Studies On The Current Status Of Centralized Tableware Cleaning And Disinfection Business In Hangzhou,with The Proposel For New Public Health Management Strategies

BackgroundWith the continuous rise of China’s labor costs in the21st century, more and more small restaurant owners began to utilize the service provided by centralized tableware cleaning and disinfection business (CTWCD). This need is an impetus for the rapid development of centralized tableware cleaning and disinfection business. This rapid development of CTWCD industry in turn poses the new challenges for the government’s regulatory agency and the new need for the more stringent regulatory standards. In2004, the State Department deregulate the administrative approval of CTWCD. Since then, there is no minimum public health standard or barrier for the establishment of CTWCD. As a result, some CTWCDs with substandard equipment, without standard operative protocol and with chaotic internal management have been established. This problem has already attracted media’s attention and has also alarmed the government. In order to standardize the behavior of CTWCDs, a series of laws, regulations and guidance have been issued by all levers of government.Hangzhou ranks number one in the quantity of CTWCDs in ZheJiang province, producing more than200,000sets of cleaned and disinfected utensils on a daily basis. In the2010Hang Zhou Committee of the Chinese People’s Political Consultative Conference, the Revolutionary Committee of the Chinese Kuomintang proposed Hangzhou No.508"proposal on strengthening the regulation on the centralized distribution services of tableware disinfection", urging the government to strengthen the regulation on tableware cleaning and disinfection business. At this juncture of gradual improvement on the performance of CTWCD, we endeavor to assess the current status of CTWCD in Hangzhou in a systemic fashion, so as to provide the basis for further legislative work and better ability to perform health surveillance by the regulatory agency.Research Methods1. Literature search:Review related literature on centralized tableware cleaning and disinfection in our country, and understand the development and regulatory status of CTWCD in our country.2. On-site survey:Formulated "Hangzhou CTWCD survey form"; the research team members conducted the on-site survey according to the form in a standardized fashion.3. On-site measurements:using a laser rangefinder to measure the areas of packaging room, disinfection room, cleaning room, laboratory and the like, and to measure the length of washing line, soaking line and heat disinfection line.4. Assessment of the cleanliness of the surfaces using ATP fluorescence detector:the surfaces tested include hands of employees working in packaging room, packaging wraps, chopstick sacks, packaging equipment, and the inner surface of temporary holding bins (for temporarily holding unwrapped sterilized tableware).Assessing the cleanliness of the finished products:from each CTWCD,6sets of the finished products were randomly sampled on the day that they were produced. Each set contained a bowl, a plate, a cup, a spoon, and a pair of chopsticks. The assessment was performed on three different dates:the date of sampling,7days later and60days later; two sets were used in each assessment and the identical items in each two sets assessed were combined together and considered to be one item.5. Field experiments:One CTWCD was randomly selected to provide the research team with168sets of used tableware, each set including a bowl, a plate, a cup, a spoon, and a pair of chopsticks. These168sets of tableware samples were then divided into14groups. Each group was subjected to different cleaning and disinfection procedures. The surface cleanliness of the finished products was assessed in the CTWCD facility using ATP fluorescence detector. 6. Statistical Analysis.Data analysis was performed using SPSS19.0softwareResultsA. On-site surveyIn2012,57CTWCDs submitted applications for "Certificate of Meeting the Public Health Standards" to Hangzhou Health Bureau. These57CTWCDs are located in12districts (or pioneering districts) and counties (or cities), and none was from the ShangCheng District, XiaCheng District or the West Lake Scenic Area District. The educational levels for the person in charge of the CTWCDs were mostly middle school graduates, while the educational levels of the quality control workers were mostly high school graduate. Each person in charge of a CTWCD was asked3questions on public health. Only four answered all questions correctly, constituting7.02%of all surveyed. A total of697employees were working at these57CTWCDs. All697employees hold valid health certificates.57CTWCDs invested average of318,000yuan in purchasing the production equipment. All the CTWCDs have quality control laboratory. The average of capital investment for the quality control laboratory facilities is12,400yuan. The smallest packaging room is50.00m2. The minimum combined area for packaging room, disinfection room and cleaning room is300.00m, the maximum895.90m, the average339.58m2, and the75th percentile337.27m2. The average of daily output is4942sets. The average of processing price is0.69yuan/set.2. Testing results of different steps and final productsThe passing rates for chopsticks sets and cutlery packaging films are relatively high,96.49%and87.72%, respectively. The passing rates for the packaging equipment and inner wall of the temporary holding bins are47.37%and49.12%. The passing rate for employees’hands is the lowest, reaching only42.11%.The average results of all the57CTWCDs are as follows:assessed on the day of production, the passing rate is52.6%, with the chopsticks being the lowest, only31.6%. On day7, the passing rate rose to70.2percent. On day60, the passing rate reaches100%. Therefore, there is a storage time-dependent increase in the passing rate. This increase is statistically significant when tested using chi-square (P<0.001).3. The results of field experiments Of all the12groups using high temperature disinfection, the passing rate is100%. Amongst the remaining two groups that are not subjected to high temperature disinfection, the passing rate for the group using soaking powder to remove solid residual is33%, while the passing rate for the tap water soaking group is0%. For statistical analysis, the RLU values read from the ATP detector were subjected to a logarithmic transformation:A=1g (RLU+1). The A value of tap water soaking group was significantly higher than that of the group soaked with solution containing soaking powder to remove solid residual (F=24.83, P<0.001). The duration of heat disinfection does not affect the A value (F=0.586, P=0.557). The A value increases with the repeated usage of soaking solution.Conclusions1. Of all the57CTWCDs in Hangzhou, every single one meets the minimal combined area (packaging room, disinfection room and cleaning room) requirement stipulated by "Zhejiang Province public health guidelines on CTWCD (Trial implementation)". In addition, packaging room area is greater than50m2in every CTWCD, and every CTWCD has a quality control laboratory. However, most CTWCDs do have their space constraint, limiting their potential for further growth.2. The persons in charge have a general lack of public health knowledge and have lower levels of education. Most of them are middle school graduate, someone are grade school graduate or only received part of the grade school education.3. The passing rate for the surface cleanliness is low, less than50%for the hands of packaging employees, packaging equipment, and the inner wall of temporary holding bins (for temporarily holding unwrapped sterilized tableware). Passing rate for the wrapping film for tableware and the sacks for chopsticks do not reach100%. These indicate that the disinfected products are subjected to high risk of re-contamination during the packaging step.4. The passing rate of the finished product is not high, with the chopsticks being the lowest, only attaining31.6%.5. The use of soaking solution containing powder can contribute to the removal of the surface contamination. Timely replacement of the soaking solution will help to effectively remove the surface contamination. 6. Although high-temperature disinfection is a necessary step to attain surface disinfection, conditions beyond100℃for2minutes, either by elevating the temperature, and/or prolonging the duration, do not appear to have added beneficial effect.