This study was performed conducting surveys to assess the Knowledge Level (KL) and Self-Reported Attitudes (SRA) of Food Handlers (FH) in order to evaluate their food safety perception. Food handlers working in 5 cafes and 6 canteens in a university campus responded to a questionnaire about food hygiene. The knowledge level about food hygiene was obtained by answering five question groups (G): Agents involved in food borne diseases (G1), Food handling hygiene (G2), Cross contamination (G3), Heat treatment/cooling techniques (G4), Reduced temperatures (G5). The SRA level was obtained through seven questions with multiple choice options on behaviors of health and safety applied to the work routine, which were considered as percentage of hits. The hygiene’s knowledge average was 75%, ranging from 63.3% (G4) to 94.5% (G3). Significant associations between establishment type and G1 (p = 0.027), professional experience and G5 (p = 0.020), training and G5 (p = 0.037) were found. Food handlers knowledge did not have effect in FH attitude (p = 0.371). From 25 FH (46.0%) who had high KL, 17 had reported incorrect attitudes. The level of hits is, in general, more than 75%, except for matters relating to the use of different cutting tables (44.4%) and knives (51.9%). Significant differences of values and odds for handlers’ knowledge were observed between cafes’ and canteens’ FH. No difference (p > 0.05) was observed in FH SRA scores according to the type of establishment. The results reveal a reduced application of knowledge acquired by food handlers, evidenced by the low level of attitudes considered correct. This clearly justifies the implementation of additional measures, including on job training as part of an effective strategy to control establishment’s food safety.
Food safety is one of the consumer’s major concerns, fearing what is not safe for their health [
Food hygiene implies the application a set of measures and conditions to control hazards to ensure that food is safe and suitable for human consumption. Besides those important regulations, the occurrence of outbreaks of Food Borne Diseases (FBD) continues to be prevalent and constitute an essential health problem in the World. In 2013, a total of 5196 food-borne outbreaks in EU, including water-borne outbreaks, were reported by the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) [
Food contamination can appear during all steps of food chain and corresponds to the occurrence of a hazard such as any biological or chemical agent, foreign matter or other substance not intentionally added to food which may compromise food safety [
Canteens and cafes are often associated with outbreaks of food borne illness and Food Handlers (FH) practices have a key role in ensuring food safety throughout the chain of food production, processing, packaging or distribution [
The main factors that are responsible for generating outbreaks of food contamination are improper handling, inadequate heat treatment, the use of contaminated unprocessed ingredients, incorrect application of the time/temperature relation in food storage and infected FH. These factors are based mainly on low knowledge and inadequate hygiene practices among FH and demonstrate the risk factor represented by humans in the context of food safety [
The importance of FH training is provided by the Regulation (EC) No. 852/2004, which stresses that those who are responsible should receive and promote adequate training in the application of HACCP principles and respect all the requirements of national law [
The effectiveness of training programs depends on changing inappropriate behavior by handlers through time. To make it happen, training programs must involve practical instruction besides theoretical lessons to become more effective. Several studies in school cafeterias [
In summary, work-based surveys conducted to FH are of great importance to discover the weak points in terms of knowledge, and combining a follow-up of theoretical courses and practical advances, to increase the level of good hygiene practices and manufacturing by those intervening in the food chain to ensure food safety to consumers.
The objective of this study was to evaluate the socio-demographic characteristics, the level of knowledge and attitudes of food handlers, with the aim of seeking relations between theory and practice, in this case, verify that the handlers have the necessary knowledge about good hygiene practices and manufacturing, and the same knowledge is reflected in attitudes, and socio-demographic characteristics influence the KL and SRA. The information obtained can facilitate those running the establishments, to choose the most appropriate type of training and it will be sufficient to correct improper behavior and attitudes.
This study was based on a survey of food handlers’ working in 6 canteens and 5 cafes located in a university campus of Portugal.
