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Evaluation of prerequisite programs implementation at schools foodservice
Food Control 39 (2014) 30e33
Contents lists available at ScienceDirect
Food Control journal homepage: www.elsevier.com/locate/foodcont
Evaluation of prerequisite programs implementation at schools foodservice M. Liz Martins 1, A. Rocha* Requimte Associated Laboratory, Faculty of Nutrition and Food Science, University of Porto, Rua Dr. Roberto Frias, 4200 465 Porto, Portugal
a r t i c l e i n f o
a b s t r a c t
Article history: Received 30 August 2013 Received in revised form 24 October 2013 Accepted 29 October 2013
Introduction: Strengthening food safety measures in schools would improve protection of students and school staff from outbreaks of foodborne illness. The main objective of this study was to evaluate the non-conformities in prerequisite programs implementation at school foodservice. Methods: This descriptive study was conducted between October and December 2011 involving 88 school foodservice units at a Portuguese Municipality. Each school foodservice was audited using a hygiene-sanitary checklist including 146 statements by the same nutritionist. Prerequisite program procedures were evaluated after categorization as standard operating procedures, sanitation and hygiene procedures and procedures for receiving and storage of foods. Food safety procedures and practices were compared between cooking and distribution food units and according to the number of meals produced daily. Results: Non conformities were detected concerning several safety practices such as incorrect thawing, temperature control of freezing equipment and cooked food, segregation between stored food and detergents and disinfectants, procedures used for handling waste, cleaning and sanitizing. Only 40% of foodservice units evaluated recorded temperature of cooked meals. All foodservice units audited revealed non conformities on cleaning and disinfection practices of equipment and facilities. Adequate labeling of stored items was properly done at 85% of units. Handling waste was undertaken incorrectly by all food handlers in this survey. Reasons identified for inappropriate personal hygiene practices were mainly lack of resources and conditions for correct hand washing procedure. No significant relationship was found between food safety procedures and practices and number of meals produced or served. Distribution food units failed safety checks in aspects such as food-handling practices and temperature control of cooked meals, more frequently than cooking units. Conclusion: Results indicate an urgent need for food safety training of personnel and point out to the need of continuous supervision by managers. It is also important to define standard operating procedures that include food safety components and improve employee motivation and responsibility. Ó 2013 Elsevier Ltd. All rights reserved.
Keywords: Good manufacturing practices Catering Food safety Children
1. Introduction Governments’ attention to food safety has been increased due to the potential health and economic impact of foodborne outbreaks (Albrecht & Nagy-Nero, 2009; WHO, 2008). Foodborne disease is a matter of concern for vulnerable groups such as infants and young children (Albrecht & Nagy-Nero, 2009). Ensuring food safety for these groups by foodservice operations is critical. The most commonly reported reasons by several authors were food preparation practices contributing to foodborne outbreaks are improper * Corresponding author. Tel.: þ351 22 5074320; fax: þ351 22 5074329. E-mail address: [email protected] (A. Rocha). 1 Tel.: þ351 22 5074320; fax: þ351 22 5074329. 0956-7135/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.foodcont.2013.10.040
heating of foods followed by inadequate handling, crosscontamination, poor hygiene, improper food storage and food contaminated by food handlers (Daniels et al., 2002; Osimani, Aquilanti, Babini, Tavoletti, & Clementi, 2011; Panisello, Rooney, Quantick, & Stanwell-Smith, 2000). In recent decades, important lifestyles changes determined deep modifications on food consumption (Kearney, 2010). Additionally, families usually work far from home and the period children have to stay at schools are longer determining an increased number of children who have lunch at school (Aranceta Bartrina et al., 2008). This situation allowed the development of the foodservice industry, contributing to the increasing importance of school meals on children’s daily food intake (Bes-Rastrollo et al., 2010).
M. Liz Martins, A. Rocha / Food Control 39 (2014) 30e33
Foodborne outbreaks are frequent in semi-enclosed environments, such as school settings due to the increased number of people and increased personal contacts among them (Mellou et al., 2013). Children spend most of their daily time at school and obtain up to 47% of their calories from meals and snacks consumed there (Briefel, Wilson, & Gleason, 2009). In Portugal, municipalities are the entities responsible for ensuring safety of meals served at primary schools and to supervise hygienic conditions of schools’ foodservice according to European legislation. This control is achieved daily by hygienic audits to school canteens performed by a trained nutrition technician according to national recommendations. The results are summarized in a report that is sent to school director and to the responsible at the municipality (Graça et al., 2001). School meals in Portugal are leased to private companies that are responsible for preparing and distributing meals at schools (Barbosa, Ávila, & Rocha, 2012). Developing or strengthening prerequisite program is one of the first steps building effective Hazard Analysis Critical Control Point (HACCP) systems. Pre-requisites are considered a basic pillar on which to build a solid self-control system. They are indispensable to the development and implementation of a successful HACCP plans (Henroid & Sneed, 2004; Wallace & Williams, 2001). Prerequisite programs should include areas such as supplier control, temperature monitoring, personnel hygiene standards, pest control, written specifications, written cleaning and sanitation procedures and documented employee training (Youn & Sneed, 2003). Major problems identified in the catering industry were insufficient knowledge, lack of personnel training, high staff turnover, large variety of products, low employee motivation and absence of prerequisite programs (PRPs) (Bánáti & Zoltán, 2012). Nutrition professionals need to assess the current status of food safety prerequisite programs in their operations and standard operating procedures should be developed and implemented in school foodservice operations (Henroid & Sneed, 2004). Scarce information is available for evaluating food safety prerequisite programs implementation at school foodservice units either in Portugal (Barros, Lameiras, & Rocha, 2008; Liz Martins & Rocha, 2011). The main objectives of this study were to determine food safety procedures and practices used in school foodservice related to prerequisite programs and to evaluate non conformities in prerequisite programs implementation at school foodservices.
