Progress 09/15/01 to 09/30/04

Outputs
Project Report: Germ City: Clean Hands, Healthy People is a science based program to increase the risk awareness of poor hand hygiene and its relationship to foodborne illness while improving effectiveness and frequency of hand washing. Education and Training: Programming was delivered to youth and adults in AL, HI, ID, WV, and WA during education and Extension outreach activities. Presentations were conducted in classrooms, senior centers, after school-Head Start programs, healthcare facilities, tribal health centers, foodservice operations, fairs, and festivals. Audiences were diverse reflecting a commitment by collaborators serving their respective state populations. Evaluation and Data Collection: Evaluation was conducted with 179 elementary 4th graders and 172 middle school 8th graders students in WA, AL, HI, WV, and ID at ten sites. A pre-and post-hand evaluation form with a four-point Likert scale to rate the cleanliness of the front and back of the right hand was developed. Both the researchers perception of hand washing effectiveness and the child's perception of hand washing effectiveness were assessed. Children answered questions about hand washing behaviors and teachers completed a questionnaire about benefits of the Germ City Program. Demographic data was completed on each school. The evaluator, from West Virginia University imputed, analyzed and interpreted the data. Review of Activities and Sequence: The elementary and middle school research component of the project was completed. On-going program delivery continued by project partners. Website development continues by Washington State University Extension: www.germcity.wsu.edu. Washington State University and University of Hawaii have an extension to complete activities in 2005. Communication to Stakeholders: Project collaborators conducted presentations-posters for the National Association of Environmental Health Association Conference, Priester National Extension Health Conference, CYFAR, University of Arizona Food Safety Conference, and the International Fairs and Expositions Association meeting. Presentations have been accepted for the National Science Teachers of America Conference and Directors of Health Promotion & Education National Conference on Health Education and Promotion in 2005. Program Sustainablity and Growth: The Germ City Program continues to grow in WA, WV, AL, HI and ID. Additionally, Extension programs in TN, VT, AZ, and CA as well as Western Illinois University, WV State University, and the Lane County, OR fair have initiated new programs linked to food safety and health. Currently, there are 52 Germ City units in 11 states involved in on-going program delivery. Volunteers have been important for program development, delivery, and evaluation. Parents, teachers, student peer educators, school nurses, infection control specialists, and public health educators in a variety of community settings have been involved in marketing the Germ City Program and conducting outreach and Extension education program activities assuring community sustainability.

Impacts
Germ City has a significant impact on children's hand washing skills. Four to six weeks after the initial presentation-assessment, with no new instruction, there was improved hand washing effectiveness confirmed by independent observations of educators-researchers and students. Assessments of the right hand included evaluation of fingernails, knuckles, back of wrist, between fingers, fingertips, palm, and front of the wrist after applying a uv-light sensitive lotion and performing a normal hand wash. Pre-and post-testing was completed with 351 matched pairs of students in the 4th and 8th grades. Self reporting conducted during post-testing, showed significantly more students reported they had washed hands before eating dinner the night before and after they last went to the bathroom than during the initial Germ City presentation. Evaluation showed that Germ City works well with 4th and 8th grade students and boys and girls. The results were better, however with 8th grade students and, to a lesser extent, better with girls. Teachers reported that the activity was informative, interactive, and creative. Teachers also reported that they observed a greater awareness on students part regarding the need to wash their hands as well as a greater awareness of the frequency and thoroughness of hand washing. Teachers were asked to identify barriers to implementing the Germ City Program and for suggestions in marketing the program to other teachers. Their suggestions will be incorporated into on-going programming.

