The role of theoretical food safety training on Brazilian food handlers' knowledge, attitude and practice

Effect of food safety training on behavior change of food handlers: A case of orange-fleshed sweetpotato purée processing in Kenya

Sweetpotato purée processing is new to Kenya and a rapidly growing value addition activity among informal, small, and medium-sized food enterprises (SMEs) in sub-Saharan Africa (SSA). Inadequate knowledge of food safety and poor hygiene practices by food handlers, low level of compliance with Good Manufacturing Practices (GMPs), and microbial contamination are major food safety challenges in orange-fleshed sweetpotato (OFSP) purée processing in Kenya. The extent of food safety training in enhancing food safety in rural-based SMEs and food processing environments has not been fully investigated. This study aimed at evaluating the impact of food safety training on food safety knowledge and hygiene practices of food handlers and in control of microbial contamination in OFSP purée processing in Kenya. Pre- and post-food safety training assessments were conducted to determine food handler's (N = 14) knowledge and practices on food safety. Food, water, and swab samples (n = 62) from the processing environment were collected before and two months after the training and analyzed for food hygiene indicator microorganisms. The findings indicate a significant (p < 0.05) improvement in overall food safety knowledge and practices of food handlers after the training. Poor knowledge scores were exhibited on aspects of cross-contamination, cleaning, and sanitation but these significantly (p < 0.05) improved after the training. Similarly, microbial counts on food equipment surfaces, installations, personnel hands, and in the final product (OFSP purée) significantly (p < 0.05) declined to acceptable levels after the food safety training. Total counts, yeasts and molds, S. aureus, Enterobacteriaceae, and total coliforms counts in the packaged OFSP purée were 2.6, 1.8, 1.5, 1.9, and 1.2 LOG CFU/g respectively hence suitable for its current application as an ingredient in baked products. The findings from this study indicate food safety training as an appropriate tool for improving food handler's knowledge and hygiene practices as well as enhancing microbial safety and quality of processed foods in SMEs if necessary food safety support resources are provided.

Home-Prepared Enteral Tube Feeding: Evaluation of Microbiological Contamination, Hygiene, and the Profile of the Food Handler

BACKGROUND

Little is known about the risk to patients' health when using home-prepared enteral tube feeding. The objective of this study was to explore the differences in hygiene conditions and microbial load of different types of home-prepared enteral tube feeding and explore associations between those differences and food handlers' characteristics.

METHODS

We evaluated 96 enteral formulations, considering 3 types used by adult patients: homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs). Enteral formulations were collected from homes and microbiologically analyzed. Hygiene criteria were assessed using a checklist, applied during the handling stages. The profile of the food handler was reviewed using a questionnaire.

RESULTS

82.3% (79/96) exceeded acceptable bacterial counts, which was 10³ colony-forming units per gram for aerobic mesophilic microorganisms and for total coliforms (35 °C), Escherichia coli, Staphylococcus sp, and Staphylococcus coagulase-positive, if present in the enteral formulations. The number of inadequate samples was higher in HEPs and BEPs than in CEFs. Considering the hygiene criteria, the home-prepared enteral tube feedings did not differ significantly. There was a significant difference among hygiene conditions considering the variables "monthly family income" and "food training."

CONCLUSION

Regardless of the type of enteral formulations used by patients, when handled at home, there was a risk of contamination. However, contaminants present in enteral formulations can be easily controlled with improvements in hygiene measures as well as with greater guidance and control during the handling stages.

Evaluation of food safety knowledge, attitude, and self-reported practices of trained and newly recruited untrained workers of two baking industries in Dhaka, Bangladesh

In Bangladesh, with the mounting esteem of bakery products, food safety issues in bakery industries are a paramount concern nowadays. In this regard, this current study was performed to evaluate food safety knowledge, attitude, and self-reported practices of two groups (160 trained and 55 new untrained) of workers from two popular baking industries in Dhaka, Bangladesh. A self-administrated questionnaire was used to acquire the data during the study. On food safety knowledge, attitude, and self-reported practices, trained workers' scores (33.01 ± 0.09, 14.86 ± 0.03, 10.66 ± 0.25, respectively) were significantly higher than the scores (9.82 ± 0.23, 10.44 ± 0.26, 5.91 ± 0.33, respectively) of newly appointed untrained workers. The quality assurance department displayed better knowledge, attitude, and self-reported practices scores than the rest of the departments of the industries. However, compared to knowledge and attitude, the self-reported practice was not up to a satisfactory level. According to the study, training can be proved effective for improving knowledge and attitude but does not always translate those into self-reported practice and behaviors. The results also reinforce the importance of conducting training for untrained workers and suggest further behavior-based food safety training for all employees.

