Professional Documents
Culture Documents
Food Control
journal homepage: www.elsevier.com/locate/foodcont
Food safety knowledge and practices of food handlers, head chefs and
managers in hotels' restaurants of Salvador, Brazil
Larissa Tannus Rebouas a, Lidiane Barbosa Santiago a, Larissa Silva Martins a,
Ana Cla ~o Nazare
udia Rios Menezes b, Maria da Puricaa Arajo a,
a, *
Rogeria Comastri de Castro Almeida
a
Department of Food Science, Nutrition School, Av. Arajo Pinho, n 32, Canela, Salvador, BA, Cep: 40.110-160, Federal University of Bahia, Brazil
b ~o de Geremoabo, s/n, Ondina, Cep: 40.170-290, Salvador, BA, Brazil
Pharmacy Faculty, Federal University of Bahia, Rua Bara
a r t i c l e i n f o a b s t r a c t
Article history: This study aimed to assess the knowledge level, attitudes and practices of food handlers, and knowledge
Received 21 June 2016 and practices of head chefs and managers in hotels' restaurants of Salvador, Brazil. Data collection was
Received in revised form done through the application of interviews with 265 food handlers and with 32 head chefs and man-
15 August 2016
agers. In addition, the inuence of the presence of nutritionist in restaurants was evaluated. The results
Accepted 16 August 2016
showed that 88.0%, 96.6% and 76.0% of handlers had knowledge, attitudes and practices appropriate for
Available online 18 August 2016
personal hygiene, respectively. However, some errors were observed such as the non-use of disposable
gloves when handling or distributing food (39.6%), tasting food with their hands (28.7%), and usually
Keywords:
Food handlers
talking while handling food (52.5%). Statistical analysis did not indicate a signicant association between
Head chef the knowledge, attitudes and self-reported practices by handlers. However, it was found association
Manager between handlers that presented good satisfaction with the job and handlers that introduced appro-
Knowledge priate practices. Regarding to chefs and managers, the results indicate that the knowledge was unsat-
Hotels' restaurants isfactory, even 75% of respondents have training certicate in food safety. A signicant percentage of
respondents were unaware of the legislation adopted in restaurants (37.5%), and only 43.8% of them
knew the recommended cooling temperature for food preservation. However, adequate practices to
reduce cross-contamination was observed. Still, the presence of the nutritionist in restaurants inuenced
positively on the adoption of the current legislation in hotels' restaurants, as well as in the participation
of the handlers in training, showing in this way the creation of a positive culture among the handlers.
2016 Elsevier Ltd. All rights reserved.
1. Introduction In Bahia, state in Brazil, traditional foods are very diverse and
therefore one of the richest in the world. The typical ingredients as
In 2014, Brazil hosted the World Cup and received a million well as the spices and seasonings give color, exuberance, beauty
tourists from 203 nationalities. In addition, Brazil will host in 2016 and unique avor, making the food even more attractive. Salvador
the World Olympic Games. city has 400 hotels, out of which 74 have their own restaurant and
In order to improve the sanitary prole of the host cities where most of them offer at least breakfast service. Large hotels offer food
the games of the World Cup and Olympic games will be held, the service for external audiences, in addition to the guests.
Ordinance Number 817/2013 was created, which aims to provide Food safety is fundamental in food service because of the high
subsidies for assessment of risk criteria proposed for food services numbers of meals served every day. Food-borne outbreaks result-
and specic strategies of communication to consumers in order to ing from such mass restaurant facilities have been reported
increase transparency and strengthen health surveillance actions worldwide (Jones & Angulo, 2006).
(Brasil, 2013a). Foodborne disease has several origins such as chemical and
parasitic; however, microbiological sources stand out for posing a
great risk to public health. Outbreaks of foodborne disease are
* Corresponding author. Current address: Nutrition School, Federal University of resultant from various factors, and among them, one of the most
Bahia, Salvador, BA, Brazil. implicated is inadequate personal hygiene (Pichiler, Ziegler,
E-mail address: rogeriac@ufba.br (R.C.C. Almeida).
http://dx.doi.org/10.1016/j.foodcont.2016.08.026
0956-7135/ 2016 Elsevier Ltd. All rights reserved.
