Current Food Safety Knowledge of Registered Dietitians

Transcription

1 ARTICLES Food Protetion Trends, Vol. 32, No. 11, Pges Copyright 2012, Interntionl Assoition for Food Protetion 6200 Auror Ave., Suite 200W, Des Moines, IA Current Food Sfety Knowledge of Registered Dietitins Lydi C. Medeiros 1* nd JANET BUFFER 2 1* The Ohio Stte University, Dept. of Humn Nutrition, 1787 Neil Ave., Columus, OH , USA; 2 Kroger Co., 2175 Prk Lke Drive, Atlnt, GA 30345, USA summry The ojetives were to ssess dietitins urrent food sfety knowledge y mesuring generl knowledge, pthogen knowledge, food sfety trining, nd informtion hnnels used y dietitins to lote food sfety informtion, nd to ompre differenes in urrent knowledge in reltion to differenes in food sfety tehing ehvior with ptients. A non-proilisti smple of registered dietitins (n = 327) in the United Sttes ws sked to omplete we-delivered survey. The study used desriptive, ross-setionl design. Non-prmetri dt etween two tehing groups were nlyzed y Chi-squre tests. Prmetri dt etween tehing groups were ompred y Student s t-tests. Dietitins were modertely knowledgele of generl food sfety priniples, showing no differenes etween tehing groups (P = 0.09), ut pthogen knowledge differed etween those who tught nd those who did not teh ptients food sfety (P = 0.02 to 0.002). Tehing ws more frequently reported y dietitins who hd prtiipted in post-undergrdute food sfety trining (P < 0.001). The Internet ws reported to e populr nd frequently utilized soure of food sfety informtion, ut Registered Dietitins (RD) re pprently seeking si food sfety informtion nd informtion tht is not in gret depth to fully understnd the implitions of pthogen exposure in suseptile ptient popultions. This study hs implitions to dieteti undergrdute nd ontinuing edution progrms. A peer-reviewed rtile *Author for orrespondene: Phone: ; Fx: E-mil: Medeiros.1@osu.edu 688 FOOD PROTECTION TRENDS NOVEMBER 2012

2 INTRODUCTION Registered dietitins (RDs) hve een identified y immune-ompromised ptients to e preferred nd redile soure of food sfety informtion (4, 7, 10, 13). Dieteti undergrdute edution required for preprtion s n RD in the United Sttes is dietitin s primry soure of si food sfety knowledge, nd individul post-grdute ontinuing edution plns my inlude more dvned preprtion if the RD pereives personl or employment need for dditionl food sfety trining (2, 3). Current knowledge my influene the ehvior of person who relies on tht knowledge. Griffin et l. (8) theorized tht motivtion to seek risk ommunition informtion, suh s food sfety informtion needed to prepre for ptient instrution, is funtion of person s urrent knowledge nd onfidene tht he or she hs suffiient knowledge to t with regrd to desirle ehvior. We hve previously reported tht dietitins who re for pregnnt women, the elderly, or other immune-ompromised ptients demonstrted tht they hve si food sfety knowledge, lthough in some ses it ws inomplete or inorret (5). These findings led us to investigte whether knowledge of food sfety influenes dietitin s tehing ehvior with ptients, regrdless of whether or not the ptient expets this informtion to e provided y the dietitin who is prt of the helth re tem (4, 7, 10, 13). The ojetives of this study were to ssess the urrent food sfety knowledge of RDs y mesuring generl knowledge, pthogen knowledge, food sfety trining, nd informtion hnnels used y dietitins to lote food sfety informtion, nd to ompre differenes in urrent knowledge in reltion to food sfety tehing ehvior with ptients. The following questions were sked: Are RDs generlly knowledgele out food sfety nd foodorne pthogens? Are RDs seeking food sfety trining nd using primry informtion hnnels to prepre themselves for ptient food sfety instrution? Does urrent food sfety knowledge differ y ptient tehing ehvior? MATERIALS AND METHODS Sujets nd survey Sujet inlusion riteri nd reruitment methods hve een previously desried (6). In rief, RDs in the United Sttes (n = 327) were reruited through live