Washing hands and risk of cross-contamination during chicken preparation among domestic practitioners in five European countries

Journal Pre-proof Washing hands and risk of cross-contamination during chicken preparation among domestic practitioners in five European countries Pierrine Didier, Christophe Nguyen-The, Lydia Martens, Mike Foden, Loredana Dumitrascu, Augustin Octavian Mihalache, Anca Ioana Nicolau, Silje Elisabeth Skuland, Monica Truninger, Luís Junqueira, Isabelle Maitre PII: S0956-7135(21)00200-0 DOI: https://doi.org/10.1016/j.foodcont.2021.108062 Reference: JFCO 108062 To appear in: Food Control Received Date: 14 December 2020 Revised Date: 23 February 2021 Accepted Date: 4 March 2021 Please cite this article as: Didier P., Nguyen-The C., Martens L., Foden M., Dumitrascu L., Mihalache A.O., Nicolau A.I., Skuland S.E., Truninger M., Junqueira L. & Maitre I., Washing hands and risk of cross-contamination during chicken preparation among domestic practitioners in five European countries, Food Control, https://doi.org/10.1016/j.foodcont.2021.108062. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2021 Published by Elsevier Ltd. CRediT author statement Add after you name the terms that best decribe your contributions (see list of terms and definitions in the table below) Pierrine Didier: conceptualization, methodology, validation, formal analysis, investigation, resources, writing original drafting, writing-review and editing, visualization. Christophe Nguyen-The: conceptualization, validation, formal analysis, investigation, resources, writing original drafting, writing-review and editing, visualization. Lydia Martens: conceptualization, methodology, validation, formal analysis, investigation, resources, writing-review and editing, supervision. Mike Foden: conceptualization, methodology, validation, formal analysis, investigation, resources, writing-review and editing, supervision. Loredana Dumitrascu: formal analysis, investigation. Augustin Octavian Mihalache: formal analysis, investigation. Anca Ioana Nicolau: resources, investigation, writing-review and editing. Silje Elisabeth Skuland: funding acquisition, p roject administration, methodology, formal analysis, investigation, review and editing. Monica Truninger: formal analysis, investigation, writing – review & editing. Luís Junqueira: Writing – Review & Editing, visualization. Isabelle Maitre: conceptualization, methodology, validation, formal analysis, investigation, resources, writing original drafting, writing-review and editing, visualization. Term Definition Conceptualization Ideas; formulation or evolution of overarching research goa ls and aims Methodology Development or design of methodology; creation of models Software Programming, software development; designing computer programs; implementation of the computer code and supporting algorithms; testing of existing code components Validation Verification, whether as a part of the activity or separate, of the overall replication/ reproducibility of results/experiments and other research outputs Formal analysis Application of statistical, mathematical, computational, or other formal techniques to analyze or synthesize study data Investigation Conducting a research an d investigation process, specifically performing the experiments, or data/evidence collection Resources Provision of study materials, reagents, materials, patients, laboratory samples, animals, instrumentation, computing resources, or other analysis tools Data Curation Management activities to annotate (produce metadata), scrub data and maintain research data (including software code, where it is necessary for interpreting the data itself) for initial use and later reuse Writing - Original Draft Preparation, creation and/or presentation of the published work, specifically writing the initial draft (including substantive translation) Writing - Review & Preparation, creation and/or presentation of the published work by those from Journal Pre-proof Term Definition Editing the orig inal research group, specifically critical review, commentary or revision – including pre-or postpublication stages Visualization Preparation, creation and/or presentation of the published work, specifically visualization/ data presentation Supervision Oversight and leadership responsibility for the research activity planning and execution, including mentorship external to the core team Project administration Management and coordination responsibility for the research activity planning and execution Funding acquisition Acquisition of the financial support for the