Survey of Observed Vendor Food- handling Practices at Farmers

PEER-REVIEWED ARTICLE

Lorraine McIntyre,1* Leyla Karden,1,2 Sion Shyng1 and Kevin Allen2

Food Protection Trends, Vol 34, No. 6, p.397-408 Copyright©2014, International Association for Food Protection 6200 Aurora Ave., Suite 200W, Des Moines, IA 50322-2864

1

Food Protection, Environmental Health Services, BC Centre for Disease Control, 655 West 12th Ave., Vancouver, British Columbia, Canada V5Z 4R4;

2

Food, Nutrition and Health Program, University of British Columbia, 2205 East Mall, Vancouver, British Columbia, Canada V6T 1Z4

Survey of Observed Vendor Foodhandling Practices at Farmers’ Markets in British Columbia, Canada ABSTRACT The purpose of this study was to assess food safety practices and support systems of farmers’ markets in British Columbia, Canada. Observations of food vendor stall sites, hand washing, samples offered for tasting, temperature control and preserved items were assessed for compliance with provincial guidelines. Support systems were evaluated by use of a survey tool and through key informant interviews of farmers’ market managers. Seven farmers’ markets and 21 vendors were observed to have good general site compliance. Six markets had issues with parking and with pets brought by visitors; five had managers on site; and four had a main handwashing station. No hand washing occurred during more than six hours of direct observation, gloves were not used appropriately, many vendors handled money and food without washing their hands, offered samples for tasting incorrectly or did not have the required hand washing stations at their stall. Although cold storage temperatures were maintained mechanically or with ice packs, four vendors did not have their food under

effective temperature control. Three market managers expressed food safety concerns that included poor food safety practices, poor hand washing and food/ money cross-contamination issues. Although most vendors and markets comply with written food safety guideline requirements, direct observation suggests that improvements are required in the areas of hand washing and temperature control.

Introduction The increasing popularity of farmers’ markets is based on markets offering consumers high quality, local, fresh seasonal foods obtained directly from farmers and producers. These values,“local” and “fresh,” along with the perceived value of purchasing high quality products, are cited by consumers shopping at farmers’ markets (3, 13), which have been increasing in Canada and North America since the 1970s, as consumers look for alternative choices to industrialized processed supermarket foods (4). In British Columbia (BC), the number of farmers’ markets has doubled in the past decade, with over 125

Corresponding author: Phone: +1 604.707.2458; Fax: +1 604.707.2441; E-mail: [email protected]

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farmers’ markets representing more than 3000 vendors reported in 2013 (5, 12). The majority can be defined as temporary food establishments, operating seasonally from spring to fall, although, a subset of winter markets operate year-round in BC. According to the BC Association of Farmers’ Markets, a farmers’ market must be comprised of a majority of vendors who make, bake, grow or raise the products they sell, and they must have a minimum of six vendors and operate two or more hours per day in a minimum of four markets per year (5). A typical farmers’ market in BC would have between 40 to 99 vendors and operate at least once per week between May and October (6). With the increased popularity of farmers’ markets, their sales have similarly increased; between 2006 and 2012, revenues from direct sales rose from $46 million to $113 million (Canadian) dollars (12). As farmers’ markets have proliferated, the foods and products sold in them have also increased in complexity. Fresh fruits, vegetables, and plants are only a few of the commodities

now sold in farmers’ markets. Non-food products, categorized under arts and crafts, bath, beauty and pet items, are sold alongside more traditional items such as baked goods, ready-to-eat (RTE) foods, ethnic foods, fresh and frozen meat, fish, dairy products, and a variety of preserved items. Foods sold at farmers’ markets may be grown at the farm, made at home, made in commercial kitchens or manufactured in a processing plant. Food safety issues may arise anywhere along the continuum from growing and preparing the food through to consumption by the consumer. These steps include growing, harvesting, purchasing of ingredients, preparation (home, commercial kitchen, processing plant), transportation to and from the market, storage, display, sales to customers, waste disposal, transport by the consumer to the home, storage at home, and consumption. When consumers were asked to rank various statements about foods from farmers’ markets, one survey found the top two beliefs were that

FIGURE 1. Locations of farmers’ markets selected for observation study

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TABLE 1. List of food safety requirements and observational checklist for five food safety categories in BC farmers’ markets

Category examined

General compliance

Guideline requirement

-- Sign displayed that states food was prepared in a kitchen not inspected by a regulatory authority -- Food products protected from contamination from pets and during storage and display at the market -- Surfaces made of easily cleanable materials, maintained and cleaned as necessary

-- If sampling for tasting is provided then, cleaning of hands and utensils (by vendor), provided by either Hand washing

Samples for tasting

-- running water, soap in a dispenser and paper towels or, -- Use of hand wipes for prepackaged food or whole fresh fruits and vegetables satisfactory or, -- Side by side vendors may share a hand-washing station

-- Samples are portioned and packaged at the home kitchen (except fruits and vegetables)

Additional requirements and detail under MarketSafe course

Farmers’ market site checklist (Choice check-boxes for Yes, No, Not observed, Not Applicable and Comments)

-- Adequate stall maintenance and set up - -No standing water on the floor -- Storage of foods above the ground -- Covered stall; protect food from dust, wind, rain and sun -- Presence of sneeze guard -- Clean attire worn by vendor

•• Stall Stall set up and maintenance adequate •• Is Is there any standing water on the floor of the stall? •• Are Are any food products stored on the floor/ground? •• Is Is the stall covered for sunlight and rain? •• Are Are the coolers clean? •• Are Are pets observed in the market? •• Is Is the vendor’s attire clean? •• Is Is there a sneeze guard to protect the foods from contaminants while on display?