links in messges to professionl listservs nd on we sites tht invited RDs to prtiipte in 152 item we-delivered survey. The we site for the online survey ws developed in-house using SeletSurvey.NET (ClssApps, Relese 2.0, Overlnd Prk, KS), with numeril dt reorded in omm delimited text file. Items ould not e skipped euse the survey would not dvne until the respondent either nswered the item or heked ox stting tht they voluntrily did not nswer the item. If the respondent proeeded to the end of the survey nd liked the sumit utton, the survey ws defined s omplete. Items voluntrily not nswered were treted s missing dt. Detils of how the survey ws oneptulized nd tested hve lso een pulished (6). Survey items were dpted from previous studies (9, 14). The oneptul model for the study ws sed on the Risk Informtion Seeking nd Proessing (RISP) model (8). The RISP model onstrut of urrent knowledge is reported in the present study. Respondents to the online survey greed to wiver of written onsent efore they were llowed to enter the survey we site nd enter dt. The protool ws pproved y the Institutionl Review Bord for Soil nd Behviorl Humn Sujets Reserh (Protool #2008B0345). Respondents were finnilly ompensted. Dependent vrile A inry dependent vrile ws onstruted from survey item proing urrent food sfety tehing ehvior of RDs who ounseled ptients. Dt were divided into Do Not Teh group (n = 159, 48.6%), omposed of dietitins who reported they were not urrently tehing food sfety to ptients, nd omprison group (Teh group, n = 168, 51.4%) of dietitins who responded tht they were urrently providing ptient food sfety edution. Current knowledge Knowledge of food sfety ws mesured s generl knowledge (17 items), self-reported wreness of four mjor foodorne illness-using pthogens (four items), nd self-reported understnding of the sme four pthogens (four items). All knowledge items in the survey were tested for fe vlidity with five key informnts who were registered dietitins nd pilot tested with 16 registered dietitins to et test the survey site nd to otin dt for item nlysis (6). Generl knowledge items were dpted from vlidted items from previous study (14), with the exeption of one item out miroil sfety of gged greens, whih hd een modified sed on susequent reserh (11). Items mesuring generl knowledge were sored s orret (ode = 1) or inorret (ode = 0) (14) nd were ssessed for item diffiulty nd item disrimintion (15). Ten items remined fter nlysis nd were heked for internl onsisteny using Cronh s lph; two dditionl items were deleted. The eight remining items hd low internl onsisteny (α = 0.51). Pthogen wreness questions sked respondents to rte how muh they hd herd (selfreported wreness) out eh of four foodorne illness-using pthogens (Herd nothing = 1, Herd lot = 4, (α = 0.79). Respondents were lso sked to rte their understnding (self-reported knowledge) of the sme four pthogens (Very low = 1, Very high = 5 (α = 0.83). Food sfety trining nd informtion hnnels Type of trining reeived s soure of food sfety informtion ws ssessed in multi-hoie survey item (No = 0, Yes = 1). Also, multi-hoie survey item ssessed the rry of food sfety informtion hnnels respondents utilized (No = 0, Yes = 1). Informtion soure nd type of trining were ompred etween tehing groups. Additionlly, openended items sked respondents to nme up to three journls nd three wesites used to lote food sfety informtion. A tegoril txonomy ws developed to orgnize responses. Dt were expressed s perent (%) of totl mentions. Dt nlysis This ws ross-setionl, desriptive study of food sfety knowledge, trining nd informtion hnnels used y non-proilisti smple of RDs who either tught or did not teh ptients out food sfety. The Sttistil Pkge for the Soil Sienes softwre (SPSS Version 19.0, SPSS In., Chigo IL, 2011) ws used for dt nlysis. Desriptive sttistis were lulted for NOVEMBER 2012 FOOD PROTECTION TRENDS 689