project leading to this publication Journal Pre-proof 1 Washing hands and risk of cross-contamination during chicken preparation among 1 domestic practitioners in five European countries 2 3 Pierrine Didier a,b , Christophe Nguyen-The a , Lydia Martens c , Mike Foden c , Loredana 4 Dumitrascu d , Augustin Octavian Mihalache d , Anca Ioana Nicolau d , Silje Elisabeth Skuland e , 5 Monica Truninger f , Luís Junqueira f , Isabelle Maitre b* 6 7 a INRAE, Avignon Université, UMR SQPOV, 84000 Avignon, France 8 b USC1422 GRAPPE, Ecole Supérieure d’Agricultures (ESA), INRAE, SFR 4207 QUASAV, 55 rue 9 Rabelais, BP 30748, 49007, Angers Cedex, France 10 c Keele University, United Kingdom 11 d Dunarea de Jos University of Galati, Faculty of Food Science and Engineering, Domnească 12 Street 111, 800201, Galati, Romania 13 e Consumption Research Norway (SIFO), Oslo Metropolitan University, Oslo, Norway 14 f Instituto de Ciências Sociais, Universidade de Lisboa, Av. Professor Aníbal de Bettencourt 9, 15 1600-189, Lisboa, Portugal 16 17 Declarations of interest: none 18 19 * Corresponding author: [email protected] USC1422 GRAPPE, Ecole Supérieure 20 d’Agricultures (ESA), INRAE, SFR 4207 QUASAV, 55 rue Rabelais, BP 30748, 49007, Angers 21 Cedex, France 22 23 24 Journal Pre-proof 2 25 ABSTRACT 26 Nearly 40% foodborne outbreaks in the European Union are attributable to food practices in 27 domestic homes that include handling and preparation of raw chicken. Hand washing is an 28 important way to prevent cross-contamination with pathogens during chicken preparation. 29 This study, which is part of the EU Horizon 2020 funded consortium SafeConsume, aimed at 30 quantifying and understanding hand washing practices in three categories of households and 31 five European countries. A quantitative survey (n=1889) was combined with qualitative 32 research, during which 75 participants from France, Norway, Portugal, Romania, and the 33 United Kingdom were observed and interviewed. An original method for analysing video 34 with “The Observer XT” software was developed to identify when and how risk arises. The 35 quantitative survey and qualitative research data revealed that touching raw chicken was 36 more frequent in Romania and Portugal. Practices to avoid touching raw chicken were 37 declared and observed, although observations revealed that these practices were not always 38 consistently followed. Only a third of the participants washed their hands with soap after 39 handling raw chicken with important variations among countries (a majority in Norway and 40 in the UK, a few in France and Portugal, none in Romania), in contrast to the results of the 41 survey. Observations and interviews suggested that rinsing hands with water only and 42 washing hands with soap are considered equivalent by many people. Barriers to washing 43 hands due to improper equipment were mainly observed in Romania. Washing hands after 44 touching raw chicken was motivated by food safety concerns for some participants in 45 Norway and the UK, but not in France and Portugal, where it was motivated by unpleasant 46 feelings on hands, or presented as a habit. Participants not washing their hands after 47 touching the chicken did it after other actions they presumably perceived as unsafe (e.g. 48 Journal Pre-proof 3 touching the bin, handling pets, and blowing the nose), indicating that they did not 49 specifically consider touching raw chicken as risky. Knowledge, habits, and equipment with 50 regard to chicken and hand washing differed among European countries, resulting in safe 51 and risky practices. 52 KEYWORDS: Consumer, kitchen, food safety, soap, habits, practices 53 54 55 Journal Pre-proof 4 1/ INTRODUCTION 56 Campylobacter and Salmonella are the first and second most frequently declared foodborne 57 zoonoses in the European Union (EFSA, 2019). These two bacteria are particularly prevalent 58 in raw chicken meat. In 2018, this food category was most frequently contaminated with 59 Salmonella and Campylobacter in the EU, with 7% and 37.5% positive samples, respectively 60 (EFSA, 2019). EFSA estimated in 2010 (EFSA, 2010) that 20% to 30% campylobacteriosis was 61 caused by handling, preparation and consumption of chicken meat in households. In France, 62 Campylobacter and Salmonella are the two foodborne pathogens with the highest impact on 63 public health, representing approximately 32% of the total foodborne disease burden. 