Canteens layouts have a physical separation between distinct areas: layoff; preparation of products; processing area, pastry area; cup; plating and distribution, and selling on-line. Instead, cafes are smaller and do not have specific areas physically separated.
When the study was conducted, all establishments had implemented a food safety system based on HACCP system according to the Portuguese legislation [
The questionnaire was adapted from Santos [
SRA measures correspond to questions with multiple answers about practical routine situations such as hand-washing and control temperatures that require to the FH respondents to choose the most correct answer correspond to the most adequate attitude.
Each question about knowledge had three choices of answers: yes, no and do not know/no answer, the latter was included to reduce the probability of random responses being considered correct.
Data were analyzed using IBM SPSS® Statistics version 22. The KL of FH was established considering the percentage of correct responses for questions groups of issues.
Chi-square nonparametric test for homogeneity was used regarding associations of the KL and SRA with demographic aspects, and in some demographic attributes ordinal categories were recorded into fewer to validate chi-square test assumptions.
A global KL score was calculated and a binary result was considered with the median (80%) as the cut-point reported in Abdul-Mutalib et al. [
Multiple logistic regression (MLR) analysis were performed by taking into consideration factors where significant differences were obtained by Chi-square tests evaluated in each Group (G) of KL and Questions (Q) about SRA of FH, and global KL, yielding regression coefficients, odds ratios (OR) and p-values.
Stepwise variable selection method was used for the selection of variables to be entered in the models. The analyses were conducted using age, gender, age, professional experience, training and type of establishment, as independent variables. Models were evaluated for binary response variables in each Group (G) of KL and Questions (Q) about SRA of FH, and global KL.
Forty participants were female and 14 male, and 87% have more or equal 36 years. Relating to the education level, from our respondents 79.6% have 9 and 12 years of schooling, and 20.4% have less or equal the 6th grade.
Regarding professional experience, 9.3% of participants had between 2 and 5 years; 20.4% had between 6 and 10 years, 48.1.% from 11 to 20 years of experience in the food area and 22.2% participants more than 20 years in the same workplace.
According to the work activity, 83.3% perform multipurpose functions related to food handling and only 16.7% perform specific functions, related to payment and storage.
Forty-eight FM (89.0%) say they have training in the food sector, including food hygiene, HACCP methodology, and health and safety at work were cited training topics. However, it should be noted that in the same survey, when faced with the question: “What is HACCP”, only 55.6% of FH responded correctly to its definition.
In addition, when asked about their interest in new training in the food area, 85.2% of respondents said yes, and only 14.8% remained uninterested.
Food handlers were subjected to questions about personal health and hygiene, where most of the handlers (51.4%) reported that when they are sick are missing or are on sick leave, and the rest going to work (48.6%) make the mistake of not informing responsible about their health status, not complying with the rules of the Codex Alimentarius [
Participants had an overall knowledge greater than 60.0% in each group of questions, and the total KL average was 75% (
The association between socio-demographic characteristics of FH with the average for questions in each group and with the average of total knowledge about food safety and hygiene are presented in
According to the type of establishment significant differences were observed in G1 of knowledge’s questions and for level of total knowledge, where 55% of FH from cafes responded correctly. On the contrary, only 25% FH from canteens responded correctly (χ2 = 4.913, df = 1, p = 0.027). FH from cafes presented 72% of high total KL, compared to those working in canteens where only 41% presented high total KL (χ2 = 4.488, df = 1, p = 0.034).
Regarding knowledge about low temperatures, significant differences (χ2 = 5.373, df = 1, p = 0.020) were observed in relation to professional experience, with respondents with more years of experience answered less correctly (75%). Significant differences (χ2 = 6.592, df = 1, p = 0.037) were also found in relation to training in food safety, where who had at most 2 years of training responded more accurately (80%).
In
In model 2, within FH that had some training (49) about knowledge of reduced temperatures (G5) two effects were significant, profession experience (Wald χ2 = 5.325, p = 0.021) and time training (Wald χ2 = 4.274, p = 0.039).
