The level of food safety knowledge in food establishments in three European countries

Confronting Views of Companies and Authorities on Food Safety Issues-A Cross-Country Survey

This study investigated food safety issues as perceived by food companies and food safety authorities in six countries in Europe and Central Asia. A total of 66 companies and 16 authorities participated in the survey. The results provide important insights related to what the main food safety priorities are, how they are addressed in the countries that participated in the survey, and what the role of the main stakeholders is in the food value chain. Almost 50% of food companies identified 'food fraud' as the most influential food safety attribute. One-third of food safety authorities recognized 'food safety management system' as the most influential food safety attribute. Principal component analysis separated food safety statements into two dimensions named 'food safety hazards and risks' and 'food safety system'. Although there are slight differences in food safety statements between the two stakeholders, i.e., food companies and food safety authorities, it is the country of origin that plays a more important role in understanding their views. Food companies will need to implement a systemic approach and transform the entire food value chain continuum while considering new food safety challenges. It is expected that food safety authorities will have to play a more proactive role in the future.

Evaluation of Food Safety Knowledge and Attitudes Among Adults in the United Arab Emirates

Background Food is handled by many individuals in large food setups, therefore increasing the chance of contamination that leads to foodborne diseases (FBDs). This study was purposed to evaluate adults' understanding of food safety, FBDs, and hygiene practices across various demographic groups in the United Arab Emirates (UAE) and to explore the link between their knowledge of food safety and their corresponding attitudes. Methods A cross-sectional study was conducted with 402 adults using a validated, self-administered questionnaire available in both printed and online formats. The study was carried out at Gulf Medical University and Thumbay hospitals and clinics over six months, beginning in December 2022 to June 2023. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The chi-squared test was employed to examine the association between variables, and significant associations were further analyzed through logistic regression. Results Out of the 402 participants, the population was predominantly female 275 (67.9%), and from Southeast Asia 222 (55.4%), with students comprising the largest occupational group 186 (47%). Only 106 (26.36%) had received food safety training, and a mere 187 (46.51%) demonstrated adequate knowledge. Awareness levels varied, with the highest for raw food safety (64.02%) and the lowest for canned foods (40.79%). Demographic analysis revealed significant associations: males exhibited more inadequate knowledge 79 (62.2%) than females 136 (49.4%), and students showed higher inadequacy 104 (55.9%) compared to healthcare workers 31 (35.6%). Positive attitudes towards food safety were prevalent 226 (56.2%), and positive attitudes were found in women 157 (57.1%), individuals above 30 years of age 110 (50.5%), individuals working in healthcare 140 (62%), and married individuals 117 (60.9%). With a strong correlation (p<0.001), women were 1.68 times more likely to possess adequate knowledge than men (95% CI: 1.09, 2.59), and healthcare workers were 2.33 times more likely than students (95% CI: 1.37, 3.95). Conclusion The study reveals a low level of knowledge about food safety among adults in the UAE. Therefore, emphasis should be placed on increasing awareness of these concepts to reduce the burden of FBDs on the healthcare system.

Infection levels of Gnathostomatidae (Nematoda) larvae in commercial fishes in north-eastern Australian waters and related food safety concerns

The majority of research on the safety of marine edible fish has primarily focused on anisakid nematodes, neglecting the potential risks posed by other parasites, including those belonging to the family Gnathostomatidae. In Australia, there have been few reported cases of human infections with gnathostomatid parasites since 2011. However, due to the absence of a standardized diagnostic test in the country, it is believed that the actual number of infections is higher than reported. This study aimed to assess the occurrence and prevalence of infectious gnathostomatid parasites in selected commercial fish species in Australia. A total of 1947 marine fish from northern Australia, representing 9 families, 16 genera, and 30 species, were examined for gnathostomatid nematode infections. Overall, 12.3 % of the fish were found to be infected with at least one gnathostomatid larva. Among the species examined, the yellow-dabbled flounder (Branchypleura novaezeelandiae) exhibited the highest prevalence (83.3 %; n = 6) and the largest number of gnathostomatid larvae. The identification of the gnathostomatid larvae was confirmed as belonging to the genus Echinocephalus based on both morphological characteristics and sequence data. No significant correlation was observed between the prevalence, mean abundance, and mean intensity of infection with the length or weight of the examined fish species. Notably, several of the infected fish species are considered popular choices in the Australian market. Hence, it is imperative to raise awareness among relevant food safety authorities regarding the occurrence of these parasites. The findings from this study should be taken into consideration for the revision of current seafood safety protocols in the country.