64 Infections caused by cross-contamination from raw poultry meat were estimated to 65 represent 3% to 29% (90% confidence interval) for Campylobacter and 0.1% to 4.7% for 66 Salmonella (Augustin et al., 2020). This indicates that the risk of cross-contamination from 67 raw poultry is particularly critical for public health in the case of Campylobacter, and less so, 68 but still significant, for Salmonella. 69 During the investigation of a Campylobacter outbreak in a restaurant that caused 17 70 infections in the 51 patrons, Brown et al. (Brown, Kidd, Riordan, & Barrell, 1988) observed 71 that the chef did not always wash his hands between handling raw chicken carcasses and 72 cooked foods. The authors also experimentally demonstrated the transfer of Campylobacter 73 from naturally contaminated raw chicken meat to hands and from hands to cooked foods. 74 The transfer of Campylobacter and Salmonella from raw meat to hands and from hands to 75 salads has since been conclusively confirmed (Carrasco, Morales-Rueda, & Garcia-Gimeno, 76 2012; De Boer & Hahné, 1990; Luber, Brynestad, Topsch, Scherer, & Bartelt, 2006; Oscar, 77 2013; Ravishankar, Zhu, & Jaroni, 2010; Verhoeff-Bakkenes, Beumer, de Jonge, van Leusden, 78 & de Jong, 2008). 79 Journal Pre-proof 5 Hand hygiene is a recognised way to limit the transfer of pathogens by healthcare workers 80 (WHO, 2009), fieldworkers (Monaghan & Hutchison, 2016) and food workers (Todd, 81 Michaels, Smith, Greig, & Bartleson, 2010). An analysis of the United States Food and Drug 82 Administration (US-FDA) food safety survey revealed that domestic food handlers who 83 reported always washing their hands with soap before food preparation also reported less 84 foodborne illness (Ali, Verrill, & Zhang, 2014). 85 The surfactant action, friction and final rinsing in water involved in washing hands with soap 86 can effectively reduce microbial load from the outer layer of skin (Foddai, Grant, & Dean, 87 2016; WHO, 2009). Thus, hand washing is particularly suited to limit the hand-transfer of 88 pathogens. Hand washing with soap is much more efficient than rinsing with water alone, 89 regardless of the water temperature (Courtenay et al., 2005; Monaghan & Hutchison, 2016), 90 particularly in the presence of meat debris (Jensen, Danyluk, Harris, & Schaffner, 2015). 91 It is important to understand the risk of cross-contamination at home during raw chicken 92 handling and preparation concerning (a) whether consumers touch raw chicken with bare 93 hands, (b) whether and how hand washing occurs and (c) what factors and barriers guide 94 consumers to wash, or not wash, their hands. For this reason, we analysed the actions of 95 consumers using theories of practice as a guiding framework. 96 A practice can be understood as a sequencing of actions guided by three basic and 97 interconnected elements: materials (including nature, objects, tools, and resources), images 98 (including meanings, understandings, and purposes), and skills (competence, expertise, and 99 technique) (Shove, Pantzar, & Watseon, 2012; Truninger, 2011). Theories of practice 100 emphasise the practicality of everyday social life in which routines, rather than reflexivity, 101 are paramount. Therefore, it is particularly suitable to analyse food preparation and kitchen 102 routines. Previous studies on food safety in home kitchens have shown how consumers 103 Journal Pre-proof 6 clean kitchens, surfaces, homes and wash hands using observational methods. Some studied 104 incorporated videotaping. The studies consistently showed that actual practices were not 105 consistent with recommended practices, especially for washing hands, which was rarely 106 correct (Evans & Redmond, 2018; Maughan et al., 2016; Mazengia, Fisk, Liao, Huang, & 107 Meschke, 2015; Moore, Sweet, Harrison, & Franck, 2019). All these studies were conducted 108 in one country only, mostly in the UK, Northern Ireland, and the US (Redmond & Griffith, 109 2003). 110 This paper is part of a larger research project (safeconsume.eu), which aims to investigate 111 the links between consumer food handling and the risks of foodborne diseases in Europe. 112 The aim of the work presented in this paper is to develop an understanding of hand washing 113 practices during chicken preparation in five European countries, drawing on insights from a 114 mixed methods analysis. Three categories of consumers are considered: elderly households 115 and families with infants who are at higher risk of falling ill with campylobacteriosis and 116 salmonellosis (ECDC) and young men who are less likely to follow food safety 117 recommendations (Katiyo, de Kock, Coorey, & Buys, 2019; Murray et al., 2017). We 118 conducted a complementary approach, which involved a wide-scale survey of the declarative 119 practices of touching raw chicken and washing hands during chicken preparation, and a 120 qualitative study at home analysing videos and interviews collected during the preparation 121 of chicken. We identified when and how consumers washed hands, considering the three 122 dimensions of practices: materials/equipment, skills/competencies, and knowledge/beliefs 123 (Shove, et al., 2012; Truninger, 2011). 