A review of food safety and food hygiene training studies in the commercial sector

Evaluating levels of knowledge and food safety practices among food handlers in the Southern part of Italy

The purpose of the present study is to assess the extent of knowledge and food safety practices among food handlers (FHs) to prevent food risks. This cross-sectional study was conducted between July 2021 and February 2022 in a random sample of FHs working in three regions of the Southern part of Italy. A two-stage cluster random sampling strategy was used to select FHs working at food businesses in the Regions. Data were collected through an anonymous self-administered questionnaire that consisted of 33 questions grouped into five sections to gather sociodemographic and professional characteristics, knowledge about foodborne illnesses (FBIs) and food safety, adherence to proper food handling practices and sources of information. The overall median knowledge score was 8 (interquartile range 6-9), but only 2.2 % of the respondents answered all 12 statements correctly. Among the recruited FHs, 71.2 % and 65.4 % reported always keeping raw and cooked food separate and using different utensils while handling raw and cooked foods, respectively. With respect to the use of personal protective equipments, 79.3 % and 67.6 % stated always wear work clothing and hair restrain (e.g., hats, hairnets), respectively. Just 20.9 % of the FHs properly defrosted food (i.e., in the fridge) and 39.9 % used food warmers for keeping food at least at 65 °C while waiting for service. The findings highlighted poor knowledge concerning the ideal temperatures for cooking, holding and storing foods, exacerbated by poor personal and hand hygiene, certain factors associated with the spread of foodborne pathogens.

Evaluation of the Handling Practices and Risk Perceptions of Dried Wood Ear Mushrooms in Asian Restaurants in the United States

In late 2020, dried wood ear mushrooms, a low-moisture food ingredient that had been imported and sold to restaurants, were linked to a foodborne outbreak of Salmonella Stanley, which sickened 55 individuals across the United States. These mushrooms are commonly used in Asian cuisine. It is unclear if the contaminated dried wood ear mushrooms that caused the foodborne illnesses were improperly handled during preparation. The objectives of this study are to assess the handling practices, risk perceptions, and food recall experiences of dried wood ear mushrooms in restaurant kitchens among Asian restaurant managers and chefs. We conducted a series of telephone interviews with managers and chefs of Asian restaurants in the United States who used dried wood ear mushrooms in making dishes. After reaching information saturation, a total of 25 restaurant managers and chefs participated in the interview. Our results showed that 76% of the participants did not keep track of package information, such as expiration date and lot number, and many participants reported using cold water for rehydration. Wood ear mushrooms were blanched before being used in all cold dishes and most stir-fry dishes, but less commonly in stew or ramen. Some participants (16%) did not view dried wood ear mushrooms as a raw food ingredient, and 16% did not perceive that low-moisture food ingredients constituted microbiological food safety risks. The majority of the participants had heard of food recalls, but only 17% knew about the dried wood ear mushroom recall, and even fewer had heard of food recalls of other low-moisture foods, like nuts and seeds (9%), and flour (4%). While this study shares similarities with previously published studies evaluating the handling practices of consumers and restaurant employees with respect to meat and poultry, it makes a distinctive contribution to the field of food safety as the first-of-its-kind to study the handling practices of a low-moisture food ingredient: dried wood ear mushrooms. This unique ethnic food ingredient has been associated with a past outbreak and multiple recalls in the United States. The findings of the study show the need to develop food safety educational programs that are tailored toward Asian restaurant food handlers and provide guidance to develop risk communication strategies for this niche audience.

Sources and contamination routes of seafood with human pathogenic Vibrio spp.: A Farm-to-Fork approach

Vibrio spp., known human foodborne pathogens, thrive in freshwater, estuaries, and marine settings, causing vibriosis upon ingestion. The rising global vibriosis cases due to climate change necessitate a deeper understanding of Vibrio epidemiology and human transmission. This review delves into Vibrio contamination in seafood, scrutinizing its sources and pathways. We comprehensively assess the contamination of human-pathogenic Vibrio in the seafood chain, covering raw materials to processed products. A "Farm-to-Fork" approach, aligned with the One Health concept, is essential for grasping the complex nature of Vibrio contamination. Vibrio's widespread presence in natural and farmed aquatic environments establishes them as potential entry points into the seafood chain. Environmental factors, including climate, human activities, and wildlife, influence contamination sources and routes, underscoring the need to understand the origin and transmission of pathogens in raw seafood. Once within the seafood chain, the formation of protective biofilms on various surfaces in production and processing poses significant food safety risks, necessitating proper cleaning and disinfection to prevent microbial residue. In addition, inadequate seafood handling, from inappropriate processing procedures to cross-contamination via pests or seafood handlers, significantly contributes to Vibrio food contamination, thus warranting attention to reduce risks. Information presented here support the imperative for proactive measures, robust research, and interdisciplinary collaboration in order to effectively mitigate the risks posed by human pathogenic Vibrio contamination, safeguarding public health and global food security. This review serves as a crucial resource for researchers, industrials, and policymakers, equipping them with the knowledge to develop biosecurity measures associated with Vibrio-contaminated seafood.

