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Thursday, 17 November 2011

The importance of Healthcare Management for Food Safety in Hong Kong

 The Importance of Healthcare Management for Food Safety in Hong Kong


 


Abstract


            Food safety issues are an important problem not only for the residents of Hong Kong but the world over. There are many people around the world who have no idea about how to handle food safely and thus expose themselves to the danger of getting an illness or disease. At the least improper handling can cause stomach upsets and on the worst can cause food poisoning of individuals and even death. Improper handling of food materials will not only affect the health of individuals but will likewise reflect on how healthcare management has performed.


This project is done with the aim of determining the food safety practices of people in Hong Kong and how healthcare organizations have managed it. In order to do this, a telephone survey of residents is conducted in a period of two months. The respondents of this study will be asked a variety of questions regarding their knowledge and practices of food handling. The results of this endeavor would show that several trends in food handling techniques have the potential to contribute to an increase in food-borne disease. Additionally, this project can help health care organizations and the public to be more aware of the importance of following safe food handling procedures. Perhaps health care organizations can come up with a better strategy to educate the public regarding food safety handling practices.


 


1. Chapter 1 – INTRODUCTION TO THE PROJECT


Meeting nutritional needs adequately and safely requires environmental controls and knowledge. Take for example at home, individuals need a refrigerator with a freezer compartment to keep perishable foods fresh. An adequate, clean water supply is needed for drinking and to wash fresh produce and dishes. Provisions for garbage collection are also necessary to maintain sanitary conditions.


            When we eat, we should be aware of what we are eating. This does not mean what kind of food we are eating, but rather what exactly is in the food we are eating. Harmful bacteria could be present in the food we eat. Harmful bacteria that may be in the soil or water where the food we are eating used to grow may come in contact with the fruits and vegetables and contaminate them. Or, fresh produce may become contaminated after it is harvested, such as during preparation or storage of the food. Such harmful bacteria that contaminate our food could be toxic and produce infection and food poisoning.


Food safety is therefore a matter that affects anyone who eats food. It is concern for both individuals and communities. It is true that there are people who thought about the safety of that food we eat, from farmers to scientists to company presidents to federal government officials and sanitarians. Yet, as individuals and communities, we also have the responsibility to protect ourselves from food contamination and poisoning with infection control strategies.


 


1.1 Bacteria and Viruses in Foods


            Foods that are inadequately prepared or stored, or that are subject to unsanitary conditions, increase an individual or even an entire community’s risk for infections and food poisoning. Most bacterial food infections result from eating food contaminated by bacteria such as Escherichia coli, Salmonella, Shigella, or Listeria organisms (2004). More than 200 known diseases are actually transmitted through food (2001). Some come from eating or drinking products that contain poisons such as insecticides. Most varieties, however, come from harmful bacteria, viruses, or parasites that grow in undercooked or spoiled food (2002).


E. coli is only one of many harmful microbes that cause food borne illness. It is mostly found in ground beef, unpasteurized fruit juices, lettuce, or alfalfa or radish sprouts contaminated by cow feces. Early symptoms include cramps and bloody diarrhea within 24 hours of ingestion. The bacteria secrete a dangerous toxin that can eat at the intestinal walls and other internal organs. In some cases, this leads to massive bleeding, kidney failure, and other complications that may be fatal ( 2006).


Salmonella bacteria commonly grow in raw meats, poultry, eggs, seafood, dairy products, salad dressing, peanut butter, coconut, cocoa, and other foods. Salmonella exists in the intestinal tracts of animals, including food-producing animals as well as turtles, cats, dogs, birds, rodents, and wild animals. Raw milk and eggs are also sources of Salmonella. While heat easily destroys Salmonella, inadequate cooking allows some of the organisms to survive (2001). Symptoms can begin six to 48 hours after eating, and last one to 14 days. These may include nausea, vomiting, cramps, diarrhea, fever, and headache. Some people may develop symptoms of arthritis a month or so after infection ( 2006).


Campylobacter infection is another particular threat because around one victim in ten suffers serious complications, including septicemia and even paralysis. The main source of campylobacter infection is undercooked, contaminated food, especially chicken (2006).


            While bacteria cause most food poisonings, a group of viruses known as Norwalk-like viruses are at fault in many cases. Usually, people get infected by eating infested food. Recently, though, doctors discovered that these viruses can be passed from person to person ( 2002).