-- A source of warm potable water -- A free running spot -- Liquid soap in a dispenser -- Single use paper towels -- A container for waste water - Gloves may be used, with • Gloves appropriate handwashing and changing

• Hand washing is present • Hand •• Potable Potable running water available •• Faucet Faucet type •• Warm Warm water •• Waste Waste water collection container •• Liquid Liquid Soap •• Paper Paper towels •• Gloves Gloves being used •• Gloves Gloves in adequate supply •• Gloves Gloves changed between each task •• Only Only one person handles food and money

-- Use of squeeze bottles for dispensing sauces -- Portions are provided in single use containers (Dixie© cups, toothpicks, spoons) - -Cleaned tongs are used to give samples directly to customer -- Display samples on clean food tray (wax paper, food grade plastic wrap) -- Hand-washing between tasks -- Keep samples protected and under control

• Samples are offered • Samples •• Offered Offered by

• the vendor (tongs or gloves), • •• in a paper cup, •• with a tooth pick, •• in a squeeze bottle

• Pre-portioned and pre-packaged • Pre-portioned •• Portioned Portioned at the market •• Food Food contact surfaces nonporous and washable •• Sanitization Sanitization frequency •• Type Type and concentration of the sanitizer •• Handwashing Handwashing is being done •• Antibacterial Antibacterial wipes are used Table 1 continued on next page

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TABLE 1. List of food safety requirements and observational checklist for five food safety categories in BC farmers’ markets (cont.)

Guideline requirement

Additional requirements and detail under MarketSafe course

Farmers’ market site checklist (Choice check-boxes for Yes, No, Not observed, Not Applicable and Comments)

-- Eggs are stored at 4°C during transportation and storage/ display at the market -- All higher risk foods must be maintained at 4°C or colder from the point of packaging through to sale sale to tothe theconsumer consume -- Meat, poultry and fish products must be kept frozen

-- Refrigerated foods kept below 4°C -- Frozen foods kept frozen -- Foods kept out of the danger zone temperature (4°C to 60°C) -- Use of food grade ice packs and/or ice made potable and potable waterofice water used when when coolerscoolers used (during (during transportation) transportation) Coolers are kept closed out of - Coolers are keptand closed direct sunlight and out of direct sunlight -- Temperatures monitored

• Mechanical cooling system in use • Mechanical •• Cooler Cooler box in use •• Mechanical Mechanical freezer available for frozen products •• Coolers Coolers used for frozen products •• Thermometer Thermometer available and in place •• Thermometer Thermometer cleaned/sanitized after each use •• Ice Ice made of potable water •• Food-grade Food-grade ice packs

-- If foods are packed in jars: only proper sealing jars (e.g. Mason-type) should be used -- vendor responsible to provide evidence that a food is lower risk - -for each food item, indicate location of processing/packaging (e.g. commercial establishment including address)

-- Complete labeling (producer’s name and contact information, a “packed on” date, storage information, the list of ingredients) -- Available documentation if PHF

•• Products Products have appropriate labeling: name, contact info, ingredients, allergens, storage info •• Made Made in approved premises •• If If PHF, documentation available on site (Aw, pH)

Category examined

Temperature control

Preserved items

foods were of higher quality and that there was less chance of foodborne disease from foods purchased from farmers’ markets (13). Foodborne illnesses arising from foods purchased at farmers’ markets, although rare, do occur. In Canada, raw milk cheese purchased at farmers’ markets in Edmonton, Alberta and manufactured at a licensed dairy processing plant was responsible for at least 12 Escherichia coli O157:H7 illnesses in 2002 and 2003 (15). In the U.S., at least three documented outbreaks have been linked to farmers’ market foods. Guacamole, salsa and uncooked tamales prepared in restaurants and sold in farmers’ markets in Iowa caused 44 illnesses, including five hospitalizations, in 2010 (22). It was concluded that poor preparation and poor food temperature control at the farmers’ markets had contributed to the outbreak (22). Cantaloupe samples offered for tasting in Colorado (2000) and strawberries sold at farmers’ markets in Oregon (2011) caused 29 illnesses, nine hospitalizations and one death (11). 400