Food handlers' practices and associated factors in public food establishments in Gondar, Ethiopia 2021/2022

Food safety is crucial to avoid foodborne illness and improve human wellbeing. Millions of people get sick, and many of them pass away due to eating unhealthy food. Foodborne diseases are still a public health problem in developing countries like Ethiopia. The objective of this study was to assess food handlers' practices and associated factors in public food establishments in Gondar, Northwest Ethiopia. Across-sectional study was conducted among 417 food handlers in food and drink service establishments. The data were collected using a structured interview-administered questionnaire and an observational checklist. Multivariable logistic regression was used to identify predictors. The prevalence of food safety practice among food handlers was 37.6%, with a 95% CI of (32.9, 42.7). More than half of the study participants had good knowledge and attitude. Sex (female) [AOR = 0.40, 95%CI: (0.23, 0.92)], educational status (diploma and above) [AOR = 1.50, 95%CI: (1.21, 3.10)], and good attitude [AOR = 0.25 95%CI: (0.12, 0.89)] were predictors of food safety practices. The prevalence of food safety practices among food handlers in Gondar food establishments was low. The provision of education and on-the-job training on food safety and personal hygiene is advised to enhance good food handling practices.

Organizational factors and safe food handling by food service workers: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to explore and map the scientific evidence on organizational factors related to safe food handling by food service workers to prevent foodborne disease.

INTRODUCTION

According to the World Health Organization, more than 600 million people become ill each year due to foodborne diseases. Improper food handling is one of the main causes of such diseases. Despite the growing literature on safe food handling, many studies focus on assessing and discussing cognitive variables, such as food safety knowledge. This indicates a need to study this topic from a new perspective, for example, through its organizational factors.

INCLUSION CRITERIA

The review will include quantitative and qualitative studies on food handlers working in food services. Food handlers involved in industrial processing, planting, harvesting, and working on the street (street food) or in the home will be excluded.

METHODS

This review will use the JBI methodology for scoping reviews to identify published and unpublished studies in all languages, with no time limit. The following databases will be searched: Scopus, CINAHL, Embase, Web of Science, MEDLINE, PsycINFO, and Food Science and Technology Abstracts. A structured search for gray literature will also be conducted. Titles, abstracts, and full texts of articles will be screened by 2 reviewers for inclusion, with discrepancies resolved by a third reviewer. Data will be extracted using a standardized form. The results will be summarized in tabular or graphical format, accompanied by a narrative summary.

KEY DETAILS OF THIS REVIEW PROJECT ARE AVAILABLE IN OPEN SCIENCE FRAMEWORK

https://osf.io/hxfe4.

Food hygiene practices and determinants among food handlers in Ethiopia: a systematic review and meta-analysis

Background

Food-borne diseases are a major public health concern worldwide, particularly in low and middle-income countries (LMICs), such as Ethiopia. Poor food hygiene practices primarily exacerbate food-borne illness transmission. Prior studies on the food hygiene practices among food handlers in Ethiopia were inconsistent. Therefore, this meta-analysis and systematic review aimed to estimate the pooled proportion of good food hygiene practices and identify the determinants in Ethiopia.

Methods

The preferred reporting items for systematic review and meta-analysis (PRISMA) instruments were used, and a systematic search was performed in the PubMed/MEDLINE, POPLINE, HINARI, Science Direct, Cochrane Library databases, and Google Scholar were systematically last searched on the 24th February 2022 for relevant articles. Only the observational studies that reported the proportion of good food hygiene practices and their associated factors among food handlers were included. The quality of the included studies was assessed by two independent authors. Articles with unclear methodologies and did not report the overall proportions of good food hygiene practice were excluded. The effect estimates for pooled proportion and pooled odds ratio (POR) along with a 95% confidence interval (CI) were determined conducting using DerSimonian–Laird's random effect model.

Results

Among 817 retrieved studies, 23 eligible articles with a total sample size of 7153 study participants were included in the meta-analysis. The pooled proportion of good food hygiene practices among food handlers was 50.5% [95% CI: (41.6, 59.4%]; I² = 98.7%, p value = 0.001]. Food handlers with formal education (POR = 4.60, 95% CI: 3.05, 6.93), good knowledge (POR = 1.98, 95% CI: 1.26, 3.11), training (POR = 3.52, 95% CI: 2.35, 5.28), and a positive attitude (POR = 3.41, 95% CI: 2.52, 4.61) about food hygiene components, as well as regular medical checkups (POR = 6.75, 95% CI: 4.49) were significantly associated with good food hygiene practice.

Conclusions

Only half of Ethiopia's food handlers had good food hygiene practice.

Implication of the study

The key elements of effective food hygiene practice that will aid in the development of feasible interventions to increase food handler compliance with food hygiene components have been identified.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41182-022-00423-6.

Structural modeling to understand the relationship among food safety knowledge, attitude, and self-reported HACCP practices in restaurant employees in Bangladesh