3 Tle 1. Desriptive hrteristis of survey respondents Chrteristi Do not teh Teh Gender n (%) n (%) Mle 4 (44.4) 5 (55.6) Femle 155 (48.9) 162 (51.1) Self-identified ril/ethni group Age White/Non-Hispni 147 (49.5) 150 (50.5) All others 9 (39.1) 14 (60.9) yers *** 62 (71.3) 25 (28.7) yers 53 (44.2) 67 (55.8) 45 yers nd older *** 44 (36.7) 76 (63.3) Self-reported edution level ompleted College grdute 71 (50.4) 70 (49.6) Postgrdute or professionl 87 (47.0) 98 (53.0) Self-reported inome tegory d $64K or less 51 (56.0) 40 (44.0) $65K $99K 45 (43.7) 58 (56.3) $100K or more 46 (49.5) 47 (50.5) US ensus region e West 41 (45.1) 50 (54.9) Midwest 31 (48.4) 33 (51.6) Northest 58 (56.3) 45 (43.7) South 25 (42.4) 34 (57.6) For eh hrteristi nd within eh row, numer of respondents (n) nd perent of totl within the hrteristi level (%) Respondents who stted they do not urrently teh nor do they intend to teh ptients out food sfety (n = 159) Respondents who stted they re urrently tehing ptients out food sfety (n = 168) d K = thousnds of United Sttes Dollrs ($) e Regions defined ording to US Census tegories *** Differene etween tehing groups, P < ll vriles. Non-prmetri vriles were nlyzed for differenes y Person Chi-Squre or y Student s t-tests for prmetri vriles. RESULTS A totl of 327 ompleted surveys were otined. An dditionl 20 ttempted ut not sumitted surveys were eliminted from dt nlysis. The demogrphi hrteristis of the survey respondents re onsistent with the desription of the popultion of RDs in the United Sttes (18) s reported previously (Tle 1) (6). No differenes were seen etween the two tehing groups for most of the demogrphi hrteristis, exept for ge. Younger dietitins (ge yers) were less likely to teh food sfety to ptients (P < 0.001), nd older dietitins (45 yers nd older) were more likely to teh (P < 0.001), ompred with other ge groups. Generl food sfety knowledge Generl food sfety knowledge ws similr etween the two tehing groups (P = 0.09) (Tle 2). Knowledge sores were modertely good (defined s etween 50% nd 75% orret), most likely refleting previous preprtion ssoited with eoming registered dietitin. It ws oserved tht dietitins in oth groups were knowledgele of food sfety fts out ooking hmurgers dequtely; eting rw lflf sprouts, old hot dogs, or heeses mde from unpsteurized milk; nd wshing fruit skins efore peeling if ross ontmintion y utensil is possile nd if the food is likely to e stored efore onsumption (Tle 690 FOOD PROTECTION TRENDS NOVEMBER 2012

4 Tle 2. Survey respondents orret responses to generl food sfety knowledge items nd overll knowledge sore Survey item (orret response) Do not teh Teh P d n (%) n (%) If you hve dirrhe, it s oky to prepre food 73 (46.8) 83 (49.7) 0.60 for others in the fmily if you wsh your hnds first. (disgree is orret) When you n t see ny pink olor inside ooked 127 (79.9) 148 (88.1) 0.04 hmurger ptty you know ll of the hrmful germs hve een killed nd the hmurger is sfe to et. (disgree is orret) Hed lettue is more likely to hve high miroil ounts 82 (51.6) 97 (58.4) 0.21 thn pre-wshed (gged) lettue. (disgree is orret) It is oky for people in high-risk groups to et lflf 126 (79.2) 139 (82.7) 0.42 or other sprouts. (disgree is orret) It is oky for people in high-risk groups to et old 126 (79.2) 145 (86.8) 0.07 (stright out of the pkge) hot dogs. (disgree is orret) It is oky for people in high-risk groups to et soft heese 138 (86.8) 145 (86.3) 0.90 mde from unpsteurized milk, like Brie or Cmemert. (disgree is orret) It is oky for people in high-risk groups to drink juies 60 (38.5) 61 (36.5) 0.72 nd smoothies mde with rw fruits nd vegetles. (disgree is orret) It is oky for people in high-risk groups to et nn 129 (81.1) 144 (86.2) 0.21 without wshing the skin first. (gree is orret) Men (SEM e ) Men (SEM e ) P f Overll knowledge sore g 5.4 (0.13) 5.7 (0.13) 0.09 Response options Avoid, Oky to et, Not sure; orret response ode = 1, inorret response nd not sure ode = 0 Respondents who stted they do not urrently teh nor do they intend to teh ptients out food sfety (n = 159) Respondents who stted they re urrently tehing ptients out food sfety (n = 168) d P = proility, Person s Chi-Squre e SEM = stndrd error of men f P = proility, Independent smples Student s t-test g Sum of orret responses, 0 = minimum sore, 8 = mximum sore 2). Food sfety fts tht were most likely to e inorretly nswered were out prepring food while sik with dirrhe, the miroiologil sfety of gged lettue, nd the sfety of everges mde with rw fruit or vegetle. Pthogen self-reported wreness nd knowledge Respondents were sked to ssess their wreness (Tle 3, α = 0.78) nd knowledge of speifi foodorne illnessusing pthogens (Tle 4, α = 0.81). Dietitins were most wre of nd est understood fts relted to Slmonell spp. nd E. oli O157:H7. Respondents hd the lest wreness nd knowledge of Cmpyloter jejuni. Those who were urrently tehing their ptients out food sfety were more wre (P < 0.001) nd etter understood (P < 0.001) eh of the four pthogens sked out in the survey thn dietitins who re not urrently tehing food sfety (Tle 5). Food sfety trining nd informtion hnnels A mjority of dietitins (n = 285, 87%) reported tht they hd reeived speifi food sfety trining (Tle 6), nd overll differene etween tehing groups ws not found (P = 0.74). No differenes were seen etween tehing groups with regrd to trining reeived through edutionl urriulum ourses (P = 0.87) or employee food servie NOVEMBER 2012 FOOD PROTECTION TRENDS 691

5 FIGURE 1. Food sfety informtion hnnels utilized y registered dietitins y their urrent tehing sttus of food sfety informtion for ptients. Signifint differenes were found for We sites (P = 0.007) nd for professionl trining (P = 0.014). Do not urrently teh (n = 159) Teh (n = 168) Frequeny (n) Tle 3. Pthogen self-reported wreness of survey respondents Survey item Group R response hoie n (%) P Nothing A little Quite it A lot How muh hve you herd Do not teh 0 24 (15.1) 96 (60.4) 39 (24.5) out the teri Slmonell? Teh 0 18 (10.7) 83 (49.4) 67 (39.9) How muh hve you herd out Do not teh 1 (0.6) 32 (20.1) 91 (57.2) 35 (22.0) the teri E. oli O157:H7? Teh 0 27 (16.1) 78 (46.4) 63 (37.5) How muh hve you herd out Do not teh 26 (16.4) 89 (56.0) 41 (25.8) 3 (1.9) the teri Cmpyloter jejuni? Teh 13 (7.7) 90 (53.6) 45 (26.8) 20 (11.9) How muh hve you herd out Do not teh 7 (4.4) 73 (45.9) 63 (39.6) 16 (10.1) the teri Listeri monoytogenes? Teh 2 (1.2) 67 (39.9) 67 (39.9) 32 (19.0) P = proility, Person Chi-Squre Respondents who stted they do not urrently teh nor do they intend to teh ptients out food sfety (n = 159) Respondents who stted they re urrently tehing ptients out food sfety (n = 168) trining (P = 0.81), the two soures of trining tht re typil nd onsistent for dieteti edution nd ompetenies required for registrtion s dietitin in the United Sttes (2). Of those who limed speifi food sfety trining, differenes etween tehing groups were noted for ontinuing edution ourses (P < 0.001) nd onferenes or workshops (P < 0.001). Respondents were sked out eight different hnnels tht they might onsult for food sfety informtion (Fig. 1). For this group of helth professionls, friends nd fmily were the lest utilized. Informtion hnnels suh s wesites, professionl urriul, professionl trining progrms nd professionl journls were the most frequently ited. Those who urrently teh ptients out food sfety ited wesites (P = 0.007) nd pro- 692 FOOD PROTECTION TRENDS NOVEMBER 2012

6 Tle 4. Pthogen self-reported knowledge of survey respondents Survey item Group Response hoie n (%) P Very Low Moderte High Very low high How would you rte your Do not teh 0 10 (6.3) 118 (74.2) 29 (18.2) 2 (1.3) understnding of the teri Teh 0 11 (6.5) 102 (60.7) 45 (26.8) 10 (6.0) Slmonell? How would you rte your Do not teh 2 (1.3) 20 (12.6) 109 (68.6) 26 (16.4) 2 (1.3) understnding of the teri Teh 0 18 (0.7) 94 (56.0) 39 (23.2) 17 (10.1) E. oli O157:H7? How would you rte your Do not teh 31 (19.5) 72 (45.3) 52 (32.7) 4 (2.5) understnding of the teri Teh 26 (15.5) 67 (39.9) 53 (31.5) 14 (8.3) 8 (4.8) Cmpyloter jejuni? How would you rte your Do not teh 11 (6.9) 45 (28.3) 90 (56.6) 12 (7.5) 