124 The originality of our study lies in the fact that it offers a comparative analysis of five 125 European countries, using a mixed methods approach with similar categories of ‘at risk’ 126 participants and food handling practices. Furthermore, it combines observations of 127 Journal Pre-proof 13 without strategies to protect their hands, using a combination of skills (using simple recipes) 272 and materials (purchasing chicken products adapted to the recipes used) (Appendix 3A). 273 Knowledge of the risks of raw chicken was not addressed in the quantitative survey, but was 274 discussed during the qualitative research. In Portugal, Romania, and France, participants 275 rarely expressed concerns about the safety of chicken meat. When there was concern, it was 276 mostly associated with storage (freshness and short storage time), need to keep it cold, 277 cooking issues (thorough cooking), contamination by butchers and contaminants like 278 hormones (Appendix 3B and 3C). The risk of hand-to-chicken cross-contamination was not 279 mentioned. These participants touched chicken with bare hands. The perceived risk of 280 hormones by one respondent (Maria-Celeste) prompted her to remove skin of the raw 281 chicken. This increased hand-chicken contact, and the risk of cross-contamination. Among 282 participants who did not touch chicken with bare hands, two (one YF in Portugal and one YSM in UK) 283 explained they got food safety training when working in the food sector. 284 3.2 / Hand cleaning following raw chicken handling 285 In the quantitative survey, respondents were asked to declare how likely it was on an 11286 point scale from 1 (“no chance or almost no chance”) to 11 (“practically certain or certain”) 287 that they would clean their hands immediately after touching chicken. The mean response 288 was 8.33 (SD=0.14). Fifty percent of respondents declared they were almost sure, certain or 289 practically certain. There was no significant country effect (F=1.08, P=0.3656), but there 290 were differences between the household groups (F=34.23, P=0.0000). YSM (M=7.9, SD=0.30) 291 and YF (M=8.2, SD=0.1) were significantly less likely than EH (M=9.3, SD=0.1) to declare 292 cleaning hands immediately after touching chicken. No country-per-group interaction was 293 found, suggesting that these group differences were found across the five countries. 294 Figure 2 about here 295 Journal Pre-proof 14 According to the quantitative survey, the most frequent ways of cleaning hands were regular 296 (34%) and antibacterial soap (29%). Nineteen percent of respondents paid attention to the 297 recommended 21 s minimum time for hand washing (Figure 2). There were differences 298 between countries for all items, especially in the use of cold (X2=51.8, P=0.000) and warm 299 (X2=54.6, P=0.000) water, and the use of antibacterial soap (X2=81.97, P=0.000). Portuguese 300 respondents were more likely to clean their hands with cold water, whereas Norwegian and 301 Romanian respondents more often cleaned with hot water. Romanian (40%) and Norwegian 302 (44%) respondents also declared cleaning hands more often with regular soap. Antibacterial 303 soap was more frequently used in UK households than in other countries. Living in urban or 304 rural areas or educational qualifications did not make a difference. 305 In the qualitative research, we identified four different types of action following raw chicken 306 handling: (1) doing nothing at all, continuing with the recipe and touching other items; (2) 307 drying hands on a cloth, a towel, or a paper towel; (3) rinsing hands with water only; and (4) 308 washing hands with soap. Descriptions of these different cases are provided in Appendix 3C. 309 For the observational analysis, we used the word “washing” for the action of washing with 310 soap and water. Exclusive use of water was termed “rinsing.” When quoting from 311 participants’ reasoning, we present the words they used, irrespective of their actual actions. 