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Foodborne illnesses are known to be caused by improper safe food-handling food handling practices such as poor personal hygiene and hand washing, inappropriate temperature control of potentially hazardous foods (PHFs), and cross-contamination that leads to RTE foods becoming contaminated with foodborne pathogens (25, 26). Each year in BC over 550,000 people, or one in eight individuals, become ill with domestically acquired foodborne illness (8). Farmers’ market operations are characterized by a lack of facilities and infrastructure compared to retail grocery stores, creating opportunities for preventable hygiene and food contamination issues. Farmers’ market managers are responsible for coordinating andand approving vendors. This are responsible for coordinating approving vendors. task includes ensuring that the stalls meet This task includes ensuring thatsite theand sitevendor and vendor basic requirements and reviewing foodvendor applications. stalls meet basic requirements andvendor reviewing Foodapplications. safety guidance for managers and vendors selling food food Food safety guidance for managers products at farmers’ markets are outlined in two documents. and vendors selling food products at farmers’ markets Oneoutlined is the Temporary Food Market guidelines are in two documents. One(TFM) is the Temporary

TABLE 2. Key informant interview questions and survey questions of farmers’ market managers How do you communicate with your vendors? What is your biggest challenge when managing the market?

Farmers’ market managers’ key informant interview questions

Do you have enough time to do your job, and how many hours per week do you spend managing your market? Suggest one thing that would give you more support or make your job easier? What is the most important food safety issue at your market? Have you ever had difficulty distinguishing between a PHF and non-PHF food?

Farmers’ market managers’ survey questions (5 scale likert (5-point likertresponse scale) choice)

When you have a question about how to manage the market, who do you ask for help? Chose from most likely to least likely (or does not apply) from the following choices: BC Association of Farmers’ Markets, Environmental Health Officer, operations manager, vendor and friend. Rate your satisfaction with different types of information provided to you. Choose from excellent to poor (or does not apply) from the following choices: meetings with regional health authorities, meetings with your local farmers’ markets, meetings with the BC Centre for Disease Control, guidelines specific for your farmers’ markets, brochures for food safety, provincial temporary food market guidelines or workshops

Food Market managed by government (TFM) guidelines health agencies managed(7). by government The second is an instructor health agencies taught (7). The MarketSafe second is course an instructor and workbook taught designed forcourse MarketSafe farmers and and workbook producers designed (9, 14).for Most farmers farmers’ and market managers producers (9, 14). have Most received farmers’ food market safetymanagers education have from provincially received foodoffered safety food education safetyfrom courses provincially such as FoodSafe offered or MarketSafe, food safety courses although such this as FOODSAFE is not a requirement. or MarketSafe, This is in although contrastthis to is provincial not a requirement. BC requirements This is for in contrast food safety to training provincial of BC owners requirements and operators for food of food safety service training premises, of where ownersatand least operators one person of food on shift service must premises, have approved where at food safety least one training person (2). on Thus, shift must farmers’ havemarket approved managers food safety may have training diverse (2). backgrounds Thus, farmers’ and market abilities managers to recognize may have food safety diversehazards, backgrounds such asand those abilities related to to recognize requirements food safety that foods hazards, be such protected as those from related contamination to requirements and bethat temperature foods controlled be protected and from thatcontamination vendors practice andbasic be temperature hygiene such as controlled hand washing. and that The vendors purpose practice of our basic studyhygiene was to observe such the as hand foodwashing. safety behaviors The purpose of food of our vendors studybywas assessing to observe their the food compliance safety behaviors with food ofsafety food vendors guidancebyand assessing to assess existing their compliance support structures with food in safety BC farmers’ guidancemarkets and to assess through aexisting combination supportofstructures direct observation, in BC farmers’ surveymarkets and interview through of a combination market managers. of direct observation, survey and interview of market managers.

MATERIALS AND METHODS Farmers’ market site and vendor selection Seven farmers’ market sites were selected from two geographically distinct areas in BC, Metro Vancouver and northern BC (Fig. 1). Three vendors from each farmers’ market were observed. Vendors were selected if they offered foods for sale, if they were handling RTE foods (e.g., baked goods), PHFs requiring temperature control (cheese, meats, fish, and eggs), foods requiring labelling (jams/jellies and pickled products) and/or foods that were being offered for tasting. Observational study of farmers’ market vendors and of compliance assessment with food safety to food guidelines safety guidelines An observational checklist was developed based on the food safety requirements for vendors described in the TFM guideline and MarketSafe educational course (Table 1). The checklist was reviewed with local Environmental Health Officers to target five food safety areas: (1) general vendor site compliance; (2) handwashing; (3) samples offered for tasting; (4) temperature control, and (5) preserved

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TABLE 3. Compliance of vendors with requirements for five food safety categories in BC farmers’ markets Category examined

General compliance

Hand Hand washing washing

No. markets

7

55

No. vendors

21

11 11

Requirements

55

11 11

90.4

Food stored appropriately appropriately Food products products are are stored off off the the ground ground

47.6a 47.6a

Vendors Vendors attire attire clean clean

100 100

Coolers Coolers clean clean Sneeze guard Sneeze guard is is used used to to protect protect displayed foods displayed foods Presence Presence of of hand-washing hand-washing station station

61.9 61.9

38.1 38.1

28.6b 28.6b

33.3 33.3

Complete Complete hand-washing hand-washing supplies supplies Appropriate use of gloves Appropriate use of gloves