31
Table 1 Percentage of adequacy of checked procedures concerning food temperature control, food storage, facilities and equipment and personnel (n ¼ 88). Food temperature control Take and record end-point temperatures of all cooked foods Hot foods held above 60 C Cold foods held at 5 C or below Adequate cooling of cooked/prepared foods Take food product samples Storage Adequate dry storage temperature Raw and cooked foods stored separately Food stored in proper containers Freezer and refrigeration temperatures are checked at least daily Freezer and refrigeration temperatures are documented with corrective action when appropriate Foods are properly labeled and dated Facility/Equipment Proper hand washing sink is located in food preparation area with proper drying Walls, floors, ceiling, lighting adequate for food production Food contact surfaces are clean, designated and maintained Areas are properly ventilated, clean and maintained Non-food contact surfaces are clean and maintained Adequate ware washing facilities Correct handling waste Personnel Proper personal hygiene practices observed Employees observed with hair restraints and clean uniforms Employees observed washing hand as needed
40% 78% 73% 94% 97% 92% 86% 100% 60% 100% 85% 40% 100% 86% 78% 78% 94% 0% 40% 60% 28%
school food unit that was not included in the final sample. Evaluation was undertaken in all school foodservice by the same nutritionist. Each school was visited several times and the technician stayed at the food unit at least 2 h during meals production and distribution. Assessment of school foodservice included observations of food preparation and service. In addition to observations, objective measurements such as food temperatures, temperatures of refrigerators and freezers were taken using a calibrated digital thermometer (FLUKE, Foodproplus thermometer, USA) and recommended procedures. Prerequisite programs procedures were classified as standard operational procedures; sanitation and hygiene procedures and procedures for receiving and storage of foods. Comparison of food safety procedures and practices between cooking and distribution food units was made, as well as according to the number of meals served daily.
2. Materials and methods 2.3. Statistical analysis 2.1. Sample selection A random sample of 88 public school foodservice at a Portuguese municipality in the north of Portugal was included in this descriptive study. These schools attend children aged 3e10 years old. The number of meals served at each school daily varied between 75 and 350. Food service units audited included cooking units (where meals are prepared and cooked) and distribution units (units without kitchen where meals are served).
All statistical analyses were conducted using SPSSÒ for Windows (version 20.0). Parametric tests were used to statistical analysis. Chi-square test was used to verify differences for each item between cooking and distribution units. T-test was used to determine differences for items evaluate according to the number of meals. Statistical significance at p 0,05 was used for all tests. 3. Results and discussion
2.2. Data collection
3.1. School foodservice characterization
Data were collected between October to December 2011 using a Hygiene-sanitary checklist specific for school canteens (Rocha et al., 2009.) including 146 statements related to implementation of HACCP and prerequisite programs such as Facilities and buildings; Equipment and utensils; Waste management; Personal hygiene; Sanitation; Storage; Documentation and Training. Yes/no responses were checked for each item. The checklist was previously tested in a
Attendance rate to the school canteen was 62,5% and school foodservices served approximately 6000 meals daily. Concerning these figures, the potential impact of improving food safety practices in school foodservice operations on Public Health could be significant. From 88 schools foodservice evaluated, 52 were cooking units and 36 had transported meals (holding hot). All the meals were
32
M. Liz Martins, A. Rocha / Food Control 39 (2014) 30e33
cooked on central cooking units and transported hot in isothermal containers to the different distribution units. Holding hot lasts 2 h maximum. Generally, results indicated that proper food-handling practices were not being followed in many school foodservice operations. The most prevalent non conformities that were detected concerning safety practices were incorrect thawing; no control of freezing equipment temperatures; no control of cooked food temperatures; no segregation between stored food and detergents; incorrect procedures used for handling waste and incorrect procedures of cleaning and sanitizing (Table 1). 3.2. Food temperature control Table 1 shows the percentage of adequacy of checked procedures concerning food temperature control. Take and record endpoint temperatures of all cooked foods was the most frequent nonconformity, at 60% of foodservices evaluated. This non-conformity was more prevalent in distribution (80%) units than in cooking units (20%) (p < 0.05). This is a matter of concern since the most commonly reported food preparation practices contributing to foodborne outbreaks are improper heating of foods (Osimani et al., 2011; Panisello, Rooney, Quantick, & Stanwell-Smith, 2000).This practice was already evaluated by other researchers that reported as the only practice implemented at 50% of school foodservice (Youn & Sneed, 2003). On the other hand (Henroid & Sneed, 2004) showed that no recording of food temperatures was performed at schools. It is important to emphasize that non-conformities related to temperature control involve a hazard to consumer safety (Domenech, Escriche, & Martorell, 2008; Lee & Greig, 2010). Considering recommendation temperatures for holding meals (WHO, 2001) 22% of hot meals were below 60 C and 27% of cold meals were above 5 C Positively, meal control sample for further microbiological analysis in case of foodborne outbreak, was done at 97% of foodservices. Giampaoli, Clusky, & Sneed (2002) found poor food-handling practices in 15 school foodservice related to time and temperature, namely transfer food to cold storage during preparation steps. Similar problems were identified at schools evaluated in the present study (Table 1).
