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Hand hygiene is the single most important intervention to reduce the risk of acquiring infection. All healthcare workers and healthcare students have a responsibility to prevent transmission of infection. The purpose of this study is to investigate students’ attitudes to hand hygiene following university-based education and practice placement. Students attended a lecture, completed an e-learning module, participated in a practical session using a ultra-violet light hand inspection cabinet and engaged in clinical placement.

In all, 64 students participated in a multimodal hand hygiene education programme before clinical placement, with each student completing an in-class questionnaire after placement. Data were analysed using descriptive and comparative statistics. Students rated educational methods that had most influence on them. Their preference was for a practical hand hygiene education session. Students were also influenced by the therapist they were on placement with. They were least influenced by the didactic college presentation.

This study highlights that students may be influenced by different methods of education at different stages in their course and that placement may be an important influencing factor in the earlier years of occupational therapy education.

This study highlights the importance of the availability of a multimodal educational approach and clinical placement to promote increased compliance with hand hygiene amongst students.

University healthcare course curricula should include multimodal approaches to the education of hand hygiene. While hand hygiene e-learning modules are beneficial, they should be used in conjunction with a multimodal educational strategy that incorporates practical elements. The influence of the therapist on a students’ behaviour should be utilised to improve both student and professionals hand hygiene adherence.

Original piece of work that is not widely discussed in Occupational Therapy literature.

Appropriate hand hygiene technique is a simple and effective method to reduce cross contamination and transmission of foodborne pathogens. The purpose of this paper is to investigate the frequency of hand hygiene activities among food handlers and consumers in fast food restaurants (FFRs).

A total of 25 FFRs and cafes were visited between May and August 2017 in North West England. A hand hygiene observational tool was adapted and modified from previous studies. The observational tool was designed to record 30 sequential hand activities of consumers and employees. Each transaction consisted of an observed action (e.g. touch with bare hands), object (e.g. exposed ready-to-eat (RTE) foods) and observed hand hygiene practice (e.g. handwashing or cleaning with wipes or sanitisers). Adenosine triphosphate (ATP) swabs of hand-contact surfaces of restaurants’ restrooms were carried out.

Findings revealed that both food handlers and consumers have low-hand hygiene compliance rate in FFRs. Consumers were more likely to clean their hands with napkins after handling exposed RTE food. Food handlers were observed to change into new gloves without washing their hands before handling exposed RTE food. The mean results for all hand-contact surfaces in restrooms were higher than 30 Relative Light Units indicating unhygienic surfaces. Male restroom exit doors’ ATP levels were significantly higher than females.

This study revealed the lack of hand hygiene practices among food handlers and consumers at FFRs and cafes. Restroom hand-contact surfaces revealed high ATP level indicating unhygienic surfaces. This can potentially re-contaminate washed hands upon touching unhygienic surface (e.g. exit door panel/handle) when leaving the restroom.

Purpose – Although hand hygiene is seen as the most important method to prevent the transmission of hospital associated infection in the UK, hand hygiene compliance rates appear to remain poor. This research aims to assess the degree to which social marketing methodology can be adopted by a particular organisation to promote hand hygiene compliance. Design/methodology/approach – The research design is based on a conceptual framework developed from analysis of social marketing literature. Data collection involved taped interviews given by nursing staff working within a specific Hospital Directorate in Manchester, England. Supplementary data were obtained from archival records of the hand hygiene compliance rates. Findings – Findings highlighted gaps in the Directorate's approach to the promotion of hand hygiene compared to what could be using social marketing methodology. Respondents highlighted how the Directorate failed to fully optimise resources required to endorse hand hygiene practice and this resulted in poorer compliance. Practical implications – From the experiences and events documented, the study suggests how the emergent phenomena could be utilised by the Directorate to apply a social marketing approach which could positively influence hand hygiene compliance. Originality/value – The paper seeks to explore the use of social marketing in nursing to promote hand hygiene compliance and offer a conceptual framework that provides a way of measuring the strength of the impact that social marketing methodology could have.

Observations of food handlers’ practices have many uses. Describes the use of a notational analysis technique to monitor and analyse specific food safety actions of caterers. A total of 115 food handlers from 29 catering businesses were observed carrying out 31,050 food preparation and hygiene actions in their workplace. Notational analysis was found to offer little advantage, compared to traditional observation methods. However, this technique did allow tracking of sequential events and was successful in identifying and recording a greater number of cross‐contamination events than would have been highlighted using traditional approaches. The results demonstrated that, based on hygiene guidelines, food handlers were required to implement de‐contamination actions on a large number of occasions. These de‐contamination actions were frequently inadequately conducted. To improve standards of food hygiene in catering there is a need to minimise the requirements for de‐contamination activities thereby reducing the potential for cross‐contamination.

