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Compliance of Food Handlers with the
Food Safety Standards
The processes of handling and preparing food at the hospital kitchen for patients are very crucial in order to prevent infections and outbreak of diseases. This becomes more imperative in the hospital kitchen environment where the tendency for infection is high due to the presence of patients suffering from various sicknesses and infections. Ironically, there are evidences that, rather, the hospital kitchens as well as their kitchen staff members are those whose hygienic conditions are neglected. The control of safety during the manufacturing process and handling of food is best achieved by means of the Hazard Analysis Critical Control Point (HACCP) technique. HACCP is a management system in which food safety is addressed through the analysis and control of biological, chemical, and physical hazards from raw material production, procurement and handling, to manufacturing, distribution and consumption of the finished product (Lestantyo et al., 2017).
Aim of the study:
The aim of this study was to assess compliance of food handlers with the food safety standards.
Subjects and methods:-
I. Research design:
A descriptive design was utilized for this study.
II. Technical Design:
The technical design includes research setting, subjects of study and tools of data collection.
This study was was conducted at the kitchen of Nasser institute Hospital which consider the largest governmental hospital of Ministry of health in Egypt (850 beds) and have around 4000 employees and serve around 1500 meals per day.
Subjects of study:
A convenient sample of all available (100) male and female food handlers in Nasser institute hospital’ kitchen were the target group of the study.
Tools and Technique of Data Collection: (Appendix I):
Data was collected by using the following tools:
First Tool: Interview questionnaire composed of three parts:
It was cited from national food safety standards (Egypt National Food Safety Authority, 2017) adopted and modified by the investigator which ncludes:
A- Socio-demographic characteristics of the studied sample which include: age, gender, nature of employment in the kitchen, shift of working and period of working in the kitchen (years of experience). (Question 1-6).
B - License, vaccination, history of suffering from certain disease in the last three months, history of contact with a family member suffering from certain disease (dysentery, typhoid, paratyphoid, virus A hepatitis, tuberculosis, parasitic infection), recent history of suffering from food borne diseases, travelling, isolation, training, pre-employment medical examination and routine investigations (pre-employment). (Questions 7-14).
C- Food handlers’ knowledge about borne disease and food safety standards.
Part (A): Observational checklist to assess practices of food handlers: It was cited from national food safety standards and Egyptian national guide of infection control, 2017. Modified by the investigator and include the following items:
- Wearing working clothes (uniform)
- Washing hand in different occasions
- Practices that prevent contamination of food.
- Foodstuffs starting from food receiving to final distribution.
- Equipment and utensils.
- Cleanliness of the environment.
- Dealing with waste.
- Security and Safety.
- Surveillance System of food and utensil safety (Through recorded data).
Part (C): Observational checklist of the kitchen enviroment: It was cited from national food safety standards and Egypt National Food Safety Authority, 2017. Modified by the investigator.
III. Operational design:
A pilot study was conducted at June 2016, involving 10% of the expected total sample size (10) of food handlers. It was conducted to test the clarity and applicability of the study tools and the time required to fulfil each tool. The average time spent for filling the questionnaire from each food handler ranged from 10 to 20 minutes. The results obtained from the pilot study were helpful in the modification of the study tools where items were corrected, omitted and added as necessary. All food handlers in the pilot study were included the study sample.
Field of work:
The actual field work was carried out over 8 months from the first week of July (2016) up to the end of February (2017). The investigator was available in the study setting three days / week. The actual work was started by interviewing and observing each worker individually along different shift (morning shift from 7am – 1 pm, afternoon shift from 1 pm – 7 pm, and evening shift from 7 pm – 7 am). The data were collected from all food handlers (100 food handlers) in the kitchen department, The investigator introduced herself to all participants and written approval consent was obtained from workers to participate in the study after explanation the purpose of the study to each worker, then they were reassured that any information obtained would be confidential and only would be used for the study’s period. Also, their work would not be affected. The investigator emphasized that the participation of the study is voluntary and anonymity of participants were assured through coding data. After that, to ensure that all questions and response understood, face- to -face interview done where the investigator read the questions and possible answer categories to all workers and workers filled their response in the questionnaire. The investigator filled observational checklist. The average number 2 to 3 workers / day during data collection period.
The main finding of this study was summarized as follows:
The mean age of studied food handlers was (33.16±8.1). 44% of them aged between 30 to 40 years, 75 % of them were males. 41% were enrolled in secondary education, 34% of them worked as food servers, and 26% have experience from 6-10 years.
Most of the studied sample (85%) had good level of knowledge about food safety and food borne disease.
There was a significant relation between job and knowledge where the highest knowledge was for nutrition specialist and the lowest was for assistant chef.
There were a significant relation between shift and practice (P-value: 0.012*) where the highest practice were for the morning shift and the lowest practice was for the night shift and there was a significant relation between job and practice (P-value: 0.001*) where the highest practice was for nutrition specialist and the lowest was for food service aid.
There was no significant relation between knowledge of studied sample and their practice.
There was correlation between practices of the studied sample and hospital kitchen environment.
The present study revealed that 75% of the studied samples were males and 85% of the studied sample had good level of knowledge and the rest had avarage level of knowledge.
Moreover, the current result indicated that there were a significant relation between job and knowledge where nutrition specialist had good knowledge and assistant chef had poor knowledge. There were a significant relation between the shifts and practice where the highest practice was for morning shift and the lowest was for night shift. There were a significant relation between job and practice where the highest practice was for nutrition specialist and the lowest was for assistant chef. There were correlation between practices of the studied sample and environmental condition of the kitchen. On the other hand there were no correlation between the total knowledge of studied sample and their practices.
Based on the result the study revealed that the total practices score of food handlers was 69% therefore; food handlers not comply with food safety standards where the total practice score was less than 80%
Oriantation program is required for all new hire foodhandlers in addition to providing on job training for food handlers staff to generate positive attitude and motivate behavior change in a definite setting.
Establish monitoring system through periodic round by using a checklist and apply performance indicators that reflect the compliance of foodhandlers with food safety standard.
Implemention of hazard Analysis critical control point system (HACCP) in the kitchen to ensure safe handling of food.
Further researches required to be done for identifying factors that hindering compliance of food handlers with food safety standard