due to the lack of knowledge by employees. It is important to raise employee’s consciousness to the hazards that may arise from this poor practice. Lack of dedicated hand washing sink in food preparation and distribution areas with proper drying setting was observed in 60% of units under evaluation (Table 1). All foodservice units audited revealed non conformities on cleaning and disinfection practices of equipment and facilities. In several operations it was observed that detergent concentration was not adequate for cleaning process, which reduces sanitizer effectiveness and impair proper disinfection operation (Henroid & Sneed, 2004). On the other hand adequate facilities for meals production were found in all food units evaluated. A worse scenario was found by Brazilian researchers with 66% of non-conformity at schools foodservice concerning prerequisite program caused by inadequate facilities (Lockis et al., 2011). 3.5. Personal hygiene Adequate global personal hygiene practices were observed in only 40% of foodservice audited, results much worse than those found by other authors in school foodservices, where appropriate personnel hygiene practices were reported in 95% of cases (Youn & Sneed, 2003). Reasons identified in our study for inappropriate personal hygiene practices were mainly lack of resources and conditions for correct hand washing procedures. Inadequate and insufficient hand washing practices were observed in most preparation operations (Table 1) as already observed by other authors (Henroid & Sneed, 2004; Lee & Greig, 2010), indicating a need to conduct basic food safety training of school foodservice employees, results supported by similar findings from other researchers (Bas, Yuksel, & Cavusoglu, 2007; Gilmore, Ne, & Jt, 1998). In spite of food safety knowledge of food handlers was considered high food-handling practices were not always consistent with accepted standards, highlighting the need for training and monitoring (Henroid & Sneed, 2004). 3.6. Other items checked
3.3. Storage Food storage in adequate containers and freezing and refrigeration temperature documentation were good practices found in all school foodservice evaluated. These positive aspects were also found in a previous study undertaken at a Portuguese school foodservice (Liz Martins & Rocha, 2011). Concerning storage conditions evaluated in this study the most frequent non-conformity was failure to check freezing and refrigeration temperatures on a daily basis. This aspect was just observed in distribution units (p < 0.05). Regular supervision is crucial to address this problem. Managers should be also responsible for the monitoring and completion of documentation, since they had a higher level of knowledge and greater familiarity with procedures (Eves & Dervisi, 2005; Lee & Greig, 2010). It was observed that raw and cooked foods were stored separately, avoiding cross-contamination, one of the most common factor contributing to foodborne outbreaks as reported by other authors (Daniels et al., 2002; Lee & Greig, 2010; Panisello, Rooney, Quantick, & Stanwell-Smith, 2000) (Table 1). 3.4. Facilities and equipment Incorrect handling of waste was found in all foodservices evaluated, observations in line with previous studies (Henroid & Sneed, 2004; Liz Martins & Rocha, 2011). This practice may be
In our study, the number of meals produced or served did not influence food safety procedures and practices (p > 0,05). When comparing cooking and distribution units, it was verified that distribution food units failed food-handling practices and temperature control of cooked foods more frequently that cooking units (p < 0.05). Failure in use of hair protection by employees was also more frequent in distribution units (p < 0.05). These results were expected since there is more frequent supervision of procedures in cooking units; additionally staff turnover is quite high in distribution units leading to poor training of workers. High job turnover and large number of part-time workers were the major problems with the training of food handlers as reported by Sun (2005). A review of food safety studies has demonstrated that training of managers can also be an effective strategy in reducing food safety problems (Egan et al., 2007). Other researchers concluded that the development and provision of training courses are crucial to achieve behavioral changes and improve skills and knowledge (Clayton, Griffith, Price, & Peters, 2002; Lee & Greig, 2010; Medeiros, Cavalli, Salay, & Proenca, 2011). Results of our research are in agreement with several studies that concluded that the weak points in foodservice units are poor personnel hygiene practices, inappropriate storage temperatures
M. Liz Martins, A. Rocha / Food Control 39 (2014) 30e33
and insufficient cooking (Bas et al., 2007; Domenech, Amoros, Perez-Gonzalvo, & Escriche, 2011; Eves & Dervisi, 2005). Strengthening food safety measures in schools would improve protection of students and school staff from outbreaks of foodborne illness. Control policies, such as training and certification of food handlers in food safety practices and food quality, may contribute to produce safer meals for school children (Daniels et al., 2002; Lee & Greig, 2010). From the point of view of infrastructure, the most important obstacles observed were the lack of equipment and incorrect kitchen layout, also reported by Panisello, Rooney, Quantick, & Stanwell-Smith (2000). Proper kitchen layout and flow charts of food production are the first two issues that need to be considered before implementation of prerequisite programs in foodservice (Sun, 2005). The information provided by audits revealed several barriers to the implementation of the food safety management system. Nonconformities identified should be communicated to local authorities and periodic visits should be done to supervise entire food production steps. In this context, Nutrition professionals hold an excellent position to provide food safety education in community, clinical settings, and foodservice units (Albrecht & Nagy-Nero, 2009). 