1 (0.6) understnding of the teri Teh 9 (5.4) 41 (24.4) 80 (47.6) 25 (14.9) 13 (7.7) Listeri monoytogenes? P = proility, Person Chi-Squre Respondents who stted they do not urrently teh nor do they intend to teh ptients out food sfety (n = 159) Respondents who stted they re urrently tehing ptients out food sfety (n = 168) fessionl trining (P = 0.014) more often thn those who re not urrently tehing food sfety. In ddition, respondents were sked to nme the top three professionl journls nd the top three wesites they use s soures of food sfety informtion. The responses were qulittively sorted into tegories, nd mentions re reported in Tle 7. DISCUSSION The registered dietitin requires n undergrdute edution from n institution tht is redited y the Ademy of Nutrition nd Dietetis, Commission on Dieteti Registrtion, nd food sfety is required edutionl ompeteny for ll didti progrms (3). Furthermore, RDs re required to omplete ontinuing edution in topis pertinent to their employment or in res in whih the individul wishes to hve dditionl informtion nd trining. Dietitins in diret lient re enounter ptients who re suseptile to foodorne illnesses nd ethilly must mintin ompeteny in food sfety (2). We designed the hypotheses of this study to test whether the professionl stndrds with regrd to food sfety knowledge were eing met in smple of RDs engged in linil prtie. We expeted to find tht RDs re knowledgele of food sfety, tht they seek trining in food sfety, nd tht they use primry informtion hnnels for stte-of-the-rt food sfety informtion. We further expeted tht urrent knowledge of RDs would not differ y tehing ehvior. Demogrphi hrteristis Although the use of non-proilisti smple is limittion of this study, the respondents to this survey hd demogrphi hrteristis tht were onsistent with those of RDs in the United Sttes (18), suggesting tht study findings n e generlized to the popultion of RDs ntionwide. Of interest were hrteristis tht distinguished those who re urrently tehing food sfety to their ptients from those who re not. Age differenes etween these two groups were noted (Tle 1, P < 0.001). Older dietitins were more likely to teh food sfety thn were younger dietitins. Two explntions re possile. First, older dietitins my hve longer nd perhps more vried employment experienes, nd ould hve een more wre of the long-term helth onsequenes of foodorne illness nd informtion needs of ritilly ill ptients. Seond, older dietitins my hve greter onfidene in their knowledge of food sfety nd therefore e more omfortle with tehing the topi to ptients. Younger dietitins my hve een more involved in tehing medil nutrition therpy to ptients thn in tehing sujet usully ssoited with food servie mngement (3), nd thus less likely to fous their ontinuing edution plns in this diretion. These possile explntions suggest tht food sfety edution nd ontinuing edution urriul my need to e reviewed to ensure tht dietitins hve suffiient knowledge to meet the helth needs of ritilly ill nd suseptile ptients under their re. Generl food sfety knowledge Dietitins were sked to respond to series of items to mesure the ury of their generl food sfety knowledge. Respondents in oth groups hd similr ut modertely orret knowledge of food sfety (Tle 2). In the development of the survey, items were eliminted if they were too esy (item disrimintion) NOVEMBER 2012 FOOD PROTECTION TRENDS 693

7 Tle 5. Pthogen self-reported wreness nd knowledge sores of survey respondents Sore Do not teh Teh P d M men (SEM) men (SEM) Pthogen self-reported wreness 10.8 (2.08) 11.7 (2.32) Pthogen self-reported understnding (1.95) 12.1 (2.98) Sum of responses (n = 326), minimum sore = 4, mximum sore = 20 Respondents who stted they do not urrently teh nor do they intend to teh ptients out food sfety (n = 159), SEM = stndrd error of men Respondents who stted they re urrently tehing ptients out food sfety; n = 168, SEM = stndrd error of men) d P = proility, t-test Tle 6. Frequeny nd type of speilized food sfety trining reeived y survey