Publications

• No publications reported this period

Progress 01/01/03 to 12/31/03

Outputs
Germ City: Clean Hands, Healthy People is a science based program to increase the risk awareness of poor hand hygiene and its relationship to foodborne illness while improving effectiveness and frequency of hand washing. EDUCATION AND TRAINING: Programming was delivered to 48,955 youth and adults in AL, HI, ID, WV, and WA during education and Extension outreach activities. Presentations were conducted in classrooms, senior centers, after school/Head Start programs, healthcare facilities, foodservice operations, fairs, and festivals. Train the trainer workshops were completed with project collaborators at the University of Hawaii, West Virginia University, and the University of Idaho. EVALUATION AND DATA COLLECTION: West Virginia University developed instruments and evaluation protocol/methodology for children and adults attending fairs and festivals and for elementary and middle school students and teachers. Fair and festival research was conducted during events in Washington, Alabama, Idaho, and Hawaii. West Virginia studied changes in hand-washing in 4th and 8th grade students using a pre/post hand evaluation and questionnaire. Participants had significantly cleaner fingernails, knuckles, spaces between fingers, fingertips, palms, and front wrists after visiting Germ City. GERM CITY DEMONSTRATION UNITS: Idaho, West Virginia, and Hawaii project collaborators purchased additional Germ City units to provide greater outreach and educational programming in large geographical areas. A pictorial set-up guide available in print as a PowerPoint/Acrobat Reader training tool was completed and implemented with faculty, staff, and volunteers. The University if Idaho initiated the development of a video set-up guide for the Germ City Demonstration Units. REVIEW OF ACTIVITIES AND SEQUENCE: The fair and festival research component of the project was completed. West Virginia University initiated data collection in elementary and middle schools. Elementary and middle school research is on-going in WA, AL, HI, and ID. COMMUNICATION TO STAKEHOLDERS: Washington State University conducted presentations during the International Fairs and Expositions Association annual meeting and for the national project collaborators for the GAPS: Microbial Safety of Fresh Fruits and Vegetables USDA/FDA Program. West Virginia University collaborators presented at the 2003 Priester Health and Safety Conference. PROGRAM SUSTAINABLITY and GROWTH: Programming has expanded to include outreach to non-profit and military health care facilities and hospitals, foodservice employees, Expanded Food and Nutrition Education and Food Stamp Nutrition Education Programs, tribal health fairs, after school programs, K-12 grade students, senior citizen centers, 4-H members and leaders, Head Start programs, and fairs and festivals. Providing both growth and sustainability, community volunteers, members of Parent Teacher organizations, teachers, school nurses, infection control specialists, and public health sanitarians have been involved in marketing the Germ City Program and conducting outreach and Extension education programs.

Impacts
Germ City: Clean Hands, Healthy People Project reached 48,995 youth and adults in AL, HI, ID, WV, and WA. Presentations were delivered in classrooms, senior centers, after school/Head Start programs, healthcare facilities, foodservice operations, fairs, and festivals. Research was conducted during fairs and festivals and in 4th and 8th grade classrooms. Impacts: 2,619 youth and adults completed a behavior change survey after visiting Germ City during events held in Washington, Hawaii, and Idaho. Fair and festival guests were asked to participate in an exit survey after completing the education outreach program. There was an 86.6% completion rate. Adults Intent to Change Hand Washing Practices (743 Adults - 90% completion rate): After Coughing/Sneezing, 155 (15.6%), After Playing/Working Outside, 114 (18.54%), Before Eating/Preparing Food, 154 (21.3%), After Using Restroom: 87 (12%), After Playing with Animals: 198 (27.4%), Nothing: 35 (4.8%). Youth, ages 5-18 years Intent to Change Hand Washing Practices (2,110 youth - 85.4% completion rate): After Coughing/Sneezing, 246 (13.7%), After Playing/ Working Outside, 245 (13.6%), Before Eating/Preparing Food, 445 (24.8%), After Using Restroom: 410 (22.3%), After Playing with Animals: 430 (23.9%), Nothing: 100 (5.6%). West Virginia studied changes in hand washing in 4th and 8th grade.

Publications

• No publications reported this period

Progress 01/01/02 to 12/31/02

Outputs
Germ City: Clean Hands, Healthy People is a science based program to increase risk awareness of poor hand hygiene and its relationship to foodborne illness while improving effectiveness and frequency of hand washing. Education and Training: Programming was delivered to 30,801 youth and adults in AL, HI, ID, WV, and WA. Workshops were developed, delivered, and evaluated for 86 educators/staff at Alabama A & M University, University of Idaho, and West Virginia University. Classroom lessons for grades K-8 were completed, tested with 1,487 students, and distributed to project collaborators. Evaluation and Data Collections: West Virginia University developed instruments and evaluation protocol/methodology and conducted pilot testing of the hand evaluation instrument and adult fair/festival instrument. Germ City Demonstration Units: Inter-locking aluminum units and pop-up tent units were developed by a commercial exhibit company. Units are portable, safe, accessible, reproducible, affordable, and large enough to create interest. 18 units are currently available for outreach and education in AL, ID, WV, WA, and HI. Detailed unit set-up guides with photographs using a PowerPoint format and posters were completed. Review of Activities and Sequence: Some project components for Year One were delayed because it took longer than anticipated to complete initial demonstration units. Additionally, while some state training with faculty and staff began in March (AL), others needed to be delayed until the fall (ID, WV), with training in HI completed in January 03. Finally, some strategic project decisions were delayed and discussed during team meetings in June and September. Communication to Stakeholders: Presentations with the demonstration unit were made for the Food and Nutrition Extension Educators pre-conference at the annual meeting of the Society of Nutrition Education, Thinking Globally, Working Locally National Food Safety Conference, and the Washington State Association of Professional Infection Control. The University of Hawaii established a website highlighting Germ City, Germ City was listed on the Washington State Office of Health Promotion website, a short video featuring Germ City was produced by BELO communications (NBC affiliate-Seattle), and the program was recognized as a Program of Excellence by CSREES and the Family Development and Resource Management Base Program Team in 2001. Program Sustainability/Growth: Opportunities for long-term sustainability and growth of the program occurred in 2002. West Virginia University partnered with the WV Dept. of Education, Child Nutrition Office on a school food safety grant funded by the CDC. Food service and health care employees in WA participated in programs including preliminary research projects developed cooperatively with Group Health of Washington and a Seattle metro school system. Incorporation of educational programming for field workers linked to the safety of fresh fruits and vegetables (Good Agriculture Practices-Food Safety Begins on the Farm) and programming for a cruise ship corporation in response to Norwalk outbreaks were investigated for inclusion in 2003.