Food safety knowledge and climate in the university canteens of three European countries

The association of food safety knowledge and climate with gender, education level, length of employment, food safety training, and professional role was measured using a 15-item food safety climate survey and a 20-item food safety questionnaire on a sample of 263 employees from 19 small and medium-sized university canteens in Croatia, Hungary, and Portugal. The relationship between knowledge and climate and the demographic determinants of both variables were examined. Food safety knowledge was inadequate (45.5% of correct responses), while perceptions of food safety, as measured by the food safety climate survey, were positive (2.69 out of a maximum of 3.00). The perception of resources in canteens was the least favorable across all countries. Leaders did not exhibit better food safety knowledge or perceptions. Food safety climate and knowledge were significantly positively correlated and influenced by training. Perceptions of food safety compared to employee knowledge levels indicated that some employees were overly optimistic about food safety risks. Therefore, food safety knowledge and food safety climate should be assessed in parallel, and both could be improved through ongoing training of employees, especially leaders.

Food Safety Behaviours among Food Handlers in Different Food Service Establishments in Montenegro

Foodborne diseases in food facilities are a major public health problem, due mostly to the limited surveillance and educational level of food-handling workers. This study was conducted in 220 food service locations in Montenegro. Participants’ behaviour was assessed by a survey using the specifically designed structured questionnaire, administered before and after the training. To determine the effect of the training on the performance of food handlers, a microbiological analysis of food contact surfaces and food handlers’ hands was also performed. The behaviour of food handlers, viewed as a whole, is unacceptable. There was a statistically significant difference (<0.05) among participants who completed catering school compared with those who did not, regarding hand washing. The type of facility in which participants worked (restaurant, bakery, or pastry shop) revealed statistically significant differences (<0.05) in relation to hand washing, that is, restaurant employees had better habits than those from bakeries and pastry shops. Before the training, participants showed acceptable behaviour regarding hand hygiene, but it was much better after the training. Results of microbiological analyses of food contact surfaces and food handlers’ hands indicated better results after the education, especially with regard to hand swabs. The results of this study indicate the importance of education to improve food handling practices among food handlers, which might also decrease the possibilities for contamination of food.

Food Safety Practices and Associated Factors in Food Operators: A Cross-Sectional Survey in the Students’ Cafeteria of Woldia University, North Eastern Ethiopia

The food safety issue is often overlooked in countries where food shortages, natural disasters, political tensions, and other major concerns dominate government and media agendas. As a result, the current study sought to assess food safety practices and associated factors among food handlers at Woldia University’s student cafeteria. An institutional cross-sectional study was conducted between May and July 2021, and a sample of 291 subjects was recruited through a simple random sampling technique. Questionnaires, focus group discussions, interviews, and observation methods were used as data collection tools. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20 software. Bivariate and multivariate logistic regressions were used to determine the effect of various factors on the outcome variable and control for confounding effects. $p<0.05$ was considered statistically significant. However, some variables are significant even at $p<0.001$ . The results were described by frequencies and percentages. The current study found that the factors of not having had food hygiene training ( $\text{AOR}=2.111$ , 95% $\text{CI}=\left(1.029-4.428\right)$ ), less than or equal to one year of work experience ( $\text{AOR}=3.070$ , 95% $\text{CI}=\left(2.020-10.246\right)$ ), poor knowledge ( $\text{AOR}=1.285$ , 95% $\text{CI}=\left(0.125-0.849\right)$ ) and poor attitude ( $\text{AOR}=1.190$ , 95% $\text{CI}=\left(1.361-9.393\right)$ ), not keeping cooked food at a safe temperature ( $\text{AOR}=3.037$ , 95% $\text{CI}=\left(1.021-12.096\right)$ ), failure to respect the safety of cooking utensils and surfaces ( $\text{AOR}=2.022$ , 95% $\text{CI}=\left(1.551-9.689\right)$ ), insufficient cleanliness of eating areas ( $\text{AOR}=2.430$ , 95% $\text{CI}=\left(1.983-6.217\right)$ ), not covering hair when cooking food ( $\text{AOR}=5.903$ , 95% $\text{CI}=\left(2.243-9.621\right)$ ), and not washing hands before starting to handle food ( $\text{AOR}=10.019$ , 95% $\text{CI}=\left(4.031-24.063\right)$ ) were statistically associated with unhygienic food handling practices. The results of this study indicated that the state of food safety practices was poor. Therefore, food safety assurance must comply with modern food safety frameworks such as Hazard Analysis and Critical Control Points (HACCP). In addition, addressing knowledge and skill gaps among food handlers, regular inspection services, and effective enforcement of food safety regulations are extremely essential. Finally, future studies should focus on enumerating bacteria and protozoa in unsanitary foods and utensils.