            Seafood products contain some naturally occurring marine toxins that present unique food hazards. Molluscan shellfish, which includes oysters, clams, scallops, and mussels, can pick up toxins from algae that they feed on, and cause paralytic shellfish poisoning, neurotoxic shellfish poisoning, amnesic shellfish poisoning, and diarrhetic shellfish poisoning. Tropical and subtropical reef fish such as grouper, barracuda, snappers, jacks, and king mackerel can accumulate ciguatera toxin by feeding on smaller fish that have ingested toxin-forming algae. Ciguatera can cause nausea, vomiting, diarrhea, and headaches in humans. Tuna, mahi mahi, bluefish, and mackerel have been the sources of scromboid poisoning, a type of food borne illness caused by the consumption of scombroid and scombroid-like marine fish species that have begun to spoil (2001).


Most incidents of these infections and food poisonings, however, do not make headlines, so people remain unaware of how common they are. Young children, the elderly, and those with weak immune systems are most vulnerable to complications or death. Most infected people survive with no lasting damage, but some develop chronic problems such as arthritis, kidney failure, or certain nerve diseases ( 2002).


 


1.2 Impacts of Food Poisoning


Food poisoning and getting a food-borne disease can have a life-altering impact. Food poisoning can lead to Guillain-Barre Syndrome, reactive arthritis, or hemolytic uremic syndrome–diseases that can leave their victims with chronic pain, paralysis, and kidney damage ( 2002). The symptoms of other food-borne illness also vary with the offending source. Most cases involve abdominal cramps, diarrhea, nausea, and vomiting. These symptoms often pass on their own, but some must be treated with medication. Some victims of food-borne infections must be hospitalized if they become dehydrated or develop other complications (2002).


 


1.3 Infection Control Strategies


Prevention is always better than cure. Individuals and communities must therefore be aware and be able to implement infection control strategies. Preventive measures include thorough hand washing before handling food, adequate cooking, and proper storage and refrigeration of perishable foods. These will be further discussed in the succeeding paragraphs. On the national level, protecting consumers require that food authorities, such as the Food and Drug Administration, subject commercially processed and packaged foods to certain regulations.


            Harmful microbes can infect food or beverages during any stage of production or storage. This means that everyone from the farmer to the consumer must be aware of how to keep food safe. Government agencies in Hong Kong such as the Food and Drug Administration and other food departments and even the agriculture section regulate and inspect food supplies. But of course, individuals must be aware that they cannot catch every bacterium. Contamination often occurs when animal feces get into meat or water, perishable foods are not stored correctly, or harmful pathogens are spread in home or restaurant kitchens (2002). These are some things that are beyond the control of food safety agencies and are therefore the responsibility of communities and individuals.


            Government agencies in Hong Kong responsible for food safety say that most cases of food-borne illness result from mishandled meats, poultry, seafood, or dairy products. Take for example, campylobacter bacteria are often found in foods in grocery stores. These bacteria can cause serious illness if the meat is not cooked enough or if the germs spread to other foods. Using the same knife or cutting board to slice raw chicken and salad fixings is one common way of spreading such germs. Because salad is not cooked, these bacteria are not killed (2002).


      When individuals are purchasing foods from supermarkets, there are certain measures that the individual can follow in order to avoid contamination of foods. At the checkout counter, the shopper must be vigilant to put the meat, seafood, or poultry in a separate bag so leaking juices don’t contaminate other foods (1999). Also, it is important that individuals must purchase produce that is not in any way bruised or damaged. When selecting fresh cut produce – such as a half a watermelon or bagged mixed salad greens – it is important to choose only those items that are refrigerated or surrounded by ice. Fresh fruits and vegetables must also be bagged separately from meat, poultry and seafood products when packing them to take home from the market (2006).


At home, these foods must be refrigerated as soon as possible. When preparing meals, it is inevitable to touch the meat. This is okay as long as after touching raw meat, poultry, seafood, or eggs, hands, utensils, and surfaces must be thoroughly washed with hot, soapy water. The same utensils and platters for raw and cooked meat, poultry, or seafood must not be used interchangeably. Frozen meat, poultry, and seafood in the refrigerator must also be completely thawed before cooking ( 1999).