312 Figure 3 about here 313 We observed that the majority of participants (red in Figure 3) did not wash their hands with 314 soap after handling raw chicken. The clear exception was Norway, where all participants 315 who touched raw chicken washed their hands with soap after a brief period during which 316 nothing was touched. In the UK, 8 of 12 participants washed their hands after handling the 317 raw chicken. In France, Portugal, and Romania, few participants washed their hands after 318 handling raw chicken. Some, like Dumitra (EH, R, RO), did not wash, rinse, or wipe hands 319 Journal Pre-proof 15 during or after preparing the chicken. On several occasions, there was contact between 320 hands and water while the chicken was rinsed, which may have been interpreted as hand 321 washing, as expressed by Maria-Celeste (EH, U, PT, Appendix 3C). Fabrice (YSM, U, FR) 322 explained he would ‘wash’ hands after touching food as a reflex, but he actually rinsed hands 323 after cutting raw chicken. Bogdan (YSM, U, and RO) knew that chicken can transmit 324 pathogenic microbes that can be removed by washing, but he rinsed and did not wash hands 325 after touching raw chicken. Bernard (EH, U, FR) and Sylviane (EH, R, FR) explained that they 326 would often ‘wash’ hands in the kitchen, but they were not observed using soap. These 327 observations highlight the ambiguity of the concept of “wash” in the common vocabulary. It 328 did not imply the use of soap for all participants and revealed a lack of knowledge of the 329 importance of soap when washing hands. The findings also reveal the importance of 330 routines: several participants mentioned washing hands, while they actually rinsed, as a 331 reflex/habit associated with food handling in the kitchen environment. 332 In the quantitative survey, 50% of respondents declared that they were almost sure, certain, 333 or practically certain that they would clean their hands immediately after touching chicken, 334 with no difference between countries. This contrasted with the qualitative research results 335 for Romania, Portugal, and France. 336 Washing hands after handling raw chicken requires access to materials, in particular, running 337 water (Appendix 3D). One urban YSM in Norway and four households (EH and YF) in rural 338 areas of Romania did not have running water in their kitchen, or had no kitchen (a gas stove, 339 fridge and table were placed in a hall connecting the two rooms of the house). The 340 Romanian participants rinsed their hands in the basin of water where they had rinsed 341 chicken. The Norwegian YSM explained that he would wash his hands more often if he had a 342 sink in his kitchen. 343 Journal Pre-proof 16 The direct availability of soap is another issue. Hélène and Bernard (EH, U, FR) hid their soap 344 and detergent in a drawer because they said they liked having a clear countertop and never 345 used it. In contrast, Amandine (YF, R, and FR) had an electric soap dispenser over her sink 346 and washed hands with soap seven times during food preparation. 347 Figure 4 about here 348 Distributions of the duration of washing hands recorded during the qualitative study (Figure 349 4) were not significantly different among countries (ANOVA, P>0.05). Hand washing was 350 brief for some respondents. However, in France, Norway, and Portugal, the percentage of 351 washing hands longer than the recommended 21 s was between 20% and 30%, higher than 352 the percentage in the quantitative survey. For some participants, the duration of hand 353 washing might be an unconscious routine. 354 Rinsing or washing hands after touching chicken was presented as a habit or was linked with 355 the feeling of dirtiness or greasiness on hands (e.g., Mathilde (YF, U, FR), Appendix 3C) that 356 needed to be removed. In Romania, only one participant (Bogdan (YSM, U, RO, Appendix 3 357 B) expressed knowledge that chicken could carry dangerous bacteria. He systematically 358 rinsed his hands after touching chicken, but he never used soap. In Norway and the UK, most 359 participants expressed safety concerns about chicken and knew that raw chicken could 360 transmit dangerous bacteria (e.g., Paul (YF, U, UK) and Sahib (YSM, U, UK), Appendix 3B; Josh 361 (YSM, U, UK) and Mary (EH, U, UK), Appendix 3A; Anna (YF, U, NO), Appendix 3C). These 362 participants washed their hands with soap after handling chicken. In the UK, several research 363 participants referred to media campaigns of the risk from chickens (Appendix 3E). Some 364 participants who washed hands with soap (France and UK) after touching raw chicken 365 mentioned safety training when working in the food sector. 