A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers

Foodborne diseases are a significant cause of morbidity and mortality worldwide. Studies have shown that the knowledge, attitude, and practices of food handlers are important factors in preventing foodborne illness. The purpose of this research is to assess the effects of training interventions on knowledge, attitude, and practice on food safety and hygiene among food handlers at different stages of the food supply chain. To this end, we conducted a systematic review and meta-analysis with close adherence to the PRISMA guidelines. We searched for training interventions among food handlers in five databases. Randomized control trials (RCT), quasi-RCTs, controlled before-after, and nonrandomized designs, including pre-post studies, were analyzed to allow a more comprehensive assessment. The meta-analysis was conducted using the random-effects model to calculate the effect sizes (Hedges's g) and 95% confidence interval (CI). Out of 1094 studies, 31 were included. Results showed an effect size of 1.24 (CI = 0.89-1.58) for knowledge, an attitude effect size of 0.28 (CI = 0.07-0.48), and an overall practice effect size of 0.65 (CI = 0.24-1.06). In addition, subgroups of self-reported practices and observed practices presented effect sizes of 0.80 (CI = 0.13-1.48) and 0.45 (CI = 0.15-0.76) respectively.

The knowledge, attitude, and practices of food handlers in central South African hospices

The escalating number of foodborne diseases and food poisoning outbreaks demand a better call for improved food-handling practices. Hospices are typically described as nongovernmental organizations that offer palliative care to terminally ill patients. The majority of hospice food handlers are not trained in food safety aspects, and services are offered on a voluntary basis. In this study, a descriptive survey design comprising of semistructured questionnaire was utilized to assess the knowledge, attitudes, and practices of the hospice food handlers (n = 100) in hospices around Central South Africa. More than half of the participants (68%) had not taken basic food safety training. The average percentage of the correct answers on the knowledge questionnaire was 66.8%. The participants had a mean age of 35 years (SD = 9.27). Attendance of food safety course had a significant effect on both the practices of using gloves to touch or distribute unwrapped foods (χ 2 = 8.411, p-value = .012), and washing hands after using gloves (χ 2 = 12.560, p-value = .001). The overall KAP mean score was 78.38. A statistically significant difference was found between the trained and untrained food handlers regarding food safety knowledge (p < .001). There was substantial lack of knowledge regarding the correct temperature for a refrigerator including hot ready-to-eat food.

The role of Optimistic Bias in safe food handling behaviours in the food service sector

This study evaluates the influences on food handlers' intention to conduct safe handling behaviours in food service settings in Brazil and the United Kingdom, focusing on Optimistic bias (OB). Although OB has been identified in food handlers in other studies, this is the first study evaluating the role of OB in determining behavioural intention. Three hundred participants, from the United Kingdom (n = 150) and Brazil (n = 150), completed a Theory of Planned Behaviour - based questionnaire, including additional questions about OB. For Brazilian food handlers, Attitude had a significant influence on Behavioural Intention followed by Subjective Norm, while Perceived Behavioural Control and OB did not significantly influence Behavioural Intention. For the United Kingdom, Perceived Behavioural Control had the largest influence, followed by Attitude, and then OB. Results suggest that cultural differences may influence predictors of behavioural intention, and that OB can contribute to predicting engagement in safe handling behaviours. Results contribute to a better understanding of the influences on food safety related behaviours.

