Food Protection Trends - May/June 2023 - 235

portions still undergoes a high level of reduction " (22).
By contrast, Oscar concludes that " Salmonella virulence,
incidence and extent of undercooking, food consumption
behavior, and host resistance were important risk factors for
salmonellosis from ground turkey " (27, 37). These findings
suggest that consumer education on adequate handling and
cooking practices could have important impacts on public
health (22, 27, 37).
Food safety education will reduce the incidence of
foodborne illness only to the extent that it improves food
handling and cooking practices. Such improvements have
proved difficult to achieve. Observational studies have
documented limited, short-term effectiveness of educational
interventions, such as having participants watch a 3-min
video on thermometer use immediately prior to cooking
turkey burgers (9), embedding food safety instructions
in recipes that were followed by study participants (24),
and exposing survey participants to a " Don't Wash Your
Chicken! " pamphlet and display (18). The persistence
of risky food handling behaviors among many of the
participants in these studies attests to the magnitude of
the challenge facing food safety educators. A review of the
food safety education literature revealed significant gaps in
understanding how food safety interventions affect consumer
food handling behaviors and adherence to the " core four "
food safety practices (clean, separate, chill, and cook), all
of which have been found to contribute significantly to
foodborne illness risk (4). Another review of 18 randomized
controlled trials and 29 nonrandomized trials assessing
the impact of food handler training found that food safety
interventions appeared to increase food handler knowledge
but not necessarily improve behavior (39). The authors
noted that " no effect on food handler knowledge was
identified among a smaller number of studies that compared
enhanced versus standard interventions, " suggesting that
" there is currently no evidence to indicate that any one type
of educational or training intervention is superior to another
to improve food handlers' knowledge " (38).
A 2015 review of 79 studies of food safety education
interventions for consumers in developed countries,
including 17 randomized controlled trials, found that
the existing research fails to provide a strong quality of
evidence to support decision making (39). A 2022 review
of 92 articles on food safety education initiatives around
the world suggested that food safety interventions should
focus on shifting consumers' risk perceptions, rather than
simply improving knowledge of food safety practices (3).
Consumer food risk perceptions, however, reflect a complex
range of factors, including cognitive biases, and have shown
themselves to be stubbornly persistent (29).
Despite the recognized challenges with modeling
consumer behavior and its impact on Salmonella
transmission, and deep uncertainty as to whether consumer
education can meaningfully influence consumer cooking
and handling practices, a Salmonella risk assessment should
include undercooking and cross-contamination as variables
to more precisely characterize Salmonella transmission
risk and the possible impact on public heath of different
consumer level interventions. Modeled rates of undercooking
and cross-contamination should range from observed
values in the field to reduced values characteristic of a more
knowledgeable and risk-averse population.
Regulatory risk management options
The regulatory system can play an overarching role
in Salmonella management by specifying Salmonella
intervention validation and/or verification requirements,
therefore setting standards for portions or the entirety of the
poultry industry. Standards could be enforced or unenforced.
Enforceability refers to the exercise of power by a regulatory
body to impose sanctions or limitations on activities in
response to breach of a standard, which can take the form of
a prohibition on sales, production or transport, or monetary
penalties. Historically, regulatory bodies have implemented
different Salmonella standards for the poultry industries
involved in (i) live bird production, (ii) processing, and (iii)
final products. Examples of existing standards are outlined in
the following.
For live bird production, the European Union requires
member states to establish national control programs with
enforced standards for Salmonella detection in live poultry,
including requirements that any poultry breeding flocks with
detected Salmonella Enteritidis and Salmonella Typhimurium
be destroyed and that eggs from Salmonella Enteritidis
positive laying flocks destined for human consumption be
heat treated (11). Enforcement may also come in the form of
a ban on interjurisdictional transport. The National Poultry
Improvement Plan has also developed live production
standards for Salmonella Gallinarum biovars Gallinarum
and Pullorum and Salmonella Enteritidis (26). Although
participation in the program is voluntary, many states have
enforced the standards by banning shipping across state lines,
demonstrating compliance with certain National Poultry
Improvement Plan program standards.
For poultry processing, the USDA-FSIS sets unenforced
performance standards for processing establishments. The
establishments are evaluated on the basis of the prevalence of
samples that test positive for Salmonella contamination over
a 52-week moving window (34). Failing the performance
standard alone does not currently result in cessation of
production, unless FSIS identifies some further basis for
regulatory action (34).
For final product standards, the European Union has
set a " zero-tolerance " enforced standard for the detection
of Salmonella Typhimurium and Salmonella Enteritidis in
fresh poultry meat products (on the basis of testing of five
25-g samples) on the market for the entire shelf life (12).
The Canadian Food Inspection Agency has also provided
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