In this materialistic era, a substantial number of people are likely to have their meals outside of their homes and largely depend on the restaurants' made food due to the prolonged working hours and tremendous pressure in workplace. Consequently, consumers expose themselves to risk and become vulnerable to illness caused by food. Unsafe food preparation and handling by restaurants' workers have made food safety concern for public health. The study was aimed to examine the relationships among food safety knowledge, attitude, and Hazard Analysis Critical Control Point (HACCP) practices in restaurant employees in Bangladesh. A total of 360 employees from 120 restaurants participated in a face-to-face interview through a structured questionnaire comprising four sections: demographic characteristics, food safety knowledge, attitudes and practices. The mean scores for each survey item were calculated and used in Structural Equation Modeling (SEM), designed to assess interrelationships among the three sections related to food safety. Participants obtained a correct average score of 53.32% in food safety knowledge, with the highest and lowest correct scores in Good Hygiene Practices (GHPs) and HACCP practices, respectively. The highest score in the attitude section belonged to "self-improvement", followed by "food safety concern". A negative correlation was observed between knowledge with practices, knowledge with attitudes, and a positive correlation was observed between practices with attitudes. A significant positive correlation was observed between HACCP practices with shelf improvement (r = 0.54, p < 0.05) and the knowledge toward food poisoning with GHP practices (r = 0.55, p < 0.05). Self-improvement and food safety concerns are negatively correlated with food poisoning, GHP, and HACCP practice. This study demonstrated that restaurant employees in Bangladesh often lack knowledge regarding food safety and HACCP. So, in order to improve knowledge and attitude on safe HACCP practice among the restaurants employees', proper education and interactive training sessions can be conducted.

A case study of food handler hand hygiene compliance in high-care and high-risk food manufacturing environments using covert-observation

Observation of behaviour is superior to cognitive data, which does not equate to behaviour. Covert-observation is seldom used in food manufacturing to assess behaviour. In this case study, closed-circuit-television footage (15 h) in a business were reviewed to assess hand hygiene compliance using an electronic-checklist. Hand hygiene attempts were observed prior to entering high-risk (cake/pie)(n= 47) and high-care (sandwich/salad)(n= 153) production areas. Business hand hygiene protocol required handwashing durations ≥ 20 s. Observed durations ranged 1-71 s, <96% of attempts were <20 s. Significantly longer durations were observed when food handlers were in the presence of others (12 s) than when alone (9 s). Although <99% utilised soap, only 56-69% wetted hands first. Failure to rub all parts of hands was commonplace (<87%) and 24-35% failed to apply sanitiser after drying. Consequently, >98% of observed attempts before entering production areas did not comply with the protocol. Observed non-compliant practices may have implications for food safety in manufacturing.

An Evaluation of a Virtual Food Safety Program for Low-Income Families: Applying the Theory of Planned Behavior

Low-income families are reported to have a limited knowledge of food safety and resources to follow food safety practices compared with the rest of the population. This paper evaluated a virtual food safety educational program targeting food handlers in low-income families. Trained native speakers of English and Spanish delivered course materials in both languages. A total of 60 individuals participated in the program, with 30 participants in each language group. Most were female, and most had fewer than three children. After the program, participants’ food safety knowledge and self-reported safe food practice behavior scores increased significantly from 5.32 to 7.43 (out of 8.00) and from 24.78 to 29.30 (out of 35.00), respectively. The theory of planned behavior (TPB) was used to understand individuals’ behavior change intention of food safety practices. All the TPB constructs’ scores, including attitudes toward the behavior, perceived behavioral control, subjective norms, and behavior change intentions, were improved significantly; however, only the subjective norms and perceived behavioral control were significantly correlated with the behavior change intentions. This virtual educational program improved low-income individuals’ food safety knowledge and changed their food safety attitudes and behaviors, giving a path to develop and evaluate more virtual food safety educational programs in the future.

New Approach to Food Safety Training: A Review of a Six-Step Knowledge-Sharing Model

Significant resources, including both human and financial capital, have been dedicated to developing and delivering food handler training programs to meet government and organizational mandates. Even with the plethora of food safety-oriented training programs, there is scant empirical evidence documenting effectiveness, suggesting the need to rethink the design and delivery of food safety training for food handlers. One underlying assumption of most training programs is that food handlers engage in unsafe practices because of lack of knowledge. As a result, many training curricula are designed to improve knowledge, assuming behavior will change as knowledge increases. However, food handlers often return to the work environment and try to implement the new knowledge with minimal success. One explanation for this is that the training context and the implementation context often differ, making it difficult for the food handler to transfer what they learned into practice. Understanding the connection between knowledge, the organization, and its environment is critical to knowledge implementation. The focus of this review is to describe a six-step knowledge-sharing model. Here, knowledge sharing is broadly defined as the process of creating and then using knowledge to change a practice or behavior. Our proposed knowledge-sharing model includes six steps: generation, adaptation, dissemination, reception, adoption, and implementation. We have organized this model into two dyads: (i) transfer between researcher (i.e., knowledge generators) and educator and (ii) transfer between educator and food handler (i.e., knowledge implementers). To put into practice this proposed model for developing and delivering effective food safety training for food handlers, we have provided suggested actions that can be performed within each step of the knowledge-sharing process.

Product line of selected agricultural entity in Slovakia and suggestion for its expansion based on analysis of consumers' interest in dairy and meat products

Studies on primary agricultural production in Slovakia aimed mainly at biological, economic, or market point of view and there is a lack of managerial approach providing a specific recommendation for farmers according to their production lines or planning process. As a reaction, we are providing a practically oriented study based on the selected livestock producer, which is aimed at statistical significances as an establishment for further recommendations for management and marketing of this entity. The paper aims to analyze the views and preferences of customers of the monitored company, which sells its meat and dairy products in its stores and verify the expected success of the planned expansion of the product lines. Regarding this, the online questionnaire study was conducted on a sample of 202 respondents. Realized statistical analysis based on the Kruskal-Wallis nonparametric test and subsequent Bonferroni post hoc correction signify that meat products, fresh meat, and slaughter specialties are the most favorite products among customers of the monitored company. Fresh milk, on the other hand, is not as attractive as a meal for them. However, selling it from vending machines placed out of the store would increase the sales. Dairy products of own production should be even more successful, as we assume they would be as interesting for customers as the currently expanding portfolio of meat products. The benefit of this study lies in the consideration of the practical use of the obtained results in the business practice of the monitored company. Regarding this, we are providing a set of recommendations, according to the planning of their product lines and connected marketing tools for their successful placement on the market.