L.T. Rebouas et al. / Food Control 73 (2017) 372e381 373
Aldrian, & Allerberger, 2014). Several studies have demonstrated Nutritionists were not interviewed.
the presence of pathogenic microorganisms in food handlers' Informed consent, previously approved by the Ethics Committee
hands, which makes them an important vehicle of foodborne dis- of the School of Nutrition of the Federal University of Bahia, was
eases (Ferreira et al., 2013; Soares, Almeida, Cerqueira, Carvalho, & provided by each participant.
Nunes, 2012). Therefore, improper handling is responsible for most
cases of foodborne disease, including the inappropriate use of 2.2. Data collection
temperature during food preparation and conservation, cross
contamination, poor personal hygiene and inadequate equipment. 2.2.1. Assessment of knowledge, attitudes and practices of food
Attitude of food handler is also a crucial factor that may inuence handlers
food safety behavior and practices (Al-Shabib, Mosilhey, & Husain, A structured questionnaire based in previous study of Angelillo,
2016). Viggiani, Greco, and Rito (2001), Ansari-Lari et al. (2010), and
According to Pichiler et al. (2014), thirty-one percent of the Jevsnik, Hlebec, and Raspor (2008) was designed to assess the food
outbreaks occurred in the European Union were associated with handlers' knowledge, attitudes and practices. The questionnaire
restaurants, cafes, pubs, bars and hotels, and 17% was linked to was peer-reviewed and underwent a pilot study with 23 food
catering for schools, kindergartens, residential institutions, tem- restaurants' handlers before the nal version was distributed to
porary mass events and workplace canteens. In Brazil, data from food handlers.
epidemiology surveillance show that restaurants and patisseries The questionnaire was divided into ve distinct parts. Part 1:
occupied the third ranking position in the foodborne disease demographic information including age, sex, education level, per-
occurrence. Bahia, in the northeast Brazil, is the state that shows sonal income, length of employment and participation in training.
the highest record of foodborne disease (Brasil, 2011). Part 2: information about the employees' work satisfaction (10
A recent meta-analysis has shown that food safety training in- questions), addressing work load, satisfaction with profession,
creases knowledge and improves attitudes about hand hygiene fullling the norms and rules, conditions to guarantee food safety,
practices and that refresher training and recurrent emphasis on relationship between work team and managers/supervisors, and
good food handling behavior may have ongoing positive effects on answers were graded on three levels of intensity: disagree, indif-
hand washing practices among food handlers (Soon & Baines, ferent, and agree. Part 3: addressing knowledge (18 questions);
2012). However, several studies report that the increase of knowl- each question consisted of three optional answers, true, false, I do
edge in food safety does not always ensure that good hygiene not know/I do not remember. The food handlers were asked about
practices are being implemented (Ansari-Lari, Soodbakhsh, & their knowledge regarding preparation and food conservation, food
Lakzadeh, 2010; Buccheri et al., 2010; Ferreira et al., 2013; Park, borne diseases, their personal hygiene, cross-contamination and
Kwak, & Chang, 2010). Important barriers can be responsible for time and temperature control of foodstuffs. Part 4: containing 14
that, such as supervisors and colleagues' inhibitory attitudes, time questions concerning food safety attitudes; each question consisted
pressure and/or lack of staff, as well as structural factors, such as of three optional answers, right, wrong and I do not know/I do not
facilities and accessibility to supplies (Laikko-Roto & Nevas, 2014; remember. The questions distribution was under the following
Soares et al., 2012). criteria: personal health, personal hygiene, hand washing, cross
Some reports have shown that kitchens' supervisors or man- contamination, and food handling. The term attitudes was used
agers that have certicates have been more proactive during the according to Princeton University denition: a complex mental
food handlers' training than those that do not have certicates state involving beliefs and feelings and values and dispositions to
(Laikko-Roto & Nevas, 2014; Roberts & Barret, 2009). The presence act in certain ways (http://wordnet.princeton.edu/) (Sharif & Al-
of supervisors with certicates has also been suggested as impor- Malki, 2010; Soares et al., 2012). Part 5: addressing practices of
tant to reduce non-compliance (Cates, Muth, et al., 2009; Kassa, personal hygiene and hand hygiene (21 questions), each question
Silverman, & Baroudi, 2010) and help to prevent foodborne dis- consisted of ve optional answers, never, rare, sometimes,
ease outbreaks in restaurants (Hedberg et al., 2006). frequently, and always. These questions focused on issues
The objectives of the present study were to evaluate the regarding personal hygiene, cross contamination, diseases carried
knowledge level, attitudes and practices adopted by food handlers, by food, microorganisms, temperature control and hygiene
and knowledge and practices in food safety of head chefs and practices.
managers in the hotels' restaurants of Salvador, in northeast Brazil. Food safety knowledge was evaluated according to Soares et al.