            When marinating foods, they should be done in the refrigerator and not on the counter. The marinade from raw meat, poultry, or seafood should not be used on cooked food unless it has been brought to a boil first to kill any bacteria. The internal temperature of meat, poultry, and seafood should be checked with an oven-safe, dial instant-read or digital meat thermometer (1999).


            Raw sprouts that are served on salads, wraps, and sandwiches may also contain bacteria that can cause food-borne illness. Rinsing sprouts first will not remove bacteria. Home-grown sprouts also present a health risk if they are eaten raw or lightly cooked. To reduce the risk of illness, raw sprouts such as bean, alfalfa, clover, or radish sprouts should not be eaten. All sprouts should be cooked thoroughly before eating to reduce the risk of illness. This advice is particularly important for children, the elderly, and persons with weakened immune systems, all of whom are at risk of developing serious illness due to food borne disease (2006).


 


1.4 Healthcare Management of the Issue


            Health care professionals are more and more becoming involved in leadership endeavors. Such leadership is not only confined to those who hold high positions in an organization but rather to everyone within the organization. Emphasis on leadership should be taught to all health care professionals within an organization. The same thought is what is supported by  (2001). and  (2005) also placed emphasis on the importance of health care professionals becoming more involved in leadership.


            As health care professionals, it is important to acquire the necessary knowledge and competencies that ultimately allow them to practice their profession. Regardless of the type of setting that these health care professionals work within the health care organization, each individual health care professional is responsible for using organizational resources, participating in organizational routine while providing care to a patient, using time productively, collaborating with all members the health care team, and using certain leadership characteristics to manage others.


            The delivery of health care services is definitely a challenge. As health care professionals develop the knowledge and skills, they will gradually learn what it takes to effectively manage patients as well as fellow health care professionals within a team and to take the initiative in becoming a leader among colleagues. This paper will further study on what can be done to influence effective leadership practice and how this could be applied within your own clinical setting.


 


1.5 Background on healthcare management and leadership


            Effective leadership style is an integral part of creating an environment that nurtures the development of empowered health care professionals. (1997) defines leadership as “a process of social influence in which one person is able to enlist the aid and support of others in the accomplishment of a common task.”      


The major points of this definition are that leadership is a group activity, is based on social influence, and revolves around a common task. Although this specification seems relatively simple, the reality of leadership is very complex. Intrapersonal factors (i.e., thoughts and emotions) interact with interpersonal processes (i.e., attraction, communication, influence) to have effects on a dynamic external environment (1997).


The demands of the health care environment have brought about changes and health care professionals have been concerned about the impact this has had on patient care. Managers have had to develop ways to achieve expected outcomes and meet targets required by their organizations. To address all these issues, health care professionals need to focus on developing relationships that facilitate working with each other from strengths and not just criticizing weaknesses ( 2001).


Increasingly, a phenomenon called decentralized management is starting to become common within health care organizations (  2004). In decentralized management, decision making is moved down to the level of staff. This type of management structure has the advantage of creating an environment where managers and staff become more actively involved in shaping a health care organization’s identity and determining success.


Developing an empowering culture in which positive relationships are nurtured, leadership capabilities are developed, and professional practice is supported can improve the work environment and satisfaction of health care professionals (2001). Simply put, collaborative work relationships where leadership is part of should be actively enhanced and promoted in order to create a positive work environment.


            Leadership processes are directed at defining, establishing, identifying, or translating this direction for their followers and facilitating or enabling the organizational processes that should result in the achievement of the organization’s purpose. Organizational purpose and direction becomes defined in many ways, including through mission, vision, strategy, goals, plans, and tasks. The operation of leadership is inextricably tied to the continual development and attainment of these organizational goal states (2001).


The lack of leadership skills is one major factor when there are problems within a health care organization, or any other organization for that matter. In order to solve this problem, focus should be given to the managers down to the staff. Leadership training programs should be offered and leaders as well as the health care staff should be required to attend. These leaders and staff in turn should perform their responsibilities of teaching and guiding the rest of the members of the health care organization in promoting a healthy work environment.


In the hospital setting, this would most commonly be at the point of direct client care or staff nurse level; however, this kind of empowerment requires an environment of autonomy where mutual trust and respect are encouraged. The empowerment process requires that staff be prepared to accept and effectively use expanded decision-making responsibilities (1998).