Managing the Risk of Food Waste in Foodservice Establishments

Although it is difficult to clearly identify the extent to which the foodservice industry contributes to food waste, its share is undoubtedly significant. As the hospitality and foodservice industry develops, more and more food waste is produced. The reduction of food waste is a key challenge for the sustainable development of the foodservice industry as it has negative economic and environmental impacts and is ethically reprehensible. The objectives of the study were to develop a risk management model of food waste based on the ISO 31000 standard for foodservice establishments, to learn the causes of food waste, and, on this basis, to estimate the risk of food waste in foodservice establishments. The survey was conducted in 130 foodservice establishments located in Poland using a specially designed questionnaire. The risk of food waste was identified in the studied foodservice establishments, manifested by throwing away of semi-finished products, hot and cold served dishes, bread, vegetables and fruit, expired products, products with signs of spoilage, and products with no visible signs of spoilage. Two risk levels were identified: medium risk for fruits and vegetables, and bread, and high (not acceptable) for the other six foodstuffs. Two risk treatment options were identified: prevention and tolerance.

Food safety knowledge, attitudes and practices of restaurant food handlers in a lower-middle-income country

Global research attention appears to be focused predominantly on self‐reported than observed food safety practices. The purpose of this study was to determine the food safety knowledge, attitudes, and self‐reported and observed practices of food handlers in 22 urban restaurants in Zimbabwe. A piloted questionnaire was used to gather qualitative data regarding socio‐demographic variables, food safety knowledge (FSK), attitudes, and self‐reported food handling practices (SRFHPs). A predesigned checklist was used to observe the food handling practices. FSK scores were significantly higher in food handlers who received basic food safety training compared to those who did not (p < .05). No differences in food safety knowledge and attitudes were noted based on the socio‐demographic characteristics of the food handlers (p > .05). A significant positive correlation was observed between FSK and attitudes (r_s = 0.371, p < .05), FSK and SRFHPs (r_s = 0.242, p < 0.05), FSK and observed food handling practices (OFHPs) (r_s = 0.254, p < .05), attitudes and SRFPs (r_s = 0.229, p < .05), and attitudes and OFHPs (r_s = 0.263, p < .05). About half of the food handlers washed their hands in sinks meant for washing cutlery, 57% did not use approved hand drying methods, and 19.8% did not adequately thaw frozen foods. Food was commonly defrosted either under room temperature or using hot water (>45°C). Results suggest a need for mandatory basic and advanced training to improve the food safety knowledge, attitudes, and practices.

The Effect of Food Handler Certification on Food Premises in Ontario, Canada

Although health units have implemented food handler certification to operators of food premises, evidence on its effectiveness to improve premise food safety remains inconclusive. Regression models were constructed using inspection data from a health unit in Ontario, Canada, to measure the effect of certification on premise inspection results. We found that premises without certified food handlers at the time of inspection were significantly more likely to fail inspections. The odds of inspection failure were significantly different depending on the premise's cultural cuisine classification. Independently owned establishments had lower odds of inspection failure versus chain operations. Inspector was a significant random effect explaining a small percentage of data variations. These results support the use of food handler certification to improve food safety outcomes at establishments. Further efforts should ensure training programs are accessible and relatable to premise operators, particularly those serving all types of cultural cuisines.

Using the RE-AIM framework to evaluate safe food village development programme through the food safety movement in village in the Special Region of Yogyakarta, Indonesia

Unsafe food is a major threat to public health both globally and in the Southeast Asia region. In Indonesia, various food safety problems are still encountered such as cases of food poisoning, food containing hazardous materials and poor food handlers’ sanitation hygiene. One of The National Agency of Drug and Food Control (NADFC)’s efforts to overcome food safety issues in Indonesia is the development of safe food villages with village community-based food safety interventions through the Food Safety Movement in Village (Gerakan Keamanan Pangan Desa/GKPD). The study used RE-AIM framework with a case study design. The study sites were Pandowoharjo Village, Sendangsari Village and Mangunan Village, the Special Region of Yogyakarta, Indonesia. Informants were selected purposively as many as 73 people. Data were collected through six FGDs, 16 interviews face to face and using telephone, observation and document review. The analytical approach used was qualitative content analysis with Opencode software version 3.6.2.0. The results of the study showed that the GKPD program involved community policy makers (village officials), the formation of food safety cadres from various community groups (family health empowerment organization, youth organizations, teachers) and the fostering of various food provider communities in the village (housewives, home-industries, food retailers, school canteen, and street food vendors), as well as the involvement of public health centre, but in its implementation there were obstacles to the adoption of food safety practices by the food vendors community which caused the program to not be fully effective in changing food safety behaviour due to economic and human resources factors.