The aim of this study was to evaluate the good manufacturing practices in meal services in public schools and day care centres in Baixada Santista, Brazil using a health risk classification.

A total of 59 public schools and day care centres in nine municipalities of Baixada Santista – Brazil were randomly selected. The sanitary conditions were evaluated by applying a validated checklist specific to school meal service. The questions were scored according to the health risks detected. A percentage of conformity to good manufacturing practices was calculated, than schools and day care centres were classified according to health risk in relation to the scores obtained for each thematic area addressed in the checklist and in relation to the overall score.

It was observed that 62 per cent of the schools were classified as average health risk failing to comply with Brazilian legislation on food safety rules. The thematic areas that showed lower percentage of conformity to good manufacturing practices were: hand hygiene (33.9 per cent), pest control (3.4 per cent), food handlers (62.4 per cent) and food hygiene (65.4 per cent). The school meal service of day care centres presented higher conformity in the hand hygiene (p<0.01) and the environmental sanitation (p<0.05) than elementary schools.

The data observed in our study highlight the need of an effective system to monitor and evaluate the hygienic sanitary conditions in Brazil. The implementation of HACCP system may be an option with good potential to produce safer meals in school environment, nevertheless, the prerequisite program must be implemented first. Professionals with expertise in food safety can act as consultants to the school meal service and may use the data from this study as a benchmark for interventions.

This paper contain new information related the state food safety practices of Brazilian school meal service. It also presents the use of scores to determine risk. The use of health risk is a novel way to evaluate the food safety practices in school meals facilitating the implementation of corrective measures.

The purpose of this study is to explore food safety measures in catering and special event programs, especially with respect to the knowledge and implementation of knowledge of food handlers in the catering sector in the USA.

A quantitative approach was utilized in this study. A questionnaire was distributed to 557 respondents, representing over 40 chapters in the National Association of Catering Executives. The questionnaire was divided into three sections of food safety (food handling, equipment, and personal hygiene). This study utilized t‐tests and ANOVA to test for differences between gender, training, management status, and employment status with regard to food safety knowledge and practices.

Results suggested that employees in the catering industry who work part‐time need more training and development. Management was seen as more knowledgeable than non‐management personnel and was seen to have more training. Overall the study found that there is a need to focus on training for employees, with even greater emphasis for new employees.

The results of this study provide significant evidence that greater emphasis must take place to require proper training of all employees in the catering sector. An educational training program that focuses on the catering sector can be developed by utilizing the usable factors gained from this research.

The present study provides a national survey representing a large geographic area of the USA, and focuses on catering servers, front‐line staff, and management in the special event industry. This study also combines the safety issues of equipment, personal hygiene, and food handling into one study as a whole to examine the overall knowledge of catering employees in the industry.

The main objective of this study is to find out how food handlers in catering establishments perceive ensuring food safety and which problems they meet along the way.

Using a qualitative approach, ten food handlers in Slovenian catering facilities were included in the case study. A semi-structured approach was applied to provide a deeper insight into food safety barriers perceived by respondents. Participants first read short fictitious newspaper news about a foodborne disease at a tourist farm, which served as a starting point.

The results demonstrate barriers which most often originate in a lack of knowledge (e.g. improper food safety training, incorrect food safety knowledge testing, knowledge and maintaining of CCPs), shortage of food hygiene skills (e.g. handwashing, food defrosting) and weak work satisfaction (e.g. insufficient payment, poor interpersonal relationships and weak motivation). Food safety knowledge and consequently training methods were found to be the biggest barrier for the efficiency of the HACCP system in practice.

Due to the small sample, the results cannot be generalised to the entire population of food handlers in Slovenia.

The results indicate weaknesses in food safety knowledge among professional food handlers.

The study provides a deeper insight into implicit opinions of ten food handlers in catering facilities regarding barriers in providing food safety, their knowledge and behaviour in their work with food.

After completion of this case study, students should be able to reflect on the concept of creating shared value and then determine whether Shesha Geza can be referred to as a shared value company and, if so, what level of shared value it demonstrates. They will be able to subjectively and objectively understand the possible meaning of when a social enterprise embarks on a strategy to scale the organisation; clarity of construct will enable managers to better plan and successfully implement scalability goals. They will also be able to recognise, once scalability goals are better understood and planned, that there are a multitude of intra-organisational levers and drivers that may contribute to the organisation’s ability to scale its operations, which are related to specific internal organisational capabilities of social enterprise companies. In addition, there are situational factors that may affect the business either positively or negatively in relation to the scalability success of which a social entrepreneur should be aware.