4. Conclusions Temperature control, waste management, cleaning and sanitizing procedures are the most frequent difficulties observed for prerequisite programs implementation at the school foodservices evaluated. This work identified several areas for improvement, namely training and education about appropriate food-handling practices, increasing documentation of food safety practices, including endpoint temperatures, refrigerator and freezing temperatures, cleaning and sanitizing procedures effectiveness, defining and implementing standard operating procedures that include food safety components in school foodservice operations and employee motivation and responsibility. References Albrecht, J. A., & Nagy-Nero, D. (2009). Position of the American Dietetic Association: food and water safety. Journal of the American Dietetic Association, 109, 1449e1460. Aranceta Bartrina, J., Perez Rodrigo, C., Dalmau Serra, J., Gil Hernandez, A., Lama More, R., Martin Mateos, M. A., et al. (2008). School meals: state of the art and recommendations. Anales de Pediatría (Barcelona), 69, 72e88. Bánáti, D., & Zoltán, L. (2012). Managerial attitudes, acceptance and efficiency of HACCP systems in Hungarian catering. Food Control, 25, 484e492. Barbosa, M., Ávila, H., & Rocha, A. (2012). Characterization of school foodservice of Portuguese Municipalities. In IJUP 12e5th Meeting of young researchers of University of Porto. Barros, M., Lameiras, J., & Rocha, A. (2008). Espaços de refeição de estabelecimentos de educação do município de Penafiel e caracterização higio-sanitária. Alimentação Humana, 14, 66e73. Bas, M., Yuksel, M., & Cavusoglu, T. (2007). Difficulties and barriers for the implementing of HACCP and food safety systems in food businesses in Turkey. Food Control, 18, 124e130. Bes-Rastrollo, M., Basterra-Gortari, F. J., Sanchez-Villegas, A., Marti, A., Martinez, J. A., & Martinez-Gonzalez, M. A. (2010). A prospective study of eating
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away-from-home meals and weight gain in a Mediterranean population: the SUN (Seguimiento Universidad de Navarra) cohort. Public Health Nutrition, 13, 1356e1363. Briefel, R. R., Wilson, A., & Gleason, P. M. (2009). Consumption of low-nutrient, energy-dense foods and beverages at school, home, and other locations among school lunch participants and nonparticipants. Journal of the American Dietetic Association, 109, S79eS90. Clayton, D. A., Griffith, C. J., Price, P., & Peters, A. C. (2002). Food handlers’ beliefs and self-reported practices. International Journal of Environmental Health Research, 12(1), 25e39. Daniels, N. A., Mackinnon, L., Rowe, S. M., Bean, N. H., Griffin, P. M., & Mead, P. S. (2002). Foodborne disease outbreaks in United States schools. Pediatric Infectious Disease Journal, 21, 623e628. Domenech, E., Amoros, J. A., Perez-Gonzalvo, M., & Escriche, I. (2011). Implementation and effectiveness of the HACCP and pre-requisites in food establishments. Food Control, 22, 1419e1423. Domenech, E., Escriche, I., & Martorell, S. (2008). Assessing the effectiveness of critical control points to guarantee food safety. Food Control, 19, 557e565. Egan, M. B., Raats, M. M., Grubb, S. M., Eves, A., Lumbers, M. L., Dean, M. S., et al. (2007). A review of food safety and food hygiene training studies in the commercial sector. Food Control, 18, 1180e1190. Eves, A., & Dervisi, P. (2005). Experiences of the implementation and operation of hazard analysis critical control points in the food service sector. Hospitality Management, 24, 3e19. Giampaoli, J., Clusky, M., & Sneed, J. (2002). Developing a practical tool for assessing employee food handling practices. Journal of Child Nutrition & Management, 26. Gilmore, S., Ne, B., & Jt, D. (1998). A food quality model for school foodservices. Journal of Child Nutrition & Management, 22, 32e39. Graça, P., Alves, E., Camarinha, B., Almeida, A. S., Alves, C., Bento, A., et al. (2001). O Nutricionista Municipal como factor de desenvolvimento local em Portugal. Alimentação Humana, 7, 3e20. Henroid, D., Jr., & Sneed, J. (2004). Readiness to implement hazard analysis and critical control point (HACCP) systems in Iowa schools. Journal of the American Dietetic Association, 104, 180e185. Kearney, J. (2010). Food consumption trends and drivers. Philosophical Transactions of the Royal Society of London B Biological Sciences, 365, 2793e2807. Lee, M. B., & Greig, J. D. (2010). A review of gastrointestinal outbreaks in schools: effective infection control interventions. Journal of School Health, 80(12), 588e 598. Liz Martins, M., & Rocha, A. (2011). Sanitary characterization of elementary school foodservices at a Portuguese municipality. Culinary Arts and Sciences, VII. Lockis, V. R., Cruz, A. G., Walter, E. H., Faria, J. A., Granato, D., & Sant’ana, A. S. (2011). Prerequisite programs at schools: Diagnosis and economic evaluation. Foodborne Pathogens and Disease, 8, 213e220. Medeiros, C. O., Cavalli, S. B., Salay, E., & Proenca, R. P. C. (2011). Assessment of the methodological strategies adopted by food safety training programmes for food service workers: a systematic review. Food Control, 22, 1136e1144. Mellou, K., Sideroglou, T., Potamiti-Komi, M., Kokkinos, P., Ziros, P., Georgakopoulou, T., et al. (2013). Epidemiological investigation of two parallel gastroenteritis outbreaks in school settings. BMC Public Health, 13, 241e248. Osimani, A., Aquilanti, L., Babini, V., Tavoletti, S., & Clementi, F. (2011). An eight-year report on the implementation of HACCP in a university canteen: impact on the microbiological quality of meals. International Journal of Environmental Health Research, 21, 120e132. Panisello, P. J., Rooney, R., Quantick, P. C., & Stanwell-Smith, R. (2000). Application of foodborne disease outbreak data in the development and maintenance of HACCP systems. International Journal of Food Microbiology, 59, 221e234. Rocha, A., Chilro, R., Santos, M. C. T., Afonso, C., Morais, C., & Franchini, B. (2009). SPARE: Sistema de Planeamento e Avaliação de Refeições Escolares e elaboração, verificação e monitorização na óptica do utilizador. Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto - FCNAUP. Sun, Y.-M. (2005). A review of the needs and current applications of hazard analysis and critical control point (HACCP) system in foodservice areas. Food Control, 16, 325e332. Wallace, C., & Williams, T. (2001). Pre-requisites: a help or a hindrance to HACCP? Food Control, 12, 235e240. WHO. (2008). Foodborne outbreaks: Guidelines for investigation and control. France. World Health Organization. (2001). Codex Alimentarius. Food hygiene basic texts. Rome: Food and Agricultural Organization of the United Nations. Youn, S., & Sneed, J. (2003). Implementation of HACCP and prerequisite programs in school foodservice. Journal of the American Dietetic Association, 103, 55e60.