respondents Food sfety trining Do not teh Teh P d Reeived food sfety trining (n = 285) 138 (48.4) 147 (51.6) Trining options (n = 285) Votionl, tehnil or ollege urriulum ourse (n = 226) 110 (48.7) 116 (51.3) Continuing edution ourse (n = 109) 38 (34.9) 71 (65.1) Conferene or workshop (n = 115) 35 (30.4) 80 (69.6) Employee food servie trining (n = 157) 75 (47.8) 82 (52.2) Comprison mde etween groups for eh trining option n (%); response options, 0 = no, 1 = yes Respondents who stted they do not urrently teh nor do they intend to teh ptients out food sfety (n = 159) Respondents who stted they re urrently tehing ptients out food sfety (n = 168) d P = proility, Person Chi-Squre or if they ompromised the homogeneity of sujet tht ws eing tested (internl onsisteny). The items tested in the survey ut not reported in this study were generlly similr to those tught to the generl puli nd re onsistent with populr edutionl progrms suh s the FightBAC progrm ( fight.org/). The reported items in Tle 2 tested knowledge of food sfety guidne primrily importnt to ptients t high risk for foodorne illness (4, 7, 10, 13). All of the reported nd nonreported knowledge items were developed nd tested to hve eptle psyhometri hrteristis with vriety of popultion groups, inluding those expeted to e less knowledgele of food sfety (low-inome onsumers, α =.75) nd more knowledgele (undergrdute students in dietetis nd hospitlity mngement, α =.82) (14). Unlike onsumers or ollege students, dietitins re edutionlly reltively homogeneous group. Therefore, generl knowledge items my not hve een suffiiently hllenging to this group of helth professionls nd, euse of the respondents edutionl kground, my hve lked the sensitivity to detet differenes etween tehing groups. Pthogen self-reported wreness nd knowledge The RDs who responded to this survey pereived they were less wre nd knowledgele of the four pthogens tht use foodorne illness thn of generl food sfety (Tle 5). The pthogens hosen for the survey were seleted for the frequeny or severity of the illness they used, the potentil for severe hroni sequele, nd their overll puli helth, soietl nd eonomi impt (16). Slmonell nd E. oli O157:H7 re pthogens tht hve een implited in reent nd highly puliized foodorne 694 FOOD PROTECTION TRENDS NOVEMBER 2012

8 Tle 7. Journl nd We sites most often mentioned y survey respondents Ctegory mentions Frequently mentioned exmple n (%) Journls 336 (100) Food servie professionl or trde 17 (5.1) Food Servie Diretor Dietetis professionl 199 (59.2) Journl Amerin Dieteti Asso. Medil professionl 31 (9.2) Journl Amerin Medil Asso. Food sfety or siene professionl 12 (3.6) Journl of Food Sfety Clinil dieteti trde 50 (14.9) Tody s Dietitin Generl nutrition or helth professionl 27 (8.0) Amer. Journl of Clinil Nutrition We sites 466 (100) Prtnership for Food Sfety Edution 107 (23.0) Food nd Drug Administrtion 58 (12.4) Centers for Disese Control nd Prevention 46 (9.9) Stte government 6 (1.3) Other government or interntionl 25 (5.4) Medil professionl 35 (7.5) Nutrition or helth professionl 51 (10.9) Food servie 20 (4.3) Dieteti professionl 76 (16.3) University or extension edution 12 (2.6) New medi 14 (3.0) Informtion serh 16 (3.4) illness outreks ssoited with highly nutritious fresh vegetles (12, 17). Listeri monoytogenes uses deth in out 25% of ses (16), nd is prtiulr helth risk for pregnnt women nd the elderly (1). The responses to items proing pthogen self-reported wreness nd knowledge indite tht dietitins were generlly fmilir with these three pthogens; however, differenes etween tehing groups were found for oth pthogen self-reported wreness (Tle 3) nd knowledge (Tle 4), with greter self-reported wreness or knowledge ssoited with urrent tehing ehvior. Overll, the respondents were less fmilir with Cmpyloter jejuni. This pthogen frequently results in illness (16), ut often resolves without ny medil intervention. While RDs my pereive less urgeny to edute highrisk ptients out Cmpyloter jejuni, dvned knowledge