الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Catering facilities are common in institutions such as hospitals, where meals are supplied to both staff and patients. Catering services in hospitals are complex because; it caters a large population; food is prepared in large quantities; A contractor can also provide the food with the majority being cook-chill or cook-freeze which become more susceptible to contamination. Moreover, the food service is delivered by ward employees as housekeepers, health care assistants and nursing staff whose other tasks are personal care or cleaning will pose risk for food handling.
Hospital populations are at a higher risk of developing a foodborne disease. “Patients may be elderly, have a chronic disease, or take medications that compromise their immune system, making it difficult for them to fight infection if they consume contaminated food.
Generally, outbreaks of foodborne diseases in hospitals are facilitated by several factors; including, staff carriers, inadequate sanitary conditions in the kitchens, carelessness, and lack of training of food handlers, as well as a lack of awareness of safe food handling. In addition, insufficient cooking, chilling and storage as well as cross contamination may be factors to be consider.
Many studies have identified that inadequate knowledge in food safety among food handlers can cause poor and unsafe hygienic practices by food handlers. It has been recommended that training on food safety could bring behavioral changes besides adoption of positive attitudes and increase the practice of food hygiene.
This work, therefore, aimed to study the effectiveness of food safety educational intervention program on knowledge, attitude, and practice of food handlers in Alexandria hospitals. To fulfill this objective, 200 food handlers in four hospitals (two private and two governmental hospitals) were included in this study. 100 participants were received the intervention program, the other 100 participants were taken as control.
The result of the present study revealed that:
1. Demographic data
Out of the 200 food handlers who participated in this study, more than half of food handlers (60.5%) were females, while (39.5%) were males. Concerning job, almost half of the food handlers (50.5%) working in services, followed by workers (20.0%), chief assistant (14.0%), master chief (8.0%) and kitchen manager (7.5%). Concerning education, 69.0%, of the food handlers had university degree,12.00% had secondary degree,3.00% had preparatory degree,6.0% had primary degree, 8.0% can read and write, and only (2.00%) of them were illiterate. The data also showed that most food handlers (94.5%) never get any previous training in food safety. As regards experience, more than half of food handlers (58.00%) were over ten years of experience, 31.00% with 5 to 10 years and 11.00% of the food handlers with 1 to 5 years’ experience. All food handlers (100.0%) had a health certificate. Concerning disease history, only (2.00%) had a diseases history. In relation to age, the overall mean score percentages of age were (38.17±73.79).
2. Food safety knowledge:
• About half (52% & 56%) of the participated food handlers had fair overall knowledge before training in the control & experimental group respectively, less than half of them (48.00% & 43.00%) had poor level in the control &experimental group respectively and none of the food handler in the control group and only 1.0% of food handlers in the experimental group had good overall knowledge.
• The overall mean score percentage of knowledge of food handlers before training were (51.09&50.56%) for the control &experimental group respectively, with no significant difference between them
• The overall mean score percent of knowledge among food handlers in experimental group before training, were higher in governmental hospital (53.64%) than that in private hospital (47.48%). 66.0% of handlers in the governmental and 20.0% in the private hospitals had poor overall knowledge.
• The training program resulted in a significant improvement in the level of knowledge among experimental group of food handlers in all parameters about food safety. The total mean score percentage increased from (50.56%) before program training to (83.08%) after program implementation. The overall total good knowledge increased from (1%) to (98.00%) and total poor level of knowledge decreased from (43.00%) before training to (0.00 %) after training.
• The level of knowledge among control group of food handlers showed un-significant improvement after training period due to unintentional contact of some handlers with trained group. The overall total good knowledge increased from (0.00%) to (7.00%).
• The improvements in knowledge after training, were significantly higher in the experimental group than the control group among the general participated food handlers as well as in both governmental and private hospitals in all parameters.
o The overall mean score percent was (83.08%) in the experimental group compared to (68.13%) in the control group. The overall good knowledge of food handlers was (98.00%) among the experimental group, compared to (7%) in the control group.
o In governmental hospitals, the overall mean score percent was (84.9%) in the experimental group compared to (69.95%) in the control group.
o In private hospitals, the overall mean score percent was (81.26%) in the experimental group compared to (66.92%) in the control group.
• The overall mean score percent of knowledge among experimental handlers in governmental hospital (84.9%) were significantly higher than that in private hospital 81.26% after training.
3. Attitude:
• Nearly all (99.00% & 100.00%) of the participated food handlers had indifferent attitude before training in the control &experimental group respectively.
• The overall mean score percentage of attitude of food handlers before training were (63.23&63.34%) for the control &experimental group respectively.
• The level of attitudes among experimental group of food handlers before training were higher in governmental hospital (64.02%) than private hospital (62.67%).
• The training program resulted in a significant improvement in the attitudes among experimental group of food handlers in all parameters about food safety. The total mean score percent increase from (63.34%) before program to (73.72%) after program implementation. The overall total positive attitude increased from (0.00%) before training to (10.00 %) after training.