Contents lists available at ScienceDirect
Food Control journal homepage: www.elsevier.com/locate/foodcont
Evaluation of prerequisite programs implementation at schools foodservice M. Liz Martins 1, A. Rocha* Requimte Associated Laboratory, Faculty of Nutrition and Food Science, University of Porto, Rua Dr. Roberto Frias, 4200 465 Porto, Portugal
a r t i c l e i n f o
a b s t r a c t
Article history: Received 30 August 2013 Received in revised form 24 October 2013 Accepted 29 October 2013
Introduction: Strengthening food safety measures in schools would improve protection of students and school staff from outbreaks of foodborne illness. The main objective of this study was to evaluate the non-conformities in prerequisite programs implementation at school foodservice. Methods: This descriptive study was conducted between October and December 2011 involving 88 school foodservice units at a Portuguese Municipality. Each school foodservice was audited using a hygiene-sanitary checklist including 146 statements by the same nutritionist. Prerequisite program procedures were evaluated after categorization as standard operating procedures, sanitation and hygiene procedures and procedures for receiving and storage of foods. Food safety procedures and practices were compared between cooking and distribution food units and according to the number of meals produced daily. Results: Non conformities were detected concerning several safety practices such as incorrect thawing, temperature control of freezing equipment and cooked food, segregation between stored food and detergents and disinfectants, procedures used for handling waste, cleaning and sanitizing. Only 40% of foodservice units evaluated recorded temperature of cooked meals. All foodservice units audited revealed non conformities on cleaning and disinfection practices of equipment and facilities. Adequate labeling of stored items was properly done at 85% of units. Handling waste was undertaken incorrectly by all food handlers in this survey. Reasons identified for inappropriate personal hygiene practices were mainly lack of resources and conditions for correct hand washing procedure. No significant relationship was found between food safety procedures and practices and number of meals produced or served. Distribution food units failed safety checks in aspects such as food-handling practices and temperature control of cooked meals, more frequently than cooking units. Conclusion: Results indicate an urgent need for food safety training of personnel and point out to the need of continuous supervision by managers. It is also important to define standard operating procedures that include food safety components and improve employee motivation and responsibility. Ó 2013 Elsevier Ltd. All rights reserved.
Keywords: Good manufacturing practices Catering Food safety Children
1. Introduction Governments’ attention to food safety has been increased due to the potential health and economic impact of foodborne outbreaks (Albrecht & Nagy-Nero, 2009; WHO, 2008). Foodborne disease is a matter of concern for vulnerable groups such as infants and young children (Albrecht & Nagy-Nero, 2009). Ensuring food safety for these groups by foodservice operations is critical. The most commonly reported reasons by several authors were food preparation practices contributing to foodborne outbreaks are improper * Corresponding author. Tel.: þ351 22 5074320; fax: þ351 22 5074329. E-mail address: [email protected] (A. Rocha). 1 Tel.: þ351 22 5074320; fax: þ351 22 5074329. 0956-7135/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.foodcont.2013.10.040
heating of foods followed by inadequate handling, crosscontamination, poor hygiene, improper food storage and food contaminated by food handlers (Daniels et al., 2002; Osimani, Aquilanti, Babini, Tavoletti, & Clementi, 2011; Panisello, Rooney, Quantick, & Stanwell-Smith, 2000). In recent decades, important lifestyles changes determined deep modifications on food consumption (Kearney, 2010). Additionally, families usually work far from home and the period children have to stay at schools are longer determining an increased number of children who have lunch at school (Aranceta Bartrina et al., 2008). This situation allowed the development of the foodservice industry, contributing to the increasing importance of school meals on children’s daily food intake (Bes-Rastrollo et al., 2010).
M. Liz Martins, A. Rocha / Food Control 39 (2014) 30e33
Foodborne outbreaks are frequent in semi-enclosed environments, such as school settings due to the increased number of people and increased personal contacts among them (Mellou et al., 2013). Children spend most of their daily time at school and obtain up to 47% of their calories from meals and snacks consumed there (Briefel, Wilson, & Gleason, 2009). In Portugal, municipalities are the entities responsible for ensuring safety of meals served at primary schools and to supervise hygienic conditions of schools’ foodservice according to European legislation. This control is achieved daily by hygienic audits to school canteens performed by a trained nutrition technician according to national recommendations. The results are summarized in a report that is sent to school director and to the responsible at the municipality (Graça et al., 2001). School meals in Portugal are leased to private companies that are responsible for preparing and distributing meals at schools (Barbosa, Ávila, & Rocha, 2012). Developing or strengthening prerequisite program is one of the first steps building effective Hazard Analysis Critical Control Point (HACCP) systems. Pre-requisites are considered a basic pillar on which to build a solid self-control system. They are indispensable to the development and implementation of a successful HACCP plans (Henroid & Sneed, 2004; Wallace & Williams, 2001). Prerequisite programs should include areas such as supplier control, temperature monitoring, personnel hygiene standards, pest control, written specifications, written cleaning and sanitation procedures and documented employee training (Youn & Sneed, 2003). Major problems identified in the catering industry were insufficient knowledge, lack of personnel training, high staff turnover, large variety of products, low employee motivation and absence of prerequisite programs (PRPs) (Bánáti & Zoltán, 2012). Nutrition professionals need to assess the current status of food safety prerequisite programs in their operations and standard operating procedures should be developed and implemented in school foodservice operations (Henroid & Sneed, 2004). Scarce information is available for evaluating food safety prerequisite programs implementation at school foodservice units either in Portugal (Barros, Lameiras, & Rocha, 2008; Liz Martins & Rocha, 2011). The main objectives of this study were to determine food safety procedures and practices used in school foodservice related to prerequisite programs and to evaluate non conformities in prerequisite programs implementation at school foodservices.