(2012), and for each correct answer was given one point whilst
2. Material and methods incorrect answer or I do not know answer was scored zero point.
Handlers that had a score less than 70% of accuracy were regarded
2.1. Sampling to have insufcient knowledge and those that had scores equal to
or greater than 70% accuracy were considered to have good
Hotels with more than 100 beds located in Salvador, Bahia, in knowledge. The cut-off point for the analysis of the results was
northeast Brazil, were chosen for the study. We screened 400 ho- higher than that reported in other studies (Angelillo et al., 2001;
tels, of which 74 has their own restaurant, and 48 of them had 100 Bas, Yuksel, & Cavusoglu, 2006) because most handlers inter-
or more beds. Of these, 23 agreed to participate in the study viewed had already received some type of training.
(response rate of 47.92%). The hotels were stratied per group,
according to their leadership/management of the restaurant. The 2.2.2. Assessment of knowledge and practices of head chefs and
group 1 was comprised of restaurants which had only one manager, mangers
group 2 by restaurants that had a manager and a head chef, the Face to face interviews were used to obtain data. The ques-
group 3 by restaurants that had a manager, a head chef and a tionnaire contained 44 questions, covering six areas: (1) de-
nutritionist for part-time, and the group 4 by restaurants that a had mographics; (2) training; (3) food storage and delivery; (4) food
manager, a head chef, and a nutritionist for full-time shift. handling; (5) personal hygiene/cleaning; and (6) food preparation.
This descriptive, cross-sectional study was conducted among 18 All questions were multiple choice with an if other, please specify
managers, 14 head chefs (a response rate of 100%) and 265 food option (adapted from Bolton, Meally, Blair, Mcdowell, & Cowan,
handlers (a response rate of 87.46%) from 23 hotels' restaurants. 2008).
374 L.T. Rebouas et al. / Food Control 73 (2017) 372e381
The questionnaire, and the interview procedures were pre- the food handlers (88.01%) were aware of the fundamental hygienic
tested in a pilot study with ten managers and four head chefs in measures in the workplace, such as washing their hands and wear
seven randomly selected restaurants in Salvador area, to conrm gloves (Table 1), only 9.1% answered correctly the number of steps
question clarity, identify response options and to estimate the involved in the washing hands process. The question identied as
probable duration of the interview. at high risk of foodborne disease was not answered correctly by
Both English questionnaires were translated into Portuguese 85.7% of respondents, as well as 33.2% of them did not know that
and adapted to the Brazilian food law and food handling hepatitis A is a foodborne disease.
requirements. In relation to attitudes (Table 2), all participants believed that
The nal survey instruments were launched between February the properly food handling is an essential part of their re-
and September 2014. sponsibility at work. However, 9.1% did not agree/did not know that
food handlers should wear gloves when touching food ready-to-eat
2.3. Statistical analysis or when they have bruises on their hands. In the hands hygiene
self-reporting practices evaluate, it was found that 76.1% answered
Data analysis was performed using the software SPSS for Win- properly about frequency in which the procedure was performed
dows, version 17.0. The descriptive statistics and Pearson's chi- (Table 3). The hotels were divided into risk and protection groups,
square test were used for analysis. Results with a p-value <0.05 considering the presence of the nutritionist in the restaurant, so we
were considered statistically signicant. categorized the answers as risk and protection. For this, the
option sometimes was grouped with never, and rare and
3. Results frequent options with always option. Thus, it was observed that
88.7% of the respondents related handwashing procedures prop-
3.1. Assessment of knowledge, attitudes and practices of food erly; 60.4% said that to wear disposable gloves when handling or
handlers distributing food, and 32.4% said not washing their hands before
using disposable gloves. More than half (52.5%) of the handlers
The participants of this part of the study included 265 food reported talking while handling foods and 28.7% said that they
handlers, who comprised 22 from group 1 (restaurants that had prove the food with their hands.