The odds that a FH with more experience has higher KL (>80%) is 5.46 times greater than the odds of a FH with low experience. On the other hand FH with less than 2 two years of training had a chance 4.43 times greater for correct answers.
Analyzing the time of formation of FH and your knowledge, we found that 8 in 14 (57%)
Statements | Correct n (%) | Not correct n (%) | I do Not Know n (%) |
---|---|---|---|
Group 1: Vehicles/Agents involved in the transmission of Foodborne disease | |||
1. Eggs can contain Salmonella even when they are fresh | 50 (92.6) | 2 (3.7) | 2 (3.7) |
2. A piece of fresh meat can contain microorganisms on the surface | 50 (92.6) | 1 (1.9) | 3 (5.6) |
3. Canned products may contain microorganisms | 20 (37.0) | 17 (31.5) | 17 (31.5) |
4. Chicken meat may be contaminated with Salmonella | 24 (50.0) | 15 (2.8) | 12 (22.2) |
5. Cooked foods are free of microorganisms | 31 (57.4) | 15 (27.8) | 8 (14.8) |
6. Fresh vegetables can contain microorganisms | 48 (88.9) | 3 (5.6) | 3 (5.6) |
Mean (%) | 73.1 | 14.8 | 12.1 |
Group 2: Food handling hygiene | |||
7. Cuts or wounds on hands should be protected with gloves or finger cots | 52 (96.2) | 1 (1.9) | 1 (1.9) |
8. Hands should always be washed with soap, water and disinfectant after handling fresh meat | 51 (94.4) | 2 (3.7) | 1 (1.9) |
9. After washing, hands should be dried with a kitchen cloth | 42 (77.7) | 9 (16.7) | 3 (5.6) |
10. To handle food that is already cooked is not necessary to wash hands | 21 (38.9) | 33 (61.1) | 0 (0.0) |
11. After smoking or going to the bathroom is necessary to disinfect your hands with soap, water and disinfectant | 53 (98.1) | 1 (1.9) | 0 (0.0) |
12. If you are wearing gloves you can handle with fresh meat and cooked food simultaneously | 5 (9.3) | 48 (88.8) | 1 (1.9) |
13. When leaving the confection area shoes must be changed or wear protective foot | 45 (83.3) | 4 (7.4) | 5 (9.3) |
Mean (%) | 71.2 | 25,9 | 2,9 |
Group 3: Cross Contamination | |||
14. Food-borne illnesses can result from contamination of cooked food | 49 (90.7) | 2 (3.7) | 3 (5.6) |
15. A preparation which involves many manipulation adds risk of contamination | 48 (88.9) | 4 (7.4) | 2 (3.7) |
16. Food can be contaminated through contact with other food | 53 (98.1) | 0 (0) | 1 (1.9) |
17. Countertops and cutting boards may be responsible for the contamination of a food | 54 (100) | 0 (0) | 0 (0) |
Mean (%) | 94.5 | 2.7 | 2.8 |
Group 4: Heat treatment and cooling techniques | |||
18. A cooked food can be kept below 5˚C safely | 30 (55.6) | 15 (27.8) | 9 (16.7) |
19. A cooked food can be kept above 65˚C a few hours safely | 40 (74.1) | 5 (9.3) | 9 (16.7) |
20. In foods to be eaten cold (salads) is necessary to make their disinfection | 35 (64.8) | 18 (33.3) | 1 (1.9) |
21. The majority of foods must be heated to temperatures of 75˚C or more | 33 (61.1) | 10 (18.5) | 11 (20.4) |
22. Microorganisms can grow in foods preserved for a long time at room temperature | 50 (92.6) | 3 (5.6) | 1 (1.9) |
23. Food should be cooled to room temperature to be placed in a refrigerator | 27 (50.0) | 25 (46.3) | 2 (3.7) |
Mean (%) | 63.3 | 23.4 | 10.2 |
Group 5: Reduced Temperatures | |||
24. Freezing kills any bacteria that can cause food-borne illness | 25 (46.3) | 24 (44.4) | 5 (9.3) |