366 3.3 / Occasions of hand washing 367 Journal Pre-proof 17 To assess the importance of contact with raw meat among other occasions to wash hands, 368 the quantitative survey asked respondents the following: “In general, when would you 369 normally wash your hands at home?” The main reasons for washing hands were: “After 370 going to the toilet” (81%); “After touching something dirty “(81%); “After touching raw meat 371 or eggs” (71%) and “After mopping up spillages from poultry or eggs” (66%). Household type 372 made a significant difference, especially for the reasons: “After going to the toilet” 373 (X2=209.37, P=0.000) and “After touching something dirty” (X2=145.11, P=0.000). The 374 proportion of EH declaring washing hands for all the reasons (from 64% to 95%) presented in 375 the survey was significantly higher, while 54% to 70% of the YF households and 48% to 68% 376 of YSM washed hands for these reasons. 377 In the qualitative fieldwork, we did not always observe hand washing after handling raw 378 chicken. However, we observed several other occurrences of washing hands during food 379 preparation (Table 1). 380 Table 1 about here 381 In France and Portugal, participants sometimes did not wash hands with soap after handling 382 raw chicken. However, they did so for other reasons that included before starting to cook, 383 after touching the waste bin and after blowing their nose. Amandine (YF, R, FR) washed 384 hands with soap when starting food preparation, and each time after she touched the waste 385 bin and her phone screen, and when she blew her nose. However, she did not wash her 386 hands after touching raw chicken. In the UK, although many research participants washed 387 hands with soap after touching the chicken, hand washing was mainly done after touching 388 the waste bin. Participants also washed their hands with soap each time they touched a pet 389 (once in Norway and France and twice in Portugal). Julie (YF, U, and FR) wiped hands on a 390 towel after manipulating the raw chicken. The only occasions she washed hands was after 391 Journal Pre-proof 18 taking the cat off the countertop and after disposing of waste. She identified the need for 392 hand washing after these actions, but not after touching raw chicken. Filipa (YF, U, and PT) 393 did not wash or rinse her hands after handling raw chicken. She washed hands with 394 antibacterial soap during food preparation on two occasions, both after touching her dog. 395 The findings suggest that most participants from France, Norway, Portugal, and the UK were 396 aware that it is important to wash hands with soap for hygiene purposes after touching 397 something they identified as a source of contamination. However, participants from France 398 and Portugal usually did not wash their hands after handling raw poultry. This highlighted 399 the fact that raw chicken was not necessarily identified as a source of contamination in these 400 countries. 401 402 4/ DISCUSSION AND CONCLUSION 403 Both the survey questionnaire and qualitative research indicated that the majority of 404 consumers touched raw chicken with bare hands during preparation. Only a minority 405 developed specific strategies to avoid this contact. These strategies were not always 406 followed throughout the process. Presumably, the routine of using their hands diverted 407 attention from the original strategy. Consistently, hand washing with soap was usually 408 needed to mitigate the risk of cross-contamination. 409 The qualitative study revealed that hand washing after touching chicken is not a systematic 410 practice in the different countries. All participants did so in Norway, most in the UK, few in 411 France and Portugal, and none in Romania. Low rates of actual washing hands after handling 412 raw chicken have been observed in other studies. In a study in Wales (UK) involving a model 413 kitchen, only 10% of 100 older adults adequately washed their hands immediately after 414 handling raw chicken (Evans & Redmond, 2018). In the Netherlands, only 25% of participants 415 Journal Pre-proof 19 washed their hands with soap (Van Asselt, Fischer, De Jong, Nauta, & De Jonge, 2009). In 416 contrast, in the United States, proper hand washing was observed in 40% of respondents 417 after handling chicken breast (Maughan, et al., 2016). 