only one manager), 25 from group 2 (restaurants that had a man-
ager and a head chef), 71 from group 3 (restaurants that had a 3.1.4. Evaluation of good hygiene practices using a checklist
manager, a head chef and a nutritionist for part-time), and 147 from The food handlers' practices covering only the items involving
group 4 (restaurants that had a manager, a head chef, and a hand hygiene practices and issues related to them in the restau-
nutritionist for full-time). rants were also evaluated using a check list form (Brasil, 2013b). For
this, the hotels were stratied into two groups, risk and protection,
3.1.1. Demographic characteristics according to presence or not of the nutritionist in the restaurant
The majority of respondents were female, with a mean age of 35 (part or full-time).
years. Education levels varied with 52.8% of the participants having Association between good hygiene practices (check-list form)
a rst to third grade and 30.9% had complete or incomplete sec- and food handlers self-reported practices, by restaurant category,
ondary school level. Personal income was more prevalent between was demonstrated in Table 4. Although the self-reporting practices
1 and 2 minimum wages (48.7%). The handlers declared a mean of of the food handlers has been adequate, the results of the check list
112 months' professional experience (0e528 months), and a mean form demonstrated that most handlers (91.3%) did not obey a fre-
of 39 months (0e360 months) work experience in the restaurant of quency suitable for cleaning of their hands. Also, a considerable
this study. portion of the hotels (n 54) did not have adequate resources to
It was found that most of respondents attended training and 17% sustain the adoption of good hygiene practices. This association was
never participated in any training related to food safety. The han- signicant. Also, it was observed that the statements food handlers
dlers claimed to have taken part, at the average of two training for take a leave of the work place when they suffer lesions or showed
the past six months; however, 44.0% reported not having partici- infections symptoms and hands are washed carefully before
pated in any training during this period. starting work, before and after food handling, after any service
interruption, after touching contaminated materials, after return-
3.1.2. Employees' work satisfaction ing from the toilet, whenever it is necessary, had a signicant
In relation to satisfaction with the service, 69.9% of the handlers association with the presence of nutritionist in restaurants of the
responded positively to this question. In this question the ambiv- hotels (protection group) (p 0, 014; p 0.034, respectively),
alence of the answers in two issues stands out, i.e., while 55.8% of suggesting that the presence of the nutritionist in restaurants
handlers would choose the same profession, 64.9% would leave its promotes adoption of appropriate practices, or at least practice
function if was offered a job in another sector. Most of them do not knowledge that should be adopted in the production area.
talk about personal issues with colleagues or supervisors. Many of On comparison between the groups in the hotels' category
the handlers (95.1%) said that they perform their work in accor- regarding the handlers satisfaction, bivaried analysis (Table 5)
dance with the rules established and 83.8% determined that the showed a signicant association (p < 0.05), i.e., the food handlers of
work load was adequate. Still, 91.7% of them believed that their the hotels classied as protection group believed that the work-
work provided every condition to guarantee the food safety, and load was adequate (p 0.000).
96.6% believed that the meals served did not represent a risk for the
guest's health. 3.1.5. Knowledge Assessment and head chefs and managers'
practices
3.1.3. Knowledge, attitudes and practices Evaluation of knowledge level of head chefs and managers in
Tables 1e3 summarizes the results of the knowledge assess- food safety is shown in Table 6.
ment, food handlers' attitudes and self-reported practices. Most of Out of the total of 32 participants in the survey, 18 were man-
the handlers demonstrated a good knowledge, responded asser- agers and 14 chefs. More than 56% of them were male and 50% were
tively about personal and hands hygiene (88.0%). Although, most of aged 35e44 years.
L.T. Rebouas et al. / Food Control 73 (2017) 372e381 375
Table 1
Knowledge of food handlers about personal/hands hygiene.