Factors associated with safe food handling practices in the food service sector

PURPOSE

This review assessed the methodological quality of relevant food safety studies, investigated the available evidences for factors associated with safe food handling practices (SFHPs) and suggested required improvements.

METHODS

A systematic literature search was carried out in five databases. A pre-designed criteria was used for data extraction and quality assessment. Evidence synthesis was performed, based on specified criteria.

RESULTS

Out of a total of 1768 published research articles, 28 met the inclusion criteria. Strong evidence suggests that food handlers' knowledge and attitudes on food safety contribute to SFHPs. Moderate evidence exists about the association between a food handler's food safety training and SFHPs. Limited evidence is available about the influence of the educational level and work experience of a food handler, to SFHPs. Insufficient evidence exists about the association between socio-demographic characteristics and SFHPs. A conceptual framework is presented to illustrate the associations.

CONCLUSIONS

Available evidence supports that in order to promote SFHPs, responsible authorities should focus on improving on the food safety knowledge and attitudes of food handlers. Future food safety studies may richly benefit from overcoming the methodological shortcomings presented in this review.

Risk Management of Dairy Product Losses as a Tool to Improve the Environment and Food Rescue

“Food loss”, defined as food produced for human consumption, which for various reasons leaves the supply chain, can be assigned to a group of new risks. Irrational use of food constitutes a risk to the environment. Moreover, food losses represent a missed opportunity to improve global food security. The aim of this study was to develop a risk management model for dairy product losses using the example of ripening cheese. The necessary data to develop the model were derived from a survey that was conducted in five dairies located in Poland. Total losses for nine products amounted to 1.1% of the average annual production, which accounted for more than 5635 t per annum. The studies that were conducted allowed the identification of three management methods of food loss in dairies: reprocessing, hand over for feed, and disposal. The level of risk was defined as “high” with two suggested courses of action: prevention and tolerance. Risks must be prevented by eliminating any errors that may result in a product of inadequate quality. Another solution is to redistribute or sell products at a reduced price, which despite their reduced quality, are nevertheless suitable for consumption. To some extent, this risk must be tolerated.

Effectiveness of Food Handler Training and Education Interventions: A Systematic Review and Meta-Analysis

Improper food handling among those working in retail and food service settings is a frequent contributor to foodborne illness outbreaks. Food safety training and education interventions are important strategies to improve the behaviors and behavioral precursors (e.g., knowledge and attitudes) of food handlers in these settings. We conducted a comprehensive systematic review to identify, characterize, and synthesize global studies in this area to determine the overall effectiveness of these interventions. The review focused on experimental studies with an independent control group. Review methods included structured search strategy, relevance screening of identified abstracts, characterization of relevant articles, risk of bias assessment, data extraction, meta-analysis of intervention effectiveness for four outcome categories (attitudes, knowledge, behavior, and food premise inspection scores), and a quality of evidence assessment. We identified 18 relevant randomized controlled trials (RCTs) and 29 nonrandomized trials. Among RCTs, 25 (64%) unique outcomes were rated as high risk of bias, primarily owing to concerns about outcome measurement methods, while 45 (98%) nonrandomized trial outcomes were rated as serious risk of bias, primarily because of concerns about confounding bias. High confidence was identified for the effect of training and education interventions to improve food handler knowledge outcomes in eight RCT studies (standardized mean difference = 0.92; 95% confidence interval: 0.03, 1.81; I² = 86%). For all other outcomes, no significant effect was identified. In contrast, nonrandomized trials identified a statistically significant positive intervention effect for all outcome types, but confidence in these findings was very low due to possible confounding and other biases. Results indicate that food safety training and education interventions are effective to improve food handler knowledge, but more evidence is needed on strategies to improve behavior change.