A quasi-experimental study on the effect of health and food safety training intervention on restaurant food handlers during the COVID-19 pandemic

The restaurant business has turned into a dynamic and ever‐growing industry. So, food safety must be a priority for these establishments, especially during the COVID‐19 pandemic. The aim of this study was to determine the effect of training intervention on the health and food safety knowledge, attitude, and self‐reported practice (KAP) of restaurant food handlers during the COVID‐19 pandemic. This quasi‐experimental study was conducted on 159 restaurant food handlers in Tehran, Iran. The training intervention was developed based on the latest global guidelines. The KAP of the subjects was measured before and after the training. Fisher's exact test, paired t test, and repeated measures ANOVA were used for statistical analysis. Data analysis was done using the IBM_SPSS software. The total knowledge scores of participants were low (17.6%), moderate (35.2%), and good (47.2%) before training, which were changed to 5% (low), 23.9% (moderate), and 71.1% (good) after training. The total pretraining attitude scores were 0.6, 77.4, 18.2, and 3.8% that were changed to 0% (strongly negative), 49.1% (negative), 33.3% (positive), and 17.6% (strongly positive), respectively. Also, the self‐reported practice scores of the participants before training were 1.3, 56, and 42.7 that were changed to 0% (weak), 26.4% (acceptable), and 73.6% (desirable) after the intervention, respectively. Paired t test results showed a statistically significant increase in all scores. The interaction of training with age and education was statistically significant in increasing the knowledge and attitude scores of the participants by the repeated measures ANOVA. Improving the KAP of food handlers by health and food safety training can improve the status of restaurants and minimize the outbreak of pandemic diseases, including COVID‐19, which is an effective step in community health. Thus, it is an urgent need for policymakers to design an online system of continuous food safety training for food handlers.

Metagenomic Analysis of Microbial Composition Revealed Cross-Contamination Pathway of Bacteria at a Foodservice Facility

Bacterial contamination of food-contact surfaces can be a potential risk factor for food quality and safety. To evaluate the spatial and temporal variations of the potential cross-contamination routes, we conducted a biogeographical assessment of bacteria in a foodservice facility based on the diversity of microflora on each surface. To this end, we performed high-throughput amplicon sequencing of 13 food-contact and non-food contact surfaces in a foodservice facility throughout a year. The results showed that Bacillus, Acinetobacter, Streptophyta, Enterobacter, Pseudomonas, Serratia, Enhydrobacter, Staphylococcus, Paracoccus, and Lysinibacillus were the dominant genera found on the kitchen surfaces of the foodservice facility. Depending on the season, changes in Firmicute/Proteobacteria ratios were observed, and the fan becomes the main source of outdoor air contamination. The microbial flow associated with spoilage was also observed throughout food preparation. Taken together, our results would be a powerful reference to hygiene managers for improvement of food processes.

What changed between 2008-2020 about Employees' perception of hygiene in the catering industry in Ankara (Turkey)?

Food safety is a public health concern because foodborne diseases have been increasing in recent years due to several factors such as urbanization, globalization and changes in consumer habits. Many countries in the world, including Turkey have upgraded their laws about food and personnel hygiene in the catering industry and undertaken changes to the organizational structure of their regulatory institutions to protect consumers' health. In this study, it was aimed to evaluate the perceptions of food processors on food safety and to determine whether there has been a change in this matter over the last 12 years. The data has been collected by conducting face to face interviews and having 500 employees from the sector fill in a questionnaire constructed for this purpose. The responses to the questionnaire have been measured by assigning 'hygiene perception points' to each respondent according to their replies. These hygiene perception points have been analysed in terms of gender, age, educational level and work experience of the employees involved. The results have revealed that employees between the ages of 26-34, women, university graduates have a higher level of perception of hygiene than other age groups, men, those with lower education levels, respectively. Hygiene perception points were found to be higher compared to the results obtained 12 years ago. The positive changes observed in the hygiene perception points are thought to result from the differences in the legislation of the years in which both studies were conducted. It is thought that the obligatory of providing hygiene and food safety training to individuals working in the catering sector with law changes leads to positive changes in the employees. Legally compulsory training activities can overcome many sanitation and safety problems that result from misinformed or uninformed employees.