418 Washing hands with water and soap is an effective way to eliminate pathogens that may be 419 present on the hands (CDC, 2020). Our study shows that this knowledge is not necessarily 420 shared and is certainly not applied everywhere. Proper hand washing after touching chicken 421 was not observed in the Romanian households and in only a few of the French and 422 Portuguese households. However, 50% of the respondents declared that they were almost 423 sure, certain, or practically certain to wash hands after handling chicken, with no difference 424 between countries. Similarly, in previous observational studies, respondents most often 425 declared that they actually washed their hands properly after manipulating chicken, but did 426 not do so when observed. Results from a survey in South Africa showed that although at 427 least 85% respondents were concerned about the safety risks with chicken meat, a large 428 proportion of respondents did not wash their hands properly before (31%) and after (36%) 429 handling raw chicken (Katiyo, et al., 2019). In the US, 84% respondents reported that they 430 always washed their hands before preparing food, whereas <16% participants correctly 431 performed handwashing (Moore, et al., 2019). Similarly, in a study in the US, all the 432 respondents declared in the questionnaires that they washed their hands before and after 433 handling raw chicken, while washing hands was done properly only 12% of the time 434 (Mazengia, et al., 2015). The findings may indicate a difference between normative 435 knowledge or intention, and actual practices. When asked about practices, respondents are 436 likely to select the answer they know is right or they think they ought to be doing (here 437 regarding hygiene), or they believe they do. However, this is not necessarily reflected in their 438 actions where barriers and routines interfere. Quantitative surveys represent a way to 439 Journal Pre-proof 20 collect normative knowledge (Redmond & Griffith, 2003), and the results from qualitative 440 and quantitative approaches allow us to study different dimensions of representations 441 (Caillaud & Flick, 2016). 442 The action of hand washing is linked to the available materials to wash hands, what hand 443 washing means to respondents and participants and the fact that chicken is perceived as a 444 risky health product or a dirty product. In our study, Romanians presumably have knowledge 445 that is out of step with their practices, which face barriers that include the availability of 446 water or kitchen equipment. Romanians, French and Portuguese consumers may also have 447 false knowledge of safe ways to clean hands, considering rinsing with water to be sufficient. 448 For French and Portuguese consumers, touching raw poultry was presumably not perceived 449 as risky, unlike other actions, such as touching the waste bin, blowing the nose and touching 450 pet, which were followed by hand washing with soap. 451 This variety of actions is associated with a variety of routines that are reasoned or not. The 452 choice of meat (whole chicken, cut pieces), recipe (whole cooked chicken, chicken purchased 453 whole and cooked in pieces, meat from which the skin was removed for cooking) led to more 454 manipulation and potential cross-contamination. Rinsing chicken is another routine that 455 leads to hand-raw chicken contact. In a study conducted in the UK (Evans & Redmond, 456 2018), 20% older participants rinsed the raw chicken under running cold water, similar to the 457 20% UK respondents who declared that they rinsed chicken in our study. Washing hands 458 with soap after touching raw chicken was presented as a routine practice and not an action 459 specific to handling of raw chicken, by some participants. In contrast, it was specific to 460 chicken for others, for a hygienic reason (mostly in Norway and UK) or because of 461 unpleasant feelings on hands. Most participants from Portugal, Romania, and France 462 routinely rinsed their hands instead of washing them with soap, without expressing a reason 463 Journal Pre-proof 21 for this practice. The exceptions were two elderly French participants who explained that 464 using soap would be excess of hygiene in this situation, compared to going to the toilet, 465 reinforcing the assumption that raw chicken was not perceived as risky by these French 466 consumers. 