1. Washing hands before working reduces the risk of food contamination. 99.6 0.4 0.0
2. Using gloves while handling food reduces the risk of food contamination. 94.3 5.7 0.0
3. Eating and drinking in the work place increase the risk of food contamination. 87.9 10.6 1.5
4. Wearing hairnet or a cap, gloves and masks is an important practice to reduce the risk of food contamination. 97.7 2.3 0.0
5. Using hands to add ice in the glass/cups offered risk to guest. 98.5 1.1 0.4
6. Using restroom at work only for urinary do not oblige you to wash your hands. 94.3 5.7 0.0
7. A health person can cause illness during food handling. 94.3 3.4 2.3
8. Food handler with infectious disease should take an eave and should not work on the activities. 98.9 0.8 0.4
9. All the people, including children, adults, pregnant women and elderly have the same risk of foodborne disease. 85.7 13.6 0.8
10. Foodborne diseases can be prevented and controlled by good hygiene practices. 98.9 1.1 0.0
11. Bacteria are normally found on the surface of human skin. 86.4 9.8 3.8
12. Hand-washing procedures contain six steps. 6.5 9.1 23.4
13. Dirty nails are one of the simplest ways to spread bacteria. 98.9 0.8 0.4
14. Cuts on ngers or hands carry millions of bacteria. 99.6 0.0 0.4
15. Jewels should not be worn for food handlers when preparing food, as it can harbor dirt and bacteria. 100.0 0.0 0.0
16. Dishcloths can replace hand towels for wiping hands. 81.1 18.1 0.8
17. Hepatitis A is transmitted through raw food contaminated by lack of proper hygiene. 63.8 3.0 33.2
18. Foodborne diseases can affect your health and have economic effect on society. 95.8 1.5 2.6
The average number of clients per week in restaurants ranged A signicant portion (71.9%) of restaurants owned thermometer
from 20 to more than 4000. The number of people employed in in refrigerators and 62.5% in freezers, which does not mean the
food-handling operations in each restaurant also presented great performing of temperature monitoring daily. It was found that only
variation, and more than 50% of them had 1e20 years employed in 43.8 percent of the respondents knew the correct temperature to
food handling. cool the food. Most head chef and managers comply with the
The participants presented a good training in food safety, with established, i.e., 12.5% store raw meat on the bottom shelf, while
participation in training courses, which ensured a certicate for 59.4% use a unique cooler.
75% of the interviewees and 21.9% obtained diploma. It was found The respondents used a variety of practices to reduce cross-
that 3.1% of the respondents, despite of reporting to have received contamination, such as using separate cutting boards for raw
training on food safety, did not possess any certicate. meat and ready-to-eat food and most of them (59.4%) used a sys-
Although 96.9% of respondents have informed that they had tem of coded color boards. A variety of practices for cleaning of the
food safety qualication, the knowledge level attained was only knives was also related, including the use of a system of two knives
53%, being this percentage considered unsatisfactory (<70%). (25.0%), washing immediately after use (56.3%) and color-coding
The knowledge results about the current legislation on food (6.3%).
safety, showed that 37.5% of respondents were unaware of which In relation to refrigerator cleaning it was reported the use of
legislation was adopted in the restaurants, and the concept of detergent (53.1%), detergent and sanitizer (21.9%), liquid soap
hazard analysis and critical control points (HACCP) was not uni- (9.4%), liquid soap and sanitizer (6.3%), and alcohol (3.1%). The same
versally understood. About 35.0% of the respondents knew what was observed for equipment cleaning; most respondents reported
the HACCP means and 50% did not know or have provided another using detergent (62.5%), while some used detergent and sanitizer
meaning. (12.5%) or just (9.4%) sanitizer. To assist in the cleaning, the par-
Although most chefs and managers (62.5%) reported to perform ticipants stated to use disposable cloths (15.6%), sponges (43.8%), or
food inspection continuously, a considerable part of them stated dish cloths (6.3%), paper towels or similar (3.1%).
that this inspection was so sporadic (Table 6). The inspections were A total of 81.3% of participants stated that the establishments
based on resolutions of the National Health Surveillance Agency have a sink for washing hands and a similar percentage (84.4%)
(ANVISA) and resolution of the establishment. stated that the same is provided with tap water, soap, antiseptic
Table 2
Food handlers' attitudes toward personal and hand hygiene.
Table 3
Food handler's self-reported practices toward personal and hand hygiene.
