Public Health Relevance of Cross-Contamination in the Fresh-Cut Vegetable Industry.

Although quantitative studies have revealed that cross-contamination during the washing stage of fresh produce occurs, the importance of cross-contamination in terms of public health relevance has rarely been assessed. The direct distribution of initially contaminated leafy vegetables to a multitude of servings by cutting and mixing also has not been addressed. The goal of this study was to assess the attribution of both contamination pathways to disease risk. We constructed a transparent and exploratory mathematical model that simulates the dispersion of contamination from a load of leafy greens during industrial washing. The risk of disease was subsequently calculated using a Beta-Poisson dose-response relation. The results indicate that up to contamination loads of 10(6) CPU the direct contamination route is more important than the indirect route (i.e., cross-contamination) in terms of number of illnesses. We highlight that the relevance of cross-contamination decreases with more diffuse and uniform contamination, and we infer that prevention of contamination in the field is the most important risk management strategy and that disinfection of washing water can be an additional intervention to tackle potentially high (>10(6) CFU) point contamination levels.