To start changing the work environment into a healthy one where leadership is emphasized for all members within the organization, there should first be mutual trust and encouragement in all the parties involved. Each and every opinion should be respected and given consideration in the decision-making process. There should also be an all-out support for this desire for change.


The professional accountabilities of the health care professional includes having a sense of value about their work and willingness to provide the full scope of practice as well as ability to work as equal members of a comprehensive interdisciplinary team. In order to move into a fully empowered position, professional nurses need mentoring, education, awareness of political activism opportunities, and networking skills (1998).


In order to achieve all these, shared leadership should be employed. Shared leadership is a health care management model that supports health care professionals in extending their influence about decisions that affect their practice, work environment, professional development, and self-fulfillment (2001).


As previously mentioned, leadership is a group activity. In shared leadership, every voice is heard and given consideration. This could relate to Crisp’s idea that leadership must be exercised at all levels in all setting in the clinical team and in support services, in the ward and in the community and in the board room.


Shared leadership is a collaborative team process in which team members share key leadership roles (2004). Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today’s organized health care delivery systems. Employees must develop or refine new behaviors and skills in empowerment, facilitation, negotiation, systems thinking, and accountability on behalf of patients (2002).


Shared leadership is a way to strengthen continuous learning and enhance relationships between leaders/managers, staff and clients, which are the foundation upon which the nurses can develop a new type of relationship with management and with each other. This in turn could significantly improve the work environment. There is an emphasis on ‘relationships’ since these relationships can be tenuous at times as both managers and staff members adopt attitudes of contention and competition with each other.


Shared leadership provides an organizational framework that offers the health care staff maximal participation in decisions about work and the work environment. Every staff has to be given a chance what he or she thinks about a current situation and what they think can help such issues.


Aside from shared leadership, the transformational leadership theory can be employed within health care organizations. The transformational health care leader typically inspires followers to do more than originally expected. Transformational leadership theories predict followers’ emotional attachment to the leader and emotional and motivational arousal of followers as a consequence of the leader’s behavior. Transformational leaders broaden and elevate the interests of followers, generate awareness and acceptance among the followers of the purposes and mission of the group and motivate followers to go beyond their self-interests for the good of the group (1997).


Many health care staff are said to have the natural characteristics of transformational leaders, but these characteristics must first be nurtured and allowed to blossom. The health care managers/leaders have a responsibility to encourage and support this growth, as this is very important in the transformation of the work environment (1998). A practice/work environment in which transformational leaders strive to create new visions for enhancing patient care and nursing practice is a better environment to work.


Various authors have discussed the use of transformational leadership. Many researches also suggest that all health care professionals could use this leadership style to enhance their practice environment (1998). The workplace can be transformed by creating a work environment that ensures quality patient care. This transformation can be achieved by health care professionals becoming transformational leaders in the workplace.


When implementing new policies or rules, or even with simple matters, the staff should be allowed to contribute to the decisions to be made. Goals have to be set also. To support the health care professional’s use of shared leadership behaviors in the clinical setting, health care staff like nurse will be mentored by the manager or clinical nurse specialist to apply the shared leadership skills during their daily work to achieve the goals that are set.


The creating and sharing of this setting and achieving of goals is a key implementation challenge, and also calls for transformational leadership. Through effective communication and persuasion, and confidence building, the transformational leader encourages the adoption of new values and beliefs, endorses the goal of organizational effectiveness, and sustains the effort to realize the improvement of work environment.


To be included with the overall plan for achieving a positive and healthy work environment with leadership capabilities is the training of the health care professionals for empowerment. Training health care professionals for empowerment must include leadership techniques to prepare the health care professional for the integrative and collaborative role.


The environment in which the health care professional works is influential in developing empowered behavior (1998) since professionals do not function in a vacuum. They need an environment that encourages empowerment. The health care professional cannot reach empowerment if there are unsatisfied needs within the working environment.


Incorporated within the concept of empowerment is the individual’s willingness to see the vision and make the personal changes necessary to connect with that vision. It is how the concept of shared leadership works (2002). All management staff plays an important role in leading the emergence of legitimacy of this “new professional authority.” The encouragement of individual health care staff to establish individual goals that achieve more self-direction, more knowledge and self-confidence, and more networking ability by the process of shared leadership leads to a more committed employee. A more committed employee in turn contributes to a positive and healthy work environment.