Questions Never (%) Rare (%) Sometimes (%) Frequent (%) Always (%) Risk (%) Protection (%)
1. Do you wear gloves when handling ready-to-eat foods? 10.6 3.4 25.6 18.1 42.3 39.6 60.4
2. Do you practice proper hand-washing procedure? 0.8 1.1 9.4 24.2 64.5 11.3 88.7
3. Do you wash your hands before putting gloves? 11.7 7.1 13.6 13.6 54.0 32.4 67.6
4. Do you wash your hands after removing or change gloves? 7.5 4.6 10.9 12.8 64.2 23.0 77.0
5. Do you wash your hands before handling raw foods? 2.6 0.8 6.4 14.4 75.8 9.8 90.2
6. Do you wash your hands after handling raw foods? 2.2 2.3 8.3 15.5 71.7 12.8 87.2
7. Do you wash your hands before handling ready-to-eat foods? 1.5 2.7 4.5 16.2 75.1 8.7 91.3
8. Do you wash your hands after handling ready-to-eat foods? 3.0 2.6 5.3 15.5 73.6 10.9 89.1
9. Do you wear nail polish at work? 82.3 8.3 5.6 2.3 1.5 9.4 90.6
10. Do you use your hands to eat foods? 63.4 7.9 11.7 5.7 11.3 28.7 71.3
11. Are your ngernails short and clean? 1.5 1.9 4.9 14.3 77.4 8.3 91.7
12. Do you use antiseptic in the hand-washing procedure? 1.1 1.1 5.7 12.5 79.6 7.9 92.1
13. Do you dry your hands with clean hand towels? 2.3 0.7 3.0 11.4 82.6 6.0 94.0
14. Do you use jewellery when preparing foods? 80.4 8.3 4.2 0.8 6.3 11.3 88.7
15. Do you talk while preparing foods? 28.3 19.2 42.6 2.3 7.6 52.5 47.5
16. Do you use antiseptic in the hand washing after using the bathroom? 0.4 0.0 1.5 9.4 88.7 1.9 98.1
17. Do you eat, drink and smoke while preparing foods? 73.2 9.8 12.8 0.4 3.8 17.0 83.0
18. Do you wash your hands after nose-wiping or scratching your body? 4.2 3.4 12.0 15.8 64.6 19.6 80.4
19. Do you wash your hands when returning to work after break? 1.9 1.1 3.0 11.7 82.3 6.0 94.0
20. Do you wash your hands after handling waste food or rubbish? 0.8 1.1 1.9 11.7 84.5 3.8 96.2
21. Do you touch food when your hands or ngers are cut and not properly covered? 89.4 6.4 8.0 0.8 2.6 4.2 95.8
and paper towels. However, no establishment had brush in the sink. managers, although in small number, still perform the meat defrost
The majority of respondents know they must wash their hands at room temperature (12.5%). Only 37.5% of the interviewees
with antibacterial soap and tap water (56.3%) after handling food. mentioned using the temperature probe to check if red meat is
Additionally, 71.9% of the respondents claimed to encourage sufciently cooked, and a similar percentage (31.3%) also used the
handwashing. probe to check the poultry and pork. Still there is the practice of
A variety of practices was reported by heads and managers to serving rare meat, prepared in accordance with the specications of
food preparation. It was observed that some head chefs and/or the customers ' taste. A high percentage of respondents (90.7%)
Table 4
Association between good hygiene practices (RDC 516/2004, Brasil, 2004) and food handlers self-reported practices, by restaurant category.
70% <70%
Facility-design (layout)
Toilet facilities have washbasin in suitable number and suitable products to C 65.2 175 19 0.022* 39 155 0.498
hands hygiene (towel paper, liquid soap, antiseptic, trash with automatic lid, NC 34.8 70 1 17 54
clean hand towel, or another safe system for hands drying).
Food handlers
Food handlers take a leave of the work place when they suffer lesions or showed C 65.2 182 17 0.287 35 164 0.014*
infections symptoms. NC 34.8 63 3 21 45
Hands are washed carefully before starting work, before and after food handling, C 8.7 25 5 0.045* 0 30 0.003*
after any service interruption, after touching contaminated materials, after NC 91.3 220 15 56 179
returning from the toilet, whenever it is necessary.
Do not smoke, talk, sing, eat, drink, sneeze or cough, money handling, or do C 73.9 166 15 0.503 33 148 0.09*
another attitude that can contaminate food. NC 26.1 79 5 23 61
Food preparation
Processing areas with washbasin in suitable number and suitable products to C 56.5 168 19 0.013* 32 155 0.013*
hands hygiene (towel paper, liquid soap, antiseptic, trash with automatic lid, NC 43.5 77 1 24 54
clean hand towel, or another safe system for hands drying)
During food preparation the workers that handle raw food wash their hands C 13 34 2 0.627 0 36 0.001*
before handling ready-to-eat foods NC 87 211 18 56 173
C Compliance.