• The level of attitude among control group of food handlers showed un-significant improvement after training period due to unintentional contact of some handlers with trained group. The overall mean score percentage of attitude of food handlers were (63.23&69.16 %) before and after intervention.
• The improvements in attitude after training, were higher in the experimental group than the control group in the general participated food handlers as well as in both governmental and private hospitals in all parameters.
o The overall mean score percent was (73.72%) in the experimental group compared to (69.16%) in the control group. The overall positive attitude after training were (10.00% and 0.00%) for the experimental and control groups respectively.
o In governmental hospitals, the overall mean score percent was (73.57%) in the experimental group compared to (68.28%) in the control group.
o In private hospitals, the overall mean score percent was (73.87%) in the experimental group, compared to (69.75%) in the control group.
• The overall mean score percent of attitudes among experimental group of food handlers were slightly higher in private group (73.87%) than governmental group (73.57%).
4. Practice:
• The overall practice of food handlers before training were poor (99.00% & 77.00%) in the control &experimental group respectively.
• The overall mean score percentage of practice of food handlers before training were (34.18&40.63%) for the control &experimental group respectively, with no significant difference between them
• The overall mean score percent of practice among food handlers in experimental group before training, was higher in governmental hospital 48.82% than in private hospital 32.44%.
• The training program resulted in a significant improvement in the level of practice among experimental group of food handlers in all parameters about food safety. The total mean score percent of practice increased from (40.63%) before program implementation to (81.56%) after program implementation. The overall total poor practice decreased from (77.00%) before training to (5.00 %) after training and the overall total good practice increased from (0.00%) to (87.00%).
• The overall mean score percentage of practice of food handlers in the control group after training period showed un-significant improvement in the practice level due to contact with trained group. The total mean score percent of practice were (34.18&37.56) before and after intervention period, respectively.
• The improvements in practices after training, were higher in the experimental group than the control group in the general participated food handlers as well as in both governmental and private hospitals in all parameters.
o The overall mean score percent was (81.56%) in the experimental group compared to (37.56%) in the control group, (p<0.05). The overall good practice of food handlers after training were (87.00%) among the experimental group, compared to (0.00%) in the control group.
o In governmental hospitals, the overall mean score percent was (77.84%) in the experimental group compared to (38.54%) in the control group, (p<0.05).
o In private hospitals, the overall mean score percent was (85.29%) in the experimental group compared to (36.91%) in the control group, (p<0.05).
• The overall mean score percent of practice among experimental handlers in private hospital (85.29%) were significantly higher than that for handlers in governmental hospital (77.84%).
5. Relation between demographic variables and overall level of KAP among experimental group of food handlers (before and after intervention).
• There is significant effect of the types of jobs, experience period, gender, and education on the overall knowledge, attitude and practice before and after intervention in food safety parameters
• The data showed insignificant effect of disease history, previous training and health certificate on the overall knowledge, attitude and practice before and after intervention in food safety parameters
• There is significant difference in the mean score percentage between types of jobs in relation to overall knowledge, attitude, and practice before and after intervention in food safety parameters except, over all knowledge in governmental hospitals before intervention, and overall attitude in private and governmental hospitals before intervention.
• There is significant difference in the mean score percentage between different levels of experience in relation to some overall knowledge, attitude, and practice before and after intervention in food safety parameters.
• The data showed insignificant difference in the mean score percentage between males and female gender in relation to overall knowledge, attitude, and practice before and after intervention with all food safety parameters except, for overall practice in governmental hospitals before intervention.
• There is insignificant difference in the mean score percentage between different levels of education in relation to overall knowledge, attitude and practice before and after intervention in food safety parameters except, overall knowledge in private hospitals before intervention, Over all knowledge in private hospitals after intervention ,overall attitude in private hospitals after intervention, over all practice governmental hospitals after intervention.
• The data showed insignificant difference in the mean score percentage regarding disease history between food handlers in relation to overall knowledge, attitude, and practice before and after intervention in food safety parameters except, overall knowledge in private hospitals before intervention and overall practice in private hospitals before intervention.
6.2 Conclusion
According to the results of the present study, it can be concluded that:
• The educational program was effective and significantly improved the food safety knowledge, attitudes, and practices among food handlers in hospitals, thus supporting the idea of inclusion of training of food handlers in food safety would increase food safety knowledge.
• The overall mean percentage of knowledge before the training program was significantly increased from 56.1% to 83.08% after the training (p<0.001).
• N0 handler showed positive overall attitude before intervention which increased to 10.0% immediately after intervention.
• The overall good practice of food handlers increased significantly from 0% before intervention to 87.0% after intervention.
• There is significant effect of the types of jobs, experience period, gender, and education level on the overall knowledge, attitude, and practice before and after intervention in food safety parameters.
• There is no significant effect of disease history, previous training and health certificate on the overall knowledge, attitude, and practice before and after intervention in food safety parameters.