Portioning Portioning before before the the market market Serving Serving methods methods to to customers customers Hand-washing Hand-washing between between tasks tasks Appropriate Appropriate food food contact contact surfaces surfaces

Temperature Temperature control control

77

10 10

Mechanical Mechanical cooling cooling Cooler Cooler No No cooling cooling system system Food temperature Food temperature under under control control Appropriate Appropriate labeling labeling No No PHF PHF are are offered offered for for sale sale

Preserved Preserved items items

33

33

Not used or Not applicable

Stall set-up adequate, stall covered, no standing water on floor

One One person person handling handling money money and and food food Portioning Portioning at at the the market market Samples Samples for for tasting tasting

Compliant or % correct

Made Made at at home home Made Made at at commercial commercial premise premise Documentation Documentation available available

63.6 63.6 45.5 45.5 00 90.0 90.0

63.6 63.6

54.5 54.5 45.5 45.5 36.3 36.3 00 100 100 60 60 30 30 10 10 60 60 100 100 100 100 100 100 00 66 66

value vendors with with coolers coolers stored stored on on ground ground value includes includes three three vendors value vendors who who did did not not use use sneeze sneeze guards guards but but sold sold pre-packaged pre-packaged foods foods value includes includes two two vendors

aa

bb

items. This study was approved by the University of British Columbia Behavioral Research Ethics Board. Permission from market managers was sought in advance to talk to vendors and to take photos at the market before the site visit. Each vendor was observed for approximately 15 to 20 minutes to witness several food safety tasks as customers were being served. Vendors were not aware they were being observed, and results were recorded away from the vendor sites to minimize the Hawthorne effect (1). 402


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Vendors were approached after the observation period, when no customers were present, to assess general site compliance, temperature control, and records. Information was collected by interviewing the vendor and observing temperatures on vendor thermometers, if present. Permission was acquired from vendors to collect this information and to take photos. Site assessments of all vendors were tallied, and proportions who correctly followed the guidelines were determined. Issues noted during initial observation were also recorded.

a

b

c

d

e

f

a. Good practice for offering samples for tasting by a cheese vendor. Toothpicks and cups are used for providing samples. Samples have been cut and pre-portioned before the market. b. Poor practice for offering samples for tasting by a cheese vendor. Toothpicks are jammed together in containers. Cross-contamination between gloved and ungloved hand in upper left of photo frame. Samples are being portioned at the market on a single cutting board with potential for cross-contamination between cheese samples. c. Good practice for reducing cross-contamination in baked goods. Goods are separately packaged. d. Partially poor practice to prevent cross-contamination in baked goods. A sneeze guard prevents cross-contamination of goods (right); however, goods placed in wicker bins are exposed to consumer handling (left), and uncovered goods in tray exposed to other sources of contamination, such as pests (back) e. Poor practice for temperature control of baked goods. The pastries depicted have a dairy (milk) topping and are displayed without refrigeration. (Ambient temperature recorded as 24°C (76°F). f. Partially poor practice for temperature control of eggs. The vendor has a refrigerator for storage of eggs (right back); however, several cartons of eggs are left on the display table without refrigeration. FIGURE 2. Observed good and poor practices at farmers’ markets

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Determining support structures and concerns of farmers’ markets managers A general site survey was conducted at each farmers’ market to assess whether a main hand-washing station was provided for vendors and consumers, to observe whether pets were found in the market, and to assess the availability of parking. Key informant interviews of farmers’ market managers, arranged prior to the site visit, were also conducted. Interviews with managers were conducted during market operations but timed to be after market set-up to minimize interview stress. Additional information about market facilities and supports was collected by an E-mail survey of farmers’ market managers and vendors on market facilities and supports described elsewhere (Table 2) (17). RESULTS Observational assessments of vendors The most common vendors chosen for inclusion in this study were those selling PHFs requiring temperature control (42.9%). These included four vendors selling eggs, three selling cheese, and one each selling frozen fish or meat products. Vendors selling pre-prepared baked goods (38%) and preserves (14.3%), as well as one vendor selling fresh vegetables, were also assessed. All BC farmers’ market vendors in this study were assessed for their compliance with provincial guidelines for general site safety (n = 21) and for one or more four food safety areas (Table 3). We found most vendor stalls were generally tidy and covered for protection from rain and sun; vendors’ coolers and attire were observed to be clean, and all vendors appeared to have appropriate washable and non-porous food contact surfaces at their stalls. However, 11 (52.5%) vendors stored food pallets and boxes directly on the ground, nine (42.9%) vendors either did not use a sneeze guard to protect uncovered foods or did not sell pre-packaged foods, and four of 11 (36.4%) vendors providing samples for tasting did not have the required hand-washing station at their stall. Two of seven (28.6%) vendors with a hand-washing station had incomplete hand-washing supplies. One vendor who did not have a hand-washing station had two people working at the stall, one handling food and the other handling money. The majority of vendors (90.9%) were observed to handle both food and money, and although four vendors used gloves, none were using them correctly (i.e., gloves were not changed between tasks; bare hand for handling money and gloved hand for handling food were touching and/or used for the same task). When vendors offering samples for tasting to the public were observed, no hand washing was observed between tasks during the entire observation period. Slightly more vendors portioned samples at the market (n = 6, 54.5%) than at home (n = 5, 45.5%); however, only four were observed to correctly serve samples for tasting to the public. Compliance with temperature control was assessed in ten vendors. One vendor selling baked goods