NC No compliance.
R Risk.
P Protection.
*Pearson Chi-square test.
L.T. Rebouas et al. / Food Control 73 (2017) 372e381 377
Table 5
Bivaried analysis between knowledge and self-reported practices and other variables.
R risk.
P protection.
C compliance.
NC no compliance.
Y yes.
N no.
*p < 0,05.
stated to adopt this practice. 2013; Soares et al., 2012). And even the handlers considered
Finally, it was veried that 53.1% of respondents knew how use healthy host millions of pathogenic bacteria that can contaminate
the bain marie, and to ensure that the food is at the proper tem- food through the mouth, nose, throat and intestinal tract (Soares
perature, 62.5% said to use the thermometer directly in food, while et al., 2012). So, the knowledge about the steps for hand washing
12.5% of them didn't know how to monitor this temperature. is essential to avoid foodborne diseases occurrence.
Ready-to-eat foods not served were stocked mostly correctly (75%) Unlike most studies conducted for the evaluation of the triad,
and 15.6% of those surveyed reported to have discarded food that knowledge, attitude and practice, the results of the statistical
was not consumed. analysis in this work did not indicate a signicant association be-
Interesting to mention that differently from the results found in tween the knowledge levels, attitudes and self-reported practices
the analysis with food handlers, the presence of nutritionist in the by handlers. However, it was found association between handlers
restaurants shows no association with head chefs and managers' that presented good satisfaction with the job and handlers that
knowledge. introduced appropriate practices.
Work performed by Lim, Chye, Sulaiman, Suki, and Lee (2016)
demonstrate that food safety knowledge and attitude of the food
4. Discussion preparer in the house was not correlated.
Differently, Ansari-Lari et al. (2010), and Vo, Le, Le, Minh, and
In this study we evaluated the knowledge, attitudes and prac- Nuorti (2015) found in their studies that there was a signicant
tices of food handler and head chefs and managers of hotels' res- positive correlation between knowledge and attitude of food
taurants with more than 100 beds in Salvador city. handler.
For the study with food handlers, a total of 265 questionnaires The question identied as groups of foodborne disease risks was
were collected in which the majority of the respondents were fe- not answered correctly by majority of respondents. The same was
male. The ratio of female respondents to male respondents re- observed in studies developed by Ansari-Lari et al. (2010) and
ected the role of female as hotels' restaurants food preparers in Soares et al. (2012). Still, more than 50% of handlers related talking
Salvador. Also, it was found that most of respondents attended during food handling and some of them tasting food with their
training and had an average of 39 months' work experience. hands.
Training for caterers has been shown to improve food safety Although some self-reporting practices have been adequate, the
knowledge and hygiene awareness and may result in improved evaluation using a checklist demonstrated that most handlers do
food safety practices. According to Soares et al. (2012), training not obey a frequency suitable for hand hygiene.
programs are an integral part of creating a positive culture of food The hotels were divided into risk and protection groups,
safety, and must occur periodically, in order to promote changes in considering the presence of the nutritionist in the restaurant,
people's behavior through attitudes and practices that encourage regardless of their frequency of days at the restaurant (full or part of
the production of a food safe by reducing the risk of foodborne time). It was found that a considerable number of the hotels (17 in
disease. the risk group and 54 in the protection group) did not have
Although almost all of handlers had reported training and adequate facility-design (layout) to provide the adoption of good
answered correct the questions about practice in hand hygiene, practices on hand hygiene. However, it was veried association
results of this present study showed that the majority of them did between hotels category and knowledge and satisfaction of the
not know the steps for hand washing. Tan, Bakar, Karim, Lee, and food handler with a job, i.e., the hotels' handlers which were clas-
Mahyudin (2013) also veried similar results. Several studies have sied as protection believed that the workload was adequate, and
demonstrated the presence of pathogenic microorganisms in the that even the healthy person handling foods could cause disease.
handlers' hands that make them an important vehicle of these due Also, in the practices evaluation, it was observed that the statement
to inadequate personal hygiene (Campos et al., 2009; Ferreira et al.,
378 L.T. Rebouas et al. / Food Control 73 (2017) 372e381
Table 6
Knowledge and practices of head chefs and mangers in food safety.