31
Table 1 Percentage of adequacy of checked procedures concerning food temperature control, food storage, facilities and equipment and personnel (n ¼ 88). Food temperature control Take and record end-point temperatures of all cooked foods Hot foods held above 60 C Cold foods held at 5 C or below Adequate cooling of cooked/prepared foods Take food product samples Storage Adequate dry storage temperature Raw and cooked foods stored separately Food stored in proper containers Freezer and refrigeration temperatures are checked at least daily Freezer and refrigeration temperatures are documented with corrective action when appropriate Foods are properly labeled and dated Facility/Equipment Proper hand washing sink is located in food preparation area with proper drying Walls, floors, ceiling, lighting adequate for food production Food contact surfaces are clean, designated and maintained Areas are properly ventilated, clean and maintained Non-food contact surfaces are clean and maintained Adequate ware washing facilities Correct handling waste Personnel Proper personal hygiene practices observed Employees observed with hair restraints and clean uniforms Employees observed washing hand as needed
40% 78% 73% 94% 97% 92% 86% 100% 60% 100% 85% 40% 100% 86% 78% 78% 94% 0% 40% 60% 28%
school food unit that was not included in the final sample. Evaluation was undertaken in all school foodservice by the same nutritionist. Each school was visited several times and the technician stayed at the food unit at least 2 h during meals production and distribution. Assessment of school foodservice included observations of food preparation and service. In addition to observations, objective measurements such as food temperatures, temperatures of refrigerators and freezers were taken using a calibrated digital thermometer (FLUKE, Foodproplus thermometer, USA) and recommended procedures. Prerequisite programs procedures were classified as standard operational procedures; sanitation and hygiene procedures and procedures for receiving and storage of foods. Comparison of food safety procedures and practices between cooking and distribution food units was made, as well as according to the number of meals served daily.
2. Materials and methods 2.3. Statistical analysis 2.1. Sample selection A random sample of 88 public school foodservice at a Portuguese municipality in the north of Portugal was included in this descriptive study. These schools attend children aged 3e10 years old. The number of meals served at each school daily varied between 75 and 350. Food service units audited included cooking units (where meals are prepared and cooked) and distribution units (units without kitchen where meals are served).
All statistical analyses were conducted using SPSSÒ for Windows (version 20.0). Parametric tests were used to statistical analysis. Chi-square test was used to verify differences for each item between cooking and distribution units. T-test was used to determine differences for items evaluate according to the number of meals. Statistical significance at p 0,05 was used for all tests. 3. Results and discussion
2.2. Data collection
3.1. School foodservice characterization
Data were collected between October to December 2011 using a Hygiene-sanitary checklist specific for school canteens (Rocha et al., 2009.) including 146 statements related to implementation of HACCP and prerequisite programs such as Facilities and buildings; Equipment and utensils; Waste management; Personal hygiene; Sanitation; Storage; Documentation and Training. Yes/no responses were checked for each item. The checklist was previously tested in a
Attendance rate to the school canteen was 62,5% and school foodservices served approximately 6000 meals daily. Concerning these figures, the potential impact of improving food safety practices in school foodservice operations on Public Health could be significant. From 88 schools foodservice evaluated, 52 were cooking units and 36 had transported meals (holding hot). All the meals were
32
M. Liz Martins, A. Rocha / Food Control 39 (2014) 30e33
cooked on central cooking units and transported hot in isothermal containers to the different distribution units. Holding hot lasts 2 h maximum. Generally, results indicated that proper food-handling practices were not being followed in many school foodservice operations. The most prevalent non conformities that were detected concerning safety practices were incorrect thawing; no control of freezing equipment temperatures; no control of cooked food temperatures; no segregation between stored food and detergents; incorrect procedures used for handling waste and incorrect procedures of cleaning and sanitizing (Table 1). 3.2. Food temperature control Table 1 shows the percentage of adequacy of checked procedures concerning food temperature control. Take and record endpoint temperatures of all cooked foods was the most frequent nonconformity, at 60% of foodservices evaluated. This non-conformity was more prevalent in distribution (80%) units than in cooking units (20%) (p < 0.05). This is a matter of concern since the most commonly reported food preparation practices contributing to foodborne outbreaks are improper heating of foods (Osimani et al., 2011; Panisello, Rooney, Quantick, & Stanwell-Smith, 2000).This practice was already evaluated by other researchers that reported as the only practice implemented at 50% of school foodservice (Youn & Sneed, 2003). On the other hand (Henroid & Sneed, 2004) showed that no recording of food temperatures was performed at schools. It is important to emphasize that non-conformities related to temperature control involve a hazard to consumer safety (Domenech, Escriche, & Martorell, 2008; Lee & Greig, 2010). Considering recommendation temperatures for holding meals (WHO, 2001) 22% of hot meals were below 60 C and 27% of cold meals were above 5 C Positively, meal control sample for further microbiological analysis in case of foodborne outbreak, was done at 97% of foodservices. Giampaoli, Clusky, & Sneed (2002) found poor food-handling practices in 15 school foodservice related to time and temperature, namely transfer food to cold storage during preparation steps. Similar problems were identified at schools evaluated in the present study (Table 1).