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with whipped cream topping did not use a cooler on site, all goods were on display, and ambient temperature recorded on that day was 24°C. Two egg vendors had more than five boxes of eggs sitting outside, and a frozen fish vendor had left the cooler open, with visible thawing of frozen product observed. One of ten vendors had a thermometer on site to assess equipment temperature. Two of three vendors selling non-PHF preserves were able to provide documentation demonstrating that their products were low risk (i.e., acidic pH values), and all vendors selling preserves had complete and appropriate labelling on products they had prepared at home. Vendor stalls depicting good and poor compliance with guidelines are illustrated in Fig. 2. Description of farmers’ markets observed and farmers’ market manager concern The number of markets visited in each geographic area, northern and metro-Vancouver, represent between 14 to 15% of the total number of markets in those areas. The number of vendors present in the seven farmers’ markets in this study varied from nine to 125 (median 35) vendors. General site observational assessments revealed that approximately half (57%) had main hand washing stations available to consumers and vendors, pets were observed in all markets except the one that displayed signs saying pets were not allowed, and parking availability was an issue for the majority of markets (85.7%). In the E-mail survey of BC farmers’ markets managers and vendors, 60% reported they had access to electricity and 70% had public washrooms. Hand-washing facilities were available at less than half of the markets (42%), with even fewer (22%) equipped with warm water. Five of seven farmers’ market managers were available onsite for interview during market visits. A manager assistant and board member were present at the remaining two markets. During key informant interviews, a variety of issues, challenges, and supports were identified (Fig. 3). Common concerns included wanting more support from their local municipality and increasing public attendance. Most market managers had no specific food safety issues to report, although three expressed concerns about temperature control of foods, poor food handling and poor hand washing by some vendors. Market managers communicate with their vendors most often via E-mail, and at meetings and annual general meetings, although direct contact by phone and face-toface is also required in some areas. When market managers were surveyed as to whom they most often contacted for assistance, they ranked their operations manager as the most likely person to contact, followed by their association, and other vendors; environmental health officers were the least likely to be contacted. Survey information found guidelines and information provided by their own farmers’ market was the most useful for managers and vendors (57%, n = 132), followed by meetings held at farmers’ markets (32%) and the temporary food market guidelines (25%).

Food safety issues

None Temp control of foods Hand-washing, poor food handling

Supports needed

Lack of volunteers Lack of produce variety Location, more parking From municipality Food safety info

Biggest challanges

Financial Lack of space, power, washrooms Municipality location Getting people to attend

Communication

Newsletter or bulletins E-mail During season meeting Direct (phone call/face-to-face) Before season metting Annual general meeting 0

1

2

3

4

5

6

7

FIGURE farmers’market marketmanagers managers FIGURE3.3. Concerns Concerns and and issues of farmers’

temporary food market guidelines (25%). DISCUSSION DISCUSSION Although good knowledge and understanding of food safety principles were demonstrated in survey Although good knowledge and understanding of food results of farmers’ market managers and vendors whenof safety principles were demonstrated in survey results they weremarket queried about hand temperature farmers’ managers and washing, vendors when they were control, providing samples for tasting, and preventing queried about hand washing, temperature control, providing cross-contamination (reported elsewhere), the samples for tasting, and preventing cross-contamination behaviors witnessed during this observation study were (reported elsewhere), the behaviors witnessed during this not in compliance with accepted standards outlined in observation study were not in compliance with accepted the temporary foodinmarket guidelines or MarketSafe standards outlined the temporary food market guidelines course (16, 17). Examples of observations in or MarketSafe course (16, 17). Examples ofnot observations compliance with accepted practices included cutting not in compliance with accepted practices included cutting of cookie samples with a pocket knife and with bare hands, hands, no cleaning hand washing; with nowith cleaning of knifeoforknife handorwashing; food onfood the on the floor of a bread vendor next to another floor of a bread vendor next to another vendorvendor with a dog; with dog; with carrotcream-cheese cake with cream-cheese icing carrota cake icing in direct suninon a hot direct sun on a hot day; inadequate use of ice packs

