 entitled "National HACCP Education Conference: Building Partnerships from Farm-to-Table".

Useful Educational Resources

Finally, respondents were asked to indicate their interest in using various types of educational materials for food safety training efforts. As shown in Table 3, strong interest exists for printed references, instructional videos, distance education technology, and interactive video/computer.

Train-the-Trainer Model

The Train-the Trainer model integrated existing and new programs developed and initiated in Pennsylvania and Utah for training food service managers and employees in effective methods of food preparation and service. County Extension agents, public health sanitarians, and local health officers have a key role in program delivery and training. They were the target audience for the Train-the-Trainer component of the model (See Figure 1). County Cooperative Extension agents and local public health officials have many opportunities to work together to train food service managers in food safety and proper preparation of food. The impact of the training for this audience is an increased knowledge of proper food preparation procedures, access to the information needed to be certified by the state, and assurances that federal HACCP guidelines are being followed.

The second target audience, food service managers, are responsible for training employees in safe food preparation. For them, the model provides opportunities for obtaining increased knowledge of foodborne illnesses and effective methods to prevent these illnesses. The model also provides food service managers with an effective and useful training tool to develop a HACCP system in their establishment. Employees, the third target audience, are responsible for preparing and serving food in food service establishments. The model provides them with training necessary to understand how foodborne pathogens are generated and spread, and an understanding of how to develop, implement, monitor and verify a HACCP system in their respective establishments.

                            Figure 1
           Integrated Cooperative Extension HACCP-Based
                   Food Safety Training Model

               State Train-the Trainer HACCP Workshops
                                for
         Local Regulators and County Cooperative Extension Agents
                                 |
                    Local HACCP Training Workshops 
                                for
                        Food Service Managers
                                 |
                       In-house HACCP Training
                                for
                       Food Service Employees

In a broader sense, the model has the potential to positively impact numerous organizations within the food system. Organizations in the food system include for-profit enterprises such as restaurants, caterers, supermarket delicatessens, street vendors, and specialty mobile units such as those found at county fairs. Non-profit organizations that prepare food can also benefit from the model. These include churches, fire halls, granges, summer camps, food banks, and soup kitchens. Health care and educational institutions can also benefit. Hospitals, schools, prisons, senior centers, nursing homes, and day care centers need to ensure that uncontaminated food is provided to the populations they serve. Finally, the universities benefit by being able to fulfill their mission as land-grant institutions by providing food safety education and training for the population in their individual states, and enabling other organizations to meet their missions of ensuring that food service managers and employees are trained in effective food safety practices.

The project combined two complementary training programs designed to reach all levels of the food service industry. The Master Foodhandler program is an advanced program taught through the Cooperative Extension System at The Pennsylvania State University and the Implementing HACCP in Food service Operations program is a basic HACCP course taught through the Cooperative Extension System at Utah State University. These programs were delivered through workshops for Cooperative Extension agents, public health officials, food service managers, and food service employees. Various technologies were used in the training effort including interactive distance education (satellite), and on-site education using CD-ROM, videos, textbooks, and individual instruction.

Two Train-the-Trainer workshops were held during the pilot phase of the development of the training model. The first workshop was held in February 1996 in Utah. It was organized by the project team from Utah State University. Two faculty from The Pennsylvania State University conducted the workshop, which was attended by 24 individuals including county Cooperative Extension agents and public health sanitarians. The second workshop, in Pennsylvania, was organized and conducted by The Pennsylvania State University project team and was attended by 14 county Cooperative Extension agents and local health officers from Pennsylvania and West Virginia.

Knowledge gain from these workshops was measured with pre- and post-tests. Scores on the tests showed an average increase of 13.5% in terms of knowledge gained. At the end of the four-day workshop, participants took the ServSafe exam offered by the National Restaurant Association. The average score on this exam was 95% with a range of 90-98%, as all 38 individuals passed this exam. The workshop itself was evaluated with an 8-point instructor effectiveness and course evaluation form. With a top rating of 7, participant ratings for the 8 points were: organization of presentation, 6.9; audience participation encouraged, 7.0; value of information presented, 7.0; speaking ability of instructor, 6.9; instructor's ability to explain ideas to the audience, 6.9; instructor's knowledge of subject matter, 7.0; overall quality of presentation, 6.9; and overall quality of instructor, 6.9.

