Antimicrobials are used on dairy farms for preventing disease and treating common infections such as mastitis. Objective: We aimed to understand farmworker practices that potentially contribute to transmission of antimicrobial resistance bacteria and their genes (ARG) among animals and farm workers, and to identify human behavioral interventions to reduce risk. Methods: Focus groups with farm workers were held at 8 dairy farms across Wisconsin selected to represent a range of antibiotic use in cattle. We explored the nature of potentially high-risk practices and farm-worker knowledge and experiences with antibiotic use and resistance. Farm workers were asked to describe common tasks, including hand hygiene and eating practices, and the policies guiding these practices. Focus groups were conducted in English and Spanish guided by the Systems Engineering in Patient Safety (SEIPS) framework, adapted for an agricultural context. Discussions were recorded, transcribed, and translated. A content analysis was conducted to identify themes. Dedoose version 8.0.35 software was used to organize the data. Results: In total, 10 focus groups were conducted on 8 farms. Knowledge of when to use antibiotics for human health varied; upset stomach, headache, and flu symptoms were suggested as appropriate uses. Few workers had personal experience with antibiotic resistance at home or on the farm. Some displayed knowledge of the role of antibiotic stewardship in preventing the spread of ARG (“I guess all dairy farmers have a responsibility not to overdo it”). Others associated the risk of spread with the consumption of raw milk or meat from cows receiving antibiotics. Knowledge of personal protective equipment was stronger among workers who commonly reported glove use. Some perceived glove use to be mandatory, and others chose to wear gloves in the perceived absence of written rules. Some workers reported changing gloves numerous times throughout the day, and others did so less frequently or “only when they rip.” In general, hand hygiene practices are guided by individual knowledge of established rules, beliefs about risk, and personal discretion. Conclusions: Knowledge about mechanisms of spread of ARGs varies among workers on Wisconsin dairy farms and reflects a combination of farm-level rules, experience, individual knowledge, and beliefs. Applying knowledge from the healthcare setting to reduce ARG spread into agriculture is crucial to the tenets of One Health. Programs to reduce ARG spread on dairy farms should focus on proper hand hygiene and PPE use at the level of knowledge, beliefs, and practices.
Funding: Funding: was provided by the USDA-NIFA Food Safety Challenge (grant no. 2017-68003-26500).