25. Food should be thawed at room temperature | 32 (59.3) | 22 (40.7) | 0 (0) |
26. The bacteria that causes diseases grows well at room temperature | 50 (92.6) | 1(1.9) | 3 (5.6) |
27. The food prepared well in advance and not stored properly can allow multiplication of microorganisms | 51 (94.4) | 2 (3.7) | 1 (1.9) |
Mean (%) | 73.1 | 22.6 | 4.2 |
Recall the last time | Yes | No |
---|---|---|
n (%) | n (%) | |
Q1. After handling foods on a board. Which he did before preparing other food on the same board? | ||
Washed their hands with soap. water and disinfectant | 41 (75.9) | 13 (24.1) |
Q2. Prepared food in a cutting board. Which did before? | ||
To prepare different food uses different utensils properly disinfected | 24 (44.4) | 30 (55.6) |
Q3. The last time you used a tool like a knife. What did you do before you use this machine to prepare other food? | ||
To prepare different food uses different utensils properly disinfected | 28 (51.9) | 26 (48.1) |
Q4. The last time there was leftover food. What you did? | ||
Not keep leftovers | 43 (79.6) | 11 (20.4) |
Q5. After cooking a cold food (salad). What have you made until it was served? | ||
Refrigerated immediately after preparation and remained refrigerated until the time of serving | 49 (90.7) | 5 (9.3) |
Q6. After confection of hot food. What have you made until it was served? | ||
Puts the food immediately in a water bath | 46 (85.2) | 8 (14.8) |
Q7. Uses the thermometer to check the temperature of food? | 0 (0) | 54 (100) |
Groups | Gender | Age | Education | Prof. experience | Training (n = 49) | Type of Establishment | |
---|---|---|---|---|---|---|---|
% of knowledge | p values | ||||||
1. Vehicles/Agents involved in the transmission of FBD’s | 73.1 | 0.547 | 0.957 | 0.991 | 0.694 | 0.781 | 0.027 |
2. Hygiene in food handling | 71.2 | 0.280 | 0.274 | 0.981 | 0.411 | 0.102 | 0.140 |
3. Cross contamination | 94.5 | 0.261 | 0.297 | 0.521 | 0.426 | 0.271 | 0.804 |
4. Heat treatments and cooling techniques | 63.3 | 0.272 | 0.120 | 0.679 | 0.673 | 0.453 | 0.060 |
5. Reduced temperatures | 71.3 | 0.826 | 0.436 | 0.836 | 0.020 | 0.037 | 0.540 |
Total Level of knowledge (≤80%, >80%) | 0.872 | 0.610 | 0.287 | 0.860 | 0.523 | 0.034 |
Models | Variable | Wald χ2 | p-value | Adjusted odds ratio | 95% CI |
---|---|---|---|---|---|
Model 1 Group 1: Vehicles/Agents involved in the transmission of FBD’s | Intercept | 8.147 | 0.004 | 0.333 | - |
Type of Establishment | 4.686 | 0.030 | 3.750 | 1.133 - 12.416 | |
Model 2 Group 5: Reduced temperatures | Intercept | 10.386 | 0.001 | 0.199 | - |
Prof. experience | 5.325 | 0.021 | 5.465 | 1.291 - 23.125 | |
Training (n = 49) | 4.274 | 0.039 | 4.436 | 1.080 - 18.215 | |
Model 3 Total Level of knowledge (≤80%, >80%) | Intercept | 0.991 | 0.320 | 0.714 | - |
Type of Establishment | 4.267 | 0.039 | 3.640 | 1.068 - 12.402 |
of which reflected higher knowledge had less than two years of training. FH of over 2 years of training just 9 in 35 (25%) had high knowledge. This factor it is related with another feature analyzed, professional experience, where we find that FH who worked more than 10 years in area (in the same workplace), only 9 in 36 (25%) had high knowledge.