In June 1996, a training workshop for food service managers and public health officers/sanitarians was conducted. This workshop was based on the HACCP food safety Train-the-Trainer sessions for Cooperative Extension agents and public health officers described above. Faculty from Utah State University, The Pennsylvania State University, and the Food and Drug Administration delivered training presentations through satellite-based distance education technology, and county Cooperative Extension agents were responsible for on-site education and training presentations. Using satellite downlinks and on-site instruction, the training was conducted in Utah and Pennsylvania during three days in May and June, 1996. Five sites were used in Utah for 61 participants, and 13 sites were used in Pennsylvania for 126 participants. Table 4 provides information on the types of food service employees that attended the training workshops.

Pre- and post-tests were used to measure knowledge gain. The overall knowledge gain for the training workshop participants was 13%. The ServSafe exam was given at the end of the workshop. The average score on this exam was 87%, with a range of 74% to 95%. Again the instructor effectiveness and course evaluation form was used to measure the overall quality of the training workshop. On a scale of 1 to 7, participant ratings ranged from 6.2 to 6.7. Over 90% of the participants recommended that the training workshop be made available to others. Participants were asked to indicate the changes they intended to implement following participation in the training workshop. The most frequently mentioned changes mentioned were: implement HACCP systems, practices and procedures; improve time-temperature controls in food preparation and storage; improve sanitation practices; and share training resources with employees and colleagues with regard to HACCP implementation.

Impact of the Training

Two months after the training program, participants were surveyed regarding changes in safe handling practices that could be attributed to their participation in the training program. A total of 77 of 187 participants returned the survey for a response rate of 41%. As evident from Table 5, six safe food handling activities were positively impacted as a result of participation in the training program. The percentage who responded "plan to do and do because of program" ranged from 11.7% to 75% for the six practices. In addition, over half of the respondents indicated that they had conducted an employee training program in their establishment as a result of attending the training. The training benefited 438 employees in 35 establishments.

Conclusions

It is evident that food safety in the food service industry is an important concern. While federal and state governments are increasing their efforts in food safety in all areas of the food system, the food service industry is an especially critical point in the food system because this is increasingly where large amounts of food are prepared and consumed by large numbers of consumers. HACCP-based food safety principles can be extremely beneficial in the food service industry. The model Train-the-Trainer program for using HACCP-based food safety training in the food service industry builds on a successful partnership between Cooperative Extension specialists, public health officials, and the food service industry to promote safe food handling practices in the food service industry.

Historically, producers and processors in the food system have been easy targets for food safety regulation and inspection. Food poisoning outbreaks are usually easy to trace back to processors and producers. However, the potential for food borne illness in the food service industry is much greater because of the lack of HACCP implementation in the large number of food service establishments in communities and cities across the country. Working together at the community level, Cooperative Extension agents, public health officials, and industry trainers can deliver critically needed HACCP-based food safety training to food service managers and employees working in retail and food service establishments where local consumers purchase their food. The preparation and handling of foods according to HACCP-based food safety principles during food service is the best defense against food borne illness. The model training approach presented and evaluated here resulted in increased safe food handling practices and employee training programs as a result of participation in the program.

References

Bean, N. H. & Griffin, P. M. (1990). Foodborne disease outbreaks in the United States, 1973-1987: Pathogens, vehicles and trends. Journal of Food Protection, 53, 804-817.

Bryan, F. L. (1988). Risks of practices, procedures and processes that lead to outbreaks of foodborne diseases. Journal of Food Protection, 51, 663-673.

Council for Agricultural Science and Technology. (1995). Foodborne pathogens: Risks and consequences. Ames, IA: Task Force of the Council for Agricultural Science and Technology.

McGorry, B. (1998). Trends and needs of the food service industry. Presentation at a conference entitled The Food Industry: Pennsylvania's Opportunities for the New Millennium, Lancaster, PA.

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