Moving Forward to the Future: A Review of Microbial Food Safety Education in China

Millions of foodborne illness cases occur in China annually, causing significant social and economic burdens. Improper food handling has been observed not only among commercial food handlers but also among residential food handlers. It is critical to conduct a comprehensive scoping review of previous efforts to identify food safety knowledge gaps, explore the factors impacting knowledge levels, and synthesize the effectiveness of all types of food safety educational interventions for commercial and residential food handlers in China. This review aims to analyze food safety education studies published over the past 20 years and provide foundations for developing more effective food safety educational interventions in China. A total of 35 studies were included in this review. Most studies reported that Chinese commercial and residential food handlers had insufficient food safety knowledge, especially in the areas of foodborne pathogens and safe food-handling practices. The factors impacting food handlers' knowledge levels included education level, gender, income level, residency (rural vs. urban), the use of WeMedia, college students' major, and food safety training experiences. Food handlers in the following demographic groups tend to have lower levels of food safety knowledge: lower education levels, the elderly, males, lower-income levels, rural residents, those who do not use WeMedia, those without food safety training experience, or college students in nonbiology-focused majors. Many food handlers did not always follow recommended food safety practices, such as proper meat handling practices, handwashing practices, and cleaning and sanitation practices. Thirteen studies evaluated the effectiveness of educational interventions, and knowledge increases were reported after all interventions. The findings of this review provide guidance to researchers, educators, and government agencies in their future efforts to develop education programs emphasizing the importance of microbial food-safety content and behavior change regarding food safety and hygiene practices.

Food Safety and Sanitation Implementation Impasse on Adolescents in Kenyan High Schools

The ability to combat food-borne illnesses in food facilities and institutional catering units require sufficient knowledge on food safety and sanitation standards by food producers and consumers. The aim of the study was to investigate the food safety and sanitation knowledge of food handlers in Kenyan high schools. A cross-sectional study was carried out among 204 food handlers in 50 schools. Questions about knowledge and practice toward food safety and sanitation were asked. Respondents were the most knowledgeable on food contamination (93%), while participants were the least knowledgeable on the importance of protective attire when distributing foods to learners (50%). One-way ANOVA revealed a significant difference between gender and food handlers' behavior and practice (F = 19.886, ρ = 0.00 < 0.05) as well as between job tenure and practice of food safety and sanitation (F = 17.874, ρ = 0.00 < 0.05). Multiple regression analysis established that knowledge contributed to 44.1% of the behavior and practice of the food handlers. It is concluded that food handlers have a fair knowledge despite lack of training, motivation, and facilities to maintain quality standards. It is recommended that the Kenyan Government develop and implement guidelines through school feeding policy that would ensure that food safety and sanitation practices are implemented and utilized by Kenyan high schools.

An Integrative Review of Hygiene Practice Studies in the Food Service Sector

ABSTRACT

This article reviews the recent literature on studies relevant to hygiene practices of food service workers. A total of 32 articles were chosen for evaluation from a systematic search of the published literature from 2014 to 2019. For the assessment of hygiene practices, hand washing as a measurement item and observation as a method were most frequently used. Factors influencing hygiene practices were categorized as internal and external variables. Internal variables included knowledge; psychological factors, such as attitude, risk perception, self-efficacy, and optimistic bias; and food handlers' sociodemographic characteristics, such as work experience and exposure to hygiene training. External variables included characteristics of food premises, such as the size of the operation and number of people served, and organizational factors, such as training. Regarding the recent training literature, attempts to bring in new methodologies and new technologies were found, such as multimedia case studies, cognitive word association, behavior-focused training, wearable technology, and simulation games. Among the theories utilized, knowledge, attitude, and practices were applied most frequently to explain hygiene practices. In particular, this review highlights the important fact that internal and external factors that affect hygiene practices should be considered to maintain good hygiene practices.

HIGHLIGHTS

Contribution of Foods and Poor Food-Handling Practices to the Burden of Foodborne Infectious Diseases in France

The foodborne disease burden (FBDB) related to 26 major biological hazards in France was attributed to foods and poor food-handling practices at the final food preparation step, in order to develop effective intervention strategies, especially food safety campaigns. Campylobacter spp. and non-typhoidal Salmonella accounted for more than 60% of the FBDB. Approximately 30% of the FBDB were attributed to 11 other hazards including bacteria, viruses and parasites. Meats were estimated as the main contributing food category causing (50-69%) (CI90) of the FBDB with (33-44%), (9-21%), (4-20%) (CI90) of the FBDB for poultry, pork and beef, respectively. Dairy products, eggs, raw produce and complex foods caused each approximately (5-20%) (CI90) of the FBDB. When foods are contaminated before the final preparation step, we estimated that inadequate cooking, cross-contamination and inadequate storage contribute for (19-49%), (7-34%) and (9-23%) (CI90) of the FBDB, respectively; (15-33%) (CI90) of the FBDB were attributed to the initial contamination of ready-to-eat foods-without any contribution from final food handlers. The thorough implementation of good hygienic practices (GHPs) at the final food preparation step could potentially reduce the FBDB by (67-85%) (CI90) (mainly with the prevention of cross-contamination and adequate cooking and storage).

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.

Effectiveness of a health intervention based on WHO food safety manual in Iran

BACKGROUND

Food safety manual was developed by the World Health Organization (WHO) to train professionals to reduce the burden of foodborne diseases as a global strategy. The present pioneering research aimed to explore the effectiveness of an intervention based on the manual of five keys to safer food by WHO in enhancing the knowledge, attitude and behavior of Iranian Female Community Health Volunteers (FCHVs).

METHODS

In the present quasi-experimental research, FCHVs (n = 125) were selected and assigned to two groups, an intervention and a control. A modified version of the questionnaire based on WHO manual was used to measure knowledge, attitude and behavior of the sample. The questionnaire was first completed at the outset of the study (pre-test) and then once again in 2 months of the intervention (post-test). Face and content validity of the questionnaire was tested and confirmed. Cronbach's alpha was used to test the reliability of the questionnaire along with the test-retest method of testing reliability. The data entered SPSS16 for statistical analysis. To this aim, Chi-squared test, dependent and independent samples T-test, ANOVA and ANCOVA were run. Partial population attributable risks were calculated and corresponding 95% confidence intervals (95% CIs) were estimated using a bootstrap method.