due to the lack of knowledge by employees. It is important to raise employee’s consciousness to the hazards that may arise from this poor practice. Lack of dedicated hand washing sink in food preparation and distribution areas with proper drying setting was observed in 60% of units under evaluation (Table 1). All foodservice units audited revealed non conformities on cleaning and disinfection practices of equipment and facilities. In several operations it was observed that detergent concentration was not adequate for cleaning process, which reduces sanitizer effectiveness and impair proper disinfection operation (Henroid & Sneed, 2004). On the other hand adequate facilities for meals production were found in all food units evaluated. A worse scenario was found by Brazilian researchers with 66% of non-conformity at schools foodservice concerning prerequisite program caused by inadequate facilities (Lockis et al., 2011). 3.5. Personal hygiene Adequate global personal hygiene practices were observed in only 40% of foodservice audited, results much worse than those found by other authors in school foodservices, where appropriate personnel hygiene practices were reported in 95% of cases (Youn & Sneed, 2003). Reasons identified in our study for inappropriate personal hygiene practices were mainly lack of resources and conditions for correct hand washing procedures. Inadequate and insufficient hand washing practices were observed in most preparation operations (Table 1) as already observed by other authors (Henroid & Sneed, 2004; Lee & Greig, 2010), indicating a need to conduct basic food safety training of school foodservice employees, results supported by similar findings from other researchers (Bas, Yuksel, & Cavusoglu, 2007; Gilmore, Ne, & Jt, 1998). In spite of food safety knowledge of food handlers was considered high food-handling practices were not always consistent with accepted standards, highlighting the need for training and monitoring (Henroid & Sneed, 2004). 3.6. Other items checked
3.3. Storage Food storage in adequate containers and freezing and refrigeration temperature documentation were good practices found in all school foodservice evaluated. These positive aspects were also found in a previous study undertaken at a Portuguese school foodservice (Liz Martins & Rocha, 2011). Concerning storage conditions evaluated in this study the most frequent non-conformity was failure to check freezing and refrigeration temperatures on a daily basis. This aspect was just observed in distribution units (p < 0.05). Regular supervision is crucial to address this problem. Managers should be also responsible for the monitoring and completion of documentation, since they had a higher level of knowledge and greater familiarity with procedures (Eves & Dervisi, 2005; Lee & Greig, 2010). It was observed that raw and cooked foods were stored separately, avoiding cross-contamination, one of the most common factor contributing to foodborne outbreaks as reported by other authors (Daniels et al., 2002; Lee & Greig, 2010; Panisello, Rooney, Quantick, & Stanwell-Smith, 2000) (Table 1). 3.4. Facilities and equipment Incorrect handling of waste was found in all foodservices evaluated, observations in line with previous studies (Henroid & Sneed, 2004; Liz Martins & Rocha, 2011). This practice may be
In our study, the number of meals produced or served did not influence food safety procedures and practices (p > 0,05). When comparing cooking and distribution units, it was verified that distribution food units failed food-handling practices and temperature control of cooked foods more frequently that cooking units (p < 0.05). Failure in use of hair protection by employees was also more frequent in distribution units (p < 0.05). These results were expected since there is more frequent supervision of procedures in cooking units; additionally staff turnover is quite high in distribution units leading to poor training of workers. High job turnover and large number of part-time workers were the major problems with the training of food handlers as reported by Sun (2005). A review of food safety studies has demonstrated that training of managers can also be an effective strategy in reducing food safety problems (Egan et al., 2007). Other researchers concluded that the development and provision of training courses are crucial to achieve behavioral changes and improve skills and knowledge (Clayton, Griffith, Price, & Peters, 2002; Lee & Greig, 2010; Medeiros, Cavalli, Salay, & Proenca, 2011). Results of our research are in agreement with several studies that concluded that the weak points in foodservice units are poor personnel hygiene practices, inappropriate storage temperatures
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and insufficient cooking (Bas et al., 2007; Domenech, Amoros, Perez-Gonzalvo, & Escriche, 2011; Eves & Dervisi, 2005). Strengthening food safety measures in schools would improve protection of students and school staff from outbreaks of foodborne illness. Control policies, such as training and certification of food handlers in food safety practices and food quality, may contribute to produce safer meals for school children (Daniels et al., 2002; Lee & Greig, 2010). From the point of view of infrastructure, the most important obstacles observed were the lack of equipment and incorrect kitchen layout, also reported by Panisello, Rooney, Quantick, & Stanwell-Smith (2000). Proper kitchen layout and flow charts of food production are the first two issues that need to be considered before implementation of prerequisite programs in foodservice (Sun, 2005). The information provided by audits revealed several barriers to the implementation of the food safety management system. Nonconformities identified should be communicated to local authorities and periodic visits should be done to supervise entire food production steps. In this context, Nutrition professionals hold an excellent position to provide food safety education in community, clinical settings, and foodservice units (Albrecht & Nagy-Nero, 2009). 