Through the model 3, in relation to the significance of type of establishment (Wald χ2 = 4.686, p = 0.030), those handlers who worked in cafes have 3.64 times greater likelihood global level of knowledge than those who work in canteens.
In Q3 about the use of different knives for food, significant differences were found for gender (χ2 = 5.405, df = 1, p = 0.02) where men responded more correctly than women. Relating to the Q2 of using separate cutting boards for different foods, significant differences were found for age (χ2 = 4.378, df = 1, p = 0.036), where youngsters responded with proper attitudes.
In
Groups | Gender | Age | Education | Prof. experience | Training (n = 49) | Type of Establishment | |
---|---|---|---|---|---|---|---|
% of correct attitude | p values | ||||||
Q1. Handled food, which made before preparing other foods in the same board? Washed their hands with soap, water and disinfectant | 41 (75.9) | 0.647 | 0.322 | 0.152 | 0.553 | 0.142 | 0.368 |
Q2. Prepared foods in a cutting board, which did before? To prepare different food uses different utensils properly disinfected | 24 (44.4) | 0.083 | 0.036 | 0.793 | 0.594 | 0.854 | 0.561 |
Q3. The last time you used a tool like a knife. What did you do before you use this machine to prepare other food? To prepare different food uses different utensils properly disinfected | 28 (51.9) | 0.020 | 0.554 | 0.914 | 0.107 | 0.588 | 0.441 |
Q4. The last time there was leftover food, which made him? Not keep leftovers | 43 (79.6) | 0.511 | 0.640 | 0.263 | 0.848 | 0.914 | 0.056 |
Q5. After a cold confection food (salad), which made up serving time? Refrigerated immediately after preparation and remained refrigerated until the time of serving | 49 (90.7) | 0.451 | 0.902 | 0.562 | 0.594 | 0.187 | 0.507 |
Q6. After quilting for hot food, which made up serving time? Puts the food immediately in a water bath | 46 (85.2) | 0.010 | 0.752 | 0.222 | 0.027 | 0.027 | 0.786 |
Level of Correct Attitude (≤80%, >80%) | 0.177 | 0.957 | 0.547 | 0.817 | 00.925 | 0.420 |
Models | Variable | Wald χ2 | p-value | Adjusted odds ratio | 95% CI |
---|---|---|---|---|---|
Model 1 Q2. Prepared foods in a cutting board, which did before? To prepare different food uses different utensils properly disinfected | Intercept | 3.011 | 0.083 | 5.081 | - |
Age | 4.224 | 0.039 | 0.306 | 0.099 - 0.944 | |
Model 2 Q3. The last time you used a tool like a knife. What did you do before you use this machine to prepare other food? To prepare different food uses different utensils properly disinfected | Intercept | 4.349 | 0.037 | 0.149 | - |
Gender | 4.871 | 0.027 | 4.961 | 1.196 - 20.569 | |
Model 3 Q6. After quilting for hot food, which made up serving time? Puts the food immediately in a water bath | Intercept | 11.676 | 0.001 | 193.65 | - |
Gender | 5.111 | 0.024 | 0.137 | 0.024 - 0.767 | |
Prof. experience | 3.901 | 0.048 | 0.176 | 0.031 - 0.987 |
cutting boards are about 0.3 times less on oldest handlers (Wald χ2 = 4.224, p = 0.039). In model 2, the odds of having the proper use of knives in different food products were 4.96 times greater in men (Wald χ2 = 4.871, p = 0.027). Through the model 3, notes that in relation to gender, the odds of having a more accurate SRA were 0.14 times lower in women (Wald χ2 = 5.111, p = 0.024). Concerning professional experience, the odds of having a more accurate SRA are 0.18 greater in who had more than 10 years of experience towards others (Wald χ2 = 3.901, p = 0.048).