RESULTS

The two groups showed no statistically significant difference in the pretest (p > .05). In the post-test, the mean scores for all variables was higher in the intervention group than the control, and this difference between the two research groups was statistically significant (p < .001). When the volunteers were adjusted for age and experience in healthcare centers, the mean scores were significantly higher in the intervention group than the control (p < .001).

CONCLUSION

It was revealed in the present study that the educational intervention based on five keys to food safety manual by WHO managed to improve participants' knowledge, attitude and behavior. Translation of the target guideline in future can be a great help to researchers in prospective research.

TRIAL REGISTRATION

Retrospectively registered: Iranian Registry of Clinical Trials IRCT20160822029485N4, at 2020-03-16.

Food Safety Practice and Associated Factors among Meat Handlers in Gondar Town: A Cross-Sectional Study

Introduction. Animal sources of foods (ASF), including meat, are a source of high-quality nutrients. However, meat composition makes it an ideal medium for the growth of a good number of microorganisms. Around 600 million foodborne illnesses and 420000 deaths occur each year due to poor food handling practice. Thus, probing into meat handling practice will be an insatiable input for the intervention. This study aims to investigate the level of meat handling practice and associated factors among meat handlers in butcheries in Gondar town, Ethiopia.

Method

The study was a community-based cross-sectional study among butcher shops in Gondar town from April 20 to 30, 2019. Data were collected using a pretested structured questionnaire by trained data collectors among 214 meat handlers from butcher shops. Multivariable logistic regression analysis with a 95% confidence interval (CI) was used to identify the factors significantly associated with a good level of meat handling practice.

Result

More than half of the meat handlers 66.4% (95% CI: (59.8, 72.4)) in butcher shops had a good level of meat handling practice. Level of attitude (AOR = 4.45; 95% CI, 2.09-9.43) and knowledge (AOR = 2.04; 95% CI, 1.09-3.82) were significantly associated with a good level of meat handling practice. The majority of respondents wash their hands after disposing garbage (91.6%) with less vigilance after smoking, sneezing, or coughing (64.0%).

Conclusion

The study revealed that the level of food handling practice was unsatisfactory among meat handlers. This result is a testimony to the prevailing potential risk faced by consumers due to the disregarding of hygienic behaviors by food handlers. Considering attitude and knowledge are associated with the outcome variable, investing time on behavioral change activities that will contribute to the improvement of meat handler's attitude & practice, primarily focusing on reducing working while ill is essential. Therefore, much supervisory and coaching work will be expected from local health departments & regulatory bodies.

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.

A systematic review and meta-regression of single group, pre-post studies evaluating food safety education and training interventions for food handlers

BACKGROUND

Food handlers working in retail and food service establishments are a frequent source of foodborne disease outbreaks. Numerous studies have investigated different education and training approaches to improve their safe food handling knowledge, attitudes, and practices. Frequently, these studies use a single group, pre-post design, measuring changes before and after an intervention without a separate control group.

OBJECTIVES

We conducted a systematic review of these studies to identify their key characteristics and to evaluate possible predictors of between study heterogeneity in their estimates of intervention effect.

METHODS

the review steps included a comprehensive search; relevance screening; article characterization; risk-of-bias assessment; data extraction; and meta-regression on five outcome categories: attitudes and beliefs, knowledge, behaviours, food premise inspection scores, and aerobic plate counts.

RESULTS

Among 85 relevant studies identified, the most commonly investigated intervention type was in-person, group-based training courses (81%). Interventions primarily targeted food handlers in educational institutions and restaurants (32% and 31%, respectively). The most frequently measured outcome was food handler knowledge (66%). Studies mostly (89%) covered multiple food safety content areas, primarily targeting personal hygiene (88%) and avoiding cross-contamination (87%). All studies were rated as 'critical' risk of bias given the lack of an independent control group. Significant intervention effects were found for all outcome categories, but substantial heterogeneity was also identified. Studies that informed their intervention from formative research reported larger effect sizes for attitude and belief outcomes, those that based their intervention on a theory of behaviour change reported larger effect sizes for behaviour outcomes, and those published in grey literature sources reported larger effect sizes for behaviour and knowledge outcomes.

IMPLICATIONS

The results of this review have identified food safety training and education research gaps and future opportunities.

Hygiene and humanization: Breaking the traditional view of food safety

Despite efforts at various levels, foodborne diseases are an extremely relevant global public health issue. This letter emphasizes the differences between the hygienist approach and the concept of sanitary risk in order to stimulate insights for researchers and decision-makers on the necessary changes in the working, training, and education modes of all agents involved in food production in the face of the new and old challenges in the food safety field.

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.