4. Conclusions Temperature control, waste management, cleaning and sanitizing procedures are the most frequent difficulties observed for prerequisite programs implementation at the school foodservices evaluated. This work identified several areas for improvement, namely training and education about appropriate food-handling practices, increasing documentation of food safety practices, including endpoint temperatures, refrigerator and freezing temperatures, cleaning and sanitizing procedures effectiveness, defining and implementing standard operating procedures that include food safety components in school foodservice operations and employee motivation and responsibility. References Albrecht, J. A., & Nagy-Nero, D. (2009). Position of the American Dietetic Association: food and water safety. Journal of the American Dietetic Association, 109, 1449e1460. Aranceta Bartrina, J., Perez Rodrigo, C., Dalmau Serra, J., Gil Hernandez, A., Lama More, R., Martin Mateos, M. A., et al. (2008). School meals: state of the art and recommendations. Anales de Pediatría (Barcelona), 69, 72e88. Bánáti, D., & Zoltán, L. (2012). Managerial attitudes, acceptance and efficiency of HACCP systems in Hungarian catering. Food Control, 25, 484e492. Barbosa, M., Ávila, H., & Rocha, A. (2012). Characterization of school foodservice of Portuguese Municipalities. In IJUP 12e5th Meeting of young researchers of University of Porto. Barros, M., Lameiras, J., & Rocha, A. (2008). Espaços de refeição de estabelecimentos de educação do município de Penafiel e caracterização higio-sanitária. Alimentação Humana, 14, 66e73. Bas, M., Yuksel, M., & Cavusoglu, T. (2007). Difficulties and barriers for the implementing of HACCP and food safety systems in food businesses in Turkey. Food Control, 18, 124e130. Bes-Rastrollo, M., Basterra-Gortari, F. J., Sanchez-Villegas, A., Marti, A., Martinez, J. A., & Martinez-Gonzalez, M. A. (2010). A prospective study of eating
33
away-from-home meals and weight gain in a Mediterranean population: the SUN (Seguimiento Universidad de Navarra) cohort. Public Health Nutrition, 13, 1356e1363. Briefel, R. R., Wilson, A., & Gleason, P. M. (2009). Consumption of low-nutrient, energy-dense foods and beverages at school, home, and other locations among school lunch participants and nonparticipants. Journal of the American Dietetic Association, 109, S79eS90. Clayton, D. A., Griffith, C. J., Price, P., & Peters, A. C. (2002). Food handlers’ beliefs and self-reported practices. International Journal of Environmental Health Research, 12(1), 25e39. Daniels, N. A., Mackinnon, L., Rowe, S. M., Bean, N. H., Griffin, P. M., & Mead, P. S. (2002). Foodborne disease outbreaks in United States schools. Pediatric Infectious Disease Journal, 21, 623e628. Domenech, E., Amoros, J. A., Perez-Gonzalvo, M., & Escriche, I. (2011). Implementation and effectiveness of the HACCP and pre-requisites in food establishments. Food Control, 22, 1419e1423. Domenech, E., Escriche, I., & Martorell, S. (2008). Assessing the effectiveness of critical control points to guarantee food safety. Food Control, 19, 557e565. Egan, M. B., Raats, M. M., Grubb, S. M., Eves, A., Lumbers, M. L., Dean, M. S., et al. (2007). A review of food safety and food hygiene training studies in the commercial sector. Food Control, 18, 1180e1190. Eves, A., & Dervisi, P. (2005). Experiences of the implementation and operation of hazard analysis critical control points in the food service sector. Hospitality Management, 24, 3e19. Giampaoli, J., Clusky, M., & Sneed, J. (2002). Developing a practical tool for assessing employee food handling practices. Journal of Child Nutrition & Management, 26. Gilmore, S., Ne, B., & Jt, D. (1998). A food quality model for school foodservices. Journal of Child Nutrition & Management, 22, 32e39. Graça, P., Alves, E., Camarinha, B., Almeida, A. S., Alves, C., Bento, A., et al. (2001). O Nutricionista Municipal como factor de desenvolvimento local em Portugal. Alimentação Humana, 7, 3e20. Henroid, D., Jr., & Sneed, J. (2004). Readiness to implement hazard analysis and critical control point (HACCP) systems in Iowa schools. Journal of the American Dietetic Association, 104, 180e185. Kearney, J. (2010). Food consumption trends and drivers. Philosophical Transactions of the Royal Society of London B Biological Sciences, 365, 2793e2807. Lee, M. B., & Greig, J. D. (2010). A review of gastrointestinal outbreaks in schools: effective infection control interventions. Journal of School Health, 80(12), 588e 598. Liz Martins, M., & Rocha, A. (2011). Sanitary characterization of elementary school foodservices at a Portuguese municipality. Culinary Arts and Sciences, VII. Lockis, V. R., Cruz, A. G., Walter, E. H., Faria, J. A., Granato, D., & Sant’ana, A. S. (2011). Prerequisite programs at schools: Diagnosis and economic evaluation. Foodborne Pathogens and Disease, 8, 213e220. Medeiros, C. O., Cavalli, S. B., Salay, E., & Proenca, R. P. C. (2011). Assessment of the methodological strategies adopted by food safety training programmes for food service workers: a systematic review. Food Control, 22, 1136e1144. Mellou, K., Sideroglou, T., Potamiti-Komi, M., Kokkinos, P., Ziros, P., Georgakopoulou, T., et al. (2013). Epidemiological investigation of two parallel gastroenteritis outbreaks in school settings. BMC Public Health, 13, 241e248. Osimani, A., Aquilanti, L., Babini, V., Tavoletti, S., & Clementi, F. (2011). An eight-year report on the implementation of HACCP in a university canteen: impact on the microbiological quality of meals. International Journal of Environmental Health Research, 21, 120e132. Panisello, P. J., Rooney, R., Quantick, P. C., & Stanwell-Smith, R. (2000). Application of foodborne disease outbreak data in the development and maintenance of HACCP systems. International Journal of Food Microbiology, 59, 221e234. Rocha, A., Chilro, R., Santos, M. C. T., Afonso, C., Morais, C., & Franchini, B. (2009). SPARE: Sistema de Planeamento e Avaliação de Refeições Escolares e elaboração, verificação e monitorização na óptica do utilizador. Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto - FCNAUP. Sun, Y.-M. (2005). A review of the needs and current applications of hazard analysis and critical control point (HACCP) system in foodservice areas. Food Control, 16, 325e332. Wallace, C., & Williams, T. (2001). Pre-requisites: a help or a hindrance to HACCP? Food Control, 12, 235e240. WHO. (2008). Foodborne outbreaks: Guidelines for investigation and control. France. World Health Organization. (2001). Codex Alimentarius. Food hygiene basic texts. Rome: Food and Agricultural Organization of the United Nations. Youn, S., & Sneed, J. (2003). Implementation of HACCP and prerequisite programs in school foodservice. Journal of the American Dietetic Association, 103, 55e60.