In this proposed approach, negative consequences may also present. Shared leadership may present a conflict and ambiguity of roles. Some of the staff might revel in the shared power to the point that they will forget what the essence of shared leadership is all about. Some staff might also take advantage of such opportunity and this creates competition and jealousy within the staff. All of these wouldn’t be in line with the goal of creating a positive and healthy environment.


To minimize such problems, there should be an ongoing monitoring of the staff. Although they are given the rights to take part in decision-making, they should also not forget where they really belong. The staff should also be constantly reminded by the managers that this effort needs teamwork and this is done for the improvement of the work environment. Perhaps motivation would also work in minimizing this problem.


Aside from all these discussed, effective clinical leadership also requires something else. Good clinical leadership can help identify inadequate governance structures and practices and provide a pathway for their understanding and resolution, but for this to happen, there must be adequate funding of individuals and teams, working with and learning from each other, in order to recognize ineffective practices, promote human rights, identify mistakes and prevent them (2005).


            This perspective of leadership is therefore a functional one, meaning that leadership is at the service of collective effectiveness. It takes not one but a collective effort in order to be an effective leader. It is very much the same sense as everyone in the group becoming a leader too.


Describing a similar approach to team leadership, it has been argued that the leader’s main job is to do, or get done, whatever is not being adequately handled for group needs (2001). If a leader manages, by whatever means, to ensure that all functions critical to both task accomplishment and group maintenance are adequately taken care of, then the leader has done his or her job well.


These assertions can be made whether leaders are leading groups, multiple groups combined into a department or a division, the organization as a whole, or conglomerates of multiple organizations. This defining element of organizational leadership also means that the success of the collective as a whole is a (if not the) major criterion for leader effectiveness.


            In accordance with today’s practice environment, in which patient care is delivered by a multidisciplinary health care team, health care professionals must focus on the wider scope of professional and clinical leadership, addressing the roles of team members including nurses, physical therapists, radiology and laboratory managers, and occupational therapists. Integrating therapy, research, and practice, there are various leadership models that incorporate leadership development through mentorship and professional development planning, which could be beneficial for all health care professionals. This clearly relates to  emphasis on the importance of health care professionals becoming more involved in leadership. From physicians, managers, nurses, down to low-level employees, everyone should be trained to become effective leaders.


 


2. Chapter 2 – THE PROJECT PROPER


            To determine the food safety practices of people in Hong Kong and how healthcare organizations have managed it, a telephone survey of residents will be conducted in a span of two months. The respondents will be asked about three food handling principles, and a comparison will be made on the percentage of how many know that hand washing reduced the risk of food poisoning, and how many actually wash their hands after handling raw meat or poultry.


In addition, the respondents will be asked if they knew that serving steak on a plate that had held the raw steak increases the risk of food poisoning, this would then be also compared with how many percent of the respondents cleaned a cutting board after contact with raw meat or poultry. Also, respondents will be asked about knowledge that cooking meat until well done reduces the risk of food poisoning.


Thus, this survey would also seek to find how many of the respondents are using safe practices for these three food-handling principles. Additionally the unsafe practices reported will be compared in terms of frequency by men, people aged between 18-29 years, and occasional food preparers, compared to women, people aged 30 or older, and frequent food preparers.


            Given that certain groups of people are more at risk (in terms of both probability of suffering food poisoning and severity of symptoms) from food-borne illness than others, it is a source of concern that consumers are quite unaware of who these groups are. Woodburn and Raab (1997) showed that respondents could not identify groups of people particularly at risk for food poisoning; only 30 per cent mentioned children aged less than five years, and 21 per cent mentioned the elderly. Interestingly, it was the younger respondents who were better at identifying at-risk groups, whereas respondents aged over 65 years could not name any at-risk groups.


An earlier study (1997) found that food safety was rated as significantly more important, when food shopping, by main meal planners who had one or more household members belonging to higher risk groups. Educational efforts should be focused on risk groups, as well as those preparing food for people in these groups.


            Food poisoning is an increasing problem and it is essential that communication strategies to combat this problem be developed. The public perception research has identified barriers to reducing the incidence of microbial food poisoning. In the future we must develop methods to reduce optimistic bias and so encourage people to attend to risk communications. It is necessary to increase issue salience and make the communications more personally relevant as well as targeting the information to ensure delivery to at-risk groups (1998).