The knowledge variable did not influence the attitude (χ2 = 0.894, p = 0.344), as of the 54 handlers, 26 had low knowledge and 28had high knowledge. But from these 28FH, 16 held improper attitudes. It was also found that the 19FH who had reduced knowledge and improper attitudes, 4 for in 5didnot have any training in food, and other FH who had training, still showed deficits in knowledge and attitudes.
In accordance to our data, a report by IP [
Our study revealed that the level of knowledge that FH on hygiene and food safety was considered good, individually seeing the percentages were above 70% for issues groups (
Training FH to use correctly the temperature is a measure recommended by the Codex Alimentarius [
An interesting aspect in this research was the discovery that FH working in these university cafes have a higher of global KL (72%) than those working in the canteens. The same was observed for G1 answers, showing significant differences of values and higher odds for the cafe handlers’ knowledge comparatively to the verified for the canteens’ handlers.
The knowledge about G4 were reduced in whom had over 10 years of professional experience and has more than 2 years of training, what can probably be explained by the involvement of the same group of participants. This situation can be related to accommodation aspects of FH with reducing the importance of certain procedures, perhaps by the fatigue from making the same work for many years and increasing of negligence.
Therefore, it is important to present training alternatives that are not only theoretical knowledge training, but with great practical and participative sessions, such as On Job training [
Individual results of the SRA (
Another important observed aspect, similarly to the one verified by Santos et al. [
Santos et al. [
In our study, no significant difference (p > 0.05) was found in SRA scores according to training effect, except for the Q6and type of establishment (χ2 = 4.862, p = 0.027). We also observed that no significant associations were observed between attitudes and educational level, mostly due to the inexistence of FH with low education level (less than 6 years) of education whereas 9.6% have higher than nine years of school, what can be considered satisfactory for a good learning level.
This study allowed us to find that the FH had a good knowledge and sufficient SRA in relation to food safety and hygiene with the mean score of 75% and 61.1%, respectively. These findings indicated that although food handlers had good KL they not often applied this while handling foods. However, an association of acquired knowledge in practice is required. For that, it is necessary to maintain the training and supervising as part of an effective strategy to control food safety and hygiene of canteens and cafes.
This study allows us to analyze the self-reported attitudes and level of knowledge of food handlers, and both parameters are needed for effective management of food safety. Besides the high level of knowledge of food handlers in this study, more than eighty percent of them demonstrate incorrect attitudes.
The professional experience and training time are interrelated. Since the average range for the working time in the ERB is 10 years, we assume that older handlers although they have more training time due to aspects such as age, education level or even the attitude of “I know all” and “make my way”, cannot get the most of the given formations, such as those that are less time in the company.
These results justify the implementation of additional measures, including On Job training as part of an effective strategy for improving establishment’s food safety in view to provide desired attitudes. The implementation of On Job training is essential as it ensures a style of training not just theoretical in closed room, but in the workplace, where trainer can do corrections of incorrect behavior and attitudes, helping in adequate practices implementation.
In short, a good education combined with good training, preferably On Job, can ensure that the handlers to gain awareness and knowledge necessary to meet the requirements of good hygiene practices and manufacturing, while safeguarding their safety and that of consumers.
The authors would like to thank to the respondents for their contributions to this research.
This work is supported by European Investment Funds by FEDER/COMPETE/POCI- Operational Competitiveness and Internationalizations Programme, under Project POCI- 01-0145-FEDER-006958 and National Funds by FCT-Portuguese Foundation for Science and Technology, under the UID/AGR/04033/2013, UID/CVT/00772/2013 and UID/ CVT/00772/2016 projects.
The authors declare they have no conflict of interest.
Soares, K., Oliveira, I., Esteves, A., Fontes, M.C. and Saraiva, C. (2016) Knowledge Level and Self-Reported Attitudes of Food Handlers: Case Study of a University Campus. Health, 8, 1383-1396. http://dx.doi.org/10.4236/health.2016.813139