day; inadequate use of ice packs for eggs offered for sale for eggs offered for sale andunits; eggs left of cooling and eggs left outside of cooling foodoutside products in units; food products in top layer of coolers open for top layer of coolers open for display, with visible thawing; display, with visible thawing; and vendors using their and vendors using their hands to assess warmth and handsoftoconcession assess warmth and doneness ofin concession doneness foods. Observations compliance foods. Observations in compliance with guidelines with guidelines included a hand-washing station set up station setuse up of in sneeze the centre of in theincluded centre ofa hand-washing the market, appropriate the market, appropriate use of sneeze guards, separate guards, separate containers or utensils (e.g., paper cups or containers or utensils (e.g., paper cups or toothpicks) toothpicks) to offer samples for tasting and correct labelling to offer samplesfor forpreserved tasting and correct labelling and documentation items. One vendor and documentation for preserved items. One vendor in in compliance with requirements for frozen meats used compliance with requirements for frozen meats used mechanical cooling; however, the recorded temperature was cooling; however, the recorded −2°C,mechanical not suitable for long-term frozen storage. temperature was −2°C, not managers suitable forand long-term frozen storage. Farmers’ market environmental health Farmers’ market managers and environmental officers have no inspection oversight of the processinghealth officers have of noproducts inspection oversight of the processing and manufacture prepared in the home and of products prepared in the home then and soldmanufacture at farmers’ markets. Home prepared foods soldand then sold at farmers’ markets. Home prepared foods sold

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good knowledge andconsidered understanding of food in Although farmers’ markets are generally as lower risk; safety principles were demonstrated survey results of however, these products still require in proper consideration farmers’transportation, market managers and and vendors when they such werethat during storage on-site display queried about hand temperature control, food safety risks are washing, minimized. For example, foodsproviding must samples be protected for tasting, from the andsun, preventing kept under cross-contamination correct temperature (reportedand control, elsewhere), protectedthe from behaviors potentialwitnessed cross-contamination, during this observation such as fromstudy dirty were utensils, not dirty in compliance surfaces orwith animals accepted (dogs), and pests. outlined Of the seven markets allowed standards in thefarmers’ temporary foodvisited, market six guidelines pets. The TFMcourse guidelines recommend excluding or MarketSafe (16, do 17).not Examples of observations pets farmers’ with markets. Rather, this decision is left to not infrom compliance accepted practices included cutting the marketsamples manager. Processing further manufacturing of cookie with a pocket or knife and with bare hands, of higher risk foods (i.e., meat, fish, and dairy products) with no cleaning of knife or hand washing; food on the at home allowed in BC, foods must bewith prepared floor ofisanot bread vendor nextsuch to another vendor a dog;in acarrot licensed or community Inspection cakecommercial with cream-cheese icing inkitchen. direct sun on a hot oversight by health environmental day; inadequate useauthorities of ice packs(i.e., for eggs offered forhealth sale officers) exist during processing these foods, in but and eggs does left outside of cooling units; of food products they are still vulnerable temperature control top layer of coolers opentofor display, with visibleissues thawing; during transportation, and sale warmth at farmers’ and vendors using theirstorage, hands to assess andmarkets. Scheinberg al. (2013)foods. reported on transportation doneness ofetconcession Observations in compliance practices of raw included and frozen poultry to farmers’ markets with guidelines a hand-washing station set up in Pennsylvania. most vendors transported products in the centre ofWhile the market, appropriate use of sneeze on ice, 38% reported transporting in a cooler or pre-cooled guards, separate containers or utensils (e.g., paper cups or chest, with no orsamples further cooling means risk toothpicks) to ice offer for tasting and (20). correctHigher labelling foods must be pre-packaged and properly labelled to protect and documentation for preserved items. One vendor them from contamination to facilitate recall meats shouldused a hazard in compliance with requirements for frozen be identified.cooling; Based on observations from this study, poor mechanical however, the recorded temperature was practices evident in some vendors, as demonstrated by −2°C, notwere suitable for long-term frozen storage. failures to protect adequately from contamination Farmers’ marketfoods managers and environmental health or to provide sufficiently cool oversight temperatures forprocessing baked goods, officers have no inspection of the eggs, and previously frozen products. as data and manufacture of products preparedHowever, in the home and was from a small number vendors in the sold seven thencollected sold at farmers’ markets. Homeofprepared foods markets visited, these may not reflect industry in farmers’ markets areobservations generally considered as lower risk; wide practices. however, these products still require proper consideration Handtransportation, washing was not practiced at any of the seven during storage and on-site display such that farmers’ markets observed duringFor thisexample, study. Although food safety risks are minimized. foods must hand washingfrom stations werekept available 64% oftemperature vendor stalls be protected the sun, underincorrect requiring thisprotected equipment, notpotential all stations were adequately control, and from cross-contamination, supplied, anddirty handutensils, washingdirty was not observed even once such as from surfaces or animals (dogs), during overOf sixthe hours of farmers’ observedmarkets operation. Simply having and pests. seven visited, six allowed the comply with a recommendation pets.equipment The TFMnecessary guidelinestodo not recommend excluding is insufficient; behaviors must also be in decision compliance. pets from farmers’ markets. Rather, this is leftThese to results suggest that farmers’ market vendorsmanufacturing need education the market manager. Processing or further about therisk rolefoods of hand washing in limiting theproducts) spread of at of higher (i.e., meat, fish, and dairy infectious agents. Hand washing is critically forin home is not allowed in BC, such foods must important be prepared vendors food samples for tasting. Farmers’ market a licensedoffering commercial or community kitchen. Inspection vendors with tight spaces in their stalls, few oversightare bychallenged health authorities (i.e., environmental health have access to exist centralized washing stations, andbut vendors officers) does duringhand processing of these foods, lack hot water to fortemperature cleaning andcontrol sanitizing. Vendors they access are stilltovulnerable issues engage in multiple activities such selling foods, unloading during transportation, storage, andassale at farmers’ markets. Scheinberg trucks, preparing et al. (2013) samples,reported managing on waste, transportation and handling practicesseldom money; of raw are andvendors frozen poultry sufficiently to farmers’ staffed markets to separate in Pennsylvania. these duties, although While most suchvendors tasks create transported opportunities products for on ice, 38% of reported transporting in amoney, cooler foods, or pre-cooled the transfer infectious agents from food chest, with no ice or further cooling means (20). Higher risk