of the long-term onsequenes of infetion with this pthogen my influene their tehing ehvior. Food sfety trining nd informtion hnnels Highly signifint differenes (P < 0.001) were noted etween tehing groups for those RDs who stted they hd speifi food sfety trining in some form of ontinuing edution or workshops (Tle 6). Speiliztion in topi is optionl nd is ssoited with the professionl development pln requirements of the Commission on Dieteti Registrtion (2). Professionl development is funtion of the long-term lerning needs pereived y the individul dietitin. If dietitins see the need to improve their grsp of prtiulr topi, they re enourged to voluntrily selet edutionl opportunities in tht topi to inlude in their required ontinuing edution plns. Post-lurete professionl development in food sfety is onsistent with the oservtion tht older RDs were more likely to teh food sfety to ptients. Forml edution did not distinguish tehing ehvior etween groups (Tle 6). We hve previously reported frequent reline on onsumer-oriented edution progrms s medi soures of food sfety informtion used y dieti- NOVEMBER 2012 FOOD PROTECTION TRENDS 695

9 tins who re helth providers for immune ompromised groups t high-risk for foodorne illnesses (5). The present study points to the importne of the Internet s soure of food sfety informtion. We sites s food sfety soures were frequently mentioned s informtion hnnels (Tle 7), nd were onsulted more frequently y RDs who re urrently tehing food sfety to ptients (Fig. 1, P < 0.001). Either professionl informtion hnnels or trining were mentioned, ut mny of the exmples re known for medil nutrition topis nd not for informtion on opportunisti infetious diseses (Tle 7) tht my e foodorne illnesses in the immuneompromised ptients. The implition of this finding, long with the findings on generl food sfety knowledge nd pthogen self-reported wreness nd knowledge, is tht RDs re pprently seeking si food sfety informtion nd informtion tht is not in-depth to fully understnd the implitions of pthogen exposure in suseptile ptient popultions. CONCLUSIONS AND RECOMMENDATIONS The Commission on Ademi Dieteti Edution orgnizes food sfety s n edutionl ompeteny under food servie mngement (3). Perhps ssoition of food sfety with medil nutrition therpy would enourge younger dietitins to ddress the topi with their ptients. The implition of this study is tht food sfety edution should e foused on mehnisms of infetion nd pthogen ontrol nd not just on onsumer ehvior. An importnt finding of this study is tht the Internet is populr nd frequently utilized soure for food sfety informtion for dietitins. This points out the opportunity to design online professionl development offerings tht will promote food sfety knowledge for the helth enefit of the immune-ompromised ptient, n informtion hnnel ville to ny RD who needs informtion in highly essile formt. The pproprite depth nd qulity of the informtion re essentil to effetive food sfety edution. ACKNOWLEDGMENTS Gin Csgrnde nd Eri Luderh re knowledged for their ontriutions to the survey development nd dt nlysis. This study ws supported y funds from the USDA, Ntionl Integrted Food Sfety Inititive, Grnt # REFERENCES 1. Anonymous Risk ssessment of Listeri monoytogenes in redy-to-et foods: interpretive summry. Miroiologil risk ssessment series, no 4. Genev: FAO, WHO. 2. Anonymous Amerin Dieteti Assoition/Commission on Dieteti Registrtion ode of ethis for the profession of dietetis nd proess for onsidertion of ethis issues. J. Amer. Diet. Asso. 109: Anonymous. Commission on redittion for dietetis edution, 2008 foundtion knowledge nd ompetenies dietitin edution. Aville t: org/uplodedfiles/cade/cade- Generl-Content/3-08_RD-FKC_ Only.pdf. Aessed 12 Jnury Athern, P. N., P. A. Kendll, V. Hillers, M. Shroeder, V. Bergmn, G. Chen, nd L. Medeiros Awreness nd eptne of urrent food sfety reommendtions during pregnny. Mter. Child Helth J. 8: Buffer, J., L. Medeiros, P. Kendll, M. 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