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.

Consumer Perception of Food Quality and Safety in Western Balkan Countries: Evidence from Albania and Kosovo

Domestic food markets are of significant importance to Kosovar and Albanian companies because access to export markets is under-developed, partly as a result of the gaps in food safety and quality standards. Kosovar and Albanian consumers’ use of food safety attributes and their evaluation of the quality of domestic food versus imported food are the research objectives of this study. The paper is based on a structured consumer survey of 300 Kosovars and 349 Albanians analyzing their perceptions of issues related to food safety and quality, measured through two respective batteries of items using a 5-point Likert scale. We used the t-test to identify differences between populations, correlation analysis and the bootstrapping method. Despite the prevalent problems with food safety, consumers in both countries consider domestic food to be safer as well as of higher quality than imported products. Kosovars are more likely than Albanians to perceive domestic food products to be significantly better than imported products. Female and better educated consumers use information related to food safety more often. Expiry date, domestic and local origin, and brand reputation are the most frequently used safety and quality cues for both samples. International food standards such as ISO or HACCP are less frequently used as quality cues by these consumer groups. It is important to strengthen the institutional framework related to food safety and quality following best practices from EU countries.

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

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.

An assessment of the food safety knowledge and attitudes of food handlers in hospitals

BACKGROUND

The possession of inadequate food safety knowledge (FSK) by food handlers poses a serious threat to food safety in service establishments. The aim of this research was to investigate factors that influenced the FSK and food safety attitudes (FSA) of employees involved in the preparation and/or the serving of food from nine hospitals in the Capricorn District Municipality (CDM) in Limpopo Province, South Africa.

METHOD

Up to 210 individuals (18-65 years) who were employed in these hospitals, and who were involved in the preparation and serving of food to patients were purposefully selected. Data collection was by means of an interview using a questionnaire design for this study. The FSK and FSA scores of hospital food handlers were obtained by adding the correct response to FSK or FSA questions.

RESULTS

Only 29% of the hospital food handlers have attended a food safety-training course. Many food handlers were not knowledgeable on the correct temperature for handling foods, and on the correct minimum internal cooking temperature for poultry, seafood and egg. Only the minority of food handlers knew that Salmonella is the main foodborne bacteria pathogen mostly associated with poultry products (47.1%) and that food borne bacteria will grow quickly in food at a temperature of 37 °C (38.1%). Hospital food handlers with higher academic qualifications do not possess more FSK than those with lower academic qualifications. 51% of the hospital food handlers possessed a Satisfactory FSK while 10% possessed a Good FSK and 39% possessed an Inadequate FSK.

CONCLUSION

More than 60% of the hospital food handlers possesses either Good FSK or Satisfactory FSK. Higher levels of education, experience in food handling and job position did not lead to better FSK outcome. All the hospital food handlers possess at least a Satisfactory FSA. There was a weak positive but significant correlation between the FSK and FSA of hospital food handlers. It is recommended all employees involved in food handlers be subjected to food safety training programmes on a regular basis irrespective of their academic, employment and training details.

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.