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foods must beconsumers pre-packaged properly labelledMoney, to protect handlers, and via and multiple pathways. for them frommay contamination to facilitate recall should a hazard example, harbor pathogens for extended periods and be be identified. observations from this study, poor transferred to Based hands on (24). practices Poor hand werewashing evidentpractices in some vendors, in farmers’ as markets demonstrated have been by reported failures toelsewhere protect foods (10, adequately 23). Behkefrom et al.contamination (2012) observed or and to provide recorded sufficiently hand washing cool temperatures activities on afor smart baked phone goods, for 18 employees at an Indiana farmers’ market (10). In eggs, and previously frozen products. However, as that datastudy, observers witnessed out of was collected from a hand small washing number in of two vendors in an theobserved seven 417 transactions that required handmay washing. Issuesindustry with staff markets visited, these observations not reflect performing multiple duties, such as vendors handling RTE wide practices. foods andwashing moneywas without subsequent hand Hand not practiced at any of washing the sevenwere also observed (10). A survey of cheese vendors at farmers’ farmers’ markets observed during this study. Although markets also found a lack of available hand washing and hand washing stations were in 64% of issues vendorwith stalls refrigeration Hand washing concerns are adequately not unique to requiring this(23). equipment, not all stations were farmers’ handwas washing compliance supplied,markets. and handPoor washing not observed evenrates, oncebased on the 2005 FDA foodofcode, wereoperation. observed inSimply food handlers during over six hours observed having in and assisted living facilities (22%) (21). therestaurants equipment(5%) necessary to comply with a recommendation Overall compliance ratesmust were also 5 to be 33% restaurantsThese and is insufficient; behaviors in in compliance. assisted living facilities, respectively (21). Inneed agreement results suggest that farmers’ market vendors education with no hand in washing aboutour theobservations, role of hand washing limitingwas theobserved spread ofafter handling money, or inwashing a surveyisofcritically Indiana important farmers’ market infectiousofagents. Hand for vendors (10, 21).food Failure to wash hands adequately is not offering samples for tasting. Farmers’ market limited food handlers.with In hospitals, average rates of hand vendorstoare challenged tight spaces in their stalls, few washing compliance following or when have access to centralized handpatient washingcontact stations, and vendors moving from and dirty sites have reported to be lack access to clean hot water for cleaning andbeen sanitizing. Vendors below (18, 19). engage50% in multiple activities such as selling foods, unloading Non-food itemssamples, offered asmanaging samples by vendors markets trucks, preparing waste, and at handling have alsoseldom been linked to illness. In one BCstaffed market 2013, money; are vendors sufficiently to in separate athese sample of hand creamsuch became in a medically duties, although tasksimplicated create opportunities for diagnosed burn.agents The affected individual wasfood offered the transferchemical of infectious from money, foods, ahandlers, sample ofand hemp hand cream that was pathways. subsequently applied consumers via multiple Money, for to an existing burn, leading tofor anextended allergic dermatitis example, maysun harbor pathogens periods and be reaction. Although date and location of the market was transferred to handsthe (24). known, the individual could not in recollect themarkets producthave name or Poor hand-washing practices farmers’ been vendor Inspectors in (2012) the investigation reportedname. elsewhere (10, were 23). hampered Behke et al. observed as trace back led to one vendoron who did not carryfor the andproduct recorded hand-washing activities a smart phone product implicated the case. Further, the implicated vendor 18 employees at an in Indiana farmers’ market (10). In that recalled other vendors were hand also selling andinoffering study, observers witnessed washing two outsamples of an of skin care products. Our conclusion washand that washing. the list ofIssues observed 417 transactions that required market vendors and products appeared to handling be incomplete; with staff performing multiplesold duties, such as RTE no further follow-up was possible. The TFM guidelines do foods and money without subsequent handwashing were state that market managers areofresponsible for maintaining also observed (10). A survey cheese vendors at farmers’a written of all avendors products sold. This incident marketsrecord also found lack of and handwashing and issues with highlighted limited ability to trace back vendor refrigerationthe (23). Hand-washing concerns are notnames unique at farmers’ markets, samples are to larger farmers’ markets. Poor particularly compliancewhen rates of food handlers offered and no products purchased. It is uncertain whether to the 2005 FDA food code for hand-washing frequency any market manager undergone a mock recall or was farmers’ directly observed in fourhas settings, including restaurants investigation this nature.rates were 5 to 33% in restaurants (21). Overallofcompliance Inassisted BC, a focus classroom style food safety education and livingon facilities, respectively (21). In agreement has in place sincenoJuly 1, 2000, when a requirement withbeen our observations, handwashing was observed after for food safety training food service establishments handling of money, or in for a survey of Indiana farmers’ market was included in the FoodtoPremises Regulation (2).is There vendors (10, 21). Failure wash hands adequately not is no regulated requirement for mangers or vendors at limited to food handlers. In hospitals, average rates of hand washing compliance following patient contact or when