Video observation of hand-hygiene compliance in a manufacturer of ready-to-eat pie and pastry products

Food-handler hand-hygiene can be a contributory factor for food-borne illness. Cognitive data (knowledge/attitudes/self-reported practices), while informative, are not indicative of behaviour, and are subject to biases. Consequently, observation of behaviour is superior to survey data. However, researcher presence in direct observation increases reactivity, whereas video observation gives comprehensive analysis over a longer period, furthermore, familiarity reduces reactivity. Although video observation has been used to assess food safety at retail/foodservice, this valuable method is under-utilized in food-manufacturing environments. For the study, footage (24 h) was reviewed to assess compliance in a food-manufacturing site with company protocol. Video observation of food-handlers entering production (n = 674) was assessed; upon 70 occasions no attempt to implement hand-hygiene was observed. Of attempted hand-hygiene practices (n = 604), only 2% implemented compliant practices. Although 78% of attempts utilized soap, only 42% included sanitizer. Duration ranged from 1 to 69 s (Median 17 s). The study provides hand-hygiene data in an area that observational data is seldom captured.

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.

Awakening from the listeriosis crisis: Food safety challenges, practices and governance in the food retail sector in South Africa

Background

The recent listeriosis outbreak in South Africa brought food safety concerns to the fore in terms of both policy and practice. These concerns encompass both health and nutrition aspects, as well as the economy, because the food system in South Africa contributes significantly to economic growth and food security. However, the food sector is challenged with food safety risks, such as foodborne diseases, food fraud and a general lack of effective enforcement of regulation. The inability of government to effectively regulate the food sector is a contributing factor to increased food safety risks. Focusing on the formal sector, which is subject to regulation, this review provides an overview of the current state of food safety policies and regulations, food safety challenges, and food safety practices in the food system, after the listeriosis crisis of 2017 and 2018.

Method

This study used a systematic process to review three sets of data in South Africa: food safety related public policies and regulations, company reports (2013-2018) and media articles (May 2017-May 2018). Food safety policies were selected from a food system policy database created by the research team. The company reports were retrieved from their websites. Factivia was used to search for the media articles. The data were thematically analyzed. The analysis framework was informed by the Food and Agriculture Organization's (FAO) food safety risk analysis. Activities related to food safety risk analysis: risk assessment, risk management, and risk communication were searched for in each material included in the study.

Results

Seventy-four documents made up of 13 policies, 47 media articles and 15 company reports were reviewed. Food safety is regulated by three governments departments: Department of Health (DOH), Department of Agriculture, Forestry and Fisheries (DAFF), and Department of Trade and Industry (DTI) through bylaws and regulations. The departments are directly (DAFF) or indirectly (DOH through municipal or metro Environmental Health Professional) involved in food safety enforcement, surveillance, and education. The enforcement of different regulatory processes is often poorly coordinated. Responding to this regulatory environment, food safety activities of the food retail industry include a self-regulatory system reliant on internal and third-party food audits, worker training, external testing, and consumer education. Given this fragmented framework and the lack of interaction, it is clear that the governance of the South African food safety system is not "fit for purpose" in that there is a gap in the effectiveness of government regulation and the self-regulation of the formal sector, and a growing risk from an inability to regulate the large informal sector. Food safety challenges identified in our analysis included disease outbreaks, concerns over mislabeling, and lack of regulation for food handling and distribution.

Conclusion

The findings suggest that there should be a combination of responsibility from all levels of stake-holders in the food retail sector in order to improve food safety and prevent food safety breaches. In addition, strong governance of the food safety system is required to enable effective legislation and enforcement.

Efficacy of Food Safety Training in Commercial Food Service

Proper food safety training is essential to decrease incidences and overall rates of foodborne illnesses and outbreaks. Though many commercial restaurants should provide proper food safety training to food handler employees, this training is not always offered or effective. Here, we summarize the results of a primary literature study concerning the effectiveness of food safety training in commercial settings. The literature chosen for review contained only studies with experimental food safety training, with before and after training data. Through evaluation of these studies, the best practice for ensuring effective training and follow-through were the use of food safety training programs, which incorporated both knowledge and behavior-based training. PRACTICAL APPLICATION: Food safety managers in food service establishments may consider reevaluating their current food safety training program to incorporate behavioral-based food safety training in addition to knowledge-based training.

Food poisoning outbreak in a religious mass gathering

Background

Food poisoning outbreaks are commonly seen in mass social events where food is prepared under temporary arrangements. This study reports a food poisoning outbreak in a city of western Maharashtra, India, where around 4000 people had consumed food during a religious community lunch and reported sick to the nearby hospital with complaints of diarrhea, abdominal cramps, fever with chills, and vomiting.

Methods

This was a retrospective-prospective study. Investigation of the food poisoning outbreak was conducted to identify the causes and recommend preventive measures. Interview method was used to elicit food history from the affected and non-affected persons. Inspection of the cooking area was conducted to find the likely source of contamination.

Results

A total of 291 patients reported sick after consumption of meal at a religious mass gathering. The range of incubation period was from 10 hours to 40 hours. Predominant features were diarrhea (100%), abdominal cramps (89%), fever with chills (81%), and vomiting (28.5%). Maximum relative risk of 14.89 was seen for green gram (moong dal) with 95% confidence interval of 2.16-102.6. Keeping the incubation period and clinical profile in view, the likely organisms are enteropathogenic Escherichia coli or Salmonella spp.

Conclusion

Maintaining food safety during mass gatherings is a major challenge for public health authorities. The Food Safety and Standards Act (2006) in India brings the food consumed during religious gatherings such as 'prasad' and 'langar' under its purview and comprehensively addresses this issue.