Assessment of human health risk based on characteristics of potential toxic elements (PTEs) contents in foods sold in Beijing, China

Metals are generally classified into essential metals groups. Essential metals include copper (Cu), iron (Fe), manganese (Mn) and zinc (Zn), and nonessential metals include cadmium (Cd) and lead (Pb) etc. However, excessive intake of metals even essential metals would have detrimental effect on the body. In this study, seven potential toxic elements (PTEs) (i.e., Cd, Cr, Cu, Fe, Mn, Pb and Zn) and their distribution characteristics in the foods were analyzed as well as the combination of correlation analysis, factor analysis and cluster analysis were constructed. Meanwhile, combined with the dietary consumption data from the Fifth China Total Diet Study (FCTDS), the dietary exposure of PTEs were analyzed and a consequent safety risk assessment was conducted. The main results are as follows: (1) PTE contents in simply-processed samples were found to be lower than those in the highly-processed samples. (2) The average daily intake of the PTEs were about 12.26 (Cd), 153.17 (Cr), 25.16 (Pb) μg/d, 1.90 (Cu), 20.19 (Fe), 7.12 (Mn) and 12.69 (Zn) mg/d, respectively. (3) The total target hazard quotient (TTHQ) was 2.88, which was lower than 10. Therefore, the long-term consumption of these foods combined with the current dietary structure would not have a detrimental effect on the health of residents in Beijing.

Factors associated with food safety practices among food handlers: facility-based cross-sectional study

Objective

The primary objective of this study was to assess factors associated with food safety practices among food handlers in Gondar city food and drinking establishments. The facility-based cross-sectional study was undertaken from March 3 to May 28, 2018, in Gondar city. Simple random sampling method was used to select both establishments and the food handlers. The data were collected through face-to-face interview using pre-tested Amharic version of the questionnaire. Data were entered and coded into Epi info version 7.0.0 and exported to SPSS version 22 for analysis.

Results

One hundred and eighty-eight (49.0%) had good food handling practice out of three hundred and eighty-four food handlers. Marital status (AOR: 0.36, 95% CI 0.05, 0.85), safety training (AOR: 4.01, 95% CI 2.71, 9.77), supervision by health professionals (AOR: 4.10, 95% CI 1.71, 9.77), routine medical checkup (AOR: 8.80, 95% CI 5.04, 15.36), and mean knowledge (AOR: 2.92, 95% CI 1.38, 4.12) were the factors significantly associated with food handling practices. The owners, managers and local health professionals should work on food safety practices improvement.

Effect of Cellulose Nanocrystals from Different Lignocellulosic Residues to Chitosan/Glycerol Films

Interest in nanocellulose obtained from natural resources has grown, mainly due to the characteristics that these materials provide when incorporated in biodegradable films as an alternative for the improvement of the properties of nanocomposites. The main purpose of this work was to investigate the effect of the incorporation of nanocellulose obtained from different fibers (corncob, corn husk, coconut shell, and wheat bran) into the chitosan/glycerol films. The nanocellulose were obtained through acid hydrolysis. The properties of the different nanobiocomposites were comparatively evaluated, including their barrier and mechanical properties. The nanocrystals obtained for coconut shell (CS), corn husk (CH), and corncob (CC) presented a length/diameter ratio of 40.18, 40.86, and 32.19, respectively. Wheat bran (WB) was not considered an interesting source of nanocrystals, which may be justified due to the low percentage of cellulose. Significant differences were observed in the properties of the films studied. The water activity varied from 0.601 (WB Film) to 0.658 (CH Film) and the moisture content from 15.13 (CS Film) to 20.86 (WB Film). The highest values for tensile strength were presented for CC (11.43 MPa) and CS (11.38 MPa) films, and this propriety was significantly increased by nanocellulose addition. The results showed that the source of the nanocrystal determined the properties of the chitosan/glycerol films.

Assessment of Food Safety Knowledge, Self-Reported Practices, and Microbiological Hand Hygiene Levels of Produce Handlers in Qatar

HIGHLIGHTS

Workers' hygiene is one of the most important risk factors in transferring pathogens to foods. Produce handlers lacked basic knowledge on personal hygiene and food safety. Produce handlers' hand hygiene levels were below set standards. This study is the first of its kind in the region; thus, it helps fill an existing knowledge gap.