The differences between observed and self-reported food safety practices: A study with food handlers using structural equation modeling

Every year, studies about food handlers' food safety knowledge, attitudes, and practices are published. Some results of these papers have been rather controversial, especially those related to food safety practices. The two most common methods for evaluating food safety practices - self-assessment and observation - are generally treated as interchangeable, but they can have different meanings. The objective of this study was, therefore, to differentiate between the observed and self-reported food safety practices of food handlers, verifying the effect of different variables in these food safety indicators through structural equation modeling, and examining the relationship between cognitive factors and these practices. A questionnaire with 37 questions was given to 183 food handlers to evaluate their food safety knowledge, attitudes, self-reported practices, and risk perceptions. For the observed assessment method of evaluating the food handlers' practices (observed practices), a checklist was developed, and food handlers were observed during one workday. Two models were developed based on the results of these two assessment methods. In the first model a significant positive effect of knowledge and a negative effect of risk perception on self-reported practices were observed. Food handlers with high risk-perception about their practices reported less adequate practices. Positive food safety attitudes acted as a moderator dampening the positive effect between knowledge and self-reported practices. In the second model a significant positive effect of knowledge on observed practices. Attitudes strengthened the positive effect between knowledge and observed practices. On the other hand, a direct effect of attitude on observed practices was not observed. In conclusion, self-reported practices and observed practices are different and should be used and discussed properly.

Evaluating Food Safety Knowledge and Practices among Foodservice Staff in Al Madinah Hospitals, Saudi Arabia

This study examines food safety knowledge and practices of food service staff in Al Madinah hospitals, Saudi Arabia. A total of 163 food service staff participated voluntarily from 10 hospitals across the city of Al Madinah. The participants completed a questionnaire composed of three parts: General characteristics, food safety knowledge, and food safety practices. Results showed that respondents generally had good food safety knowledge with the highest pass rate of 77.9% for knowledge of cross contamination followed by 52.8% for knowledge of food poisoning, and 49.7% of knowledge of food storage. Food safety practices were also strongly observed in the hospitals with a pass rate of 92.6%. Food safety knowledge among the hospital food service staff varied with the level of education, age, and having received food hygiene/safety practices, training while food safety practices had a significant association with the level of education and food hygiene/safety practices training of the staff. Spearman rho coefficient results showed that there was a significant linear relationship between food safety practice and food safety knowledge, and that food safety knowledge significantly predicts food safety practices. This research revealed the importance of education and consistent training of food service staff in improving knowledge and thereby better and safe food handling practices, which could contribute to apply food safety in the hospitals.

Knowledge and risk perceptions of foodborne disease by consumers and food handlers at restaurants with different food safety profiles

Food handlers and consumers are responsible for avoiding foodborne diseases (FBD). Considering the meals consumed away from home, can the consumer identify the FBD risk level of the food that he/she consumes in restaurants? This study aimed to evaluate the knowledge, risk perception, and optimistic bias of food handlers and consumers of restaurants and the relationship of these variables with the FBD risk of these establishments. Sixty-four handlers and 265 consumers of 14 restaurants in the city of Limeira - São Paulo, Brazil participated in the study. A validated checklist was used to evaluate the food safety profile of restaurants with a score ranging from zero to 2565.95. A structured questionnaire was employed to assess knowledge of food safety and the risk perception of FBD. The food handlers indicated their own risk and their peers' risk of causing a FBD. Consumers evaluated their own risk and the risk of their peers of contracting a FBD after making their own meals, consuming meals at the studied restaurants and consuming meals in other food establishments. The answers were based on a structured scale with seven options. The difference between their risk perception levels (risk attributed to itself and to a peer) indicated the optimistic bias of FBD risk. The mean food safety risk score of the food service establishments was 105.51. The restaurants were classified into two groups, higher or lower FBD risk. The mean score of knowledge (percentage of correct answers) of food safety was 61.7% for handlers and 59% for consumers, showing a nonsignificant difference (p = .29). Both food handlers and consumers stated that they were less at risk for FBD than their peers (p < .001). A direct effect of consumers' optimistic bias on food service FBD risk was observed through multivariate analysis. Optimistic bias may lead consumers to choose restaurants with a higher FDB risk. A direct negative effect of food handlers' knowledge of food service FBD risk was observed. These results show that consumers may have incorporated a sense of affection and identity to a place, associating it with making their own meals at home. Therefore, the consumer may not differentiate restaurants with regard to food safety. This result reinforces the need for governments and health agencies to protect the health of the population.