Review on Nanomaterial-Based Melamine Detection

Illegal adulteration of milk products by melamine and its analogs has become a threat to the world. In 2008, the misuse of melamine with infant formula caused serious effects on babies of China. Thereafter, the government of China and the US Food and Drug Administration (FDA) limited the use of melamine of 1 mg/kg for infant formula and 2.5 mg/kg for other dairy products. Similarly, the World Health Organization (WHO) has also limited the daily intake of melamine of 0.2 mg/kg body weight per day. Many sensory schemes have been proposed by the scientists for carrying out screening on melamine poisoning. Among them, nanomaterial-based sensing techniques are very promising in terms of real-time applicability. These materials uncover and quantify the melamine by means of diverse mechanisms, such as fluorescence resonance energy transfer (FRET), aggregation, inner filter effect, surface-enhanced Raman scattering (SERS), and self-assembly, etc. Nanomaterials used for the melamine determination include carbon dots, quantum dots, nanocomposites, nanocrystals, nanoclusters, nanoparticles, nanorods, nanowires, and nanotubes. In this review, we summarize and comment on the melamine sensing abilities of these nanomaterials for their suitability and future research directions.

Importance of training in ensuring the hygiene-sanitary quality of lettuce salads served in nursery schools

Abstract The food provided in nursery schools should meet the sanitary and nutritional requirements needed to promote a child's intellectual and physical health. Therefore, training of the School Nutrition Technicians (SNT) in good food handling practices is essential to ensure the safety of the foods prepared. This study was aimed at evaluating the microbiological quality of lettuce salads consumed by children in public nursery schools in the municipality of Cuiabá, Mato Grosso, Brazil. The lettuce salad samples were collected in two distinct phases: before and after training of the SNTs in good food handling practices by the nutritionists of the school meals program of the municipality of Cuiabá, according to the school calendar routine. Thirty fresh (in natura) lettuce samples that had not been sanitized (representing samples obtained from the supplier) were collected for the detection of Salmonella spp. and 240 prepared lettuce salad samples (salads ready for consumption), for the detection of Salmonella spp. and the heat-tolerant coliform count. The genus Salmonella was not detected in either of the phases of the study. However, prior to training, 54% of the lettuce salad batches were contaminated with heat-tolerant coliforms, but after training 100% of the batches were considered to be in satisfactory sanitary conditions. In conclusion, offering training courses on good food handling practices to food handlers in school meals units was capable of reducing contamination.

Wearable Technology Effects on Training Outcomes of Restaurant Food Handlers

Food safety training does not always result in behavior change, perhaps because of flaws inherent in traditional training designs. New technologies such as augmented reality headsets or head-mounted action cameras could transform the way food safety training is conducted in the food industry. Training conducted with wearable technology presents visual content in the first-person or actor's perspective, as opposed to the traditional third-person or observer perspective. This visual hands-on first-person perspective may provide an effective way of conveying information and encouraging behavior execution because it uses the mirror neuron system. There is little published literature about the impact of perspective on food safety training outcomes, such as motivation. The present study included a repeated-measures design to determine how first- and third-person camera angles affected hand washing training reactions among 108 currently employed restaurant food handlers. Participants were assessed on their posttraining compliance intentions, compliance self-efficacy, perceived utility of the training, overall satisfaction with the training, and video perspective preference. A significant proportion of food handlers (64%) preferred the first-person video perspective ( z = 5.00, P < 0.001), and a significant correlation was found between compliance intentions and compliance self-efficacy ( r(108) = 0.361, P < 0.001) for the first-person video. No significant differences in video preference were found for demographic variables, including age (χ² (2, n = 104) = 1.69, P = 0.430), which suggests that the first-person training format appeals to a diverse workforce. These findings support the application of wearable technology to enhance hand washing training outcomes across a wide range of demographic groups. This research lays the framework for future studies to assess the impact of instructional design on compliance concerning hand washing and other food handling behaviors.

Factors Associated with Food Hygiene Practices Among Street Food Vendors in Padawan, Sarawak

The safety and quality of street foods are still questionable. Street food vendors are often poorly educated and untrained in food safety with lack of food safety knowledge and poor hygiene practice. This study aims to identify the factors associated with hygienic practice of food safety among the streets food vendors in Padawan district, Sarawak. This was a cross-sectional study conducted in Padawan, Sarawak. Data was collected by face to face interview using a validated structured questionnaire. The practice of food safety was observed using a structured observation checklist. Data entry and analysis was done by SPSS version 22.0. A p value <0.05 was considered as statistically significant. A total of 117 street food vendors were interviewed. The mean (SD) age was 41.0 (11.8) years. Three-fifths (62.9%) of the respondents had secondary level of education and higher. The mean (SD) duration of vending was 7.2 (6.7) years. Only 35.9% of the street food vendors received at least one training on food safety. Bivariate analysis revealed that religion, knowledge and attitude appeared to be statistically significant predictors of food safety and hygiene practice. However, multinomial regression analysis revealed that only religion appeared to be important predictor of food safety and hygiene practice (AOR = 14.730, 95% CI: 1.267, 171.228). Although this study failed to establish a statistical significant association between knowledge and attitude with the hygiene practice due to inadequate sample size, some relationship does seem to exist, suggesting that food safety knowledge is vital for all street food vendors to have the necessary skills to enable them to handle food hygienically and ensure food sold is safe for consumption. Keywords: Food safety, food vendors, hygiene practices, Malaysia, Sarawak