Impacts
The Germ City: Clean Hands, Healthy People Program reached 30,801 youth and adults in Alabama, Hawaii, Idaho, West Virginia, and Washington State. Presentations were delivered in classrooms, senior centers, after school and Head Start programs, with food service employees, and during fairs, festivals and special events. Program impacts primarily reflect data collection from pilot testing of project evaluation instruments designed by West Virginia University during Year One of this project. Impacts with Youth: 488 elementary students participated in pilot testing of the hand evaluation instrument and answering a series of proposed evaluation question. Children's hands were examined at three intervals. Preliminary results showed that there was a significant difference in some hand-washing behaviors from the pre-test to the post-test. There were also differences on the post test between boys and girls. Impacts with Adults: Adult evaluation forms including an adult hand-washing behavior survey were tested at the WV State Fair. 100 adults participated in the survey. Results did not help in answering the project research question and provided little new information. Additional adult evaluation tools will be discussed in 2003. Evaluation of Collaborator Training: 20 participants of the West Virginia University In-Service for faculty and staff responded to an evaluation survey. 100% said the training left them motivated to conduct Germ City programming in West Virginia. 95% appraised the training and it's relevance to them as excellent.

Publications

• No publications reported this period

Progress 01/01/01 to 12/31/01

Outputs
This Multi-state project was initiated October 1, 2001. Progress in first quarter of project included finalizing budgets for all collaborators, work plan development, human subjects review at WSU and other participating institutions, further development of evaluation tools at West Virginia University, and securing a commercial exhibit company for the manufacture of the Germ City units. West Virginia University, the University of Idaho, and Alabama A & M University will begin to conduct Germ City Programs in elementary schools and for community events beginning in 2002. Germ City has been an on-going program in Washington State for the past 3 years. This year there were 2,515 participants in Germ City in Washington State. Participants were reached during Health Fairs and in classroom settings. Students were queried in Washington State regarding the "real" number of times that they wash their hands every day. There was a substantial gap between their initial positive response to washing hands before meals and after using the bathroom and their honest recollection of their existing behaviors. Informal data reflecting attitudes about hand washing and personal motivation were also collected during programs in 3 to 6 grades and with middle and high school students. This information will be used in the future to refine curriculum and evaluation tools. We have now generated a data/research base to support future study and evaluate the effectiveness of hand washing education programs related to behavior change, attitudes, and personal motivation. An evaluation had been conducted earlier with similar groups (400 students). Students were asked pre and post questions during hand washing education programs. All students improved their identification of times to wash hands after completing the program. Younger students had largest increases in awareness for "After You Play, After You Sneeze, and After You Touch Your Pet". Evaluation tools previously developed by B. Susie Craig were shared with West Virginia University faculty including the evaluation specialist working with the Germ City: Clean Hands, Healthy People Program. After review, the evaluation tools will be tested during programming in the first and second quarter of 2002 in West Virginia.

Impacts
This project enhanced awareness of the importance of hand washing using science-based education for youth, adults, and older Americans preparing food in the home. This project improved the effectiveness and frequency of hand washing, and reached a diverse audience in rural and urban settings including children, adults, senior citizens, and at-risk population groups. The program modifies attitudes, enhanced personal motivation, and facilitated positive behavior change for hand washing. In a follow-up study conducted 45 days after the program with 274 students, 64% indicated they were washing more frequently and 70% were washing longer after participation in the "Germ City" program.

Publications

• No publications reported this period