VTEC/E. coli O157 Action Plan for Scotland, 2013-2017

VIII. PROPOSALS FOR RISK COMMUNICATION AND HEALTH EDUCATION

Communication of risk and preventive measures are essential to risk reduction. Communication strategies should target those groups:

• Who are most vulnerable to infection or its consequences
• Where the greatest reduction in case numbers is likely to be achieved

Communication strategies should be those that most effectively promote the required knowledge, attitudes and behaviours, to comply with the current and new control measures described in the Action Plan.

Current Position

Epidemiological data and expert reports indicate the main risk factors for VTEC and associated target audiences for risk communication and health education, as summarised below:

Risk Factor	Target Audiences
Livestock/ animals and their environments	Farming and other rural residents. Farm/agricultural and other rural workers; animal handlers; veterinarians. Visitors to the countryside or to animal visitor attractions[67]; rural activity groups e.g. scouts, walkers, sporting groups. Proprietors of animal visitor attractions[66], or farmland used by walkers, etc. Organisers of farm visits, events in rural areas, on pasture, etc.
Food	Food handlers (occupational and domestic) and consumers. Food production workers eg abattoirs, food processing plants. LA staff or others involved in inspection and enforcement
Private Water Supplies	PWS owners and users. LA staff or others involved in inspection, operation, maintenance, treatment installation, etc. Visitors to properties supplied by PWS. Land users, farmers, forestry workers.
Secondary spread	Cases, their households, carers, relatives, and social contacts. GPs, other frontline medical practitioners, and other health and social care staff. Proprietors and managers of child care facilities, care homes, etc.

A wealth of information on VTEC is currently available from various sources. It can be either specific to VTEC, or generic e.g. general prevention of food borne, zoonotic or gastrointestinal disease. It covers most of the target audiences, using various formats e.g. web pages, leaflets and professional guidelines. For more detail about the information available, including sources, types and target audiences, see Online Appendix (iii). The perceptions and attitudes of certain groups to VTEC risks have also been investigated. There are nonetheless gaps and inconsistencies, and an integrated VTEC risk communication strategy should therefore address:

• Undertaking risk communication needs assessment of both the population and target groups.
• Reviewing all research on attitudes to and perceptions of risk.
• The lessons learned from major investigations and inquiries.
• Analysing and assessing the content of current risk communication materials.
• Options for nationally co-ordinated advice on topics that may be covered differently by different HBs or LAs at present (e.g. infection control advice to cases, households and carers).
• Promoting a joined up approach between key agencies to ensure consistent content/quality.

Recommendation

C1 - SG should convene a Communications Strategy Group to develop and support the implementation of a comprehensive communication strategy for VTEC involving all the key agencies, and feed back to the VTEC/E. coli O157 Action Group.

Implementation of the strategy will be across a matrix of both generic and targeted approaches and will take into account social marketing methodology aimed at a sustainable change in attitudes and behaviours. Specific components that should be considered for inclusion in the strategy are:

Rural Households, Workers or Visitors, Proprietors/Inspectors of animal visitor attractions^[68]

C2 - SG with NFUS should ensure VTEC risks are covered in communication with landowners and the public on access to and recreational use of pasture/intensively
grazed land.

C3 - SG should develop information and resources for the public about VTEC risks, which may also help to reduce risk from other zoonoses; this should include: advice on supervision of children; the importance of hand washing after contact with animal and rural environments, and before eating, drinking or preparing food; and what constitutes effective handwashing (including advice against relying on anti-bacterial hand gels or wipes).

Food Handlers and Consumers (Occupational and Domestic)

C4 - FSAS and LAs should continue to highlight the risks associated with undercooked minced meat products, and promote advice on safe cooking.

C5 - FSAS should ensure that consumers and caterers continue to be reminded of the potential risks associated with vegetables and fruit that are not supplied as RTE, and how these products should be prepared prior to consumption.

C6 - FSAS should continue to ensure that the practices that lead to effective cross contamination control are promoted in food hygiene communication activities, including annual Food Safety Week initiatives.

C7 - FSAS, in partnership with other stakeholders such as REHIS, should ensure that hand hygiene is prioritised in strategies for improving health education for food handlers in catering and domestic kitchens.

C8 - SG should liaise with REHIS and SoCOEHS to ensure that LAs and HPTs continue to provide information and guidance on preventing contamination of food by human faeces in both private households and commercial premises.

Private Water Supply Owners and Users, and Relevant LA and Health Protection Staff

C9 - SG, LAs and REHIS, with input from DWQR and HPS, should develop educational materials to promote risk awareness and management for all PWS owners or users.

C10 - SG should ensure that their resources for PWS owners and users include advice on early reporting of diarrhoeal illness (as this is the best way to promote early identification of contaminated supplies); prompt issuing and implementation of boil water notices; and guidance on risk communication for Health Protection Teams and LAs.

C11 - SG should consider integrating advice on PWS into generic resources such as the SG leaflet 'Shedding Light on E. coli O157'.

C12 - SG, SEPA and other key stakeholders, through the Diffuse Pollution Management Advisory Group (DPMAG), should continue to work in partnership with the farming and forestry sectors in order to maximise the protection of sources of drinking water, and minimise the risk to human health.

Secondary Spread, General Infection Control, Diagnosis and Testing

C13 - SG, in liaison with HPS and FSAS should consider options for raising awareness of the importance of hand hygiene, both generic and targeted at specific settings such as childcare.

C14 - SG should consider specific measures to help young children apply hand hygiene.

C15 - SG should provide advice for frontline NHS and LA staff on achieving early diagnosis of infectious diarrhoea; on the need for low thresholds for suspecting and testing for VTEC, especially in acute onset bloody diarrhoea; on the issues for cases with non-O157 strains, who may initially have been told they were negative, based on local laboratory results; and on the need to forward locally negative stools from clinically suspicious cases, to the Scottish E. coli O157/VTEC Reference Laboratory.

C16 - SG should advise frontline NHS and LA staff to provide cases, families and health/social care staff with advice on hygiene and preventing secondary spread, as soon as infectious diarrhoea is suspected (whether VTEC or other aetiology), without waiting for laboratory confirmation.