Properly executed handwashing by food employees can greatly minimize the risk of transmitting foodborne pathogens to food and food contact surfaces in restaurants. However, food employee handwashing is often not done correctly nor does it occur as often as it should. The purpose of this study was to assess the relative impact of 1) the convenience and accessibility of handwashing facilities; 2) the maintenance of handwashing supplies, 3) multi-unit status, 4) having a Certified Food Protection Manager, and 5) having a Food Safety Management System on compliance with proper handwashing. Results showed marked differences in handwashing behaviors between fast-food and full-service restaurants. Forty-five percent of fast-food restaurants and 57% of full-service restaurants were found to be out of compliance for washing hands correctly. Fifty-seven percent of fast-food establishments and 78% of full-service establishments were out-of-compliance for employee hands being washed when required. Logistic regression results point toward the benefits of accessibility and maintenance of the handwashing sink and food establishments having a Food Safety Management System to increase the likelihood of employees washing hands when they are supposed to and washing them correctly when they do.
This case represents a rare fulminant course of fried-rice associated food poisoning in an immunocompetent person due to pre-formed exotoxin produced by Bacillus cereus, with severe manifestations of sepsis, including multi-organ (hepatic, renal, cardiac, respiratory and neurological) failure, shock, metabolic acidosis, rhabdomyolysis and coagulopathy. Despite maximal supportive measures (continuous renal replacement therapy, plasmapheresis, N-acetylcysteine infusion and blood products, and broad-spectrum antimicrobials) and input from a multidisciplinary team (consisting of infectious diseases, intensive care, gastroenterology, surgery, toxicology, immunology and haematology), mortality resulted. This case is the first to use whole genome sequencing techniques to confirm the toxigenic potential of B. cereus. It has important implications for food preparation and storage, particularly given its occurrence in home isolation during the COVID-19 pandemic.