farmers’from moving markets cleantoand take dirty food sites safety havetraining, been reported although to be belowdo. most 50% Choices (18, 19). available include FOODSAFE, established Non-food in items 1985, offered and as another samples classroom-based by vendors at markets food safety have also training been linked program to illness. created In for onefarmers’ BC market market in 2013, personnel a sample ofcalled hand cream MarketSafe, becamefirst implicated offeredinina medically 2010. MarketSafe diagnosed chemical provides burn. more The detail affected on the individual best practices was offered for preparing a sample offoods hempat hand home, cream transporting that was subsequently foods to market, applied offering to an existing samples sun burn, to consumers leading tofor an tasting, allergic dermatitis general food handling, reaction. Although and cleaning the date andand sanitation location of expectations the market was (9). However, known, thewhile individual food could safetynot training recollect may theimprove productgeneral name or food vendor safety name.knowledge, Inspectors were this does hampered not impact in the investigation food safety behaviors, as product trace as evidenced back led tobyone thevendor resultswho of this did study. not carry the Subjects product implicated missing from in theFOODSAFE, case. Further, MarketSafe the implicated orvendor the recalled TFM guidelines other vendors include wererecall also selling practices andfor offering food samples and nonof skinproducts; food care products. handling Our of conclusion consumer was complaints; that the listdealing of market with reports vendors of and illness; products and guidance sold appeared on how to betoincomplete; provide no further follow-up information to health wasauthorities possible. The onTFM theseguidelines issues. do state Farmers’ that market market managers managers are responsible receive most forof maintaining their a written recordthrough information of all vendors meetings and products with theirsold. association This incident or highlighted from their operations the limited ability managers. to trace Although back vendor they names do consult at larger the online farmers’ TFMmarkets, guidelines, particularly they arewhen less likely samples to are contact offered an environmental and no products health purchased. officer directly It is uncertain for assistance whether any farmers’ with a food market issue. To manager deliverhas food undergone safety information a mock recall or investigationtoofmanagers effectively this nature. and vendors of farmers’ markets, food In BC, safety a focus information on classroom shouldstyle be shared food safety by operations education has been inand/or managers place since association July 1,members 2000, when at their a requirement own for food safety meetings. We recommend training for food that health serviceauthorities establishments was included liaise with farmers’ in the market Food Premises associations, Regulation managers, (2). and There

operations is no regulated manager requirement to discuss forfood mangers safetyorconcerns vendors and at deliver farmers’food markets safetytotraining. take foodMore safetyemphasis training,should although be placed most do. onChoices supporting available behavioral include changes FoodSafe, in vendors established handling in 1985, and RTEanother foods, specifically classroom-based on thefood importance safety training of handwashing; program created appropriate for farmers’ practices market for personnel sampling called and tasting; MarketSafe, temperature first offered control; in 2010. and MarketSafe product display provides to prevent more detail cross-contamination. on the best practices In for the preparing event a vendor foods at selling home, transporting food is linkedfoods to human to market, disease, offering farmers’ samples market administrators to consumers for and tasting, managers general alsofood needhandling, to be aware andof the role cleaning of product and sanitation traceability expectations in food safety. (9). However, In conclusion, while although food safety most training vendors mayand improve markets general comply food with safety written food knowledge, safety guideline this does not requirements, impact food and safety general behaviors, vendor site as evidenced observations by the indicated results of good thiscompliance, study. Subjects direct missing observation from FoodSafe, of vendor MarketSafe behavior or the andTFM practices guidelines suggest that improvements include recall practices are required for food in theand areas non-food of handproducts; washing and handling temperature of consumer control. complaints; Communications dealing with between reports of health illness;and andregulatory guidance on agencies how toand provide the farmers’ information markets to and health their authorities associations on these also require issues. improvement. Farmers’ market managers receive most of their ACKNOWLEDGMENTS information through meetings with their association or from operations managers. Although they do consult Thetheir support of Jon Bell and Elizabeth Quinn (BC the online TFM guidelines, they are less likely to contact Association of Farmers’ Markets), Roberta LaQuaglia (Vancouver an environmental Farmers’ health Markets), officer Brian directly Johnston for assistance and Jasmina with a food Egeler issue. (Vancouver To deliverCoastal food safety Health), information Jim Green effectively to managers and vendors of are farmers’ markets, and Greg Thibault (Northern Health) appreciated. food safetysupport information should be shared from by operations Financial was gratefully received the BC managers Secretariat. and/or association members at their own FoodSafe meetings. We recommend that health authorities liaise

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