Query Response %
Table 6 (continued )
Query Response %
Table 6 (continued )
Query Response %
31. In your estimation, what percentage of customers prefer their meat 1-10% 50.0
rare? 11-20% 9.4
21-30% 6.3
31-40% 6.3
41-50% 3.1
51-60% 3.1
Over 60% 12.5
Do not know 6.3
32. What temperature is the food in the Bain Marie? Above 63 C 53.1
Bellow 63 C 15.6
At 63 C 0.0
Do not know 12.5
Not applicable 18.8
(continued on next page)
33. How do you know the food is at that temperature? Probe food 62.5
Probe water 6.3
Read dial 0.0
Do not know 15.6
Not applicable 15.6
34. How do you store food that is cooked/uneaten? Allowed to cool then placed in the refrigerator 50.0
Allowed to cool then frozen 25.0
Discarded 15.6
At room temperature 0.0
Other 0.0
Not applicable 9.4
35. What temperature do you reheat this food to? Above 63 C 62.5
Bellow 63 C 6.3
Served cold 0.0
Do not know 15.6
Not applicable 15.6
use disposable gloves when handling or distributing food, washing 200 chefs and managers of restaurants in Ireland, found that there
their hands before using gloves, using an antiseptic in cleaning is a high risk of cross-contamination in kitchens of restaurants
hands and drying hands with paper towels had a signicant as- through tools and work surfaces, since most of the study partici-
sociation with the presence of nutritionist in restaurant's hotel. pants said that they do not use color-coding to the knives and
This results suggested that the presence of the nutritionist in cutting boards.
restaurants promotes adoption of appropriate practices, or at least Related to hand hygiene, the results showed that the investi-
knowledge of practice that should be adopted in the safety meals gated hotels did not have any supplies for washing and drying
production. hands. The same was observed in study by Bolton et al. (2008),
Related to the study with restaurants' head chefs and managers, where few establishments provided brush to wash their hands,
the results showed that the men were majority, and most of the suggesting that the contaminants may not be removed efciently.
respondents were aged 25 years or older. Similar result was found In the practice of defrosting foods, it was veried that some head
in a study developed in a company in Portugal, in which only men chefs and/or managers, although in small number, still perform the
were employed at management position and most participants meat defrost at room temperature. Work reported by Santos et al.
were aged 36 years or older (Martins, Hogg, & Otero, 2012). (2010), when assessing various forms of food defrosting, found
The participants showed good performance in food safety that the best method to reduce bacteria levels in the product was
because they had participated in training courses, and most of them the use of the microwave, followed by cooling and nal defrost at
had certicate. According to Cavalli and Salay (2007), the level of room temperature.
the workers' formal schooling, participation in training courses, According to Adams and Moss (2008) the temperature control is
and the positive experience in the professional area, are factors that one of the main tools for the control of microbial growth and when
contribute to food safety. done inappropriately is one of the leading causes of proliferation
Due to the variety of roles and functions being exercised by and permanence of the microbial hazard.
managers throughout history, even conceptual gaps are identied All restaurants investigated had technicians, but part of them
and related to their performance (Barros et al., 2011). In this had not implemented the good manufacturing practices (GMF) and
context, the lack of time management can be seen as one of the standards operation procedures (SOP). This is worrying, because
major barriers to food handler training (Roberts & Barret, 2009), Brazil legislation is mandatory for GMP and SOP implementation. It
which may reect the adoption of inappropriate practices. is due mainly to nancial difculties in adequacy of the physical
The low level of knowledge of head chefs and managers as structure, and lack of conscious and compromised professionals in
veried in this study is worrying, considering that any action with the establishments.
the aim of ensuring food safety should be the essential to
contamination control in the restaurants. Thus, the inspection of
raw material on delivery and storage is a control point and the 5. Conclusion
present investigation showed certain fragility in this item, since in
some restaurants the supplies were inspected by other people. This study concluded that food handlers of the hotels' restau-
Unlike our results, Bolton et al. (2008) in a study developed with rants have good knowledge levels, attitudes and self-reported
practices. However, the knowledge level about the steps used in
L.T. Rebouas et al. / Food Control 73 (2017) 372e381 381