Food safety performance and risk of food services from different natures and the role of nutritionist as food safety leader

Abstract The objective of this study was to evaluate the food safety performance of food services and its associated factors. The study involved 84 food businesses in the city of Santos as follows: street food kiosks and beach kiosks (street food), commercial restaurants, hospitals and school meal services (institutional food services). A food safety checklist with 81 items was applied. The overall percentage of adequacy was lower in street food kiosk (49.7%) and beach kiosk (62.0%) than in restaurants (69.7%), hospitals (83.9%) and schools (86%). Institutional and commercial restaurants showed higher scores of food safety performance than street food services, mainly regarding risker practices. The variables positively associated with food safety performance in commercial restaurants were: presence of a nutritionist as leader and adequate structure. These results show that street food services need, in a mediate way, the implementation of new strategies and regulations to improve food safety. A nutritionist acting as food safety leader may improve the food safety performance at commercial restaurants.

Food safety in Brazilian popular public restaurants: Food handlers' knowledge and practices

This study aims to assess food safety knowledge and practices of food handlers in popular public restaurants in Brazil. A questionnaire has been applied with 70 food handlers in different municipalities, with questions related to food safety knowledge and food safety self-reported practices, and observed practices. To check hygienic-sanitary conditions of restaurants, a checklist has been applied. Regarding food safety knowledge, an average of 72.64% of correct answers has been observed. Food safety self-reported practices presented 80.71% of adequacy, while observed practices were 75.40%. A positive correlation has been observed between food safety knowledge and self-reported practices of handlers. The observed food safety practice of handlers presented no correlation with food safety knowledge and self-reported practices. The average adequacy of hygienic-sanitary conditions was 68.08%, classifying the units as "regular." Despite satisfactory results related to the handlers' food safety knowledge and practices, the hygienic-sanitary conditions of the restaurants are of concern.

PRACTICAL APPLICATIONS

The Popular Restaurant Program in Brazil aims to provide proper food from a nutritional and hygienic-sanitary aspect at affordable prices. The assessment of food handlers' food safety knowledge and practices and the assessment of hygienic-sanitary conditions of these units are key in supporting actions aimed at improving the quality of the meals served, as food handlers are the essential agents in the production of meals and can become a source for food contamination if necessary care is not taken. Therefore, conducting this assessment can be an important tool for quality management in these units and can provide improvements in the process of food handling, in addition to ensuring compliance with the objectives proposed by the Popular Restaurant Program.

The existence of optimistic bias about foodborne disease by food handlers and its association with training participation and food safety performance

A positive outlook regarding future events, in which individuals find themselves less likely than others to experience negative events, is called optimistic bias (OB). The aims of this study were: 1. To ascertain the existence and measure the OB phenomenon in food handlers in relation to foodborne disease and 2. To examine the association of OB with food handlers' risk perceptions, knowledge, attitudes, self-reported practices, training participation, food safety performance of the establishments and microbiological analysis. This study examined different food businesses in Santos city, in Brazil, as follows: street food kiosks, beach kiosks, restaurants, hospitals, and school meal services. The food handlers indicated their own risk and their peers' risk of causing a foodborne disease. Responses were given on a 10cm linear scale anchored with descriptors of intensity ranging from "none" to "very high". The difference between these risk perceptions characterized a score of tendency of an OB. A structured questionnaire was administered to evaluate knowledge, attitudes, self-reported practices and food safety performance. A total of 183 food handlers participated in the study. Microbiological analyses were conducted with ready-to-eat foods/preparations from selected sites. The food handlers perceived themselves as less likely than their peers to cause a foodborne disease (p<0.001), demonstrating the tendency of an OB. Food handlers who had undergone some training presented lower scores for the perceived risk of themselves being responsible for a foodborne disease and higher knowledge than did untrained individuals. Hospitals, schools and restaurants performed better than street food group considering food safety performance. However, microorganisms were found in food samples from hospitals. This result may be motivated by OB and other subjective factors. Apparently, this positive outlook of food handlers is associated with training participation, lethality perception and correlating positively with age. No association was found between OB scores and knowledge, attitudes and self-reported practices. Since OB may lead individuals to adopt inappropriate or dangerous behavior, strategies for debiasing food handlers should be designed.