Food Handling Behaviors Associated with Reported Acute Gastrointestinal Disease That May Have Been Caused by Food

Family food handling by women plays a key role in the risk of foodborne acute gastroenteritis. Nevertheless, the data indicating the association between women's food handling and foodborne disease has not been reported in the People's Republic of China. The purpose of this study was to determinate the status of food handling for women and the association between food handling behaviors and foodborne acute gastroenteritis. A cross-sectional survey was conducted from 1 September 2015 to 30 August 2016 in Anhui Province, China. Data on foodborne disease and food handling was collected via a questionnaire. Of the 630 respondents included in the study, 99 (16.0%) reported having experienced symptoms in the past 4 weeks of acute gastroenteritis that may have been caused by food. The following behaviors were prevalent in respondents: (i) infrequently boiling kitchen utensils to disinfect (70.6%); (ii) infrequently heating cooked food purchased from outside the home (64.3%); (iii) infrequently storing leftovers in the refrigerator (38.6%); and (iv) often purchasing stale raw vegetables, meat, and other ingredients (23.3%). Urban and rural respondents differed significantly in their answers to the food handling questions. Foodborne acute gastroenteritis was associated with the following behaviors: (i) infrequently heating milk (odds ratio [OR] = 2.587, 95% confidence interval [CI] = 1.396 to 6.458); (ii) infrequently heating leftovers stored in the refrigerator (OR = 16.967, 95% CI = 9.030 to 31.882); (iii) infrequently thoroughly heating kidney beans (OR = 3.524, 95% CI = 1.834 to 6.773); (iv) often storing raw and cooked meat in the same container (OR = 10.216, 95% CI = 5.109 to 20.431); and (v) often eating raw seafood (OR = 2.587, 95% CI = 1.424 to 4.700). Inappropriate food handling behaviors of women in the family are associated with foodborne acute gastroenteritis. Infrequent thorough heating and improper food storage are the most critical risk factors in foodborne acute gastroenteritis.

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.

The correlation between family food handling behaviors and foodborne acute gastroenteritis: a community-oriented, population-based survey in Anhui, China

BACKGROUND

Foodborne acute gastroenteritis is a significant public health concern. Food handling plays a key role in the risk of foodborne acute gastroenteritis. However, research focused on the correlation between foodborne acute gastroenteritis and food handling in the family environment is limited. The purpose of the current study was to determinate the association between food handling behaviors in the family environment and foodborne acute gastroenteritis.

METHODS

A cross-sectional investigation was conducted from September 1, 2015 to August 30, 2016 in Anhui Province, China. A multistage stratified cluster sampling method was designed to select subjects. Data on foodborne acute gastroenteritis and food handling were collected via questionnaire survey.

RESULTS

Of the 1516 subjects included in the study, 165 (10.9%) reported having experienced symptoms of foodborne acute gastroenteritis in the past 4 weeks. The following behaviors were more prevalent in those that experienced acute gastroenteritis: (1) infrequently thoroughly heating milk (75.6%); (2) infrequently thoroughly heating cooked food purchased from outside (71.3%); (3) infrequently thoroughly heating leftovers stored in the refrigerator (32.5%), and (4) infrequently storing leftovers in the refrigerator (41.6%). A multivariate logistic regression analysis found that foodborne acute gastroenteritis was associated with the following behaviors: (1) often eating raw seafood (P < 0.001, OR = 3.250, 95% CI = 2.136-4.946); (2) often storing raw meat and cooked meat in the same container (P < 0.001, OR = 4.291, 95% CI = 2.722-6.765); (3) infrequently thoroughly heating milk (P < 0.001, OR = 4.665, 95% CI = 2.526-8.617); (4) infrequently thoroughly heating leftovers stored in the refrigerator (P < 0.001, OR = 3.416, 95% CI = 2.139-5.454); (5) infrequently storing leftovers in the refrigerator (P < 0.05, OR = 1.775, 95% CI = 1.169-2.696); and (6) infrequently thoroughly cooking green beans (P < 0.001, OR = 2.859, 95% CI = 1.798-4.545).

CONCLUSIONS

Poor food handling behaviors in the family environment are associated with foodborne acute gastroenteritis. Infrequent thorough heating and improper food storage are the most critical risk factors in foodborne acute gastroenteritis.