In April 2021, Dean Boniface and his brother, Roger, had just signed off a new informational video for their Shesha Geza innovation, a low-cost hand-washing station designed for use at commuter hubs and high-traffic areas across the African continent. The unit used diluted chlorine instead of alcohol-based sanitisers to ensure a more expedient and sustainable solution, one better suited to Africa’s logistical challenges. Boniface, the co-founder of Vue Architects, had conceptualised the idea of the hand-washing hub during South African Government’s enforced COVID-19 lockdown from 27 March 2020 to 1 May 2020. Shesha Geza’s speed to market was a key contributor to its successful response in solving a critical social need. Throughout 2020, Boniface and his team built successful partnerships and secured an impressive order pipeline within a short span. Export opportunities across Africa, installations and maintenance of a sizable number of units across South Africa and the development of a behavioural change programme aimed at hygiene in schools kept the momentum going in the business. However, a year into the business and the future sustainability of a crisis–response enterprise and the ability of a shared value enterprise to scale were playing on Boniface’s mind. He was worried about the future of the small resource-constrained business. Holding onto the mental map of everything the team had learned over the past year, Boniface was confident about one thing: “All the programmes we build around Shesha Geza are value-adds to our current business. Hand hygiene will not diminish after COVID-19; it will continue to be an important social issue across the African continent.”

This case is intended for discussion in post-graduate-level courses such as an MBA and in postgraduate courses focused on business model innovation or on creating shared value. This case is suitable for use in the environment of business courses in relation to environmental situational factors that may affect the ability to scale social enterprises or strategic implementation courses, considering the still pervasive challenge of scaling increasingly important social impact enterprises.

Teaching notes are available for educators only.

CSS 11: Strategy.

The Edmonton Zone, one of five Zones in Alberta Health Services (the health system in the province of Alberta, Canada), established a quality management framework (QMF) as a means to improve the delivery of high quality health care in the spring of 2014. The purpose of this research study was to understand the factors that facilitated or hindered the implementation of a quality improvement (QI) initiative for hand hygiene led by a newly formed frontline unit quality council (UQC), a part of the QMF, based out of the pediatric intensive care unit (PICU) at the Stollery Children’s Hospital in the Edmonton Zone. This research will provide an understanding of the newly established QMF in the Edmonton Zone and the factors needed to foster the ongoing development of frontline UQC that do improvement work as part of their daily routine.

Using a qualitative case study research design data were collected using semi-structured open-ended interviews with six key stakeholders (one registered nurse, one physician, one patient case manager, medical director for QI, clinical QI consultant and director of clinical QI) involved in UQC at the PICU.

Individual, unit and organizational level factors were identified as influencing the function of the UQC. Leadership and work culture were the key facilitating factors to success and lack of QI training and personnel/dedicated time were perceived barriers to completing the QI initiative.

The findings from this research illustrate that frontline UQC are able to impact positive sustained change early in their establishment as part of a larger QMF. It is important, however, for the system to foster ongoing development of capacity and capability of these frontline UQC to ensure sustained success of the larger systems change.

Food handlers are often a major source of norovirus transmission in the UK. Considering key behaviours of food handlers that lead to norovirus transmission would help prevent the spread. The purpose of this paper is to examine the key risk behaviours of food handlers that lead to norovirus transmission, and to recognise important prevention strategies.

A narrative review of the literature summarising the main risk behaviours of food handlers that lead to norovirus transmission.

Suboptimal personal hygiene such as poor hand washing compliance, working while ill or returning to work too early and not adhering to cleaning and disinfecting protocols were the main risk behaviours of food handlers identified. To prevent the transmission of norovirus within UK food establishments, environmental barriers such as limited access to cleaning products and facilities, workload and pay concerns should be resolved, and a theory-based approach should be used when developing training programmes to improve food handlers’ knowledge and behaviour. Systematic monitoring adhered to ensure food safety protocols should be regularly carried out.

A limited number of qualitative studies assessing food handlers’ attitudes and beliefs concerning norovirus transmission are available. Gaining more detailed and in-depth information on what food handlers perceive are the main barriers when it comes to adhering to food safety guidelines, would aid in the development of effective norovirus mitigation strategies.

This review discusses the main risk behaviours of food handlers associated with norovirus transmission. It highlights the need for more qualitative research on exploring the attitudes and beliefs of food handlers with regard to norovirus transmission.