467 Qualitative research revealed important differences among countries in the perception of 468 risks associated with raw chicken. The most obvious reason is the actual knowledge of the 469 risk, which is probably linked to the existence of effective campaigns on the health risks 470 associated with handling chicken. These campaigns have been run in Norway and the UK. In 471 France, food safety is assumed. Concerns instead are linked to nutritional risks (Laporte, 472 2019). In addition, perceptions of the various food safety risks differed among EU countries 473 (Eurobarometer, 2019). French consumers were mostly aware of pesticides in food, whereas 474 food hygiene was paramount for UK consumers. The issue of food poisoning bacteria ranked 475 6 th as a food safety concern in France, but was the 2 nd ranked concern in the UK. Accordingly, 476 a study (Didier, 2019) reported appreciable concern about pesticides among French 477 consumers. More generally, education in food hygiene could explain the perceptions 478 associated with different behaviours. Presently, this was evident at the country level 479 (Norway and UK) and at the individual level (participants in the UK, Portugal, and France who 480 were trained in hygiene practices in restaurants). 481 This knowledge will lead to strategies to avoid touching chicken, to wash hands or 482 alternatively to a simplified strategy, such as choosing a trusted provider, such as 483 supermarkets in Portugal (Brunel & Pichon, 2004). Moreover, the home is not perceived as a 484 place at risk (Byrd-Bredbenner, Berning, Martin-Biggers, & Quick, 2013), which can explain 485 why, despite consumers’ awareness of the importance of hand washing as measured in the 486 survey, observed practices revealed incomplete or absent hand washing. 487 Journal Pre-proof 22 Our study shows that the practice of washing hands after handling raw chicken varies in 488 several European countries. These differences may reflect knowledge, routines, materials, 489 and risk perception. Countries should consider these dimensions when formulating food 490 safety communication policies. 491 492 ACKNOWLEDGMENTS 493 This work was supported by the Horizon 2020 project SafeConsume (Grant Agreement No. 494 727580). Joachim Scholderer and his team are acknowledged for designing and organizing 495 the consumer survey. We thank Flore Lourtioux, Rui Maia, Maria João Cardoso, Joana Feio, 496 Corina Neagu, Valerica Celmare, Răzvan Dinică, Therese Hagtvedt for their participation to 497 the fieldwork. 498 499 Journal Pre-proof 29 642 Figures Captions 643 Figure 1 - Hand-chicken contact declared during food preparation. Results from the quantitative 644 survey in percentage per country. Fr: France, No: Norway, Pt: Portugal, Ro: Romania, UK: United-645 Kingdom. (print in color) 646 Figure 2 - How respondents declared cleaning and drying hands immediately after touching raw 647 chicken by country. Results from the quantitative survey in percentage per country. (print in color) 648 Figure 3 – Observed hand washing with soap immediately after touching raw chicken among 649 participants by country. Results from the qualitative fieldwork. Green bars: participants who washed 650 hands with soap. Red bars: participants who rinsed hands with water, or only wipe hands or did 651 nothing. (print in color) 652 Figure 4 – Duration of washing hands during food preparation among participants in five countries. 653 Results from the qualitative fieldwork. (print in color) 654 655 656 Journal Pre-proof 30 Figure 1 657 658 659 Journal Pre-proof 31 Figure 2 660 661 662 Journal Pre-proof 32 Figure 3 663 664 665 666 667 Journal Pre-proof 33 Figure 4 668 669 670 671 672 Journal Pre-proof HIGHLIGHTS • Differences among countries exist in the extend of touching raw chicken • Washing hands with soap was more often observed in UK and Norway • Washing hands was more often declared than observed in real situation • Routines and barriers can prevent hand washing • Routines, materials and knowledge were all involved in the observed practices Journal Pre-proof Conflict of interest form Declarations of interest: none From : Pierrine Didier a,b,$ , Christophe Nguyen-The a , Lydia Martens c , Mike Foden c , Loredana Dumitrascu d , Augustin Octavian Mihalache d , Anca Ioana Nicolau d , Silje Elisabeth Skuland e , Monica Truninger f , Luís Junqueira f , Isabelle Maitre b* a INRAE, Avignon Université, UMR SQPOV, 84000 Avignon, France b USC1422 GRAPPE, Ecole Supérieure d’Agricultures (ESA), INRAE, SFR 4207 QUASAV, 55 rue Rabelais, BP 30748, 49007, Angers Cedex, France c Keele University, United Kingdom d Dunarea de Jos University of Galati, Faculty of Food Science and Engineering, Domnească Street 111, 800201, Galati, Romania e Silje Elisabeth Skuland, Consumption Research Norway (SIFO), Oslo Metropolitan University, Oslo, Norway f Instituto de Ciências Sociais,Universidade de Lisboa, Av. Professor Aníbal de Bettencourt 9, 1600-189, Lisboa, Portugal Submission of « Washing hands and risk of cross contamination during chicken preparation among domestic practitioners in five European countries” Journal Pre-proof