            The media also plays an important role in providing information about the occurrence of microbiological food hazards; they could be equally useful in providing advice about how to reduce risk, but at present the public perception of the media regarding this issue is that of “scare-mongering”. Other natural information sources such as TV cookery programmes could be utilised to provide food safety information.


            Risk-benefit communication has influenced consumer responses to food irradiation, particularly in the USA, where acceptance is higher than in the UK. Concerns of UK consumers are highly risk-oriented, and include concerns about the potential carcinogenity of irradiated food products, the risks to workers in food irradiation facilities, the risk of radiation escaping from irradiation facilities, and risks associated with transportation of radioactive material.


The link between radiation and cancer may be the major reason for unwillingness to purchase irradiated food products. In addition, there is evidence that consumers may not place a high value on the potential benefits of irradiation, such as increased shelf life, because consumers do not associate increased shelf life with freshness. There is little positive consumer response to the major benefit of improvement in food safety.


Survey data have suggested that the majority of consumers perceive the major beneficiaries of new technologies to be food manufacturers and retailers and, consequently, they question the necessity of the technologies (1995). Unless effective risk-benefit communication strategies are developed between regulators, scientists and consumers, the benefits of technologies like food irradiation may not be realised in the UK.


            This survey will be conducted through telephones. Telephone surveys are a cheap method of interviewing, which is why almost a quarter of all surveys carried out are done by this method. Surveys conducted over the telephone are increasingly popular as they are so convenient for both interviewer and respondent. The interviewer can conduct the interview either without leaving the office or from home, and the respondent similarly can reply from an armchair. There is a ready supply of respondents to contact – you only need to look in a telephone directory. It is also possible to sample wide geographical areas, even abroad, very easily, and it is sometimes easier to ask and respond to sensitive questions when you do not have to look at the other person.


            There are limitations to telephone interviewing. You automatically restrict your sample to those people who own telephones; admittedly this is the majority of people today, but you are excluding certain types of person, such as the deaf, those who are ex-directory, and full-time students away from home. Equally it is not possible to show the respondent prompts, and it can be difficult to build up a rapport between the interviewer and respondent. The other main problem with telephone interviewing is that so many companies are engaged in it and people become tired of being called at home and asked questions. The number of people who refuse to take part is on the increase.


            Many organizations now use computers to assist telephone surveys, and the interviewer will input responses directly into a computer. This technique is known as computer assisted telephone interviewing, or CATI. Inputting directly to computer can make the analysis of quantitative data very rapid and the program can be designed so that it will display only questions that are relevant to particular respondents.


Every participant in the study will be interviewed in the same manner and the data will all be collected in the same way. The timing of when the interviews will take place will also be within one timeframe – e.g. within a span of two weeks. The reason for this is because discrepancies in time could significantly affect the data collected.


The researchers will use a questionnaire (with simple/dichotomous items and multiple choices) in obtaining the information relevant to this study. This will be administered through the telephone. This method is useful in collecting data for the following reasons: (1) subjects were asked to respond to the same set of questions, in the same order, (2) they had the same set of options for their responses, (3) it is economical.


To assess the health care system’s strengths and weaknesses and to develop rational and credible options for reform, every effort will be made to ensure that the assessment was based on the best evidence available.


The results of this endeavor would show that several trends have the potential to contribute to an increase in food-borne disease. Changes in diet will result in a greater variety of foods available and an increase in worldwide sourcing of foods. An increase in the use of animal waste and sewage sludge on land would involve an increased potential risk of contamination of food crops by pathogens. The increasing scale of production and distribution of foods means that even low level contamination of a food can affect very large numbers of people. Lifestyle changes will also lead to increased consumption of food outside the home with an increased involvement of food handlers, an increased use of prepared meals and possibly to a reduced awareness of food safety techniques in the home.


The most important implications for the results can be twofold – more awareness for the public and more programs from health care organizations. Health care organizations can focus on communicating messages designed to help people understand and initiate the basic precautions which can be taken to reduce the risk of food poisoning and in the process provide fun and entertainment for thousands throughout Hong Kong. Additionally this can also create more attention from the media. The media, by promoting the best food safety handling practices, can significantly contribute to the problem of healthcare management regarding the issue. Both food safety incidents and media attention that focuses on food safety can influence the extent to which people perceive a particular food is risky. This can create more awareness for the public.


 


 


 


 


 


 


 


 


 



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